Objective:To investigate the survival outcomes and prognostic factors in patients undergoing radical resection for pancreatic body and tail cancer.Methods:A retrospective case series study was conducted on 992 patients who underwent radical resection for pancreatic body and tail cancer at the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2024. In this study, 577 (58.2%) were male and 415 (41.8%) were female,with an age of (65±9) years (range: 26 to 86 years). Follow-up continued until June 2024. Survival rates were estimated using the Kaplan-Meier method,and prognostic factors were identified using univariate and multivariate Cox proportional hazards models.Results:Among 992 patients,open surgery was the predominant approach (89.1%, 884/992), and radical antegrade modular pancreatosplenectomy (RAMPS) was performed in 317 patients (32.0%). Combined organ resection,venous resection,and arterial resection were performed in 23.5%, 9.3%,and 11.2% of patients,respectively. The rates of R0, R1-1 mm, and R1-direct resections were 49.8% (494/992),41.5% (412/992), and 8.7% (86/992),respectively. Stage ⅡB was the most common TNM stage (32.2%,319/992). A total of 801 patients (80.8%) received adjuvant chemotherapy. The median follow-up period was 32.0(8.8) months(range:3.2 to 105.3 months),during which 508 patients (51.2%) died. The overall median survival (OS) was 26.4 months,with 1-,3-, and 5-year survival rates of 79.0%,40.0%, and 29.0%, respectively. In the recent five years (from 2020 to 2024), the median OS improved significantly to 34.1 months compared to 20.0 months from 2016 to 2019 ( P<0.01). Histological subtype analysis showed that the median OS time was 26.7 months for pancreatic ductal adenocarcinoma (PDAC, n=855),58.9 months for invasive intraductal papillary mucinous carcinoma (IPMC, n=32),and 15.7 months for adenosquamous carcinoma of pancreas (ASCP, n=73) ( P=0.001). Among PDAC patients, adjuvant chemotherapy significantly improved survival (29.1 months vs. 14.4 months, P<0.01);in IPMC patients, adjuvant chemotherapy also extended survival (65.7 months vs. 58.9 months, P=0.047). Although ASCP patients receiving chemotherapy had a longer median OS time than those without (18.8 months vs. 8.9 months),the difference was not statistically significant ( P=0.151). Multivariate Cox regression analysis in PDAC patients indicated that adjuvant chemotherapy, R0 resection, T stage,N stage,and tumor differentiation were independent prognostic factors ( P<0.01). The median OS time by TNM stage was:not reached for stage ⅠA, 51.6 months for ⅠB, 25.5 months for ⅡA, 23.7 months for ⅡB, 23.0 months for Ⅲ, and 14.4 months for Ⅳ. The median OS time for R0,R1-1 mm,and R1-direct resections was 34.1,24.7,and 15.7 months,respectively ( P<0.01). Conclusion:Adjuvant chemotherapy,R0 resection,tumor stage,and differentiation are independent prognostic factors for pancreatic body and tail cancer.

Objective:To investigate the survival outcomes and prognostic factors in patients undergoing radical resection for pancreatic body and tail cancer.Methods:A retrospective case series study was conducted on 992 patients who underwent radical resection for pancreatic body and tail cancer at the Pancreatic Center of the First Affiliated Hospital of Nanjing Medical University from January 2016 to June 2024. In this study, 577 (58.2%) were male and 415 (41.8%) were female,with an age of (65±9) years (range: 26 to 86 years). Follow-up continued until June 2024. Survival rates were estimated using the Kaplan-Meier method,and prognostic factors were identified using univariate and multivariate Cox proportional hazards models.Results:Among 992 patients,open surgery was the predominant approach (89.1%, 884/992), and radical antegrade modular pancreatosplenectomy (RAMPS) was performed in 317 patients (32.0%). Combined organ resection,venous resection,and arterial resection were performed in 23.5%, 9.3%,and 11.2% of patients,respectively. The rates of R0, R1-1 mm, and R1-direct resections were 49.8% (494/992),41.5% (412/992), and 8.7% (86/992),respectively. Stage ⅡB was the most common TNM stage (32.2%,319/992). A total of 801 patients (80.8%) received adjuvant chemotherapy. The median follow-up period was 32.0(8.8) months(range:3.2 to 105.3 months),during which 508 patients (51.2%) died. The overall median survival (OS) was 26.4 months,with 1-,3-, and 5-year survival rates of 79.0%,40.0%, and 29.0%, respectively. In the recent five years (from 2020 to 2024), the median OS improved significantly to 34.1 months compared to 20.0 months from 2016 to 2019 ( P<0.01). Histological subtype analysis showed that the median OS time was 26.7 months for pancreatic ductal adenocarcinoma (PDAC, n=855),58.9 months for invasive intraductal papillary mucinous carcinoma (IPMC, n=32),and 15.7 months for adenosquamous carcinoma of pancreas (ASCP, n=73) ( P=0.001). Among PDAC patients, adjuvant chemotherapy significantly improved survival (29.1 months vs. 14.4 months, P<0.01);in IPMC patients, adjuvant chemotherapy also extended survival (65.7 months vs. 58.9 months, P=0.047). Although ASCP patients receiving chemotherapy had a longer median OS time than those without (18.8 months vs. 8.9 months),the difference was not statistically significant ( P=0.151). Multivariate Cox regression analysis in PDAC patients indicated that adjuvant chemotherapy, R0 resection, T stage,N stage,and tumor differentiation were independent prognostic factors ( P<0.01). The median OS time by TNM stage was:not reached for stage ⅠA, 51.6 months for ⅠB, 25.5 months for ⅡA, 23.7 months for ⅡB, 23.0 months for Ⅲ, and 14.4 months for Ⅳ. The median OS time for R0,R1-1 mm,and R1-direct resections was 34.1,24.7,and 15.7 months,respectively ( P<0.01). Conclusion:Adjuvant chemotherapy,R0 resection,tumor stage,and differentiation are independent prognostic factors for pancreatic body and tail cancer.

Objective:To explore the clinical effectiveness of Masquelet technique combined with improved bone grafting in the treatment of open tibial fractures of Gustilo-Anderson ⅢB with segmental bone defects.Methods:A retrospective study was conducted to analyze the clinical data of 13 patients with open tibial fracture of Gustilo-Anderson ⅢB with segmental bone defects who had been admitted to Department of Orthopeadics, Xijing Hospital, Air Force Medical University from January 2021 to May 2023. There were 9 males and 4 females with an age of (36.9±9.3) years. The length of tibial defects after debridement was (8.1±2.8) cm, and the area of soft-tissue defects 95.0 (53.6, 202.0) cm 2. At the first stage, Masquelet technique was used, soft-tissue defects were covered simultaneously or step by step, skin grafting was conducted on the donor site surface simultaneously, and survival of the tissue and skin grafts was observed. At the second stage, intramedullary space occupation with bone cement rods was conducted using improved bone grafting for which iliac bone, artificial bone, platelet rich plasma (PRP), and recombinant human bone morphogenetic protein-2 (rhBMP-2) were mixed; internal fixation was replaced. The interval between 2 stages of surgery was 4 to 7 weeks. The occurrence of infection, bone defect healing time, knee Lysholm score, ankle Mazur score, and knee and ankle ranges of motion at the last follow-up were recorded. The knee and ankle function scores before the second stage bone grafting and at the last follow-up were compared. Results:After the first-stage surgery, all the 13 patients did not need any revision with fine wound healing. After the second-stage surgery, all patients were followed up for (14.9±4.4) months with no infection at all. The healing time for bone defects was 8.0 (6.0, 12.0) months. At the last follow-up, the knee Lysholm score and the ankle Mazur score were (77.2±5.2) points and (76.1±10.9) points respectively, significantly different from those before the second-stage bone grafting [(41.3±7.5) points and (37.4±5.2) points] ( P<0.05). In the 13 patients at the last follow-up, ankle dorsiflexion limitation was 5.0° (0, 10.0°), knee flexion 105.0°±9.6°, and knee extension limitation 5.0° (5.0°, 5.0°). Conclusion:In the treatment of open tibial fractures of Gustilo-Anderson ⅢB with segmental bone defects, Masquelet technique combined with improved bone grafting can effectively prevent infection, repair bone defects, and restore the function of lower extremities, leading to definite curative efficacy.

Objective:To explore the clinical effectiveness of Masquelet technique combined with improved bone grafting in the treatment of open tibial fractures of Gustilo-Anderson ⅢB with segmental bone defects.Methods:A retrospective study was conducted to analyze the clinical data of 13 patients with open tibial fracture of Gustilo-Anderson ⅢB with segmental bone defects who had been admitted to Department of Orthopeadics, Xijing Hospital, Air Force Medical University from January 2021 to May 2023. There were 9 males and 4 females with an age of (36.9±9.3) years. The length of tibial defects after debridement was (8.1±2.8) cm, and the area of soft-tissue defects 95.0 (53.6, 202.0) cm 2. At the first stage, Masquelet technique was used, soft-tissue defects were covered simultaneously or step by step, skin grafting was conducted on the donor site surface simultaneously, and survival of the tissue and skin grafts was observed. At the second stage, intramedullary space occupation with bone cement rods was conducted using improved bone grafting for which iliac bone, artificial bone, platelet rich plasma (PRP), and recombinant human bone morphogenetic protein-2 (rhBMP-2) were mixed; internal fixation was replaced. The interval between 2 stages of surgery was 4 to 7 weeks. The occurrence of infection, bone defect healing time, knee Lysholm score, ankle Mazur score, and knee and ankle ranges of motion at the last follow-up were recorded. The knee and ankle function scores before the second stage bone grafting and at the last follow-up were compared. Results:After the first-stage surgery, all the 13 patients did not need any revision with fine wound healing. After the second-stage surgery, all patients were followed up for (14.9±4.4) months with no infection at all. The healing time for bone defects was 8.0 (6.0, 12.0) months. At the last follow-up, the knee Lysholm score and the ankle Mazur score were (77.2±5.2) points and (76.1±10.9) points respectively, significantly different from those before the second-stage bone grafting [(41.3±7.5) points and (37.4±5.2) points] ( P<0.05). In the 13 patients at the last follow-up, ankle dorsiflexion limitation was 5.0° (0, 10.0°), knee flexion 105.0°±9.6°, and knee extension limitation 5.0° (5.0°, 5.0°). Conclusion:In the treatment of open tibial fractures of Gustilo-Anderson ⅢB with segmental bone defects, Masquelet technique combined with improved bone grafting can effectively prevent infection, repair bone defects, and restore the function of lower extremities, leading to definite curative efficacy.

Objective:To analyze the relationship between plasma D-dimer level and cancer-related fatigue and quality of life in patients with lung cancer after chemotherapy.Methods:A cross-sectional study was conducted involving 58 patients with stage ⅠB-ⅢA lung cancer who received chemotherapy at The First Hospital of Anhui University of Science and Technology from January 2020 to December 2023. These patients comprised the observation group. The control group consisted of 41 patients diagnosed with lung cancer who had completed adjuvant chemotherapy and entered the follow-up stage. The plasma D-dimer level in the observation group was monitored before and after four cycles of postoperative adjuvant chemotherapy. The plasma D-dimer level in the control group was monitored before and after 3 months of follow-up. The Chinese version of the Cancer Fatigue Scale and the Chinese version of the Functional Assessment of Cancer Therapy-Lung (FACT-L) were used to evaluate cancer-related fatigue levels and quality of life in both groups. Pearson correlation analysis was performed to assess the relationship between plasma D-dimer levels and cancer-related fatigue and quality of life.Results:After four cycles of chemotherapy and 3 months of follow-up, the plasma D-dimer level in the observation group was significantly higher than that in the control group [(1.17 ± 0.32) mg/L vs. (0.66 ± 0.29) mg/L, t = -8.26, P < 0.001]. The score of the Chinese version of the FACT-L in the observation group was significantly higher than that in the control group [(79.82 ± 9.74) points vs. (67.49 ± 8.12) points, t = -6.85, P < 0.001]. The scores for tumor-related symptoms, physiological status, social/family status, functional status, and emotional status in the FACT-L for the observation group were (21.26 ± 3.17) points, (14.37 ± 2.24) points, (22.63 ± 3.48) points, (11.53 ± 2.13) points, and (14.79 ± 2.73) points, which were significantly lower than those in the control group [(22.42 ± 3.31) points, (17.65 ± 2.64) points, (25.12 ± 3.39) points, (16.34 ± 2.68) points, (16.37 ± 2.76) points, t = 3.26, 6.48, 3.56, 3.60, 2.82, all P < 0.05]. Pearson correlation analysis revealed that the plasma D-dimer level was positively correlated with the cancer-related fatigue score ( r = 0.367, P < 0.001) and negatively correlated with the total FACT-L score ( r = -0.334, P < 0.001). Conclusion:In patients with stage ⅠB-ⅢA lung cancer after surgery, changes in plasma D-dimer levels during adjuvant chemotherapy are associated with the degree of cancer-related fatigue and affect quality of life. Therefore, monitoring plasma D-dimer levels can provide important reference value for assessing the outcome of chemotherapy and guiding clinical treatment.

BACKGROUND: Currently, the effect of the 2022 nationwide coronavirus disease 2019 (COVID-19) wave on the perioperative prognosis of surgical patients in China is unclear. Thus, we aimed to explore its influence on postoperative morbidity and mortality in surgical patients. METHODS: An ambispective cohort study was conducted at Xijing Hospital, China. We collected 10-day time-series data from December 29 until January 7 for the 2018-2022 period. The primary outcome was major postoperative complications (Clavien-Dindo class III-V). The association between COVID-19 exposure and postoperative prognosis was explored by comparing consecutive 5-year data at the population level and by comparing patients with and without COVID-19 exposure at the patient level. RESULTS: The entire cohort consisted of 3350 patients (age: 48.5 ± 19.2 years), including 1759 females (52.5%). Overall, 961 (28.7%) underwent emergency surgery, and 553 (16.5%) had COVID-19 exposure (from the 2022 cohort). At the population level, major postoperative complications occurred in 5.9% (42/707), 5.7% (53/935), 5.1% (46/901), 9.4% (11/117), and 22.0% (152/690) patients in the 2018-2022 cohorts, respectively. After adjusting for potential confounding factors, the 2022 cohort (80% patients with COVID-19 history) had a significantly higher postoperative major complication risk than did the 2018 cohort (adjusted risk difference [aRD], 14.9% (95% confidence interval [CI], 11.5-18.4%); adjusted odds ratio [aOR], 8.19 (95% CI, 5.24-12.81)). At the patient level, the incidence of major postoperative complications was significantly greater in patients with (24.6%, 136/553) than that in patients without COVID-19 history (6.0% [168/2797]; aRD, 17.8% [95% CI, 13.6-22.1%]; aOR, 7.89 [95% CI, 5.76-10.83]). Secondary outcomes of postoperative pulmonary complications were consistent with primary findings. These findings were verified through sensitivity analyses using time-series data projections and propensity score matching. CONCLUSION: Based on a single-center observation, patients with recent COVID-19 exposure were likely to have a high incidence of major postoperative complications. REGISTRATION NCT05677815 at https://clinicaltrials.gov/ .
Female ; Humans ; Adult ; Middle Aged ; Aged ; Cohort Studies ; COVID-19/complications* ; Pandemics ; Retrospective Studies ; Postoperative Complications/epidemiology*

Objective:To investigate the Correlation between ADC combined with serum C-reactive protein (CRP) and delayed encephalopathy after carbon monoxide poisoning (DEACMP), It provides scientific basis for early prediction of DEACMP.Methods:According to the design principle of case-control study, the data of acute carbon monoxide poisoning (ACOP) patients admitted to Shandong Provincial Hospital from December 2017 to December 2021 were retrospectively selected. Among them, patients with DEACMP were selected as the case group, without DEACMP were used as the control group. Univariate and multivariate analyses were performed on the two groups. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacy of ADC combined with CRP as a combined predictor for disease.Results:A total of 89 patients with ACOP were included, including 33 patients with DEACMP and 56 patients without DEACMP. There were no significant differences in gender, age, smoking, drinking, and underlying diseases (hypertension, coronary heart disease) between groups ( P>0.05). Logistic regression analysis showed that white blood cell count (WBC) ( OR=1.64, 95% CI: 1.19-2.26, P=0.003), CRP ( OR=1.22, 95% CI: 1.03-1.45, P=0.019) and ADC value of central semiovale white matter ( OR=0.99, 95% CI: 0.98-1.00, P=0.010) were associated with DEACMP in patients with ACOP. The ROC curve results showed that the area under the ROC of ADC combined with CRP in the center of semiovale was 0.765 (95% CI: 0.656-0.845), the specificity was 87.9%, the sensitivity was 23.2%, and the cut-off value was 3.5°. Conclusions:WBC, CRP and ADC value of central semiovale are independent factors for DEACMP. ADC value of central semiovale combined with CRP has more clinical value in the early diagnosis of DEACMP. For ACOP patients with DEACMP triggering factors, the diagnosis and treatment awareness of early screening of brain magnetic resonance imaging should be strengthened to avoid DEACMP.

Objective:To determine the epidemiology of hyperkalemia and influencing factors in a general population in Pinggu district of Beijing city.Methods:This study was a cross-sectional survey. The subjects were from the epidemiological survey population of chronic diseases in Pinggu district of Beijing city from March to May 2014. All participants completed a questionnaire, anthropological measurement, and venous blood samples collection to detect serum creatinine and potassium and so on. First void morning urine was collected to detect the albumin-creatinine ratio. Hyperkalemia and hypokalemia were defined as serum potassium level>5.0 mmol/L and≤3.5 mmol/L, respectively. Logistic regression analysis method was used to analyze the influencing factors of hyperkalemia.Results:Of the 10 252 people in this study, the prevalence of hyperkalemia was 6.17%(95% CI 5.70%-6.67%), the prevalence of hypokalemia was 0.61%(95% CI 0.47%-0.79%), and the prevalence of participants with serum potassium>5.5 mmol/L was 0.53%(95% CI 0.40%-0.69%). Multivariate logistic regression analysis results showed that males ( OR=1.269, 95% CI 1.074-1.498, P=0.005), diabetes ( OR=1.226, 95% CI 1.008-1.490, P=0.041), increased total cholesterol ( OR=1.219, 95% CI 1.119-1.329, P<0.001), and decreased estimated glomerular filtration rate ( OR=0.971, 95% CI 0.965-0.977, P<0.001) were significantly correlated with the increased risk of hyperkalemia. Usage of renin-angiotensin-aldosterone system inhibitors and diuretics were not found to be significantly associated with the risk of hyperkalemia ( OR=1.018, 95% CI 0.751-1.380, P=0.908; OR=0.638, 95% CI 0.229-1.781, P=0.391). Conclusions:The prevalence of HK in the general population is 6.17%. The male, decreased estimated glomerular filtration rate, diabetes, and increased total cholesterol are influencing factors of hyperkalemia.

Objective:To evaluate the effect of active cycle of breathing techniques (ACBT) on respiratory muscle training in patients undergoing coronary artery bypass grafting (CABG) surgery.Methods:A quasi-experimental trial was performed. Patients were allocated to the control group or intervention group according to their time of admission. Patients who were admitted to hospital from January 2019 to April 2019 were assigned to the control group and patients admitted from May 2019 to October 2019 were allocated to the intervention group. The control group ( n=84) received routine perioperative care, and the intervention group ( n=82) received ACBT in addition to routine perioperative care. Patients in both groups were trained 3 to 5 times a day throughout their stay in the hospital. The primary outcome measure was maximum inspiratory pressure (MIP), peak of expiratory flow (PEF), forced vital capacity (FVC). Other outcomes included the postoperative pulmonary complications (PPC), days of postoperative hospital stay. Results:The MIP, PEF, FVC value of the control group 3 days after extubation were (64.77±9.80) cmH 2O (1 cmH 2O=0.098 kPa), (139.52±23.74) L/min, (1.07±0.20) L, the intervention group were (69.89±10.92) cmH 2O, (150.37±28.65) L/min, (1.15±0.22)L, the differences between the two groups were statistically significant ( t values were -3.177,-2.657,-2.409, P <0.05). The MIP, PEF, FVC value of the control group 5 days after extubation were (71.13±8.64) cmH 2O, (270.48±44.36) L/min, (2.02±0.29) L, the intervention group were (74.72±12.48) cmH 2O, (287.07±58.61) L/min, (2.21±0.35) L, the differences between the two groups were statistically significant ( t values were -2.161,-2.060,-3.605, P <0.05). The days of postoperative hospital stay of control group and intervention group were (8.15±0.98) and (7.80±1.23) d, there were significant differences ( t value was 2.021, P <0.05). Conclusions:ACBT is an effective and economical pulmonary rehabilitation method, it has effect on Respiratory Muscle Training in Patients Undergoing CABG surgery.

Objective:This study intends to explore the clinical outcomes of liposuction combined with a vacuum-assisted biopsy device in the treatment of Simon grade Ⅰ or Ⅱ gynecomastia (GYN) caused by glandular proliferation and excrescent fat deposition.Methods:The clinical data of Simon grade Ⅰ or Ⅱ GYN caused by glandular proliferation and excrescent fat deposition treated by liposuction and vacuum-assisted biopsy device in the Department of Plastic and Reconstructive Surgery of the Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiao Tong University from June 2016 to June 2019 were analyzed retrospectively. Surgical procedures: A 5-mm skin incision was made at the lower outer margin of the breast, through which the excrescent fat deposition was removed by liposuction. In addition, a vacuum-assisted biopsy device was applied to remove the residual glandular tissue. The operation time, liposuction volume, removed glandular tissue weight, blood loss, drainage volume, drainage duration, patient satisfaction, and complications were observed and recorded. The patients were followed up from June to December 2020. Patients were asked to grade the cosmetic outcome between 0 and 5 (0 was extremely dissatisfied, 5 was extremely satisfied). The data were sorted out and analyzed by SPSS 19.0, and the data were expressed as Mean±SD or M ( P25, P75). Results:A total of 27 patients with 51 breasts were enrolled in this study. Unilateral operation time, liposuction volume, removed glandular tissue weight, blood loss, drainage volume, drainage duration were (45.3±11.1) min, (206.0±66.7) ml, (28.9±9.5) g, (10.0±4.3) ml, (78.8±33.9) ml and (2.3±0.4) d respectively. Bruising occurred in 9 breasts. No other complications were observed. The postoperative follow-up time was 21.0 (17.0, 28.0) months, and the score of patient satisfaction was 4.98±0.14.Conclusions:Liposuction combined with vacuum-assisted biopsy device can be used as a feasible and minimally invasive approach to treat the Simon grade Ⅰ or Ⅱ GYN caused by glandular proliferation and excrescent fat deposition, which is safe and reliable with few complications, excellent cosmetic results, and high patient satisfaction. However, it has some shortcomings, such as hemostasis under the indirect vision.