ObjectiveTo analyze rate of intraperitoneal lymph node metastasis (LNM) in Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction (AEG) so as to determine optimal extent of lymph node dissection. MethodsA systematic and comprehensive search of PubMed, Medline, and Cochrane Library databases for study reports on LNM in patients with Siewert type Ⅱ/Ⅲ AEG was performed. The retrieval time ranged from database establishment to October 1, 2021. The pooled LNM rate was analyzed for each lymph node group. In addition, the influencing factors of LNM in AEG were analyzed. ResultsAfter screening, a total of 22 relevant studies were included, with a total of 3 934 cases. For the patients with Siewert type Ⅱ/Ⅲ AEG, the LNM rates of No.1, 2, 1&2, 3, 7 lymph nodes were ≥20%, LNM rates of No.4, 9, 11 (11p+11d), 11p, 16 lymph nodes were 10%–20%, LNM rates of No.4sa, 8a, 10, 11d lymph nodes were 5%–10%, the rest were <5%. For the patients with Siewert type Ⅱ AEG, the LNM rates of No.1, 2, 1&2, 3, 7 lymph nodes were ≥20%, LNM rates of No.4, 9, 11 (11p+11d), 11p lymph nodes were 10%–20%, LNM rates of No.8a, 10 lymph nodes were 5%–10%, and the rest were <5%. For the patients with Siewert type Ⅲ AEG, the LNM rates of No.1, 2, 1&2, 3, 4, 7 lymph nodes were ≥20%, LNM rate of No.11p lymph nodes was 10%–20%, LNM rates of No.4sa, 4sb, 4d, 8a, 9, 10, 11(11p+11d), 11d lymph nodes were 5%–10%, and the rest were <5%. No matter Siewert Ⅱ and (or) Ⅲ AEG patients, the rates of LNM in No.5, 6, and 12a lymph nodes were <5%. The tumor diameter ≥2 cm and higher T stage (T2–T4) increased the probability of LNM in AEG (P<0.05). ConclusionsThe results of this meta-analysis combined with the literature suggest that in clinical practice, No.10 lymph node dissection is not necessary for Siewert Ⅱ and Siewert Ⅲ AEG patients with tumor length diameter <2 cm and T1 of tumor invasion. No matter Siewert Ⅱ or Ⅲ AEG, as long as the tumor length diameter <2 cm and T1 of tumor invasion, the distal perigastric lymph nodes (No.4d, 5, 6) may not be dissected; Siewert type Ⅱ or Ⅲ AEG patients don’t need to clean No.12a lymph nodes.
Abstract: Objective To evaluate the prediction validation of European system for cardiac operative risk evaluation （EuroSCORE） in prolonged intensive care unit (ICU) stay, mortality, and major postoperative complications for Chinese patients operated for acquired heart valve disease. Methods Between January 2004 and January 2006, 2 218 consecutive patients treated for acquired heart valve diseases were enrolled in Fu Wai Hospital. All these patients accepted valvular surgery. Both logistic model and additive model were applied to EuroSCORE to evaluate its ability in predicting mortality, prolonged ICU stay and major postoperative complications of patients who had undergone heart valve surgery. An receiver operating characteristic curve（ ROC) area was used to test the discrimination of the models. Calibration was assessed by HosmerLemeshow goodnessoffit statistic. Results Discriminating abilities of logistic and additive EuroSCORE algorithm were 0.710 and 0.690 respectively for mortality, 0.670 and 0.660 for prolonged ICU stay, 0.650 and 0.640 for heart failure, 0.720 and 0.710 for respiratory failure, 0.700 and 0.740 for renal failure, and 0.540 and 0.550 for reexploration for bleeding. There was significant difference between logistic and additive algorithm in predicting renal failure and heart failure (Plt;0.05). Calibration of logistic and additive algorithm in predicting mortality, prolonged ICU stay and major postoperative complications were not satisfactory. However, logistic algorithm could be used to predict postoperative respiratory failure (P=0.120). Conclusion EuroSCORE is not an accurate predictor in predicting mortality, prolonged ICU stay and major postoperative complications, but the logistic model can be used to predict postoperative respiratory failure in Chinese patients operated for acquired heart valve diseases.
Objective To analyze the clinical characteristics of the Guang’an Omicron epidemic and summarize the management experiences and practices in pandemic prevention and control of major infectious diseases.Methods Retrospective analysis was performed on patients infected with coronavirus disease (COVID-19), afterwards treated and observed in the isolation ward of Guang’an People’s Hospital and the shelter of Guang’an City from May 9 to June 26, 2022. The characteristics of patients at different age stages and the related factors affecting the severity, re-positive and negative conversion was analyzed. Results Finally 1 278 patients were collected, including 508 males and 770 females, with an average age of 41.3±22.6 years. Among them, 1 054 patients were asymptomatic carriers. The overall severe rate was 0.86%, the severe rate of the high-risk group was 3.06%. The median negative conversion time was 10.0 days and re-positive rate was 7.36%. Patients aged＞60 years were 2.589 times more likely to have a longer negative conversion time than those aged≤60 years (95%CI 1.921-3.489, P＜0.001). Conclusion The clinical characteristics of Guang’an COVID-19 epidemic are mainly that the elderly with high risk factors are more likely to develop severe cases, have longer clearance time, and re-positve is more likely to occur.
ObjectiveTo investigate the specific CT findings of high-risk gastrointestinal stromal tumors (GISTs). MethodsCT findings of 24 patients with high-risk GISTs from August 2009 to March 2014 proved by surgery and pathology were retrospectively reviewed. ResultsTwelve of the high-risk GISTs were from the stomach, 11 from the small intestine (5 from duodenum, 4 from jejunum, and 2 from ileum), and 1 from the rectum. The biggest transverse diameter of the tumor was between 2.5 and 15.0 cm, and 2 were less than 5 cm and 22 of them were over 5 cm. The tumors appeared as irregular in 20 cases, and with indefinite boundary in 21 cases. Twenty-four tumors showed different levels of necrosis and cystic change, 15 showed ulcer, 2 showed perforation with effusion and pneumatosis, and 3 showed calcification. The enhancement of lesion was mostly moderately to markedly inhomogeneous. High-risk small intestinal stromal tumors had more significant enhancement and vessels. Hepatic metastasis in 3 cases was detected. ConclusionCT features of HRGISTs can be found with certain characteristics, which may contribute to the diagnosis.
ObjectiveTo onstructe a prognostic model for gastric cancer based on disulfidoptosis-related genes. MethodsFirstly, transcriptome data and clinical data were obtained from the TCGA and GEO databases to explore the expression of disulfidoptosis-related genes in gastric cancer tissues and normal tissues, as well as their impact on the overall survival (OS) of gastric cancer patients. Subsequently, two clusters of disulfidoptosis-related gene were determined by consensus clustering, key genes were further selected by using LASSO regression, and a multivariate Cox proportional hazards regression model was constructed to predict OS. ResultsAmong the 24 kinds of disulfidoptosis-associated genes, 16 exhibited statistically significant differences in expression between gastric cancer tissues and normal tissues (P<0.05), and results of univariate Cox proportional hazards regression model showed that 9 kinds of disulfidoptosis-associated genes were associated with OS (P<0.05). The 24 kinds of disulfidoptosis-associated genes were grouped into 2 clusters by using the consensus clustering algorithm, with 299 differentially expressed genes between the two clusters. In the training set, 14 genes were determined by using LASSO regression to construct the OS prediction model, and risk scores were calculated. The OS of the high-risk group was significantly worse than that of the low-risk group (P<0.05), and this prediction model also had a high area under the curve value in the validation set. ConclusionsThe OS prediction model based on disulfidoptosis-associated genes can predict the prognosis of gastric cancer patients.
ObejectiveTo summarize the research progress of risk factors contributing to postoperative pulmonary infection in gastric cancer, so as to provide reference for medical decision-makers and clinical practitioners to effectively control the incidence of postoperative pulmonary infection in gastric cancer, ensure medical safety and improve the quality of life of patients. MethodThe researches at home and abroad on the factors contributing to pulmonary infection after gastric cancer surgery in recent years were reviewed and analyzed. ResultsThere was currently no uniform diagnostic standard for pulmonary infection. The incidence of postoperative pulmonary infection for gastric cancer varied in the different countries and regions. The pathogenic bacteria that caused postoperative pulmonary infection of gastric cancer was mainly gram-negative bacteria, especially Pseudomonas aeruginosa, Escherichia coli, Acinetobacter boulardii, and Klebsiella pneumoniae. The patient’s age, history of smoking, preoperative pulmonary function, preoperative laboratory indicators, preoperative comorbidities, preoperative nutritional status, preoperative weakness, anesthesia, tumor location, surgical modality, duration of surgery, blood transfusion, indwelling gastrointestinal decompression tube, wound pain, and so on were possible factors associated with postoperative pulmonary infection of gastric cancer. ConclusionsThe incidence of postoperative pulmonary infection for gastric cancer is not promising. Based on the recognition of related factors, it is proposed that it is necessary to develop a risk prediction model for postoperative pulmonary infection of gastric cancer to identify high-risk patients. In addition to the conventional intervention strategy, taking the pathogenesis as the breakthrough, finding the key factors that lead to the occurrence of postoperative pulmonary infection of gastric cancer is the fundamental way to reduce its occurrence.
ObjectiveTo explore and analyze the nutritional risk and dietary intake of patients with coronavirus disease 2019 (COVID-19), and provide data support for nutritional intervention.MethodsCOVID-19 inpatients were investigated in Wuhan Wuchang Hospital and the People’s Hospital of Wuhan University (East Area) from March 9th to 16th, 2020 by Nutrition Risk Screening 2002 (NRS 2002) scale and designed questionnaire. The energy and protein requirements were calculated according to the standard of 30 kcal/(kg·d) and 1.2 g/(kg·d). The nutritional risk, energy and protein intake, body weight and body mass index and their changes in the mild and severe patients were analyzed. The energy and protein intake of the two types of nutritional risk patients was analyzed.ResultsA total of 98 patients with COVID-19 completed the investigation, in whom 46 (46.94%) had nutritional risk, including 32 (39.02%) with mild type and 14 (87.50%) with severe type; and the difference was statistically significant (P<0.001). Compared with the usual condition, the body weight and body mass index of the two types of patients significantly decreased (P<0.01 or P<0.001); the energy and protein intake in mild type patients were significantly higher than those in the severe type patients (P<0.001); compared with the requirement, the protein intake in the two types of patients were significantly lower than the demand, while the energy and protein intake in the mild type patients were significantly lower than the requirement (P<0.05 or P<0.01). The proportion of energy and protein intakes in patients with nutritional risk was significantly higher than that in patients without nutritional risk (P<0.001 or P<0.01); the energy and protein intakes in patients without nutritional risk was significantly higher than that in patients with nutritional risk (P<0.001); the protein intakes in patients with nutritional risk was obviously insufficient (P<0.001); while the energy intake of the patients without nutritional risk was higher than the requirement (P<0.001).ConclusionsCOVID-19 patients has high incidence of nutritional risk which was higher in the severe patients compared with the mild patients. Higher incidence and lower intake of energy and protein are in the severe patients compared with those in the mild patients. Patients with nutritional risk has a higher proportion of energy and protein inadequate intake and lower intake compared with the patients without nutritional risk.
Objective To investigate the risk factors for delayed discharge following same-day choledochoscopic lithotomy for residual stones after biliary tract surgery. Methods The clinical data of 607 patients with residual stone after biliary tract surgery admitted to the Day Surgery Center of West China Hospital of Sichuan University between July 2019 and July 2022 were retrospectively collected. According to whether the patients were discharged on the same day, they were divided into same-day discharge group and delayed discharge group. The differences in gender, age, first surgical procedure (surgical method, hepatectomy or not, intraoperative choledochoscopy or not), choledochoscopic lithotomy (first choledochoscopy or not, lithotomy method, number of stones and site of stones), operation duration, hospital stay, hospital cost, and postoperative complications (fever, poor drainage, and T tube dislodgement) between the two groups were compared and analyzed. Multiple logistic regression model was used to analyze the risk factors for delayed discharge following same-day choledochoscopic lithotomy. Results All patients were admitted and discharged within 24 h, among them, 557 cases (91.8%) were discharged on the same day and 50 cases (8.2%) were discharged the next day. The results of multiple logistic regression analysis showed that choledochoscopy for the first time [odds ratio (OR)=2.359, 95% confidence interval (CI) (1.303, 4.273), P=0.005], lithotomy after electrohydraulic lithotripsy [OR=1.857, 95%CI (1.013, 3.402), P=0.045], and multiple stones (number of stones ≥2) [OR=2.741, 95%CI (1.194, 6.288), P=0.017] were independent risk factors for delayed discharge. Conclusion The operation of same-day choledochoscopic lithotomy is mature, and choledochoscopy for the first time, lithotomy after electrohydraulic lithotripsy, and multiple stones (number of stones ≥2) are independent risk factors for delayed discharge.
Objective To explore the effects of intravenous treprostinil in different doses on the hemodynamics and postoperative outcomes after high-risk total cavo-pulmonary connection (TCPC). MethodsFrom 2018 to 2021, among 189 patients who underwent TCPC in the Department of Pediatric Cardiac Surgery of Fuwai Hospital, 26 high-risk patients who received the intravenous treprostinil therapy were retrospectively analyzed. There were 12 males and 14 females, with an age of 4 (3, 6) years and a weight of 17.6±6.2 kg. The patients were divided into two groups: a high-dose group [15 patients, maintaining dose>10 ng/(kg·min)] and a low-dose group [11 patients, maintaining dose≤10 ng/(kg·min)]. The hemodynamics before treprostinil using and during the first 24 hours after reaching the maintaining dose of treprostinil, and postoperative outcomes of the two groups were investigated. ResultsThe incidence of heterotaxia was higher in the high-dose group (66.7% vs. 18.2%, P=0.021). During the observation period, the mean pulmonary artery pressure decreased from 11.9±3.6 mm Hg to 11.0±3.3 mm Hg in the low-dose group (P=0.013), and from 12.9±4.7 mm Hg to 10.2±3.4 mm Hg in the high-dose group (P=0.001). The decreasing effect in the high-dose group was better than that in the low-dose group (P=0.010). There was no statistical difference in the postoperative outcomes between the two groups (P>0.05). In terms of side effects, patients needed temporarily increased dosage of vasoactive drugs to maintain stable blood pressure during 6-12 h after treprostinil therapy in the high-dose group. ConclusionIn patients after high-risk TCPC, intravenous high-dose treprostinil has a better therapeutic effect on reducing pulmonary artery pressure. However, it should be noted that increased dosage of vasoactive agents may be required to maintain blood pressure stability in patients with high-dose treprostinil.