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Objective:To investigate the prognostic factors of patients with esophageal squamous cell carcinoma with pulmonary metastasis.Methods:Clinical characteristics of 135 esophageal squamous cell carcinoma patients presenting with pulmonary metastasis after treatment in Zhejiang Cancer Hospital from 2008 to 2018 were retrospectively analyzed. Thesurvival rate was calculated by Kaplan-Meier method. Univariate analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox models.Results:The median follow-up time of 135 patients with esophageal squamous cell carcinoma was 94.2 months (19.5-258.9 months), and 109 patients died (80.7%). The 1-and 2-year overall survival rates were 47.4% and 25.1%, with the median survival time was 11.1 months (7.3-14.9 months). Univariate prognostic analysis showed that age, number of lung metastases, treatment of lung metastases, lymph node metastasis, distant organ metastasis, and the interval between the first treatment and lung metastasis were the prognostic factors of esophageal squamous cell carcinoma with lung metastasis (all P<0.05). Multivariate analysis demonstrated that age and number of lung metastases were the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases (all P<0.05). Conclusions:Age and number of lung metastases are the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases. Surgery or radiotherapy-based regional therapy can enhance clinical prognosis.
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Objective:To summarize the incidence of acute radiation pneumonitis (ARP) after gemcitabine induction chemotherapy for non-small cell lung cancer (NSCLC) and identify the high risk factors and dosimetric limitations of ARP after gemcitabine induction chemotherapy.Methods:We retrospectively analyzed 191 NSCLC cases who were received gemcitabine induction chemotherapy and chest radiotherapy in radiotherapy department of Zhejiang Cancer Hospital between January 2010 and December 2010. Base line data, treatment information and the incidence of ARP after treatment were collected. The risk factors of ARP were analyzed with univariate and multivariate Logistic regression method.Results:A total of 49 patients developed ≥ grade Ⅱ ARP, accounting for 25.7% of all cases. Univariate analysis indicated that the probability of ARP in patients who received the cumulative dose of gemcitabine ≥ 9.0 g was 3.45 times higher than that in those treated at a dose of < 9.0 g ( P=0.015). Radiation dose ≥ 50 Gy was significantly correlated with the occurrence of ARP ( P=0.008). The risk of ARP was increased by 7.69 times if the time interval between radiotherapy and chemotherapy was within 10 weeks ( P=0.047). Among the dosimetric parameters, V 5Gy, V 20Gy, V 30Gy and mean lung dose (MLD) of bilateral lungs were 45%, 22%, 16%, and 1 200 cGy respectively. All of them could effectively predict the occurrence of ARP (all P≤0.001). Multivariate analysis indicated that only radiotherapy dose ( P=0.044) and V 5Gy( P=0.02) were the independent predictors of ARP. Conclusions:For NSCLC patients who receive gemcitabine induction chemotherapy, the cumulative dose of gemcitabine, the interval time between chemotherapy and radiotherapy and the radiation dose are associated with the occurrence of ARP. We should strictly limit the total lung dosimetric parameters, such as V 5Gy, V 20Gy, V 30Gy and MLD to reduce the incidence of ARP.
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Objective To investigate and analyze the reasons for the omission of adjuvant radiotherapy after breast-conserving surgery (BCS) in patients with breast cancer.Methods The clinicopathologial characteristics and socioeconomic data of 55 breast cancer patients undergoing BCS without postoperative adjuvant radiotherapy in our hospital from 2012 to 2016 were retrospectively analyzed.Results Among the 55 patients who did not receive radiotherapy,25 patients were due to low local recurrence risk,12 patients were due to economic or family reasons,12 patients were due to fear of adverse reactions of radiotherapy,and 5 patients were not recommended by primary physicians for radiotherapy.In addition,3 cases with multiple distant metastases and 3 cases with concomitant thyroid cancer didn't received radiotherapy.Conclnsions Low risk local recurrence is the main reason for the omission of adjuvant radiotherapy,followed by the fear of radiation-induced toxicity and poor financial support.Patient education and medical insurance may improve the adjuvant radiotherapy compliance.
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Objective To evaluate the protective effects of methylprednisolone combined with dexmedetomidine of cardiac valve replacement in patients with brain cognitive function under cardiopulmonary bypass (CPB).Methods Sixty patients for heart valve replacement in Affiliated Hospital.Inner Mongolia Medical University were randomly divided into four groups (n =15 each):group A control,methylprednisolone group (group M),dexmedetomidine group (Group D) and methylprednisolone combined with dexmedetomidine group (group B).After the induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated.Methylprednisolone 20mg/kg was administered to the CPB circuit prime in group M.A loading dose of dexmedetomidine 1 μg/kg was pumped intravenously over 10 minutes after induction,followed by continuous infusion at 0.05μg/(kg · h) until the end of operation in group D.A loading dose of dexmedetomidine 1 μg/kg was pumped intravenously over 10 minutes after induction,followed by continuous infusion at 0.05μ g/(kg · h) until the end of operation and methylprednisolone 20mg/kg was also administered to the CPB circuit prime in group B.At the same time the equal volume of normal saline was given in group A.After induction (T1),CPB instantly (T2),CPB 30min (T3),l0min after CPB(T4),at the end of operation(T5),6h after CPB (T6),the jugular bulb venous blood samples were taken for testing the serum concentrations of interleukin-6 (IL-6),interleukin-10 (IL-10),S100βprotein and neuron-specific enolase (NSE) using the method of ELISA.Simplified mini-mental state examination (MMSE) is used to assess the cognitive function of patients in pre-operation and 2days,3days as well as 7days after operation.Results At T1-6,IL-6,S100 protein and NSE in group M,group D and group B were significantly lower than those in control group,IL-10 was higher than that in control group,and there was significant difference (P ＜ 0.05).In B group at all time points IL-6 、S100 protein and NSE were lower than those in other groups,IL-10 was higher than other groups,and there was significant differences (P ＜ 0.05).The incidence of postoperative cognitive dysfunction in group M,group D and group B was higher than that in control group,and the incidence of cognitive dysfunction in B group was lowest,and there were significant differences (P ＜ 0.05).Conclusion Methylprednisolone and dexmedetomidine can effectively reduce the concentration of IL-6,S100 protein and NSE in cardiopulmonary bypass,reduce brain injury and the incidence of postoperative cognitive dysfunction.The protective effect on cerebral injury is better when using dexmedetomidine combined with methylprednisolone under cardiopulmonary bypass (CPB).
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Objective To study the value and feasibility of temporary emergency bedside cardiac pacing. Method Two hundred patients with severe witnessed bradycardia were treated with temporary emergency cardiac pacing. We treated 130 patients with emergency bedside pacing and 70 patients with x-ray-guided pacing. Results Emergency bedside pacing was successful in 127 patients except three patients and no postoperative complications occurred. X-ray-guided pacing was successful in all 70 patients but three patients experienced complications: one deep venous thrombosis and two cardiac tamponades due to myocardial perforation. The pacing electrodes were more likely to be displaced in X-ray-guided pacing than in emergency bedside pacing (six cases versus three cases) . The door-to-operation time was 30-90 min for x-ray-guided cardiac pacing and 5-15 min for emergency bedside pacing. Needle-to-pacing times were similar for both procedures (3.5 ± 1.5 min for x-ray guided pacing versus 4± 2.5 min for bedside pacing). Conclusions Temporary emergency bedside cardiac pacing is a rapid, efficient and safe procedure for treating severe witnessed bradycardia. The technique is easily mastered and may prove lifesaving in an emergency.
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Objective To investigate the therapeutic effect and side effect of prourokinase (Pro-uk) on the patients with acute myocardial infarction. Method From May 2004 to May 2005, a total of 68 cases of acute myocardial infarction treated by thrombolytic agents within 6 hours after onset were divided randomly into Pro-uk group ( n = 43) and urokinase (UK) group ( re = 25). In the Pro- uk group, there were 22 eases treated with 50 mg Pro-uk and 21 cases prescribed in 60 mg Pro-uk. The patency of involved coronary artery was evaluated by using selective coronary angiography at 90 minutes after thrombolytic therapy. The incidence of early heart events, bleeding and adverse reaction, were alse observed. Results (1) The total rates of resumed patency of obstructed coronary artery (TIMI grade 2 and 3 flow) were 76.7% in Pro-uk treated patients and 52.2% in UK treated patient ( P = 0. 041). (2) The occurrence of hyporrhea was lowered more significantly in Pro-uk treated patients than in UK treated patients (P = 0.029), but there were no intracranial hemorrhage found in both group. (3) Early cardiac events and adverse reactions were similar between two groups. Conclusions Pro-UK is safe and effective for the patients with acute myocardial infarction.