Objective:To compare the feasibility,complications and advantages of the nose-intestine tube and the jejunostic tube in early enteral nutrition after double incisions for the therapy of esophageal cancer.Methods: 52 postoprative patients were divided into three groups.The nose-intestine tube group(A group,n =16) and the jejunostic tube group(B group,n = 21) received the enteral nutrition(Nutrison Fibre) and the conrtrol group(C group,n = 15) received intravenous isotonic glucose solution and oral liquid diet after the bowel movement recovery.The blood glucose,the function of liver and kidney,electrolytes and nutritional status were observed.The recovery of bowel movement and other digestive symptoms such as abdominal pain,distention,diarrhea,nausea and vomiting were observed during the period of study.Some complications such as acute intestinal obstruction,pnumonia and rhinolaryngitis were observed during the period of study.Results: The time for placing the jejunostic tube was faster than that for placing the nose-intestine tube(P

Objective To analyze prognostic factors of surgical treatment for elderly patients with non-small cell lung cancer,in order to provide a theoretic basis for improving the prognosis of patients with non-small cell lung cancer.Methods Clinical data of 145 elderly patients with non-small cell lung cancer who had received surgical treatment at our hospital from January 2012 to September 2012 were retrospectively analyzed.The survival rates of patients were investigated.Results The median survival time was 31.5 months,and 1-year,2-year and 3-year survival rates were 61.4％,45.5％ and 40％,respectively.Single factor analysis showed that lesion size,number of metastatic lymph nodes,clinical stage,pathological type and radiotherapy were among the factors affecting prognosis.Multiple COX regression analysis showed that a lesion size ＞3cm,number of lymph nodes with metastasis ＞ 2 and pathological type were independent risk factors for patient prognosis,and radiotherapy was a protective factor for prognosis.Conclusions Surgical treatment has good curative effects on non-small cell lung cancer in elderly patients.Lesion size,number of lymph nodes with metastasis,pathological type and radiotherapy are important factors affecting prognosis,and can be used for prognosis assessment.

Objective To compare the incidence of cardiopulmonary complications between treatment of video assisted thoracoscopic operation and traditional thoracotomy operation in elderly patients with non-small cell lung cancer.Methods 122 cases of elderly patients with non small cell lung cancer were treated in our hospital from Mar 2010 to Jun 2014,and randomly divided into observation group (therapeutic lobectomy by video assisted thoracoscopic operation) and control group (therapeutic lobectomy by traditional thoracotomy operation) (n=61,each).The postoperative cardiopulmonary complications and relevant indexes of cardiopulmonary function were analyzed and compared between the two groups.Results Before operation,there was no significant difference in the relevant indexes of cardiopulmonary function between the two groups (P＞0.05).After operation,the forced expiratory volume in one second (FEV1) and maximal ventilatory volume (MMV) were higher and the heart rate was lower in observation group than in control group (t=3.682,2.243,5.677,all P＜0.05).The incidence of cardiopulmonary complication was lower in observation group than in control group (13.1％ vs.27.9％,x2 =4.075,P=0.044).Conclusions Video assisted thoracoscopic operation is better for the recovery of cardiopulmonary function,and can reduce cardiopulmonary complication in elderly patients with non-small cell lung cancer.

Objectives:To investigate the safety,feasibility and clinical effects of early EN(EEN) in postoperative patients with esophageal cancer. Methods:On the first postoperative day,40 patients were randomly divided into EEN group and TEN group(traditional enteral nutrition group), 20 patients per group.A series of parameters including plasma protein and lymphocyte count were tested before and after nutritional therapy.The complications,vital signs and resumption of gastrointestinal functions were carefully observed and recorded simultaneously. Results:Neither mortality nor serious morbidity occurred in all patients during the period of study.The concentrations of serum prealbumin and transferrin were significantly elevated after nutritional support in EEN group.The lymphocyte count was also higher in EEN group.The bowel movement resumed significantly earlier in EEN group than in TEN group. Conclusions:Postoperative EEN for esophageal cancer is safe and feasible,not only improving nutritional status and maintaining gastrointestinal function,but also ameliorating immunological function.

Objective:To observe heart rate circadian rhythm in patients with chronic kidney disease (CKD) stage 5 and to analyze the effects of parathyroidectomy (PTX) on heart rate circadian rhythm in severe secondary hyperparathyroidism (SHPT) patients.Methods:A cross-sectional observation was performed in 213 patients with CKD stage 5 and 96 controls, and the patients were divided into those with severe SHPT (PTX group, n=70) and without severe SHPT (non-PTX group, n=143). Forty-six PTX patients were followed up prospectively. The baseline data were compared among these groups. Holter electrocardiogram was performed for each participant. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Multiple linear regression analysis was used to analyze the related factors of heart rate circadian rhythm in patients with CKD stage 5. Results:The 24-hour, daytime and nighttime mean heart rate in patients with CKD stage 5 were all higher than those in controls, especially in PTX group (all P<0.05). The night/day heart rate ratios of controls and CKD stage 5 patients were (0.81±0.08) and (0.91±0.08) respectively ( P<0.01). Correlation analysis showed 24-hour and daytime or nighttime mean heart rate in patients with CKD stage 5 were positively correlated with serum levels of phosphorus and ln(alkaline phosphatase), while nighttime mean heart rate and night/day heart rate ratio were positively related with serum intact parathyroid hormone level. After adjusting with postoperative follow-up period (median time: 10.9 months), 24-hour and nighttime mean heart rate, and night/day heart rate ratio in PTX patients all decreased significantly (all P<0.01). Conclusions:Heart rate is increased and circadian rhythm is abnormal in patients with CKD stage 5, which are related with mineral and bone disorder. PTX significantly decreases 24-hour and nighttime mean heart rate in severe SHPT patients, and improves the heart rate circadian rhythm.

Objective:To investigate the predictive value of abnormal heart rate circadian rhythm for all-cause mortality in stage 5 chronic kidney disease (CKD 5) patients.Methods:The retrospective study was performed in CKD 5 patients enrolled from the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) and the Affiliated BenQ Hospital of Nanjing Medical University from February, 2011 to December, 2019. A total of 159 healthy volunteers were enrolled as the healthy control group during the same period. The circadian rhythm of heart rate was monitored by 24-hour Holter. Related indices (including 24-hour, daytime and nighttime mean heart rate, night/day heart rate ratio, 24-hour maximum heart rate, 24-hour minimum heart rate and difference between maximum and minimum of 24-hour heart rate) were calculated. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Cox regression model was used to analyze the risk factors of all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve and Log-rank test were used to compare the differences of cumulative mortality between high ratio group (night/day heart rate ratio>0.91) and low ratio group (night/day heart rate ratio≤0.91). The nonlinear relationship between night/day heart rate ratio and all-cause mortality was analyzed by restricted cubic spline plot. Time-dependent receiver operating characteristic (ROC) curve was used to analyze the predictive value of night/day heart rate ratio for all-cause mortality in CKD 5 patients.Results:A total of 159 healthy volunteers and 221 CKD 5 patients were included in this study. There were 123 males (55.66%) and the age was (52.72±13.13) years old in CKD 5 patients. The total median follow-up time was 50.0 months. Compared with controls, 24-hour, nighttime mean heart rate, 24-hour minimum heart rate in CKD 5 patients were increased (all P<0.05), furthermore, the night/day heart rate ratio was higher [(0.91±0.09) vs (0.81±0.08), P<0.001], showing "non-dipping heart rate". However, the 24-hour maximum heart rate and the difference between maximum and minimum of 24-hour heart rate in CKD 5 patients were lower than controls (both P<0.05). Multivariate Cox regression analysis showed that the increased night/day heart rate ratio (per 0.1 increase, HR=1.557, 95% CI 1.073-2.258, P=0.020) was an independent influencing factor for all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve analysis showed that the cumulative mortality of the high ratio group was significantly increased than that of the low ratio group (Log-rank test χ 2=7.232, P=0.007). From the restricted cubic spline plot, there was a linear effect between night/day heart rate ratio and all-cause mortality ( P=0.141), and when night/day heart rate ratio was above 0.91, the risk of all-cause mortality was significantly increased in CKD 5 patients. According to time-dependent ROC curve, the accuracy of night/day heart rate ratio in predicting all-cause mortality was 70.90% even when the survival time was up to 70.0 months. Conclusions:The circadian rhythm of heart rate in CKD 5 patients displays "non-dipping" state. High night/day heart rate ratio is an independent influencing factor for all-cause mortality in CKD 5 patients.