Objective To analyze the efficacy of breast-conserving surgery with adjuvant radiation therapy (BCS+RT) vs. mastectomy (MAST) for early breast cancer among young Chinese patients. Methods Young female breast cancer patients (≤40 years old) treated at West China Hospital of Sichuan University between January 1st, 2008, and December 31st, 2019 were analyzed for clinical staging, molecular subtypes, surgical techniques, and prognostic assessments using follow-up data. Results Of 974 eligible patients in this study, 211 underwent BCS+RT and 763 underwent MAST. The Kaplan-Meier analyses indicated that there was no significant difference in the 5-year locoregional recurrence-free survival rate (99.1% vs. 99.4%, P=0.299), distant metastasis-free survival rate (97.9% vs. 96.4%, P=0.309), breast cancer-specific survival rate (100.0% vs. 97.0%, P=0.209), or overall survival rate (99.4% vs. 96.8%, P=0.342) between patients who underwent BCS+RT and those who underwent MAST. The multiple Cox proportional hazards regression analyses revealed that the treatment approach (BCS+RT or MAST) did not significantly predict locoregional recurrence-free survival (P=0.427), distant metastasis-free survival (P=0.154), breast cancer-specific survival (P=0.155), or overall survival (P=0.263). Subgroup analyses showed that there was no statistically significant difference in survival outcomes between BCS+RT and MAST in different clinical stages or molecular subtypes. Clinical stage and molecular subtype should also not be regarded as independent factors in deciding the treatment approach. Conclusions Receiving BCS+RT or MAST treatment does not affect the survival outcomes of young early-stage breast cancer patients, showing similar efficacy across various clinical stages and molecular subtypes. Choosing BCS+RT is considered safe for early-stage young female breast cancer patients eligible for breast conservation.
Objective To explore a scientific disease cost accounting. Method Disease cost accounting = disease cost accounting of clinic pathway + disease basis cost accounting. Conclusions It is the tendency with the medical reform for the social security department to pay by disease for the hospitals, as a result, both social security department and hospitals have to resort to the scientific way in terms of cost accounting of disease. And it is practical and effective by means of cost accounting for clinic pathway.
ObjectiveTo investigate the dynamic changes of nodule volume in benign thyroid tumors after radiofrequency ablation (RFA), and to analyze the predictive value of risk factors for nodule regeneration. MethodsA total of 165 patients with benign thyroid nodules who received RFA treatment in the People’s Hospital of Yuechi County from June 2019 to June 2021 were retrospectively collected and divided into small nodule volume group (≤15 mL, n=116) and large nodule volume group (>15 mL, n=49) according to the median nodule volume at admission. The clinical data and serological data of the two groups were compared. Multivariate Cox proportional hazard regression model was used to adjust confounding factors to explore the relationship between initial nodule volume, vascular density, nodule location near critical structure and postoperative nodule regeneration in patients with benign thyroid nodules. According to the proposed Nomogram of the model, Bootstrap method was adopted for sampling verification, calibration curve was adopted to evaluate the calibration degree of the model, and area under the curve (AUC) of receiver operating characteristics (ROC) curve was adopted to evaluate the model differentiation. ResultsIn the small volume nodule group, the proportion of unilateral nodule was higher, and the preoperative beauty score, preoperative symptom score, radiofrequency power, ablation time, total energy, operative time, intraoperative blood loss and hospital stay were lower or short, P<0.05. The change value of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), catalase (CAT) after operation in small volume nodule group were higher than those in the large nodule volume group (P<0.05), but change value of the free thyroxine (FT4), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were lower than those in the large nodule volume group (P<0.05). At 1, 3, 6, 12, and 24 months after RFA operation, the nodule volume of the two groups decreased successively, and volume reduction rate (VRR) increased successively. The changes of nodule volume and VRR in the small nodule volume group were better than those in the large nodule volume group. In the large nodule group, the nodule volume was larger at 1, 3, 6, 12, and 24 months after operation, and the VRR was higher at 1 month after operation, the regeneration time was shorter, the number of residual nodules was higher, and the initial ablation rate (IAR) was lower (P<0.05). After adjusting for age, gender and other factors, the correlation effect value increased with the increase of initial volume and blood vessel density, and the differences in trend test were statistically significant (Ptrend <0.05). Nodules located near the critical structure had an increased risk of regeneration (OR=1.76, P<0.001). The Nomogram constructed according to the multi-factor model has good differentiation (AUC before and after ROC curve validation were 0.854 and 0.814, respectively) and accuracy (mean absolute error of 0.023). ConclusionsRFA achieved clinically relevant volume reduction in both ≤15 mL and >15 mL of single benign thyroid nodules, lasting for at least 2 years. However, the nodule VRR and cosmetic effect were better in the small volume nodule group, and the initial nodule volume, blood vessel density and location were closely related to nodule regeneration. The Nomogram model showed good differentiation and accuracy in predicting the risk of nodule regeneration, providing strong support for clinical decision-making.
目的 探討胃腸道穿孔的多層螺旋CT（MSCT）表現及診斷價值。 方法 收集2010年3月－2011年3月18例經手術證實為胃腸道穿孔患者的臨床及MSCT資料，回顧性分析了胃腸道穿孔及穿孔部位的MSCT表現。 結果 18例患者中，MSCT明確診斷穿孔17例，對穿孔部位準確定位11例。其中術后診斷胃穿孔4例、十二指腸球部穿孔9例、小腸穿孔3例、結腸穿孔1例、闌尾穿孔1例。MSCT表現有腹腔游離氣體，腸壁周圍局限性積氣、腹腔積液及腸袢積液、腸壁增厚、腸腔周圍脂肪間隙密度增高（條紋征）。 結論 MS CT有利于顯示腹腔游離氣體、胃腸道穿孔部位及其腸壁周圍的變化情況，對胃腸道穿孔術前的定性及定位診斷有較明顯的優勢 ，可為臨床提供更多有價值的診斷信息。
Objective To investigate the clinical effects and the brain protection effect of different cardiopulmonary bypass in treating descending aortic aneurysms. Methods From January 2001 to December 2008, 65 patients were diagnosed to have descending aortic aneurysm with magnetic resonance imaging (MRI) in our hospital. Among them, there were 56 males and 9 females whose age was between 15 and 71 years old with an average of 48.1 years. The disease process ranged from 6 days to 4 months (19.0±6.5 d ). Preoperative diagnosis showed that there were 41 cases of DeBakey type Ⅲinterlayer, 9 cases of Marfan syndrome with postoperative complications of type Ⅲ interlayer, 7 cases of pseudoaneurysm and 8 cases of true aneurysm. We adopted artificial blood vessel repair patch to repair the damaged point of the descending aorta in 2 cases, performed vascular aneurysm resection and artificial vessel replacement on 63 patients, and carried out descending aorta replacement and intercostal artery grafting in 18 cases. Results Among the 65 cases of cardiopulmonary bypass patients, there were 13 cases of left heart bypass, 12 cases of heart bypass, 30 cases of deep hypothermic circulatory arrest (DHCA) with total body retrograde perfusion (TBRP) and 10 cases of modified separate perfusion of upper and low body. Cardiopulmonary bypass time, DHCA time, retrograde perfusion time, upper body circulatory arrest time and low body circulatory arrest time were respectively 51-212 min, 18-75min, 18-73 min, 21-31 min, and 39-67 min. No death occurred during the operation, and there were no brain complications or complications of paralysis among all the patients. Two patients died after operation because of renal failure. Conclusion Good results can be achieved by selecting different method of cardiopulmonary bypass based on the anatomical location and range of the thoracic descending aortic aneurysms. The selection criteria should be favorable to the surgical operation and organ protection.
【摘要】 目的 探討深吸氣量（inspiratory capacity，IC）與慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者臨床特征的相關性。 方法 2009年12月-2010年6月納入84例穩定期COPD患者，測定6分鐘步行試驗（6-minute walk test，6MWT）、圣喬治生活問卷評分（St George′s respiratory questionnaire，SGRQ）及肺功能檢查:第1秒用力呼氣容積（forced expirotovy volume in one second，FEV1）、IC、IC與肺總量（total lung capacity，TLC）比值（IC/TLC）等相關指標，并進行相關性分析。 結果 6MWT值與FEV1無明顯直線相關（r=0.14，Pgt;0.1）；6MWT值與FEV1≥60%無明顯直線相關（r=0.16，Pgt;0.1）；6MWT值與IC值呈正的直線相關（r=0.317，Plt;0.01）；6MWT值與IC/TLC值呈正的直線相關（r=0.274，Plt;0.01）；SGRQ值與FEV1呈負的直線相關（r=-0.307，Plt;0.01）；SGRQ值與IC值無直線相關（r=-0.001，Pgt;0.25）；SGRQ值與IC/TLC值無直線相關（r=-0.003，Pgt;0.25）。 結論 對COPD患者，IC比FEV1更準確地反映患者的運動耐量的程度，FEV1比IC更準確地反映患者呼吸困難的嚴重程度。【Abstract】 Objective To explore the relationship between the inspiratory capacity (IC) and clinical characters of stable chronic obstructive pulmonary disease (COPD). Methods Between December 2009 and June 2010, 84 patients with stable COPD were enrolled. Lung function (FEV1, IC, IC/TLC) ,6 minute walk-test (6MWT) and St George′s respiratory questionnaire (SGRQ) were examined. The relationship among FEV1, IC, IC/TLC, and the results of 6MWT and SGRQ by Pearson correlation analysis. Results There was no linear correlation between 6MWT and FEV1 （r=0.14，Pgt;0.1）, and 6MWT and FEV1≥60% （r=0.16，Pgt;0.1）. There was positive correlation between 6MWT and IC （r=0.317，Plt;0.01）, and 6MWT and IC/TLC （r=0.274，Plt;0.01）. There was negative correlation between SGRQ and FEV1 （r=-0.307，Plt;0.01）; and no linear correlation between SGRQ and IC （r=-0.001，Pgt;0.25）, and SGRQ and IC/TLC （r=-0.003，Pgt;0.25）. Conclusion In stable COPD patients, IC may be more accurate than FEV1 in refection of exercise tolerance while FEV1 may be more sensitive than IC in evaluation of dyspnea.
【摘要】 目的 探討整體護理在壓瘡治療中的應用和效果。 方法 2006年1月-2009年11月對98例壓瘡患者采用整體護理程序，從評估、提出護理診斷、實施護理措施以及評價作用效果四個方面對患者進行護理。 結果 50例壓瘡完全愈合，38例壓瘡經過護理后達到顯效標準，10例壓瘡經過護理后好轉。 結論 整體護理應用于壓瘡患者可取得滿意的效果。【Abstract】 Objective To assess the application and effects of holistic nursing in the treatment of pressure sore. Methods Ninety-eight patients with pressure sores were treated from January 2006 to November 2009 in this department, accompanying with the holistic nursing which includes assessment, proposed nursing diagnosis, implementation and evaluation of the effect. Results Fifty patients were completely healed, 38 patients showed obvious effect and 10 patients relieved slightly. Conclusion The holistic nursing has satisfactory effects on the patients with pressure sores.
Objective To summarize our experience of using rigid bronchoscopy in the managent of patients with tracheobronchial disease. Methods From Sep.2002 to Nov.2007, 44 patients of tracheobronchial disease（31 men，13 women, median age 51.9 years) underwent rigid bronchoscopic operations. All procedures were carried out under general anesthesia with high frequency jet ventilation. After the rigid bronchoscope was placed in the main trachea through the mouth , the airway was checked out firstly, and then the lesion was removed by repeated freezing, argon plasma coagulation, cauterization or mechanical ablation, and a stent maybe implanted while needed. Results All 54 procedures were accomplished endoscopically without mortality or major morbidity (16 clearence,19 core out,8 scar clearance,3 foreign body removal, 8 stent insert or removal).The lesion located at trachea in 19 cases, at carina in 4 cases,at left main bronchus in 11 cases and at right main bronchus in 10 cases. There were 17 benign diseases and 27 malignant diseases. There were 3 slight complications. 16 patients compliating with benign disease were followed-up and 1 patient was missed,there was no tumor recurrence except 3 patients complicating with tracheal scar who received reoperations during 4-44 (mean 23.0) months follow-up period. Of the 27 malignant cases,23 patients were followed-up and 4 patients were missed, the follow-up period were 5-58(mean 27.1)months.3 patients died in one months after operation of other disease; the other patients all survived more than one month,especially 7 patients who received radical resection of the tumor survived more than one year. Conclusions These data show that rigid bronchoscope can be applied safely and effectively in the management of tracheobronchial disease.
目的:探討后路椎弓根螺釘固定在地震傷胸腰椎骨折中的應用及優點。方法:對19例胸腰椎骨折的地震傷患者行后路椎弓根螺釘內固定術。結果:本組病例的手術時間70～115分鐘,平均出血量約280mL,兩例病員術中出血超過400mL進行輸血,復位椎體前緣高度由術前平均57.5%恢復到術后平均93.6%,后突角由術前平均21°矯正到術后平均3°,術后3～7天轉往外地繼續治療,Frankel分級平均提高0.4。結論:后路椎弓根螺釘固定具有省時、節約醫療資源、提高救治效率、減輕患者痛苦的優點,尤其適用于大批傷病員的緊急救治。
Objective To elucidate the protective effect of leukocyte depletion on the myocardium during the settings of myocardial reperfusion injury. Methods Twenty patients undergoing cardiopulmonary bypass with continuous infusion of blood cardioplegia were randomized into two groups:the control group (n=10) with no leukocyte depletion filter used, and the experimental group (n=10) with the use of leukocyte depletion filter on the bypass circuit. The blood cells count before and after the filtration were measure...