Surgery is an accepted standard in the treatment of adenocarcinoma of esophagogastric junction (AEG), but the efficacy of surgery alone for locally advanced AEG is limited. In-depth studies concerning combined therapy for AEG have been carried out worldwide, including neoadjuvant chemotherapy (nCT), neoadjuvant chemoradiotherapy (nCRT), perioperative chemotherapy (pCT), postoperative chemoradiotherapy, etc. Significantly, the contribution of nCRT and pCT to improving the prognosis of locally advanced AEG patients has been shed light on. Compared with that, multimodality treatment for AEG patients is not well established in China. An attempt was thus made to take an overview of the evidence-based research advance regarding integrated therapy of AEG.
目的 总结胸腔镜下二尖瓣置换术的护理配合要点。 方法 2011年7月－12月利用腔镜技术以肋间开胸方式对5例心脏疾患患者施行二尖瓣置换手术，术前充分准备和术中密切配合，确保了手术的顺利施行和完成。 结果 除1例患者因术中出血改为传统开胸手术外，其余4例均顺利完成手术。患者术中出血量平均约300 mL，术后平均引流量约100 mL，手术平均时间4 h，患者术后在监护室留观1 d后转入病房。 结论 腔镜二尖瓣置换术是一项值得推广的手术方式，护理人员要不断加强知识的学习和更新，以适应新术式发展对护理工作的挑战和要求。
Objective To investigate the expression of Th17 cells in peripheral blood of patients with sarcoidosis at different stage. Methods Flow cytometry was used to detect the Th17 cells in peripheral blood of 38 patients with sarcoidosis, including 18 cases of newly diagnosed active patients with obvious symptoms such as cough, fever, fatigue and weight loss, and 20 stable cases who were followed up regularly.15 cases of healthy volunteers were enrolled as control. Serumangiotensin-converting enzyme ( SACE) of the patients with sarcoidosis was detected by ultraviolet spectrophotometry. The cell classification and CD4 + /CD8 + T in the BALF of the newly diagnosed active patients were calculated. Results The expression of Th17 cells in peripheral blood in the patients with active sarcoidosis were higher than that in the sable patients and the controls [ ( 1. 59 ±0. 44) % vs. ( 0. 56 ±0. 32) % and ( 0. 49 ±0. 23) % , all P lt; 0. 05] . Th17 cells in peripheral blood in the patients with stable sarcoidosis and the controls were not different significantly ( P gt;0. 05) . The levels of SACE in the patients with active sarcoidosis were higher than that in the patients with stable sarcoidosis [ ( 56. 6 ±14. 6) IU/L vs. ( 35. 8 ±18. 3) IU/L, P lt; 0. 05) . There was not significant correlation between the Th17 cells in peripheral blood and SACE in the patients with sarcoidosis ( P gt;0. 05) . In the patients with active sarcoidosis, the Th17 cells in peripheral blood were not significantly correlated with lymphocyte percentages in BALF( P gt; 0. 05) , but significantly correlated with CD4 + /CD8 + in BALF ( r=0. 63, P lt;0. 05) .Conclusion In patients with active sarcoidosis, the increased expression of Th17 cells in peripheral blood may correlate with the activity of sarcoidosis.
Non-alcoholic fatty liver disease (NAFLD) is one of the major chronic liver diseases that endanger human health. It is characterized by hepatic steatosis and absence of other causes of hepatic fat accumulation, such as alcohol abuse. The incidence of NAFLD is increasing year by year. However, the pathogenesis is still undefined. Porphyromonas gingivalis is a major periodontal pathogen of various periodontal disease. Apart from affecting periodontal health, Porphyromonas gingivalis is also related to the incidence of many systemic diseases. In recent years, Porphyromonas gingivalis is considered to be a risk factor of NAFLD. In this paper, the relationship between NAFLD and Porphyromonas gingivalis, as well as the possible pathogenesis are discussed.
Objective To systematically review the abroad studies on patients for patient safety, and compare them with the current status of domestic studies, so as to provide suggestions for evidence-based strategic decision about how to conduct the education of patients for patient safety and improve the medical quality. Methods The databases of MEDLINE, EMbase and Chinese Biomedical Literature Database (CBM) were searched to identify the relevant studies and their references. Literatures were screened with data extraction in accordance with the predefined inclusive and exclusive criteria. The quality of literatures was assessed with the standard of Cochrane Handbook 5.0 and Critical Appraisal Skills Programme, and the data were comprehensively analyzed with qualitative research methods.Results Among 28 included studies, 5 were Chinese literatures, 1 was RCT, and the others were cross-sectional studies. The results showed that: a) Generally, the patients at home and abroad were poor in the awareness of patient safety, but they were eager to participate in the patient safety; b) Factors affecting patients’ participation were their characteristics, disease-related, and emotional feelings; c) Three studies reported the methods of involving patients in patient safety from the aspects of infection, malpractice, and medication; d) Some studies showed that patients’ participation could effectively promote the standardized operation of medical staffs, prevent unsafe events, and reduce damages; and e) The research contents of the included Chinese literatures were just related to the patients’ awareness of patient safety, attitude to participation, and influencing factors. Conclusion The limited studies relevant to patients for patient safety are short of high-quality RCTs for proving the effectiveness of patient participation methods, so it indicates that the stress should be laid on evaluating the effectiveness of patients for patient safety in future research.
Objective To investigate the clinical characteristics and bacterial drug resistance of bloodstream infection of gram-negative bacteria, and provide guidance for clinical rational drug use and control of hospital infection. Methods A retrospective analysis was conducted in the patients diagnosed as severe pneumonia with blood culture of gram-negative bacteria from January 2015 to December 2017 in Beijing Anzhen Hospital. Results A total of 60 severe pneumonia patients suffered from bloodstream infection of gram-negative bacteria were recruited including 34 males and 26 females aging from 42 to 89 years and 73.4 years in average. In the 60 patients, 32 cases were infected with Klebsiella pneumonias, 20 cases were infected with Acinetobacter baumanni, and 8 cases were infected with Escherichia coli. The antimicrobial susceptibility testing result of Klebsiella pneumonias showed that the drug susceptibility rate was 100% to tigecycline, and 6.3% to amikacin. Escherichia coli was sensitive to Amikacin, imipenem, ceftazidime and meropenem while resistance to other drugs. The antimicrobial resistance of Acinetobacter baumanni was 28.6% for cefoperazone/sulbactam, and 14.3% for tigecycline. C-reactive protein, procalcitonin and SOFA scores were higher in the patients infected with Acinetobacter baumanni. Neutrophils and blood lactic acid were higher in the patients infected with Klebsiella pneumonias. There were no statistical differences in white blood cell, platelet or motality rate between the patients infected with Acinetobacter baumanni and the patients infected with Klebsiella pneumonias. SOFA scores and blood lactic acid had significantly statistical relevance with prognosis. Conclusion There is a high proportion of drug resistance of Klebsiella pneumoniae and Acinetobacter baumanni in the bloodstream infection of gram-negative bacteria.
The precise anatomical division of liver segments is the foundation of liver surgery, while the anatomical division of the S9 segment of liver is a further precise division of the caudate lobe of the liver. This article retrospectively analyzed and summarized the precise minimally invasive ablation and follow-up results of four representative lesions of the S9 segment of liver, including primary liver cancer, recurrent liver cancer, metastatic liver cancer, and focal liver hyperplasia, treated at Affiliated Dongguan Hospital of Southern Medical University. The aim of this study is to explore the minimally invasive ablation effect of lesions located at the S9 segment of liver under CT guidance.
【Abstract】 Objective To compare the accuracy of color-doppler ultrasonography, mammography and near-infrared light scanning for diagnosing breast diseases. Methods The diagnostic accuracy of the above three imaging methods were analyzed and compared with each other on the basis of the postoperative pathological results. ResultsFive hundreds and sixty-five cases (breast cancer: 274 cases, benign diseases: 291 cases) were examined. The sensitivity of color-doppler ultrasonography, mammography and near-infrared light scanning for diagnosing breast cancer were 83.7%(200/239), 84.2%(64/76) and 76.9%(100/130), respectively. The specificity were 88.6%(226/255), 93.2%(69/74) and 82.6%(114/138), and the accuracy were 86.2%(426/494), 88.7%(133/150) and 79.9%(214/268), respectively. Color-doppler ultrasonography and mammography were superior to near-infrared light in the item of accuracy (P＜0.05), especially for lesions of breast cancers that were less than 2 cm. The false negative rate of near-infrared light was higher (48.8%, 21/43）than those of the other methods in detecting breast cancer at early stage. The sensitivity for detecting intraductal papilloma and inflammation of breast using color-doppler ultrasonography were 58.8%(10/17) and 69.2%(18/26), respectively, which were higher than that of near-infrared light scanning 〔0 and 23.5%(4/17)， P＜0.05 and P＜0.01〕. The sensitivity and the accuracy of near-infrared light without physical examination reduced significantly, in which the sensitivity reduced from 76.9%(100/130) to 56.9%(74/130), P＜0.01, and the accuracy reduced from 79.9%(214/298) to 61.9%(166/268), P＜0.01. Conclusion Color-doppler ultrasonography and mammography are accurate imaging methods for diagnosing breast diseases.
Nonrandomized studies are an important method for evaluating the effects of exposures (including environmental, occupational, and behavioral exposures) on human health. Risk of bias in nonrandomized studies of exposures (ROBINS-E) is used to evaluate the risk of bias in natural or occupational exposure observational studies. This paper introduces the main contents of ROBINS-E 2022, including backgrounds, seven domains, signal questions and the operation process.
ObjectiveTo study the correlation between international normalized ratio (INR) and coagulation factor Ⅱ and Ⅹ in patients with pulmonary thromboembolism treated with warfarin at moderate and low intensity anticoagulation.MethodsFifty-one patients with pulmonary thromboembolism treated with warfarin orally were divided into low-intensity anticoagulation group (INR from 1.6 to 2.0) and standard-intensity anticoagulation group (INR form 2.0 to 3.0) according to their monitoring INR indices. The levels of coagulation factor Ⅱ and Ⅹ were measured, and the correlation between INR level and coagulation factor activity was compared.ResultsThe INR of the low intensity anticoagulation group was 1.69±0.2 and the standard intensity anticoagulation group was 2.55±0.46. The corresponding activity of coagulation factor Ⅱ was (48.3±28.0)% and (24.0±8.0)% respectively. The activity of coagulation factor Ⅹ was (32.8±24.0)% and (16.7±6.0)%. There was a negative correlation between the activity of INR and coagulation factor Ⅱ and Ⅹ, with correlation coefficients of –0.903 and –0.459, respectively. Coagulation factor Ⅱ activity < 40%, coagulation factor Ⅹ activity inhibitory level < 25% is defined as anticoagulation effect. When coagulation factor Ⅱ activity level reaches anticoagulation effect, the corresponding minimum INR value was 1.56 and as to coagulation factor Ⅹ, the corresponding minimum INR value was 1.66.ConclusionsINR is negatively correlated with the activity of coagulation factor Ⅱ and coagulation factor Ⅹ. With the increase of INR, the activity of coagulation factor Ⅱ and coagulation factor Ⅹ decrease. Low intensity anticoagulation could not effectively inhibit the activity of coagulation factor.