Objective:To develop a self-directed learning feedback system for patients with post-stroke dysphagia (PSD) and analyze its effectiveness.Methods:From November 2022 to July 2023, convenience sampling was used to select 108 PSD patients from the Neurological Disease Center of Taiyuan Central Hospital as the research subject. The patients were divided into a control group and an experimental group using a random number table method, with 54 cases in each group. The control group received routine nursing upon discharge, while the experimental group was treated intervention measures through the self-directed learning feedback system. The self-efficacy, quality of life, swallowing function, and psychological status of two groups of patients were compared before intervention and one and three months after intervention, respectively.Results:A total of 52 patients in the experimental group and 50 patients in the control group completed the study. Repeated measures analysis of variance showed that the self-efficacy and quality of life scores of both groups improved with the extension of intervention time, and the self-efficacy and quality of life scores of the experimental group were higher than those of the control group at one and three months after intervention, with statistical differences ( P<0.01). After one and three months of intervention, the severity scores of dysphagia in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.01). As the intervention time extended, the psychological status scores of the experimental group were lower than those of the control group at different time periods, and the differences were statistically significant ( P<0.05) . Conclusions:The application of self-directed learning feedback system in the rehabilitation of PSD patients at home can improve their self-efficacy, quality of life and swallowing function, and relieve negative emotions, which is worthy of further promotion.

OBJECTIVE: To summarize and analyze the postoperative short-term complications of laparoscope-assisted transanal total mesorectal excision (taTME) for rectal cancer patients after neoadjuvant therapy. METHODS: A prospectively established database on taTME patients at Peking University Cancer Hospital was screened with the following conditions: data retrieval from June 2016 to August 2018, pathologically confirmed adenocarcinoma, receiving preoperative neoadjuvant chemoradiotherapy or chemotherapy. The transabdominal procedure and the transanal procedure were performed simultaneously in the taTME operation. Occurrence of complications during perioperative period (within postoperative 3 months) in these patients, especially anastomosis-related complications and their management were analyzed. The relevant complications were recorded according to the Clavien-Dindo (CD) grading criteria. The severity of anastomotic leakage and anastomotic stenosis was evaluated according to criteria developed by the International Rectal Cancer Research Group. RESULTS: A total of 29 patients were enrolled in this study. In the 29 patients, 25 (86.2%) were male and 4 (13.8%) were female, the median age was 60 (range, 30 to 72) years, the median body mass index was 25.8 (range, 19.8 to 36.4) kg/m, the median distance from the tumor to anal verge was 4 (range, 2 to 8) cm. All the patients completed laparoscope-assisted taTME operations successfully without conversion to laparotomy, intra-operative severe complication or death. The median operation time was 300 (range, 198 to 405) minutes, and the median intra-operative blood loss was 100 (range, 50 to 200) ml. All the TME specimens were complete according to the Nagtegaal standard. All the patients underwent prophylactic ileostomy. Hartmann procedure was performed in one case due to poor blood supply in the proximal bowel without the possibility of anastomosis. Anal sphincter preservation rate was 96.6% (28/29). The median postoperative exhaust time was 2 (range, 1 to 10) days, and the median postoperative hospital stay was 9 (range, 7 to 24) days. Fifteen patients (51.7%) had postoperative complications, among which serious complication (CD grade IIIb and above) accounted for 6.9% (2/29). No perioperative death was observed. Five patients (17.2%) presented anastomosis-related complications, including 2 cases of grade C anastomotic leakage due to anastomotic rupture, who underwent abdominal perineal resection 1 month after operation; 2 cases of grade B anastomotic leakage, who improved after conservative treatment; 1 case of grade A anastomotic stenosis, who improved with anal expansion 1 month after operation. The incidence of postoperative infection was 24.1% (7/29), including 6 cases of pelvic infection and 1 case of trocar site infection, all of which were CD grade II. One case had incomplete intestinal obstruction (CD grade II); 1 case had gastroplegia; 1 case had abdominal trocar hernia. All the patients were followed up for a median of 12.0 (range, 3.9 to 29.9) months. Seven cases did not undergo ileal stoma closure. The anal sphincter preservation rate was 75.9% (22/29). CONCLUSION Pelvic infection and anastomosis-related complications are common after laparoscope-assisted taTME surgery for rectal cancer patients following neoadjuvant chemoradiotherapy, which require active management and appropriate treatment.
Adult ; Aged ; Anal Canal ; Female ; Humans ; Laparoscopes ; Male ; Middle Aged ; Neoadjuvant Therapy ; Postoperative Complications ; Rectal Neoplasms ; therapy

Objective: To explore the short-term efficacy and prognosis of palliative surgical treatment for malignant bowel obstruction (MBO) caused by peritoneal metastasis of colorectal cancer (mCRC). Methods: A retrospective cohort study was conducted. The inclusion criteria for patients were as follows: (1) primary colorectal cancer; (2) massive peritoneal metastasis; (3)obstructive site located below Treitz ligament by imaging; (4) obstruction refractory to conservative treatment; (5) estimated rese survival time more than 2 months; (6) patients and their families had strong willingness for operation; (7) surgical treatment included stoma/bypass and debulking surgery. In accordance with the above criteria, clinicopathological data of 46 patients undergoing palliative surgery at Peking University Gastrointestinal Cancer Center, Unit III from January 2016 to October 2018 were retrospectively collected. Postoperative symptomatic relief rate, morbidity of complication within 30 days, complication classification (Clavien-Dindo classification), mortality and survival after operation were analyzed. Kaplan-Meier method was used to evaluate survival and Cox regression analysis was used to identify prognostic factors. Results: Among 46 patients, 30 were male and 16 were female with median age of 63 (19-87) years; 23 patients received stoma/bypass surgery (stoma/bypass group), and 23 cases received tumor debulking surgery (debulking group). The overall symptom relief rate was 76.1% (35/46), while symptom relief rate in the debulking group was 91.3% (21/23), which was significantly higher than 60.9% (14/23) in the stoma/bypass group (χ²=4.301, P=0.038). Postoperative complications occurred in 25 patients. The complication rate was 52.2% (12/23) in the debulking group and 56.5% (13/23) in the stoma/bypass group, without statistically significant difference (χ²=0.088, P=0.767). Morbidity of complication beyond grade III was 8.7% (2/23) and 13.0% (3/23) in the debulking group and stoma/bypass group respectively, without statistically significant difference (χ²=0.224, P=0.636). Four patients died within 30 days after operation, 2 (8.7%) in each group. Twenty-four patients underwent 1-8 cycles of chemotherapy ± targeting therapy (regimens: CapeOX ± Bevacizumab, FOLFOX/FOLFIRI ± Bevacizumab/Cetuximab), including 10 cases in the stoma/bypass group and 14 cases in the debulking group. Two patients of debulking group received postoperative radiotherapy and chemotherapy (50.6 Gy/22 f, with concurrent oral capecitabine). Till the last follow up of April 2019, 34 patients died (34/46, 73.9%) with a median overall survival time of 6.4 months, and the 6-month and 1-year survival rate was 54.5% and 29.2% respectively. The median survival time in the debulking group was significantly longer than that in the stoma/bypass group (11.5 months vs. 5.2 months, χ²=5.117, P=0.024). The median survival time of the 35 patients with symptomatic relief after operation was significant longer than that of 11 patients without relief (7.1 months vs 5.1 months, χ²=3.844, P=0.050). Multivariate analysis showed stoma/bypass surgery (HR=2.917, 95%CI:1.357-6.269, P=0.006) and greater omental metastasis (HR=4.060, 95%CI:1.419-11.617, P=0.009) were independent risk factors associated with prognosis of patients with MBO caused by peritoneal mCRC. Conclusions For patients of MBO caused by peritoneal mCRC, tumor debulking surgery may achieve higher symptom relief rate and prolong survival. Greater omental metastasis indicates poor prognosis.

Transanal total mesorectal excision is a new surgical procedure which has emerged in the recent years.This procedure performs a "bottom-to-up" resection of the rectum and its surrounding mesenteries through the anus,which provides better view compared with laparoscopic or open total mesorectal excision.However,it is undeniable that as a new surgical procedure,transanal total mesorectal excision is also bound to have some complications of surgery.Therefore,how to prevent and treat the complications of transanal total mesorectal excision is still a problem that must be faced in the future.This article intends to review the prevention and treatment of surgical complications and provide some experience for the development of transanal total mesorectal excision.

OBJECTIVETo explore the applicable value of transanal total mesorectal excision (taTME) in male low rectal cancer patients with narrow pelvis-"difficult pelvis", which remains difficult for both open and laparoscopic sphincter-saving operations.

METHODSClinical data of male low rectal cancer patients diagnosed by pathology undergoing taTME between June 2016 and January 2018 at Peking University Cancer Hospital were collected. A retrospective cohort study was performed. Patients were selected according to the following criteria: (1) low rectal cancer, the distance between inferior margin of tumor and anal verge ≤5 cm; (2) the distance between two sciatic tubercles <5 cm; (3) body mass index (BMI) >25 kg/m; (4) tumor horizontal diameter ≤4 cm. Operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications and anal function were analyzed.

RESULTSA total of 20 patients were included in this study. All the patients received preoperative neoadjuvant chemoradiation and hybrid transabdominal and transanal surgery. The median BMI was 27.7(26.2-36.4) kg/m; the median distance between two sciatic tubercles was 92.5 (78-100) mm; the median distance between the inferior margin of tumor to the anal verge was 4 (2-5) cm; the median operation time was 302 (215-402) min; the median intraoperative blood loss was 100 (50-200) ml; the median postoperative hospital stay was 9 (5-15) d. Postoperative complications occurred in 5 patients (25%), including 3 pelvic infection, 1 intestinal obstruction, 1 anastomotic leakage receiving sigmoid colostomy. There was no perioperative death. Sphincter-preservation rate was 100%. Nineteen patients received anal manometry 1 month after operation with normal resting pressure (41.5±8.6) mmHg and squeeze pressure (121.0±11.6) mmHg. All the patients were followed up to March 2018, and the median follow-up time was 4.5 months. Only 1 patient had supraclavicular lymph node metastasis and no local recurrence was found.

CONCLUSIONSThe safety of transanal total mesorectal excision for male patients with low rectal cancer and difficult pelvis is acceptable. TaTME is helpful to preserve the anal sphincter.

Adult ; Anal Canal ; surgery ; Humans ; Laparoscopy ; Male ; Neoplasm Recurrence, Local ; Pelvis ; surgery ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome ; Universities

Peritoneal metastasis from colorectal cancer (CRC) are generally considered to be end-stage disease of CRC,which has greatly impacted the prognosis and quality of life of patients.In recent years,cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy following systemic control has gradually been accepted for the treatment of peritoneal metastasis from CRC.Unfortunately,it has not widely used in clinical practice for the reasons of instruments,experience,surgical complexity,postoperative complications and cost-effectiveness.There is still no sufficient importance attached to CRC with peritoneal metastasis.Researches on the mechanism and treatment of peritoneal metastasis should be encouraged.Screening of high risk patients for early intervention to reduce incidence of peritoneal metastasis,selecting effective regimens and exploring optimal model for patients with other distal metastasis to improve the outcome of patients may be of importance.

Objective To assess the factors associated with the restoration of spontaneous circulation (ROSC) and 2-year survival prognosis in patients with cardiac arrest (CA) after acute myocardial infarction (AMI),and after ROSC,the effects of various factors on midian survival time and on 2-year survival.Methods In a registry study from January 2005 to January 2015,all consecutive AMI-induced CA patients treated with cardiopulmonary resuscitation (CPR) admitted to our hospital were enrolled.The survivors were followed-up for 2 years.Univariate analysis was applied to evaluate factors associated with rate of ROSC and 2-year survival.Multivariable logistic regression analysis was applied to evaluate statistically significant factors in the univariate analysis.Medians with inter-quartile ranges were used to describe 2-year survival time affected by various factors after ROSC.Kaplan-Meier survival curve analysis was used to evaluate the effect of factors on 2-year survival.Results A total of 254 cases with CA after AMI were enrolled,including 129 cases of ROSC and 71 cases of 2-year survival.Univariate analysis showed age ≥ 70 years,CA occurred during 22:00-8:00,the duration time ofCPR ≥ 15 min and adrenaline dosage ＞ 5 mg were unfavorable predictors of ROSC;while,left ventricular ejection fraction (LVEF) ≥ 40％ before CA,shockable rhythm and percutaneous coronary intervention (PCI) therapy were favorable predictors.Besides,age ≥ 70 years,intubation during CPR,adrenaline dosage ＞ 5 mg and cardiogenic shock were unfavorable predictors of 2-year survival;While,male,normal daily activity before CA and PCI treatment were favorable predictors.Multivariable analysis showed age,the duration of CPR,adrenaline dosage,LVEF before CA,the rhythm during CPR and PCI therapy were independent predictors of ROSC.Age and PCI therapy were independent predictors of 2-year survival.Among patients,the survival time was affected by various factors after ROSC,and the factors with minimum 25％ and small median value were associated with cardiac rupture,cancer,adrenaline dosage ＞ 5 mg and cardiogenic shock.The factor with maximum 25％ value was PCI treatment (216 days).Kaplan-Meier survival analysis suggested that age ≥ 70 years was an unfavorable factor of 2-years survival (Log-rank test,P=0.007);while,PCI treatment was a favorable factor (Log-rank test,P＜0.01).PCI-related prognosis analysis showed that the effectiveness of PCI was related to the timing of PCI,the number of infarctrelated artery and the difference in culprit lesion.Conclusions The age ≥ 70 years was disadvantageous to both ROSC and 2-year survival.PCI treatment was favorable to both ROSC and 2-year survival.

Objective To determine the predictive factors for antiviral therapy in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) infection [HBeAg(-) CHBI] patients with HBV DNA＜4.3 lg IU/mL.Methods A total of 179 HBeAg (-) CHBI patients were retrospective analyzed.Histology activity index (HAI) and fibrosis (S) were scored according to the Knodell HAI scoring system,and HAI＞3 and/or S≥3 was adopted as indications for treatment.Univariate and multiple regression analysis were used to assess factors associated with treatment indications.Receiver operating curves (ROC) and area under curve (AUC) were used to determine the predictive value of relevant factors.Results There were 81 cases with HAI＞3 (45.3％) and 72 with S≥3 (40.22％),and the proportion of patients with indications for treatment was 54.7 ％.Multiple regression analysis showed that age,γ-glutamyl transpeptadase (γ-GT),platelet (PLT) and albumin (Alb) were the predictive factors for the severity of liver damage and indication for treatment (all P＜0.05).The AUC for age,PLT,γ-GT and Alb were 0.655,0.657,0.726 and 0.65,respectively,and the corresponding Yoden index for age,PLT,γ-GT,and Alb were 0.297,0.426,0.03 and 0.012,respectively,the sensitivities of predicting HBeAg (-CHBI for treatment indications were 0.643,0.842,0.705 and 0.653,respectively.Conclusions This study shows that 54.7％ of HBeAg(-)CHBI patients with HBV DNA＜4.3 lg IU/ml have significant liver histological changes and require antiviral treatment.Older age,higher γ-GT,lower PLT and lower Alb levels are the predictive factors for treatment.

OBJECTIVETo explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture.

METHODSFor a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation.

RESULTSThe operation was completed successfully with a shortened postoperative recovery time.

CONCLUSIONSThe application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.

Adult ; Bone Screws ; Fracture Fixation, Internal ; methods ; Hip Fractures ; rehabilitation ; Humans ; Imaging, Three-Dimensional ; Male ; Postoperative Period ; Printing, Three-Dimensional ; Rehabilitation ; instrumentation ; methods

OBJECTIVETo evaluate the efficacy and safety profile of XELOX (capecitabine/oxaliplatin) in patients with locally advanced gastric cancer who underwent curative D2 resection in China.

METHODSThis is a subgroup analysis of Chinese patients in the capecitabine and oxaliplatin adjuvant study in stomach cancer (CLASSIC study), which was a randomised, open-label, multicentre, parallel-group, phase III( study in the Asia-Pacific region. A total of 100 gastric cancer patients who received curative D2 gastrectomy were enrolled in this study and were randomly assigned to either XELOX group (oral capecitabine combined with intravenous oxaliplatin chemotherapy) or the control group (surgery alone). This study aims to compare the 3-year disease-free between the two groups.

RESULTSSubgroup analysis showed that 3-year DFS rate were 78% and 56% in XELOX and control group, respectively. The risk of relapse in XELOX group was reduced by 59% (HR=0.41, 95%CI:0.20-0.85, P=0.013), compared with the control group. The 3-year overall survival rate were 78% and 66% in XELOX and control group, with no statistically significant difference (HR=0.55, 95%CI:0.26-1.16, P=0.110).

CONCLUSIONAdjuvant XELOX chemotherapy following D2 gastrectomy may improve the survival in patients with advanced gastric cancer in China.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Capecitabine ; Chemotherapy, Adjuvant ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Disease-Free Survival ; Fluorouracil ; administration & dosage ; analogs & derivatives ; Gastrectomy ; Humans ; Neoplasm Recurrence, Local ; Organoplatinum Compounds ; administration & dosage ; Stomach Neoplasms ; drug therapy ; surgery ; Survival Rate