1.Progress of Study on the Relationship between Indoor Air Formaldehyde Pollution and Leukemia
Zhongfa JIANG ; Wenju YUAN ; Benyan ZHANG
Journal of Environment and Health 1993;0(03):-
Leukemia is one of the common tumors,and it seriously harms to the health.The more serious environmental pollutions become,the more people pay attention to the relationship between environmental exposures and leukemia,especially children leukemia.To discuss the progress of study on formaldehyde and leukemia,this study states the characteristics of formaldehyde,the resources of formaldehyde indoor air and the harms to health,toxicity and human cancinogenicity,and reviews the researches on the relationship between formaldehyde and leukemia.It concludes that there is "strong but not sufficient evidence for a causal association between leukemia and occupational exposure to formaldehyde".
2.Effects of health education based on behavior change wheel theory on functional exercise compliance of stroke patients
Wenju JIANG ; Meng ZHANG ; Qi ZHANG ; Xiujuan ZHAO
Chinese Journal of Modern Nursing 2019;25(34):4492-4495
Objective To explore the effects of health education based on behavioral change wheel theory on functional exercise compliance of stroke patients. Methods Using convenience sampling method, we selected 70 stroke patients hospitalized in Beijing Shijitan Hospital from June 2018 to April 2019 as the research object, and divided them into control group and observation group according to the odd and even number of hospitalization, with 35 cases in each. Finally, 30 cases were included in the control group and 32 cases in the observation group. The control group was given routine health education and routine follow-up after discharge. The observation group was given health education based on the theory of behavioral change wheel. Three months after discharge, exercise compliance and satisfaction with nursing were compared between the two groups. Results Before intervention, there was no significant difference in the scores of each dimension and total score of functional exercise compliance between the two groups (P> 0.05).After intervention, the scores of each dimension and total score of functional exercise compliance in the observation group were higher than those in the control group, and the difference was statistically significant (P< 0.05). There were 8 very satisfied cases, 18 satisfied cases and 4 unsatisfied cases in the control group, and the satisfied rate was 86.7%. There were 22 very satisfied cases and10 satisfied cases in the observation group, and the satisfied rate was100%. The difference was statistically significant (P< 0.05). Conclusions Health education based on behavioral change wheel theory can improve functional exercise compliance and nursing satisfaction of stroke patients, and is conducive to functional rehabilitation of patients, which is worthy of clinical promotion.
3.Risk factor analysis on anastomotic leakage after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and establishment of a nomogram prediction model
Wei JIANG ; Mingyuan FENG ; Xiaoyu DONG ; Shumin DONG ; Jixiang ZHENG ; Xiumin LIU ; Wenju LIU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2019;22(8):748-754
Objective To investigate the risk factors of anastomotic leakage (AL) after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and construct a nomogram prediction model. Methods This study was a retrospective case?control study that collected and reviewed the clinicopathological data of 359 patients who underwent laparoscopic surgery from January 2012 to January 2018, including 202 patients from the Department of General Surgery, Nanfang Hospital of Southern Medical University and 157 patients from the Department of Gastrointestinal Surgery of Fujian Provincial Cancer Hospital. Inclusion criteria: (1) age ≥ 18 years old; (2) diagnosis as rectal cancer by biopsy before treatment; (3) distance from tumor to anus within 12 cm; (4) locally advanced stage (T3?T4 or N+) diagnosed by imaging (CT, MRI, PET or ultrasound); (5) standardized neoadjuvant therapy followed by laparoscopic radical operation. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) short?term or incomplete standardized neoadjuvant therapy; (3) Miles, Hartmann, emergency surgery, palliative resection; (4) conversion to open surgery. Clinicopathological data, including age, gender, body mass index (BMI), preoperative albumin, distance from tumor to anus, operation hospital, American Society of Anesthesiologists score (ASA score), operation time, T stage, N stage, M stage, TNM stage, pathological complete response (pCR) were analyzed with univariate analysis to identify predictors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. Then, incorporated predictors of AL, which were screened by multivariate logistic regression, were plotted by the "rms" package in R software to establish a nomogram model. According to the scale of the nomogram of each risk factor, the total score could be obtained by adding each single score, then the corresponding probability of postoperative AL could be acquired. The area under ROC curve (AUC) was used to evaluate the predictive ability of each risk factor and nomogram on model. AUC > 0.75 indicated that the model had good predictive ability. The Bootstrap method (1000 bootstrapping resamples) was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C?index) whose rage was 0.5 to 1.0. Higher C?index indicated better consistency with actual risk. The calibration curve was used to assess the calibration of prediction model. The Hosmer?Lemeshow test yielding a non?significant statistic (P>0.05) suggested no departure from the perfect fit. Results Of 359 cases, 224 were male, 135 were female, 189 were ≥ 55 years old, 98 had a BMI > 24 kg/m2, 176 had preoperative albumin ≤ 40 g/L, 128 had distance from tumor to anus ≤ 5 cm, 257 were TNM 0?II stage, 102 were TNM III?IV stage, and 84 achieved pCR after neoadjuvant therapy. The incidence of postoperative AL was 9.5% (34/359). Univariate analysis showed that gender, preoperative albumin and distance from tumor to the anus were associated with postoperative AL (All P<0.05). Multivariate logistic regression analysis revealed that male (OR=2.480, 95% CI: 1.012?6.077, P=0.047), preoperative albumin≤40 g/L (OR=5.319, 95% CI: 2.106?13.433, P<0.001) and distance from tumor to anus≤5 cm (OR=4.339, 95% CI: 1.990?9.458, P<0.001) were significant independent risk factors for postoperative AL. According to these results, a nomogram prediction model was constructed. The male was for 55 points, the preoperative albumin≤40 g/L was for 100 points, and the distance from tumor to the anus ≤ 5 cm was for 88 points. Adding all the points of each risk factor, the corresponding probability of total score would indicated the morbidity of postoperative AL predicted by this nomogram modal. The AUC of the nomogram was 0.792 (95% CI: 0.729?0.856), and the C?index was 0.792 after internal verification. The calibration curve showed that the predictive results were well correlated with the actual results (P=0.562). Conclusions Male, preoperative albumin ≤ 40 g/L and distance from tumor to the anus≤5 cm are independent risk factors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. The nomogram prediction model is helpful to predict the probability of AL after surgery.
4.Experience of teaching and training for medical students at gastrointestinal surgery department under COVID-19 epidemic situation
Wenju CHANG ; Yudong JIANG ; Jianmin XU
Chinese Journal of Gastrointestinal Surgery 2020;23(6):616-618
In hospitals and medical schools as densely populated sites with high risk of coronavirus disease 2019 (COVID-19), it is vital to adjust the teaching and training strategy for medical students to ensure curriculum completion with safety. This article aims to introduce the experience of teaching and training for medical students under the epidemic situation at Department of Surgery, Shanghai Medical College, Fudan University and Zhongshan Hospital. The content includes exploring diversified online teaching models for undergraduate surgery courses and clinical practice, carrying out online graduate education and dissertation plans, and strengthening comprehensive education of medical humanity combined with knowledge of COVID-19 prevention. Through implementation of the above teaching strategies, scheduled learning plans of medical students can be well completed in an orderly, safe and quality-ensured manner. Our experience provides practical solution of medical teaching and could be advisable for other medical colleges and teaching hospitals.
5.Risk factor analysis on anastomotic leakage after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and establishment of a nomogram prediction model
Wei JIANG ; Mingyuan FENG ; Xiaoyu DONG ; Shumin DONG ; Jixiang ZHENG ; Xiumin LIU ; Wenju LIU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2019;22(8):748-754
Objective To investigate the risk factors of anastomotic leakage (AL) after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and construct a nomogram prediction model. Methods This study was a retrospective case?control study that collected and reviewed the clinicopathological data of 359 patients who underwent laparoscopic surgery from January 2012 to January 2018, including 202 patients from the Department of General Surgery, Nanfang Hospital of Southern Medical University and 157 patients from the Department of Gastrointestinal Surgery of Fujian Provincial Cancer Hospital. Inclusion criteria: (1) age ≥ 18 years old; (2) diagnosis as rectal cancer by biopsy before treatment; (3) distance from tumor to anus within 12 cm; (4) locally advanced stage (T3?T4 or N+) diagnosed by imaging (CT, MRI, PET or ultrasound); (5) standardized neoadjuvant therapy followed by laparoscopic radical operation. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) short?term or incomplete standardized neoadjuvant therapy; (3) Miles, Hartmann, emergency surgery, palliative resection; (4) conversion to open surgery. Clinicopathological data, including age, gender, body mass index (BMI), preoperative albumin, distance from tumor to anus, operation hospital, American Society of Anesthesiologists score (ASA score), operation time, T stage, N stage, M stage, TNM stage, pathological complete response (pCR) were analyzed with univariate analysis to identify predictors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. Then, incorporated predictors of AL, which were screened by multivariate logistic regression, were plotted by the "rms" package in R software to establish a nomogram model. According to the scale of the nomogram of each risk factor, the total score could be obtained by adding each single score, then the corresponding probability of postoperative AL could be acquired. The area under ROC curve (AUC) was used to evaluate the predictive ability of each risk factor and nomogram on model. AUC > 0.75 indicated that the model had good predictive ability. The Bootstrap method (1000 bootstrapping resamples) was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C?index) whose rage was 0.5 to 1.0. Higher C?index indicated better consistency with actual risk. The calibration curve was used to assess the calibration of prediction model. The Hosmer?Lemeshow test yielding a non?significant statistic (P>0.05) suggested no departure from the perfect fit. Results Of 359 cases, 224 were male, 135 were female, 189 were ≥ 55 years old, 98 had a BMI > 24 kg/m2, 176 had preoperative albumin ≤ 40 g/L, 128 had distance from tumor to anus ≤ 5 cm, 257 were TNM 0?II stage, 102 were TNM III?IV stage, and 84 achieved pCR after neoadjuvant therapy. The incidence of postoperative AL was 9.5% (34/359). Univariate analysis showed that gender, preoperative albumin and distance from tumor to the anus were associated with postoperative AL (All P<0.05). Multivariate logistic regression analysis revealed that male (OR=2.480, 95% CI: 1.012?6.077, P=0.047), preoperative albumin≤40 g/L (OR=5.319, 95% CI: 2.106?13.433, P<0.001) and distance from tumor to anus≤5 cm (OR=4.339, 95% CI: 1.990?9.458, P<0.001) were significant independent risk factors for postoperative AL. According to these results, a nomogram prediction model was constructed. The male was for 55 points, the preoperative albumin≤40 g/L was for 100 points, and the distance from tumor to the anus ≤ 5 cm was for 88 points. Adding all the points of each risk factor, the corresponding probability of total score would indicated the morbidity of postoperative AL predicted by this nomogram modal. The AUC of the nomogram was 0.792 (95% CI: 0.729?0.856), and the C?index was 0.792 after internal verification. The calibration curve showed that the predictive results were well correlated with the actual results (P=0.562). Conclusions Male, preoperative albumin ≤ 40 g/L and distance from tumor to the anus≤5 cm are independent risk factors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. The nomogram prediction model is helpful to predict the probability of AL after surgery.
6.Experience of teaching and training for medical students at gastrointestinal surgery department under COVID-19 epidemic situation
Wenju CHANG ; Yudong JIANG ; Jianmin XU
Chinese Journal of Gastrointestinal Surgery 2020;23(6):616-618
In hospitals and medical schools as densely populated sites with high risk of coronavirus disease 2019 (COVID-19), it is vital to adjust the teaching and training strategy for medical students to ensure curriculum completion with safety. This article aims to introduce the experience of teaching and training for medical students under the epidemic situation at Department of Surgery, Shanghai Medical College, Fudan University and Zhongshan Hospital. The content includes exploring diversified online teaching models for undergraduate surgery courses and clinical practice, carrying out online graduate education and dissertation plans, and strengthening comprehensive education of medical humanity combined with knowledge of COVID-19 prevention. Through implementation of the above teaching strategies, scheduled learning plans of medical students can be well completed in an orderly, safe and quality-ensured manner. Our experience provides practical solution of medical teaching and could be advisable for other medical colleges and teaching hospitals.
7. Risk factor analysis on anastomotic leakage after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and establishment of a nomogram prediction model
Wei JIANG ; Mingyuan FENG ; Xiaoyu DONG ; Shumin DONG ; Jixiang ZHENG ; Xiumin LIU ; Wenju LIU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2019;22(8):748-754
Objective:
To investigate the risk factors of anastomotic leakage (AL) after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and construct a nomogram prediction model.
Methods:
This study was a retrospective case-control study that collected and reviewed the clinicopathological data of 359 patients who underwent laparoscopic surgery from January 2012 to January 2018, including 202 patients from the Department of General Surgery, Nanfang Hospital of Southern Medical University and 157 patients from the Department of Gastrointestinal Surgery of Fujian Provincial Cancer Hospital. Inclusion criteria: (1) age ≥ 18 years old; (2) diagnosis as rectal cancer by biopsy before treatment; (3) distance from tumor to anus within 12 cm; (4) locally advanced stage (T3-T4 or N+) diagnosed by imaging (CT, MRI, PET or ultrasound); (5) standardized neoadjuvant therapy followed by laparoscopic radical operation. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) short-term or incomplete standardized neoadjuvant therapy; (3) Miles, Hartmann, emergency surgery, palliative resection; (4) conversion to open surgery. Clinicopathological data, including age, gender, body mass index (BMI), preoperative albumin, distance from tumor to anus, operation hospital, American Society of Anesthesiologists score (ASA score), operation time, T stage, N stage, M stage, TNM stage, pathological complete response (pCR) were analyzed with univariate analysis to identify predictors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. Then, incorporated predictors of AL, which were screened by multivariate logistic regression, were plotted by the "rms" package in R software to establish a nomogram model. According to the scale of the nomogram of each risk factor, the total score could be obtained by adding each single score, then the corresponding probability of postoperative AL could be acquired. The area under ROC curve (AUC) was used to evaluate the predictive ability of each risk factor and nomogram on model. AUC > 0.75 indicated that the model had good predictive ability. The Bootstrap method (1000 bootstrapping resamples) was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C-index) whose rage was 0.5 to 1.0. Higher C-index indicated better consistency with actual risk. The calibration curve was used to assess the calibration of prediction model. The Hosmer-Lemeshow test yielding a non-significant statistic (