Objective:To investigate the effect of adjuvant radiotherapy on the prognosis of patients with N 2 stage non-small cell lung cancer (NSCLC) undergoing radical resection. Methods:The data of 1 208 patients with NSCLC who received radical lung cancer resection combined with chemotherapy or post-operative adjuvant radiotherapy and chemotherapy from SEER database of the United States from 2004 to 2016 were included in the study. 627 patients received radical lung cancer resection combined with chemotherapy (surgery + chemotherapy group), and 581 patients received radical lung cancer resection combined with radiochemotherapy (surgery + radiochemotherapy group). We analyzed and compared the effect of postoperative adjuvant radiotherapy on the prognosis of patients with N 2 stage NSCLC undergoing radical resection. The 1∶1 propensity matching method was used to analyze the prognosis of the two groups. Results:In the two groups of patients with stage N 2 NSCLC included in the study, the median survival time was 51 months in the operation + radiotherapy and chemotherapy group, and the 3- and 5-year cancer specific survival rates were 58.3% and 44.9%, respectively. The median survival time was 50 months in operation + chemotherapy group, and the 3- and 5-year cancer specific survival rates were 59.9% and 46.5%, respectively. There was no statistically significant difference between the two groups in cancer specific survival ( P>0.05). The result of subgroup analysis showed that the cancer specific survival of patients in operation + radiotherapy and chemotherapy group was significantly worse than that in operation + chemotherapy group ( χ2=5.085, P<0.05). Multivariate Cox regression analysis showed that age, gender, G stage, T stage and the number of lymph node metastasis were the important factors affecting the cancer specific survival of patients with N 2 NSCLC ( Wald =15.236, 7.039, 4.841, 10.155, 11.192, respectively, P<0.05). After propensity matching, there was no statistically significant difference in cancer specific survival ( P>0.05) between the two groups. However, in the T 1 NSCLC patients, the cancer specific survival of operation + radiochemotherapy group was significantly worse than that of operation + chemotherapy group ( χ2=5.364, P<0.05), while the cancer specific survival of operation + radiochemotherapy group was significantly better than that of operation + chemotherapy group in T 3-4 subgroup( χ2=4.486, P<0.05). According to the tendency matching of pathological subgroups, the cancer specific survival of surgery + radiochemotherapy group was significantly better than that of surgery + chemotherapy group ( χ2=6.279, P<0.05) in the non adenocarcinoma subgroup. And the multivariate Cox regression analysis indicated that postoperative radiotherapy was an important factor for cancer specific survival in patients with N 2 non adenocarcinoma non-small cell lung cancer ( Wald=7.300, P<0.05). However, before and after propensity matching in lung adenocarcinoma subgroup, there was no statistically significant difference in cancer specific survival between the surgery + radiochemotherapy group and the surgery + chemotherapy group ( P>0.05). Conclusions:Postoperative adjuvant radiotherapy can improve the prognosis of patients with T 3-4 or non-adenocarcinoma N 2 NSCLC. But, for other patients with N 2 non-small cell lung cancer, the choice of postoperative adjuvant radiotherapy should be cautious, especially for T 1 stage.

One hundred and eighty three patients with esophageal cancer admitted from September 2015 to September 2016 were randomly divided into two groups:91 patients received clinician-involving pre-discharge and postoperative follow-up health education (study group) and 92 patients received traditional health education (control group).The quality of life and the compliance rate of comprehensive treatment within 3 months after discharge were evaluated and compared between two groups.The overall scores of quality of life in study group was significantly better than those of the control group (P＜ 0.05),and the compliance rate of comprehensive treatment after discharge in study group was significantly higher than that of control group [82.4％(75/91) vs.67.4％(62/92),x2=5.49,P=0.02].It is suggested that clinician participating in the pre-discharge and follow-up health education can improve the quality of life of patients,and improve the compliance of comprehensive treatment after discharge.

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 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 investigate the value of intervention bundles in enteral nutrition for patients with esophageal cancer.Methods From October 2014 to September 2015,226 patients with esophageal squamous cell carcinoma were collected.From April 2015 to September 2015,109 patients(intervention group)were treated with intervention bundles during perioperative period,and from October 2014 to March 2015,117 patients(control group)were treated by routine intervention.Results The albumin,prealbumin,and transferrin showed no significant difference(all P>0.05)before treatment but were significantly different on the eighth day[albumin:(38.2±3.5)g/L vs.(36.3±4.8)g/L,P=0.001;prealbumin:(126.7±52.8)g/L vs.(72.9±42.3)g/L,P=0.001;transferrin:(2.9±1.2)g/L vs.(2.1±1.6)g/L,P=0.001].The incidence of complications was 11.01％(12/109)in intervention group and 21.37％(25/117)in control group(X2=4.422,P=0.035).In addition,the postoperative exhaust time[(52.8±10.9)h vs.(58.7±14.3)h,P=0.001],time to the removal of chest drainage tube[(3.5±0.9)d vs.(4.8±1.3)d,P=0.001],postoperative hospital stay[(11.2±1.3)d vs.(12.1±1.5)d,P=0.001],and hospital costs[(37±4)thousand yuan vs.(39±5)thousand yuan,P=0.004] were also significantly shorter or smaller in the intervention group.Conclusions Intervention bundles is clinically valuable in the early enteral nutrition for patients with esophageal cancer.It can improve the nutritional status of patients,reduce complications,and improve the clinical outcomes.

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 explore the influences of integrated nursing care on bad emotion and immune function of postoperative patients with esophageal cancer. Methods A total of 102 postoperative patients selected from October 2012 to October 2013 were randomly divided into research group ( 52 cases, integrated nursing care) and control group(50 cases, routine nursing). Self rating anxiety scale (SAS) and self rating depression scale ( SDS) were used to evaluate the anxiety and depression of patients before and after operations. We detected the contents of immune index such as immunoglobulin ( IgA, IgG, IgM ) , peripheral blood lymphocyte count ( LYM ) , cytokine and etc. before operation, the first and eighth days after operation. Results Patients in the research and the control group all had anxiety and depression symptoms before operation. After operation, the scores of SAS (34. 6 ± 6. 7) and SDS (33. 7 ± 6. 9) of patients in the research group were lower than that in the control group (P<0. 05). Eighth days after operation, the contents of IgA and IgM rose again compared with that in the first postoperative day (t=5. 174,9. 439;P<0. 05). The contents of LYM and cytokine CD4/CD8 of patients in the research group were higher than that in the control group ( P<0. 05), and all of them were higher than that in the first postoperative day. Conclusions Integrated nursing care can relieve anxiety and depression of patients with esophageal cancer, enhance patients′immune function, and benefit patients′recovery.

Objective To evaluate the influence of smoking on carotid intima-media thickness (IMT) in patients with hypertension.Methods Two hundred and three patients with hypertension were consecutively enrolled with smoking or without smoking.They were divided into two groups:smoking group (84 patients) and no smoking group (119 patients).Carotid IMT was measured.Results Carotid in smoking group was (0.1118 ± 0.0234) cm,which was thickened compared with that in no smoking group [(0.098 ± 0.0249) cm] (P ＜ 0.01).Conclusions Smoking has significant influence on carotid IMT in patients with hypertension.

Objective To compare the effect between i-gel mask and SHPA mask in the airway management of general anesthesia.Methods Sixty patients of general anesthesia with ASA I or Ⅱ were randomly divided into two groups:i-gel mask group (30 cases) and SLIPA group(30 cases).After intubation and general anesthesia,fiberoptic bronchoscopy was used to detect and evaluate.The peak airway pressure,mean airway pressure,condition of the laryngeal mask intubation,time of intubation,time of extubation,time of recovery and the side effect occurrence of extubation were recorded.Results The time of anesthesia,time of operation,time of extubation,time of recovery,achievement ratio of first time,achievement ratio of second time,time of intubation,peak airway pressure and mean airway pressure had no significant difference between two groups (P ＞ 0.05).The airway seal pressure in i-gel mask group was significantly higher than that in SL1PA group [(29 + 6) cm H2O (1 c m H2O =0.098 kPa) vs.(23 ± 4) cm H2O] (P ＜ 0.05).For the grade of fiberoptic bronchoscopy in i-gel mask group,there was 27 patients in I grade,3 patients in Ⅱ grade.But in SL1PA group,there was 3 patients in I grade,4 patients in Ⅱ grade,13 patients in Ⅲ grade,10 patients in ⅣVgrade.There was significant difference between two groups (P ＜ 0.05).There were none of regurgitation in two groups.Conclusions The i-gel mask and SLIPA mask can provide the same effective ventilation.The i-gel mask has higher airway seal pressure,less side effect during the intubation and extubation,and have better airway management of general anesthesia.

Objective To analyze the current situation of traditional risk factors in acute myocardial infarction (AMI) patients with different age,and to explore the impact of different risk factors on AMI.Methods The personal clinical characteristics of 682 hospitalized AMI patients in CCU were recorded from October 2003 to October 2010 with a retrospective cohort study.The effect of smoking,hyperlipidemia,diabetes and hypertension on AMI was observed.Results Six hundred and thirteen patients were enrolled in the end,43 cases in young group,216 cases in middle age group,234 cases in older age group,120cases in old-old age group.(1) Compared with that in middle age group,older age group and old-old age group,the ratio of smoking and hyperlipidemia in young group was significantly higher(P ＜ 0.0125 or ＜ 0.001).The ratio of smoking in middle age group was significantly higher than that in older age group(P ＜ 0.001),and the ratio of hyperlipidemia between two groups had no significant difference (P ＞ 0.0125).The ratio of smoking and hyperlipidemia was significantly higher in middle age group compared with that in old-old age group(P＜0.001 or ＜ 0.0125).(2) The average age in smoking patients with AMI was (56.84 ± 13.00) years,which was significantly younger than that in non-smoking patients[(74.29 ± 10.57) years] (P ＜ 0.01).The average age in patients with hyperlipidemia suffering from AMI was significantly younger than that in patients with normal lipid level patients [(62.92 ± 15.04) years vs.(68.63 ± 13.93) years] (P ＜ 0.01).Conclusions Smoking and hyperlipidemia,especially smoking plays an important role in inducing AMI in young and middle age.Smoking cessation and lipid-lowering therapy is vital for reducing the occurrence of AMI in young and middle age.