OBJECTIVETo evaluate the potential reconsideration of curative operative treatment for patients with unresectable stage IIIA (N2) non-small-cell lung cancer (NSCLC).

METHODSFrom Jan. 1999 to Dec. 2002, 76 patients with unresectable stage IIIA (N2) NSCLC were entered in this study. They had all been proved by chest CT, chest film and fiberobronchoscopy. Twenty-one (27.6%) patients were examined by mediastinoscopy. All the patients received two cycles of chemotherapy with NVB (25 mg/m(2), D1, D5) and carboplatin (300 mg/m(2), D1). All the patients were staged again three weeks after induction chemotherapy. Sixty-four patients who achieved partial response (PR) or complete response (CR) were allowed to undergo surgery. Twelve patients who did not responde to chemotherapy received radiotherapy instead. Of the 64 surgically treated patients, 56 (84.7%) had a complete resection and then received 2 cycles of chemotherapy using the same regime, 8 patients had an incomplete resection and then received radiotherapy for the residual tumor.

RESULTSThe median survival for these 76 patients with unresectable stage IIIA (N2) NSCLC treated by either surgery or radiation after induction chemotherapy was 18.6 months with 1-, 2-, 3-year survival rate of 64.2%, 39.4% and 25.6%, respectively. The median survival for the 56 patients with a complete resection was 28.2 months with 1-, 2-, 3-year survival rate of 70.4%, 52.5% and 38.6%, respectively.

CONCLUSIONPreoperative induction chemotherapy with NVB plus carboplatin should be seriously considered for the patients with unresectable stage IIIA (N2) NSCLC, It is suggested that, whenever possible, surgery should be taken as the first choice for the patients who show down-staged benefits that complete resection can be attempted.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carboplatin ; administration & dosage ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; surgery ; Chemotherapy, Adjuvant ; methods ; Combined Modality Therapy ; Drug Administration Schedule ; Female ; Humans ; Lung Neoplasms ; drug therapy ; surgery ; Male ; Mediastinoscopy ; Middle Aged ; Preoperative Care ; Vinblastine ; administration & dosage ; analogs & derivatives

OBJECTIVETo explore the changes of CD(14)(+) monocyte human leucocyte antigen DR (HLA-DR) and their relationship with multiple organ dysfunction syndrome (MODS) in severe sepsis.

METHODSNinety-one patients with a definite diagnosis of severe sepsis in the intensive care unit (ICU) were included. CD(14)(+) monocyte HLA-DR levels were detected by flow cytometry on the first, 4th and 7th days of the study, and Marshall scores and prognosis on day 28 were evaluated.

RESULTSThirty-four patients died within 28 days following the onset with a mortality rate of 37.4%. Persistently lowered levels of HLA-DR were detected and significantly increased Marshall scores were found in the fatal cases at all the time points (P<0.001). In the surviving patients, the levels of HLA-DR were significantly increased (P<0.01) and Marshall scores were gradually decreased (P<0.001). During the observation period, the levels of HLA-DR decreased significantly as the number of dysfunctional organs and Marshall scores increased (P<0.001). The levels of HLA-DR were significantly increased in severe sepsis patients with 2-4 dysfunctional organs and Marshall score of 5-12 (P<0.05 or P<0.001). No changes in HLA-DR levels in severe sepsis patients with 5-6 dysfunctional organs and Marshall scores of 13-22. The levels of HLA-DR showed a significant inverse correlation to Marshall scores (r=-0.368, P<0.001).

CONCLUSIONIn patients with severe sepsis, persistent low CD(14)(+) monocyte HLA-DR levels predicts high mortality. The levels of HLA-DR are significantly correlated to the severity of organ dysfunction.

Adult ; Aged ; Aged, 80 and over ; Female ; HLA-DR Antigens ; metabolism ; Humans ; Lipopolysaccharide Receptors ; Male ; Middle Aged ; Monocytes ; immunology ; metabolism ; Multiple Organ Failure ; pathology ; Sepsis ; immunology ; metabolism

Objective:To explore whether renal artery involvement is an independent risk factor of acute renal injury (AKI) KDIGO stage 3 after moderate hypothermic circulatory arrest in patients with acute Stanford type A aortic dissection.Methods:From December 2015 to October 2017, 492 consecutive patients with acute Stanford A-type aortic dissection received surgical treatment, 486 of them were included in the study. All patients underwent aortic CTA to determine the extent of aortic dissection and renal artery involvement. According to the standard of Improving Global Outcomes (KDIGO), the renal function of patients after operation was graded. The risk factors of AKI KDIGO stage 3 were analyzed.Renal artery involvement and other risk factors were included in univariate analysis, and significant variables in univariate analysis were included in multivariate logistic regression analysis.Results:In 492 patients, 40 (8.13%) died in hospital, of which 6 died of severe bleeding during operation or failed to wean from cardiopulmonary bypass which lead to unable to leave the Weaning from cardiopulmonary bypass and these 6 patients were excluded in the research. Among 486 patients included in the study, 251 (51.64%) had AKI. Among them, 83 (17.08%) were in the KDIGO stage 1, 56 (11.52%) in stage 2 and 112 (23.05%) in stage 3.The results of univariate analysis showed that there were significant differences in renal artery involvement, age, time from onset to operation, D-dimer, leukocytes and platelets in peripheral blood, creatinine clearance rate, time of cardiopulmonary bypass during operation and aortic cross-clamping time( P>0.05). The above risk factors were included in multivariate logistic regression. The results showed that preoperative renal artery involvement ( OR=1.94, P=0.02), age ( OR=1.03, P=0.02), creatinine clearance rate<85 ml/min ( OR=2.28, P=0.001), and intraoperative cardiopulmonary bypass time ( OR=1.01, P=0.02) were independent risk factors. The incidence of AKI in patients with renal artery involvement was 54.65%, significantly higher than 41.98% in patients without renal artery involvement ( P>0.05). Conclusion:Renal artery involvement is an independent risk factor of AKI KDIGO stage 3 after moderate deep hypothermic circulatory arrest of acute Stanford type A aortic dissection.

Objective To investigate the distribution of ghitathione-S-transferase M1 (GSTM1) and T1 (GSTT1) genes polymorphisms in Chinese population and smear-positive pulmonary tuberculosis cases of Jilin province. Methods Articles about GSTM1 and GSTT1 genes polymorphisms published before 2009 in China were searched. The study population was obtained from fourteen counties (or districts) of Jilin province, which included all cases from November, 2007 to May, 2008, totally 1120. The genotypes of GSTM1 and GSTT1 were detected by multiplex PCR technique. Results The frequencies of GSTM1 and GSTT1 'null' genotypes and combination M1-T1 'null' genotype acquired from systematic review were 54.2%, 46.8% and 26.2%, respectively, in Chinese Hans they were 53.4%, 44.9% and 25.5%, and in our research they are 57.2%, 20.4% and 13.7%, respectively. No significant differences between the frequencies of males and females as well as among that of different age groups were observed(P>0.05). The frequency of GSTM1 'null' genotype in our research is slightly higher than that in systematic review (P=0.016) , and the frequencies of GSTT1 'null' genotype and combination M1-T1 'null' genotype and are significantly lower than those in systematic review (both P<0.001). Conclusion The frequencies of GSTM1 and GSTTI 'null' genotypes were different among ethnics. The statistical difference between systematic review and our research may due to our large sample size and mostly Soutbern people in previous studies.

OBJECTIVETo estimate the frequency of injections and proportion of unsafe injections and to analyses the critical determinants of poor injection practices in general population in China. Also, to study knowledge, attitudes, practice research in providers and general population.

METHODSA random sample consisting residents and health care providers in a rural county was elected and interview about the frequency of received injection, as well as knowledge, attitudes and practices regarding injections were studied.

RESULTSOverall, 1 004 village residents, and 94 providers were interviewed. Among residents, 145 persons (14.4%), with 457 times (0.46 times per person) had received at least one injection during the previous 3 months. The frequency of injection was 1.84 per year. The proportion of received injections on treatment and immunizations was significantly different among > 12 years age group and < or = 12 years age group. Ninety-four point four percent of disposable syringes/needles were used for injections. Knowledge among the population and providers regarding injection safety was limited.

CONCLUSIONInjections were moderately frequent in this rural area and the proportions of disposable syringes/needles used for injections was very high. Knowledge of safe injection and reasonable injection as well as consciousness of self-protection in the providers and residents need to be improved.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; China ; epidemiology ; Disposable Equipment ; statistics & numerical data ; Equipment Reuse ; statistics & numerical data ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Infant ; Injections ; adverse effects ; statistics & numerical data ; Male ; Middle Aged ; Risk Factors ; Rural Health Services ; Safety ; Surveys and Questionnaires ; Syringes

Objective To explore the obstacles in palliative care consultation services and put forward the suggestions for improving the services in grade A tertiary hospitals. Methods A semi-structured interview was conducted with 17 medical workers who had requested palliative care consultation services in Peking Union Medical College Hospital. Results The palliative care consultation services were hindered by five obstacle factors including insufficient knowledge of patients and their families about palliative care,unsound understanding of medical workers about palliative care,poor implementation of consultation opinions,limited labor of palliative care team,and poor economic benefits from palliative care.In view of such obstacles,the following suggestions were put forward,which included increasing the acceptance of palliative care by patients and their families,enriching the knowledge of medical staff on palliative care,establishing a new cooperation model between consultation team and medical staff,strengthening the institutional guarantee for the development of palliative care,and establishing and perfecting the laws and policies related to palliative care. Conclusion Although there are many difficulties in the in-hospital palliative care consultation services in grade A tertiary hospitals,the demand and expectation of medical staff for palliative care are still increasing.
Humans ; Palliative Care ; Tertiary Care Centers ; Referral and Consultation ; Hospitalization