ObjectiveTo investigate the risk factors of cervical lymph node metastasis of papillary thyroid microcarcinoma (PTMC) with clinical lymph node metastasis negative (cN0).MethodThe clinicopathologic data of patients with cN0 PTMC who underwent at least one lobectomy plus central lymph node dissection in this hospital from January 2013 to December 2018 were retrospectively collected and the risk factors of lymph node metastasis were analyzed.ResultsA total of 1 821 patients with cN0 PTMC were enrolled in this study. The results of postoperative pathology showed there were 837 (46.0%) cases with lymph node metastasis, in which of 805 (44.2%) cases with central lymph node metastasis; 252 (33.1%) had lateral lymph node metastasis among 761 patients underwent lateral lymph node dissection. The results of univariate analysis showed that male, age <55 years old, tumor diameter ≥5 mm, bilateral cancer, capsule invasion, and multiple foci were associated with lymph node metastasis of cN0 PTMC (P<0.05). Further binary logistic regression multivariate analysis results showed that these factors (except multiple foci) were the independent risk factors of lymph node metastasis of cN0 PTMC (P<0.05). While the results found that the risk of lateral lymph node metastasis was increased with the increasing of the number of central lymph node metastasis in patients with cN0 PTMC (P<0.05).ConclusionsCervical lymph node metastasis of cN0 PTMC is related to many factors, and central lymph node metastasis indicates a higher risk of lateral lymph node metastasis. For patients with risk factors, preventive central lymph node dissection should be given at the first surgery and decided whether to perform lateral lymph node dissection according to the intraoperative situation.
Objective To summarize the best evidence for discharge planning of elderly patients with hip fracture. Methods UpToDate, BMJ Best Practice, BMJ Evidence-Based Medicine, Guidelines International Network, National Institute for Health and Clinical Excellence, Registered Nurses’ Association of Ontario, Agency for Healthcare Research and Quality, Scottish Intercollegiate Guidelines Network, Web of Science, PubMed, CINAHL, Embase, Cochrane Library, VIP data, China National Knowledge Infrastructure, SinoMed, Wanfang were searched by computer for literature about discharge planning of elderly patients with hip fracture. The retrieval time was from the establishment of the databases to July 31, 2023. The quality of the included literature was evaluated by 2 researchers with evidence-based training. Results A total of 15 articles were included, including 1 clinical decision, 3 guidelines, 3 expert consensuses, 4 evidence summaries, and 4 systematic reviews, covering 5 aspects of implementers and participants of discharge services, pre-discharge preparation during hospitalization, pre-discharge assessment, discharge guidance, and post-discharge follow-up. A total of 22 best evidences of discharge planning of elderly patients with hip fracture were extracted, including 15 A-level recommendations and 7 B-level recommendations. Conclusions There are many aspects involved in the discharge planning of elderly patients with hip fracture. In future clinical practice, healthcare professionals should develop individualized plans based on the actual conditions of each patient, aiming to meet their specific discharge needs. This approach can help reduce adverse outcomes such as recurrent fractures and readmission rates, while promoting better physical and mental recovery and facilitating the patient’s return to society.
Objective To evaluate the clinical efficacy of dexmedetomidine in perioperative management of on-pump cardiac surgery. Methods Randomized controlled trials (RCTs) were identified through a systematic literature search of PubMed, EBSCO, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Database (up to December 2016). RevMan 5.3 software was used for meta-analysis. Results Sixteen studies with 1 432 patients were included. Dexmedetomidine significantly decreased the risk of postoperative delirium (RR=0.28, 95% CI 0.18 to 0.44, P<0.000 01) and postoperative atrial fibrillation (RR=0.65, 95% CI 0.44 to 0.98, P=0.04) compared with the controls. The duration of intubation (RR=–1.96, 95% CI –2.07 to –1.86, P<0.000 01), length of ICU stay (RR=–0.49, 95% CI –0.74, –0.24, P=0.000 1) and hospital stay (RR=–1.24, 95% CI –2.26 to –0.22, P=0.02) in the dexmedetomidine group were significantly shorter than those of the control group. In addition, dexmedetomidine was shown to improve the score of the the Montreal Cognitive Assessment (RR=0.88, 95% CI 0.42 to 1.35, P=0.000 2) compared to the control group. Conclusion Dexmedetomidine can reduce the complications after cardiac surgery, which is safe and effective. However, more studies with good methodologic quality and large samples are still needed to make further assessment.
ObjectiveTo analyze the effect of type 2 diabetes (T2DM) on the short-term prognosis of patients with non-small cell lung cancer (NSCLC) after resection surgery.MethodsClinical data of 207 NSCLC patients who underwent resection surgery in our hospital from January 2016 to January 2019 were retrospectively analyzed. The 100 NSCLC patients with T2DM were allocated to a T2DM group (58 males and 42 females, with an average age of 65.26±7.26 years), and 107 patients without T2DM were allocated to a non-T2DM group (66 males and 41 females, with an average age of 64.21±7.51 years). The short-term prognosis of the patients was compared between the two groups.ResultsCompared with the non-T2DM group, the postoperative atelectasis (P=0.012) and pulmonary infection (P=0.040) were statistically different in the T2DM group. The postoperative complication rate in the T2DM group was significantly higher than that in the non-T2DM group (66.0% vs. 33.6%, P<0.001). The postoperative hospitalization time in the T2DM group was longer than that in the non-T2DM group (9.83±6.35 d vs. 8.09±4.40 d, P=0.007).ConclusionT2DM will increase the incidence of postoperative complications, prolong the length of hospital stay and increase the economic burden of the NSCLC patients, which is not conducive to the postoperative prognosis of patients.
ObjectiveTo provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease (COPD) through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy.MethodsThe clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed, including 124 males and 39 females, with a median age of 64 years (IQR: 23.8 years). They were divided into a COPD group (n=87) and a non-COPD group (n=76) according to the presence of COPD before operation. The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed.ResultsThe incidence of major postoperative complications (pulmonary infection, respiratory failure, arrhythmia and anastomotic leakage) in the COPD group were higher than those in the non-COPD group (all P<0.05). Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer (r=0.437, P<0.001). The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD. The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group (56.1% vs. 78.5.%, P=0.001), and the severity of COPD was negatively correlated to the survival rate.ConclusionCOPD significantly increases the incidence of postoperative complications in patients with esophageal cancer, which is not conducive to the prognosis of patients, and the severity of COPD is correlated with postoperative complications and 2-year survival rate.