Objective To investigate the factors affecting the occurrence of new postoperative cardiac complications in patients undergoing esophageal cancer surgery with concomitant coronary heart disease. Methods Clinical data of patients who underwent esophageal cancer surgery with coronary heart disease at the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from December 2019 to June 2023 were collected. Patients were divided into two groups based on whether they experienced postoperative cardiac complications. Using the occurrence of cardiac complications as the dependent variable, a multivariate logistic regression model was established to identify related influencing factors. Results A total of 223 patients were included, comprising 148 males and 75 females, with an average age of (71.78±6.31) years (range 53-88 years). Seventy-one (31.84%) patients experienced at least one new cardiac complication postoperatively, including 2 acute coronary syndrome, 13 heart failure, and 59 new-onset postoperative arrhythmias. Univariate analysis showed that age, systemic immune-inflammation index, pulmonary infection, need for invasive mechanical ventilation due to respiratory failure, acute respiratory distress syndrome (ARDS), acute delirium, pleural effusion requiring drainage, and acute renal failure were risk factors for postoperative new-onset cardiac complications (all P<0.05). Multivariate logistic regression analysis identified age, postoperative length of hospital stay, ARDS, and systemic immune-inflammation index as independent risk factors for new cardiac complications in esophageal cancer patients with coronary heart disease. Conclusion Strengthening perioperative management of esophageal cancer patients, ranging from preoperative evaluation to postoperative complication treatment, is crucial. Particular attention should be paid to age, ARDS, and other indicators to improve postoperative prognoses in patients with coronary heart disease complicated by esophageal cancer.

Objective:To investigate the clinical application value of commonly used preoperative indicators of sarcopenia in predicting postoperative pneumonia in patients aged 70 years and above with esophageal cancer.Methods:A retrospective analysis was conducted on the clinical data of 398 elderly patients(≥70 years old)with esophageal squamous cell carcinoma who underwent thoracic laparoscopic radical resection of esophageal cancer in our hospital from January 2020 to December 2021.The study aimed to investigate the correlation between clinical pathological indicators and commonly used measurement indicators of sarcopenia and postoperative pneumonia.Statistical analysis was performed to analyze the data.Results:The study found that the proportion of postoperative pneumonia in esophageal squamous cell carcinoma patients aged 70 years and above was 27.9%(111 out of 398). The pneumonia group had significantly lower preoperative BMI and peak expiratory flow(PEF)measurements compared to the non-pneumonia group, with statistically significant differences( t=2.799, 2.674, both P<0.05). Logistic multivariate analysis revealed that low PEF, low psoas major muscle index(PMI), and low psoas muscle density(PMD)were the primary risk factors for postoperative pneumonia in esophageal cancer patients aged 70 years and above(Wald χ2 values were 7.577, 6.091, 6.845, all P<0.05). The risk of postoperative pneumonia in esophageal cancer patients aged 70 years and above with low PEF, low PMI, and low PMD was found to be 1.969 times higher(95% CI: 1.215-3.185, P=0.006), 1.912 times higher(95% CI: 1.143-3.205, P=0.014), and 1.832 times higher(95% CI: 1.164-2.882, P=0.009)respectively, compared to patients with high PEF, high PMI, and high PMD. Conclusions:Low PEF, low PMI, and low PMD are significant risk factors for postoperative pneumonia in esophageal cancer patients aged 70 years and older.Preoperative PEF, PMI, and PMD, which are commonly utilized measurement indicators for sarcopenia, can be utilized as early screening indicators for postoperative pneumonia.

Objective:To investigate the effect of sarcopenia on the perioperative clinical outcomes of esophageal squamous cell carcinoma (ESCC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 1 148 ESCC patients who were admitted to the Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University from January 2020 to December 2021 were collected. There were 789 males and 359 females, aged (67±7)years. All patients under-went thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer. Observation indicators: (1) incidence of sarcopenia in patients with ESCC; (2) comparison of general data between ESCC patients complicated with sarcopenia and those without sarcopenia; (3) comparison of clinical outcomes between ESCC patients complicated with sarcopenia and those without sarcopenia; (4) analysis of influencing factors for sarcopenia in ESCC patients. Measurement data of normal distri-bution were represented by Mean± SD, and comparison between groups was conducted using the t test. Count data were represented as absolute numbers, and comparison between groups was conducted using the chi-square test. Ordinal data was analyzed using the Mann-Whitney U test. Logistic regression analysis was used to conduct univariate analysis. Logistic backward stepwise regression model was used to conduct multivariate analysis. Results:(1) Incidence of sarcopenia in patients with ESCC. Among 1 148 ESCC patients, 469 cases were complicated with sarcopenia, 679 were without sarcopenia. The incidence of sarcopenia was 40.854%(469/1 148). Among the 469 patients with sarcopenia, there were 313 males and 156 females. There were 125 cases <65 years old, 145 cases ≥65 years old but <70 years old, 106 cases ≥70 years old but<75 years old, 93 cases ≥75 years old, respectively. (2) Comparison of general data between patients with ESCC complicated with sarco-penia and those without sarcopenia. The age, tumor diameter, body mass index, cases in stage T1, T2, T3, preoperative albumin, preoperative serum prealbumin, psoas muscle index, psoas muscle density were (68±7)years, (3.3±1.5)cm, (22.4±2.9)kg/m 2, 100, 105, 264, (43±4)g/L, (193±38)mg/dL, (3.9±0.8)cm 2/m 2, (48±8)HU of 469 ESCC patients complicated with sarcopenia, versus (66±7)years, (3.2±1.4)cm, (23.8±3.0)kg/m 2, 173, 170, 336, (44±4)g/L, (206±37)mg/dL, (6.0±2.2)cm 2/m 2, (50±7)HU of 679 ESCC patients without sarcopenia, showing significant differences between the two groups ( t=5.74, 2.11, 7.57, Z=-2.93, t=2.25, 5.52,20.36, 4.18, P<0.05). (3) Comparison of clinical outcomes between patients with ESCC complicated with sarcopenia and those without sarcopenia. The duration of postoperative hospital stay, cases with postoperative hospital stay>30 days, pneumonia, acute respiratory failure, anastomotic fistula, and abnormal heart rhythm were (17±9)days, 32, 158, 39, 33, and 103 of 469 ESCC patients complicated with sarcopenia, respectively, versus (15±6)days, 15, 102, 18, 19, and 85 of 679 ESCC patients without sarcopenia, showing significant differences between the two groups ( t=4.89, χ2=15.04, 55.17, 18.86, 11.52, 18.06, P<0.05). (4) Analysis of influencing factors for sarcopenia in ESCC patients. Results of multivariate analysis showed that age ≥65 years was an independent risk factor for sarcopenia in ESCC patients ( odds ratio=1.64, 95% confidence interval as 1.26-2.14, P<0.05). Preoperative serum prealbumin ≥200 mg/dL, psoas muscle density ≥48 HU and body mass index >24 kg/m 2 were independent protective factors for sarcopenia in ESCC patients ( odds ratio=0.64, 0.72, 0.53, 95% confidence interval as 0.50-0.82, 0.56-0.92, 0.41-0.69, P<0.05). Conclusions:Age ≥65 years is an independent risk factor for sarcopenia in ESCC patients. Preoperative serum prealbumin ≥200 mg/dL, psoas muscle density ≥48 HU and body mass index >24 kg/m 2 are independent protective factors for sarcopenia in ESCC patients. Compared with patients without sarcopenia, ESCC patients with sarcopenia are more prone to postoperative compli-cations such as pneumonia, acute respiratory failure, anastomotic fistula, and arrhythmia, and have a longer postoperative hospital stay.

Objective To compare the efficacy of neoadjuvant radiotherapy and adjuvant radiotherapy in the treatment of patients who underwent radical esophagectomy for T3 N0 stage. Methods Totally 555 cases of T3 N0 , who underwent t neoadjuvant radiotherapy or adjuvant radiotherapy from 2004 to 2014, were selected from the SEER cancer registry in this study. 486 cases received neoadjuvant radiotherapy ( neoadjuvant radiotherapy group ) and 69 cases received adjuvant radiotherapy ( adjuvant radiotherapy group). Kaplan-Meier (KM) survival and multivariate Cox regression analyses were used to analyze the overall survival ( OS) and cancer specify survival ( CSS) of the two groups. A propensity score model was utilized to balance the baseline covariates. Results The CSS in the neoadjuvant radiotherapy group was significantly better than that in the adjuvant radiotherapy group (χ2 = 6. 030, P<0. 05 ) . Multivariate COX regression analysis showed that age, gender, and radiotherapy sequence with surgery were important factors influencing the prognosis of esophageal cancer with T3N0 stage ( Wald=10. 099, 10. 562, 4. 331, P<0. 05) . Compared with the neoadjuvant radiotherapy group, the adjuvant radiotherapy group had a worse CSS ( hazard ratio:1. 649, 95％CI 1. 173-2. 316, P=0. 004) and OS ( hazard ratio:1. 402, 95％CI 1. 020-1. 928, P=0. 037) . According to K-M survival analysis, the adjuvant radiotherapy group showed the worse CSS ( hazard ratio: 1. 813, 95％CI 1. 072-3. 069, P=0. 027) and OS ( hazard ratio: 1. 424, 95％ CI 0. 896-2. 262, P=0. 134) than the neoadjuvant radiotherapy in esophageal cancer with T3N0 stage, which was similar to the matched cohort. Conclusions Compared with postoperative adjuvant radiotherapy, neoadjuvant radiotherapy significantly improves the CSS and OS of T3 N0 patients with esophageal cancer.

Objective: To retrospectively analyze the distribution of non-fermentative bacteria causing bloodstream infection in hospitalized patients in Sichuan Province and their drug susceptibility to common antibiotics for better understanding their epidemiological characteristics. Methods: From January 1, 2015 to December 31, 2017, all of the non-fermentative bacteria isolated from patients with bloodstream infection in nine hospitals in Sichuan Province were collected. Species distribution and drug resistance test results were retrospectively analyzed. Results: A total of 6 291 strains of pathogenic bacteria were isolated, including 3 674 strains of gram-negative bacteria (58.4%) and 2 617 strains of gram-positive bacteria (41.6%). The gram-positive bacteria were 1 895 strains of Staphylococcus (30.1%), 372 strains of Streptococcus (5.9%), 317 strains of Enterococcus (5.1%) and 33 strains of other gram-positive bacteria (0.5%). The gram-negative bacteria were 3 191 Enterobacteriaceae strains (50.7%), 389 non-fermentative strains (6.2%) and 94 other gram-negative strains (1.5%). The isolated non-fermentative bacteria were mainly Pseudomonas aeruginosa (136 strains, 35.0%), Acinetobacter baumannii (126 strains, 32.0%) and Stenotrophomonas maltophilia (33 strains, 8.5%). There were 167 (42.9%), 112 (28.8%) and 82 (21.1%) non-fermentative bacteria isolated in internal medicine departments, ICUs and surgery departments, respectively. The drug resistance rates of Pseudomonas aeruginosa to cefepime, ciprofloxacin and gentamicin were 16.5%, 10.7% and 9.9%, respectively. Carbapenems-resistant Pseudomonas aeruginosa (CR-PA) accounted for 13.6%. No polymyxin-resistant Pseudomonas aeruginosa was found. The resistance rates of Acinetobacter baumannii to all antibiotics were over 30% except for minocycline and polymyxin and 75.7% of carbapenem-resistant Acinetobacter baumannii (CR-AB) were isolated. The drug resistance rates to levofloxacin, trimethoprim/sulfamethoxazole and ceftazidime were 0%, 0% and 37.0% in Stenotrophomonas maltophilia isolates and 10.5%, 4.2% and 19% in Burkholderia cepacia isolates, respectively. Conclusions Non-fermentative bacteria causing 6.2% of bloodstream infection in Sichuan, mainly by Pseudomonas aeruginosa and Acinetobacter baumannii. There were significant differences in the isolation rate of non-fermentative bacteria in different departments and most of the strains were isolated in internal medicine departments. The detection rate of Acinetobacter baumannii with multiple drug resistance was high, while other non-fermentative bacteria had good sensitivity to antibiotics.

Objective To investigate the application of bundles of intervention in the treatment of postoperative delirium in esophageal cancer.Methods Thirty-six cases of delirium associated with esophageal cancer(study group)after the application of bundles of intervention in the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from November 2015 to August 2016 were analyzed,and 41 cases of postoperative delirium(control group)from January 2015 to October 2015 were treated by routine treatment.Results The mean duration of postoperative delirium was(3.6±0.8)d in the study group and(4.7± 1.2)d in the control group,and the difference was statistically significant(t =4.783,P<0.01).The incidence rates of other complications in the study group and control group were 19.4％(7/36)and 34.1％(14/41),respectively,and there was no significant difference(χ2=2.089,P=0.148).The incidence rates of accidental events in the study group and control group were 13.9％(5/36)and 31.7％(13/41),respectively,and the difference was statistically significant(χ2= 4232,P= 0.040).There was no significant difference in the postoperative exhaust time and removal of chest tube drainage time between the two groups(both P＞ 0.05),but there was a significant difference in postoperative hospital stay and hospital costs between the two groups(t values were 4.726 and 2.065,both P<0.05).Conclusions In the treatment of postoperative delirium in esophageal cancer,applying the bundles of intervention concept is feasible and effective.It can significantly reduce postoperative delirium duration and accelerate the rehabilitation of patients.

Objective: To evaluate the application of FISH testing of bcl-2/IgH gene translocation and IgH/L gene rearrangement in different stages of follicular lymphoma. Methods: In 32 follicular lymphoma cases, which were collected at Guangdong General Hospital from September 2014 to December 2016, the bcl-2/IgH gene ectopic state was detected by FISH while the IgH/L gene rearrangement was tested using PCR-GeneScan to analyze the relationship between bcl-2/IgH gene translocation, different stages of follicular lymphoma and clonal immunoglobulin (IgH/L) gene rearrangements. Results: From the paraffin sections of all 32 follicular lymphomas, 17 cases showed bcl-2/IgH gene translocation, and the percentages of FL1, FL2 and FL3 translocation were 12/13, 3/5 and 2/14, respectively. Among the 24 cases of IgH/L gene arrangements identified from the total sample, the occurrence rates of FL1, FL2 and FL3 gene arrangement were 7/13, 4/5 and 13/14, respectively. Spearman′s rank correlation analysis and χ² analysis showed that bcl-2/IgH gene translocation was negatively correlated with follicular lymphoma stage and the association was statistically significant. In more advanced stages of follicular lymphoma, the occurrence of bcl-2/IgH gene translocation tended to decrease with distinct FL1, FL2 and Fl3 gene expression (P<0.05). As IgH/L gene rearrangement in FL3 was higher than that in FL1 and FL2, its detection may be complimentary to FISH test for bcl-2/IgH gene translocation in diagnosing follicular lymphoma. Conclusions The combined use of FISH and PCR-GeneScan increases the positive rate of follicular lymphoma diagnosis, and this combination is more sensitive than FISH or clonal analysis only to detect the chromosomal abnormality or the gene rearrangement.

Objective To investigate the effect of quadratus lumborum block on postoperative analgesia and T lympho-cyte subsets in patients receiving transabdominal radical resection of rectal cancer, so as to provide clinical references. Methods From May 2016 to November 2017, 30 patients receiving selective radical resection of rectal cancer in our hospital were selected. The random number table was used to divide the patients into quadratus lumborum block group(experimental group) and incision partial infiltration block group (control group), with 15 patients in each group. After induction of general anesthesia, the experimental group underwent ultrasound-guided bilateral anterior lateral quadratus lumborum block. Each side was injected with 0. 375％ ropivacaine of 20 mL. The control group was induced by general anesthesia and 0. 375％ ropivacaine of 40 mL was injected for local infiltration block. The surgery time, volume of blood loss, total infusion volume of propofol, effective analgesia time, the amount of sufentanil infusion every 12 hours after surgery and resting VAS scores at postoperative different time points (2, 6, 12, 24, 36, 48 hours postoperatively) were observed and recorded. Venous blood (1 mL) was drawn 30 minutes before anesthesia(TO), 2 hours after surgery(T1), 1 day after surgery(T2) and 3 days after surgery(T3). T lymphocyte subsets were detected by flow cytometry(CD3+, CD4+, CD8+, CD4+/CD8+). Results Compared with the control group, the dosage of propofol in the experimental group was significantly less than that in the control group (P＜0. 05); the effective analgesia time in the experimental group was significantly longer than that in the control group (P＜0. 0l); the amount of sufentanil in the experimental group was significantly less than that in the control group at 0-12 h and 12-24 h after surgery (P＜0. 05); the resting VAS scores in the experimental group at 6 h and 12 h after the surgery were significantly lower than those in the control group (P＜0. 05); the levels of CD3+, CD4+, CD4+/CD8+ in the experimental group were significantly higher than those in control group at T2 (P＜0. 05). Compared with TO, CD3+, CD4+, CD4+/CD8+ at T1 and T2 in the two groups were significantly lower than those at TO(P＜0. 05); at T2, CD8+ in the control group was significantly lower than that at TO(P＜0. 05). Conclusion Bilateral quadratus lumborum block can significantly improve postoperative analgesia effect in patients receiving radical resection of rectal cancer and reduce the inhibition of T lymphocytes by surgical stress.

OBJECTIVETo investigate the application of bundles of intervention in the treatment of esophageal carcinoma anastomotic leak.

METHODSFrom January 2014 to May 2015, 44 cases of esophageal carcinoma anastomotic fistula were treated by bundles of intervention (through the collection of a series of evidence-based treatment and care measures for the treatment of diseases) in Department of Thoracic Surgery, Huai'an First Hospital, Nanjing Medical University (bundles of intervention group), and 68 patients with esophageal carcinoma postoperative anastomotic leak from December 2013 to January 2012 receiving traditional therapy were selected as the control group. The clinical and nutritional indexes of both groups were compared.

RESULTSThere were no significant differences in general data and proportion of anastomotic leak between the two groups. Eleven patients died during hospital stay, including 3 cases in bundles of intervention group(6.8%) and 8 cases in control group (11.8%) without significant difference(P = 0.390). In bundles of intervention group, 1 case died of type III( intrathoracic anastomotic leak, 2 died of type IIII( intrathoracic anastomotic leak. In control group, 2 cases died of type III( cervical anastomotic leak, 2 died of type III( intrathoracic anastomotic leak and 4 of type IIII( intrathoracic anastomotic leak. The mortality of bundles of intervention group was lower than that of control group. The duration of moderate fever [(4.1±2.4) days vs. (8.3±4.4) days, t=6.171, P=0.001], the time of antibiotic use [(8.2±3.8) days vs.(12.8±5.2) days, t=5.134, P = 0.001], the healing time [(21.5±12.7) days vs.(32.2±15.8) days, t=3.610, P=0.001] were shorter, and the average hospitalization expenses[(63±12) thousand yuan vs. (74±19) thansand yuan, t=3.564, P=0.001] was lower in bundles of intervention group than those in control group. Forty-eight hours after occurrence of anastomotic leak, the levels of hemoglobin, albumin and prealbumin were similar in both groups. However, at the time of fistula healing, the levels of hemoglobin [(110.6±10.5) g/L vs.(103.8±11.1) g/L, t=3.090, P=0.002], albumin [(39.2±5.2) g/L vs.(36.3±5.9) g/L, t=2.543, P=0.013] and prealbumin [(129.3±61.9) g/L vs.(94.1±66.4) g/L, t=2.688, P=0.008] were significantly higher in bundles of intervention group.

CONCLUSIONIn the treatment of postoperative esophageal carcinoma anastomotic leak, application of bundles of intervention concept can significantly improve the nutritional status and improve the clinical outcomes.

Anastomotic Leak ; mortality ; therapy ; Anti-Infective Agents ; therapeutic use ; Carcinoma ; complications ; surgery ; Esophageal Fistula ; complications ; mortality ; therapy ; Esophageal Neoplasms ; complications ; surgery ; Esophagectomy ; adverse effects ; mortality ; Female ; Fever ; epidemiology ; etiology ; Hemoglobins ; metabolism ; Hospital Costs ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Nutritional Status ; Patient Care Bundles ; mortality ; statistics & numerical data ; Prealbumin ; metabolism ; Serum Albumin ; metabolism ; Treatment Outcome

Objective To investigate the correlations of serum total bilirubin level with infarct volume,severity and etiological typing in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to hospital from January 2012 to January 2014 were used as subjects of study.Their clinical and imaging data were collected,and serum total bilirubin levels were detected.The correlations of the serum total bilirubin levels with the infarct volume,severity and etiological typing were analyzed.Results A total of 290 patients with acute ischemic stroke were enrolled in the study.The patients were divided into either a large infarction group (≥1.8 cm3,n =145) or a small infarction group (＜ 1.8 cm3;n =145)according to the median cerebral infarction volume.The total bilirubin level of the large infarction group was significantly higher than that of the small infarction group (16.896± 7.761 μmol/L vs.13.039±4.477 μmol/L;t =5.185,P ＜ 0.001).Multivariate logistic regression analysis showed that the bilirubin highest quantile group (＞ 17.893 μmol/L) was an independent risk factor for large infarction (odds ratio [OR] 2.754,95％ confidence interval [CI] 1.028-7.375;P =0.044).According to the National Institutes of Health Stroke Scale (NIHSS) score,the patients were divided into a mild stroke group (NIHSS score ＜8;n =210) and a moderate to severe stroke group (NIHSS score≥ 8,n =80).The total bilirubin level of the moderate to severe stroke group was significantly higher than that of the mild stroke group (16.861 ±7.689)μmol/L vs.14.246 ± 6.019 μmol/L;t =3.052,P =0.002).Multivariate logistic regression analysis showed that the total bilirubin level was not an independent risk factor for moderate to severe stroke.Small artery occlusive stroke,large artery atherosclerotic stroke,and other definite causes of stroke were combined into non-cardioembolic stroke group (n =244).The total bilirubin level in the cardioembolic stroke group (n=46) was significantly higher than that in the non-cardioembolic stroke group (19.639±8.409 μmol/L vs.14.087 ±5.831 μmol/L;t =5.479,P＜0.001).Multivariate logistic regression analysis showed that the bilirubin highest quartile group (＞ 17.893 μmol/L) was an independent risk factor for cardioembolic stroke (OR 8.405,95％ CI 1.719-41.106,P =0.009).Conclusions The increased serum total bilirubin level is an independent risk factor for larger infarction and cardioembolic stroke.As an oxidative stress index,serum total bilirubin in acute stage can provide help for early identification of infarct volume and etiological subtype in patients with ischemic stroke.