Background and purpose: The incidence rate of elderly esophageal carcinoma patients is increasing year by year. In this study, the clinicopathologic factors, operational factors and postoperative complications were compared between the older and the younger elderly patients with thoracic esophageal squamous cell carcinoma (ESCC), and the influence of different surgical approaches to older elderly patients were analyzed. Methods: A retrospective review of 371 cases of elderly patients with thoracic esophageal squamous cell carcinoma (≥60 years) between Jan. 2006 and Dec. 2008 were performed. The patients were divided into two age groups. The patients over 75 years old named the older elderly group including 53 patients, and the patients between 60-74 years named the younger elderly group including 318 patients, the clinicopathological factors, operational factors, postoperative hospital mortality and average length of stay were compared. Meanwhile, according to different surgical approaches, the comparison of the left chest and right chest approach of operative time, blood loss and postoperative complication rate, and so on and so forth. Results: The older elderly group compared with the younger elderly group had more preoperative complications. Preoperative ASA classiifcation and postoperative complications, length of stay and hospital mortality rates were signiifcantly higher. The older elderly group over the right chest approach had less postoperative complications, especially pulmonary complications, the results were statistically signiifcant.(13.0%vs 40.0%,P<0.05) Conclusion: The patients over 75 years old with thoracic esophageal squamous cell carcinoma have a higher risk during the operation, we can choose relatively simpler operation approach to reduce the incidence of postoperative complications, especially pulmonary complications.

Objective To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE MRA) in infrapopliteal occlusive diseases of diabetic patients.Methods A total of 105 patients with known diabetes and peripheral vascular occlusive disease who underwent both CE MRA and DSA examnations were included in this study.They had no obvious stenosis or with stenosis of less than 75％ in iliac,femoral,and popliteal arteries.Every infra-popliteal artery was anatomically divided into 9 vascular segments as tibiofibular trunk artery,proximal and distal anterior tibial artery,proximal and distal posterior tibial artery,proximal and distal peroneal artery,plantar and dorsalis pedis artery.There were 945 segments.The arterial stenosis was accessed with CE MRA and DSA respectively.The segments were scored in 5 categories as＜30％,≥30％ and＜50％,≥50％ and＜75％,≥75％ and＜100％,and 100％ according to stenostic degrees.The Kappa test was used to compare the diagnostic consistency of CE MRA and DSA.Taken DSA as a gold standard for reference,ROC curve was drawn to calculate the diagnostic accuracy of CE MRA in diagnosis of lower limb arterial disease.Results The ratio of statistically valid segments for both CE MRA and DSA were 97.7％ (923/945) in 945 vessel segments of 105 patients,and 390 of 923 arterial segments were both indicated as occlusion by CE MRA and DSA.The diagnostic consistency for the segments was listed in the decreasing order as follows:proximal peroneal artery,proximal posterior tibial artery,distal posterior tibial artery,proximal anterior tibial artery,distal anterior tibial artery,tibiofibular trunk artery,dorsalis pedis artery,plantar artery,distal peroneal artery,and corresponding Kappa values were 0.88,0.86,0.84,0.84,0.81,0.77,0.75,0.75 and 0.73,P＜ 0.05.The AUC(area under ROC curve) of CE MRA was 0.893 with 95％ confidence interval of 0.882 to 0.904.Conclusion CE MRA is an accurate imaging modality in the diagnosis of infrapopliteal occlusive disease s for diabetes.

Objective To investigate the correlations between social support and self efficacy of young and middle-aged patients with peritoneal dialysis. Method The status of social support and self-efficacy of 97 young and middle-aged patients undergoing peritoneal dialysis were investigated and the correlation were analyzed. Results The score on social was (28.0 ± 6.4), lower than the norm (P < 0.01). The score on self-efficacy was (2.38 ± 0.62). The level of confidence was lower in 28 cases (28.9%), high in 58 cases (59.8%), very high in 11 cases (11.3%). The self-efficacy was positively correlated with social support, subjective support and support utilization (all P<0.05). Conclusions The levels of social support and self-efficacy are lower than the norm in young and middle-aged patients undergoing peritoneal dialysis. The self-efficacy is positively correlated with social support including subjective support and support utilization, which indicates that improved social support is effective for the improvement of self-efficacy by providing patients with family and social support.

Objective:To explore the clinical characteristics of cryptococcus neoformans patients who suspected as lung cancer and treated with surgery, and to improve the diagnosis of the disease.Methods:A retrospective analysis on clinical data(including preoperative laboratory examination, chest CT imaging and postoperative pathology) of 21 cryptococcosis neoformans patients misdiagnosed as lung cancer in our hospital from February 2016 to July 2019.Results:Among the 21 patients, 17 cases were single nodules and 4 cases were multiple nodules, among which 15 cases were highly suspected malignancy. The postoperative pathological diagnosis was cryptococcal pulmonary granulomatosis. 14 patients were treated with antifungal therapy after surgery. No recurrence was found after postoperative follow-up.Conclusion:The clinical manifestations and imaging examination of pulmonary cryptococcus neoformans patients have no obvious specificity, and it is easy to be misdiagnosed as early lung cancer. The diagnosis can only be confirmed by the combination of various means such as regular follow-up, laboratory examination, percutaneous lung puncture or surgical biopsy.

Objective: To identify the long-term outcome of patients with myasthenia gravis (MG) after extended thymectomy, and to analyze the prognostic factors. Methods: The medical data and follow-up results in 72 patients with MG who underwent extended thymectomy in Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University from January 2006 to October 2015 were retrospectively reviewed and analyzed. There were 32 male and 40 female patients, aging from 10 to 70 years with a mean age of 39.5 years. The outcome-related factors including gender, age while being operated on, duration of preoperative period, whether taking steroid before operation, modified Osserman classification, pathology type of thymus were analyzed by χ² test and multivariate regression analysis. Results: All patients were followed up from 6 to 75 months (median 37 months). Among them, 21 patients (29.2%) achieved complete stable remission, 18 patients (25.0%) experienced pharmacological remission, 20 patients (27.8%) improved, 9 patients (12.5%) reminded stable and 4 patients (5.6%) deteriorated. Both univariate and multicariate analysis revealed that duration of preoperative period (OR=22.871, 95% CI: 2.813 to 185.917, P=0.003) and Osserman classification (OR=0.103, 95% CI: 0.014 to 0.774, P=0.027) showed significantly associated with the surgical curative effect. Conclusions Extended thymectomy is an efective measure for MG. The duration of preoperative period and Osserman classification are prognostic factors for thymectomized MG. Those patients with generalized MG or whose duration of preperative period is less than 6 months are likely to have better prognosis.

Objective:To investigate the application value of fluorescence imaging in single-port thoracoscopic anatomic segmentectomy.Methods:The clinical data of 280 patients (145 patients with fluorescence method and 135 patients with modified inflation-deflation method) who underwent thoracoscopic anatomic segmentectomy were retrospectively studied in the Anhui Chest Hospital from June 2020 to June 2021. There were 113 patients in the simple segmentectomy group and 167 patients in the complex segmentectomy group. The baseline data of the fluorescence method and the modified inflation-deflation method in the complex segmentectomy group were corrected by propensity score matching, and the perioperative results were compared between the groups.Results:There were no significant differences in segmental resection time, intraoperative blood loss, postoperative drainage, postoperative pain, postoperative extubation time, length of hospital stay, incidence of complications and cost of hand-holding between the fluorescence method and the modified method of the simple segmentectomy group.In the complex segmentectomy group, the time of segmental resection with the fluorescence method was significantly shorter than that with the modified inflation-deflation method( P<0.05), and other indexes had no significant difference. Conclusion:Fluorescence method single-port thoracoscopic anatomic segmentectomy has the same perioperative safety and short-term efficacy as modified inflation-deflation method, which can significantly shorten the operative time and improve the operative efficiency in complex anatomic segmentectomy.

Objective To investigate the status of social participation of young and middle-age peritoneal dialysis patients and analyze its influencing factors. Methods Descriptive study was used to investigate the general information and social participation of 113 cases of young and middle-age patients with peritoneal dialysis, and we analyzed the influencing factors of social participation using ordinal Logistic regression analysis. Results In the 113 cases of young and middle-age patients with peritoneal dialysis, 97. 3%of patients could take care of themselves. Rating of social participation showed that 63. 7% of patients were in grade three, that was, to take care of themselves, and to carry out at least one of the social participation; the unemployed people accounted for 76. 1%. The status of social participation was related to age, marriage, education, social support, self efficacy and other factors. Conclusions The unemployed rate of young and middle-age peritoneal dialysis patients is high. To pay attention to the peritoneal dialysis population at work age, and improve the social participation of young and middle-age patients with peritoneal dialysis, the matter needs the joint efforts of medical personnel and social forces.