Relationship of lymph node metastasis rate with prognosis of esophageal squamous cell carcinoma after radical resection and postoperative adjuvant chemotherapy / 中华消化外科杂志

Objective To investigate the relationship of lymph node metastasis rate (LNR) with prognosis of esophageal squamous cell carcinoma after radical resection and postoperative adjuvant chemotherapy.Methods The retrospective case-control study was conducted.The clinicopathological data of 121 patients who underwent radical resection of esophageal squamous cell carcinoma in the Peking University Cancer Hospital from January 2012 to September 2016 were collected.There were 105 males and 16 females,aged from 42 to 76 years,with a median age of 58 years.All patients underwent radical resection of esophageal cancer with at least two-field lymph nodes dissection.Some patients underwent corresponding chemotherapy and radiotherapy.The thoracic and abdominal lymph nodes were grouped according to the 7th edition standard of Americau Joint Committee on Cancer (AJCC).The lymph nodes dissected were labeled in groups,and all the lymph nodes were examined by pathology test.Observation indicators:(1) follow-up;(2) effects of LNR on prognosis of patients in different AJCC N staging;(3) relationship between LNR and postoperative adjuvant chemotherapy.Follow-up was conducted by outpatient examination,telephone interview and hospital statistical office to detect postoperative survival of patients up to February 2017.The disease-free survival time was from surgery date to date of confirmation of tumor recurrence,and the overall survival time was from surgery date to death of the patient or the last follow-up date.Measurement data with skewed distribution were expressed by M (range).The Kaplan-Meier method was used to calculate the survival rate and draw the survival curve.The Log-rank test was used for survival analysis.Results (1) Follow-up:121 patients were followed up for 3.0-94.2 months,with a median follow-up time of 27.1 months.During the follow-up,98 of 121 patients had tumor recurrence and metastasis (including 64 deaths),22 had no metastasis,and 1 had unknown tumor metastasis.The mean overall survival time of patients was 30.8 months.The 1-,3-,5-year disease-free survival rates were 47.1％,20.3％,and 5.9％,respectively.The 1-,3-,5-year overall survival rates were 93.1％,48.7％,and 35.3％,respectively.(2) Effects of LNR on prognosis of patients in different AJCC N staging:of 121 patients,46 were in N0 stage,42 were in N1 stage,28 were in N2 stage,and 5 were in N3 stage.Of 42 patients in N1 stage,35 with 0 ＜ LNR ≤ 0.15 had a disease-free survival time of 12.2 months (range,1.2-82.3 months),and 7 with LNR ＞ 0.15 had a disease-free survival time of 6.9 months (range,2.1-23.1 months);the difference between the two groups was statistically significant (x2 =3.888,P＜0.05).Of the 28 patients in N2 stage,12 with 0 ＜ LNR ≤ 0.15 had a disease-free survival time of 8.5 months (range,1.2-38.8 months),and 16 with LNR ＞ 0.15 had a disease-free survival time of 4.4 months (range,1.0-52.7 months);the difference was not statistically significant (x2 =0.007,P＞0.05).Forty-six patients in N0 stage were detected no lymph node metastasis,and only 5 cases were in N3 stage,with no analysis.(3) Relationship between LNR and postoperative adjuvant chemotherapy:of the 121 patients,56 underwent postoperative adjuvant chemotherapy,which was mainly constituted by pactitaxel,platinum,and 5-fluorouracilbased regimens,58 didn't undergo postoperative adjuvant chemotherapy,and 7 had unknown data of postoperative adjuvant chemotherapy.Of 121 patients,46 had LNR =0,47 had 0 ＜ LNR ≤ 0.15,28 had LNR ＞ 0.15.Of the 46 patients with LNR =0,17 who underwent postoperative adjuvant chemotherapy had a disease-free survival time of 8.1 months (range,3.9-66.7 months) and a overall survival time of 34.0 months (range,4.7-76.0 months);29 who didn't undergo postoperative adjuvant chemotherapy had a disease-free survival time of 18.8 months (range,1.6-53.2 months),and a overall survival time of 48.6 months (range,8.3-94.2 months);there was no significant difference in the disease-free survival time and overall survival time between the two groups (x2=0.311,0.858,P＞0.05).Of the 47 patients with 0 ＜ LNR ≤ 0.15,27 who underwent postoperative adjuvant chemotherapy had a disease-free survival time of 13.3 months (range,5.0-82.3 months),and a overall survival time of 53.1 months (range,5.7-82.3 months);20 without postoperative adjuvant chemotherapy had a disease-free survival time of 8.4 months (range,1.2-39.2 months),and a overall survival time of 26.5 months (range,5.9-52.6 months).There were significant differences in the disease-free survival time and overall survival time between the two groups (x2 =10.322,4.971,P＜0.05).Of the 28 patients with LNR ＞ 0.15 (7 had unknown data of postoperative adjuvant chemotherapy),12 who underwent adjuvant chemotherapy had a diseasefree survival time of 10.3 months (range,2.9-52.7 months),and a overall survival time of 29.5 months (range,11.2-58.5 months);9 without postoperative adjuvant chemotherapy had a disease-free survival time of 2.9 months (range,1.4-35.7 months),and a overall survival time of 14.5 months (range,3.0-62.3 months);there was a significant difference in the disease-free survival time between the two groups (x2 =6.687,P＜0.05),and no significant difference in the overall survival time between the two groups (x2=2.938,P＞ 0.05).Conclusions LNR can be used as a supplementation of AJCC N staging system.In patients with 0＜ LNR ≤ 0.15,postoperative adjuvant chemotherapy can improve disease-free survival time and overall survival time.

Comparison and treatment of left-and right-side colon cancer / 中国肿瘤临床

Colorectal cancer is one of the most common malignancies. Various studies have focused on differences between colon can-cers on the left and right sides. These types of colon cancer differ in terms of their molecular features, embryologic origin, anatomy, pathogenesis to physiological functions, clinical features, treatment response, and prognosis. Therefore, the left-and right-side colon cancers are regarded as different diseases. These differences have significant effect on clinical decision-making and personalized medi-cine.

Difference analysis of chemotherapy efficacy among different primary tumor sites in metastatic colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the relationship between primary tumor location and clinical response of chemotherapy in patients with metastatic colorectal cancer(mCRC).</p><p><b>METHODS</b>Clinical data of 721 mCRC patients who received first-line and second-line chemotherapy in Peking University Cancer Hospital between January 1996 and December 2011 were collected. All the patients were divided into 5 groups according to primary tumor location: ileocecum in 61 patients(8.5%), ascending colon or hepatic flexure in 126 patients (17.5%), transverse colon or splenic flexure in 26 patients (3.6%), descending or sigmoid colon in 172 patients (23.9%), rectum in 336 patients (46.6%). Outcomes of chemotherapy were evaluated by Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1), including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). The overall response rate (ORR) was counted with the total number of patients divided by the number of CR+PR. Differences in first-line and second-line chemotherapy efficacy among different primary tumor sites in metastatic colorectal cancer were compared by using Chi-square test.</p><p><b>RESULTS</b>Of the 571 patients receiving first-line chemotherapy, no one patient was classified as CR, while there were 190 as PR (33.3%), 277 as SD (48.5%) and 104 as PD (18.2%), with ORR 33.3% (190/571). The ORRs of patients with primary tumor located at ileocecum, ascending colon or hepatic flexure, transverse colon or splenic flexure, descending or sigmoid colon, rectum were 21.3% (10/47), 35.3% (36/102), 14.3% (3/21), 41.3% (57/138) and 31.9% (84/263), respectively, with statistically significant difference(P = 0.028). Difference of oxaliplatin-based first-line chemotherapy efficacy among different tumor sites was statistically significant(P = 0.009), while differences in irinotecan-based or single-agent 5-fluorouracil chemotherapy efficacy were not statistically significant (all P>0.05). In patients with primary tumor located at transverse colon or splenic flexure, irinotecan-based first-line chemotherapy had higher ORR than oxaliplatin-based or single-agent 5-fluorouracil chemotherapy, and the difference was statistically significant (P=0.042). There was no significant difference in the efficacy of different first-line chemotherapy regimens in patients with primary tumor located at other sites (all P>0.05). Of the 353 patients receiving second-line chemotherapy, no one patient was classified as CR, while there were 43 as PR (12.2%), 187 as SD (53.0%) and 123 as PD (34.8%), with ORR 12.2%(43/353). The ORRs of patients with primary tumor located at the ileocecum, the ascending colon or the hepatic flexure, the transverse colon or the splenic flexure, the descending or sigmoid colon, the rectum were 4.2%(1/24), 12.1%(8/66), 8.3%(1/12), 15.2%(12/79) and 12.3%(21/171) respectively, without statistically significant difference (P=0.686). Differences in second-line chemotherapy efficacy with the same regimen among different tumor sites were not statistically significant, and there were also no significant differences of efficacy of different second-line chemotherapy regimens in patients with the same tumor site (all P>0.05).</p><p><b>CONCLUSION</b>There are differences in first-line chemotherapy efficacy among different primary tumor sites in metastatic colorectal cancer, while their second-line chemotherapy efficacy is equivalent.</p>

Effect of semi dose of tiotropium on lung function in severe chronic obstructive pulmonary disease / 中国医师进修杂志

Objective To evaluate the efficacy of 9 μ g tiotropium inhalation once daily in patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods One hundred seventy-one patients with moderate to severe COPD were divided into two groups by random digits table methods:86 patients in test group who used 9 μ g tiotropium powder inhaler once daily,and 85 patients in control group who used the recommended dose 18 μ g once daily,both for 6 months.Patients' pulmonary function and 6-minute walk test were measured before treatment,3 months after treatment and 6 months after treatment.Results Two groups were compared 6 months after treatment.The level of forced expiratory volume in first second(FEV1) in the control group increased an average of (0.21 ± 0.12) L,and the rising rate was (19.31 ± 10.61)％.The level of FEV1 in test group increased (0.22 ±0.13) L,and the rising rate was (19.25 ± 11.52)％.The level of forced vital capacity (FVC) in control group increased an average of (0.22 ±0.10) L,and the rising rate was (11.63 ±5.31)％.The level of FVC in test group increased (0.23 ± 0.15) L,and the rising rate was (11.62 ± 6.45)％.The distance of 6-minute walk test in control group increased an average of (29.24 ± 11.92) m after treatment for 6 months,and the rising rate was (18.30 ± 3.77)％.The distance of 6-minute walk test in test group increased an average of (29.14 ± 11.89) m,and the rising rate was (18.20 ± 3.85)％.The number of acute exacerbations and rehospitalizations in two groups at these period had no significant difference (P ＞ 0.05).As for the test group,though the number of acute exacerbations and rehospitalizations decreased,there were no significant differences (P ＞ 0.05).Conclusions The effect of inhalation therapy of 9 μ g tiotropium once daily is more or less the same with that of 18 μ g once daily.

Evaluation of the training effect of CPR for relatives of patients with high-risk sudden cardiacdeath / 中国实用护理杂志

Objective To investigate the training effect of CPR for relatives of patients with high-risk sudden cardiac death. Methods 35 patients with sudden cardiac death whose relatives did not re-ceived systematic CPR training were set as the control group, 35 patients of the same kind whose relatives received systematic CPR training were named as the experimental group. The resuscitation effect and emer-gency response time of the two groups were compared and the results underwent t test. Results The re-suscitation effect and emergency response time in the experimental group was obviously better than those of the control group. Conclusions CPR training for the first witness of patients with high-risk sudden cardiac death can significantly increase the pre-hospital rescue rate of sudden cardiac death.

Current Prevention Situation of Clinical Laboratory Standard in Grass-roots Hospital:Investigation and Analysis / 中华医院感染学杂志

OBJECTIVE To invesitigate the prevention knowledge and executing situation of clinical laboratory standard in grass-roots hospitals,then give improvement measure.METHODS A total of 342 clinical laboratory staffs in 45 hospitals were investigated using self-designed questionnaire.RESULTS The prevention knowledge rate of clinical laboratory staff was low and the standard prevention technique execution was not good.The protecting consciousness of the staff was low.The protection equipment and the organization system were not complete.The situation of grass-roots hospitals is not as good as the secondary care level hospitals.CONCLUSIONS The standard prevention capability of clinical laboratory staffs in the grass-roots hospitals must be improved necessarily.The hospital leader should attend to the laboratory staff′s standard prevention knowledge,complete the organization system and reduce the nosocomial infection rate.

Using evidence - based nursing in the course of nursing patients with severe cranktcerebral injury combined pulmonary diseases / 中国实用护理杂志

Objective To investigate the effect of using evidence - based nursing (EBN) in the course of nursing patients with severe craniocerebral injury combined pulmonary diseases. Method Divided 160 patients into research group and control group randomly, there were 80 patients in each group. Using EBN in the research group, and routine nursing measures was used in the control group, and then compare the rehabilitation of patients in 2 groups. Result The condition of rehabilitation in research group was significant better than that of in control group, P