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A Prospective Survey Comparing Patients’ Experience of a Nurse-Led Clinic and Consultant-Led Clinic for Surveillance of Patients with Dilatation of the Intrathoracic Aorta

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World Journal of Cardiovascular surgery 2019年第2期9卷 24-34页

作者： Bhuvaneswari Krishnamoorthy Rashmi Birla William R. Critchley Paul D. Waterworth Department of Cardiothoracic surgery Manchester Foundation NHS Trust Manchester UK Division of Cardiovascular Sciences Faculty of Biology Medicine and Health The University of Manchester Manchester UK Faculty of Health and Social Care Edge Hill University Ormskirk UK The Endothelial Cell Biology Unit School of Molecular and Cellular Biology University of Leeds Leeds UK

Background: Increasing workload in consultant-led clinics often means patients to wait a long time for clinic appointments. To address this, there is an increasing trend in developing nurse-led clinics across many specialities in the National Health Service. This study aims to assess whether the implementation of a nurse-led clinic in thoracic aortic surgery will optimise the utilisation of health care services and improve overall patient satisfaction. Methods: 80 follow-up patients were asked to complete a questionnaire following their appointment in an aortic clinic, which was led either by a consultant (n = 40) or an aortic specialist nurse (n = 40). All patients seen by a nurse in the clinic were assessed by a consultant surgeon prior to the clinic for suitability. No new patients were seen by a nurse. Any patient with an aortic dimension of 5 cm or greater was seen by the consultant. If there were any complicated clinical features, the patient was seen in the consultant-led clinic. Patients were asked questions about their time spent with the respective health care professionals across 12 categories (punctuality, preparedness, understanding of concerns, clarity of speech, listening, respect, explaining, letting you talk, putting you at ease, emotional support, advice and advice for next follow-up). Patients rated each category using an ordinal scale from 0 - 10. Results: Patient scores were greater in nurse-led clinics compared to consultant-led clinics across a number of categories although only punctuality reached significance (mean 9.2 vs. 6.8, p 0.05). Conclusion: Patients were highly satisfied with the nurse-led clinic across all categories, with greater satisfaction for punctuality. These findings suggest that a nurse-led clinic can be implemented for the management of carefully selected thoracic aortic surgery patient without reduction in patient satisfaction.

关键词： Nurse-Led Clinic Consultant-Led Clinic thoracic Aortic surgery Surveillance Patient Satisfaction

Per-Operative Discovery of Tympanic Paraganglioma: A Case Report

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International Journal of Otolaryngology and Head & Neck surgery 2023年第1期12卷 38-43页

作者： Esthelle Geneviève Stéphanie Minka Ngom Nchinda Emmanuel Choffor Dalil Asmaou Bouba Valentin Fokouo Fogha Louis Richard Njock Amadou Njifou Njimah Otorhinolaryngology Unit of General Hospital Douala Douala Cameroon Faculty of Medicine and Pharmaceutical Sciences University of Douala Douala Cameroon Department of surgery and Specialties Faculty of Health Sciences University of Buea Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaoundé Yaoundé Cameroon Otorhinolaryngology Unit of Bertoua Regional Hospital Bertoua Cameroon

Background: Tympanic paragangliomas are common middle ear benign neoplasias that develop from endocrines cells situated along the great blood vessels of the head and neck, as well as those of the thoracic and lumbar spine. Primary symptoms of tympanic locations include hearing loss and pulsatile tinnitus. Otoscopy often shows a retrotympanic reddish mass, causing tympanic bulging. Computerized tomography scan findings include a tissue density regular mass located at the promontory and limited within the middle ear cavity. Surgical management comprises tumour excision with control of bleeding, with or without prior embolization. Aim: The aim of this presentation is to report an unusual case of tympanic paraganglioma. Case Presentation: We report the case of a 56-year-old patient whose clinical and paraclinical presentations were consistent with cholesteatoma, though a tympanic paraganglioma was discovered per-operatively. Conclusion: In some rare cases, tympanic paraganglioma can be present like a cholesteatoma.

关键词： Tympanic Paraganglioma Cholesteatoma Middle Ear Tumour

Conservative approach in drilling-cutting tool injuries

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Journal of Acute Disease 2018年第4期7卷 167-174页

作者： Osman Kones Murat Akarsu Cevher Akarsu Mehmet Emin Günes Halil Dogan Department of General surgery Bakirkoy Dr Sadi Konuk Training and Research HospitalIstanbulTurkey Department of Internal Medicine Bakirkoy Dr Sadi Konuk Training and Research HospitalIstanbulTurkey Department of Emergency Medicine University of Health Sciences Bakirkoy Dr.Sadi Konuk Training and Research HospitalIstanbulTurkey

Objective: To prevent unnecessary laparotomies by evaluating the effectiveness of conservative approach in abdominal trauma cases due to drilling-cutting ***: Demographic data, effected region of the body, additional findings of trauma, hemodynamic parameters, duration of admission, diagnostic methods and treatment modalities were retrospectively evaluated in 217 cases with abdominal injury (lower thoracic region, abdominal wall and back) among 1128 victims with drilling-cutting instrument injuries between January 1, 2012 and December 31, 2017. The conservative approach was based on physical examination, hemogram follow-up and hemodynamic ***: Totally 177 (81.6%) cases of 217 patients were followed conservatively while 25 cases were operated at early (1-8 hours) and 15 were operated at late (9-48 hours) periods. Two patients who underwent surgery in the early period and two patients who underwent surgery in the late period were accepted as negative laparotomy while 1 patient in the late operated group was regarded as non-therapeutic laparotomy. Diagnostic laparoscopy was performed in 81 cases. Complications developed in 7 patients who were operated in the early period and 10 patients who were operated in the late period. The mean hospital stay period was 5.3 days (1-33) in all cases, 4.5 days (2-20) in conservative treatment group and 8.4 days (3-33) in the operated patients;and the difference was statistically ***: Detailed physical examination, accurate assessment and effective use of different diagnostic methods reduce the frequency of negative and non-therapeutic laparotomies in abdominal stab wound injuries.

关键词： Conservative approach Drilling Cutting Injuries Trauma

Anesthesia Management for Pulmonary Cryoablation

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Open Journal of Anesthesiology 2013年第4期3卷 255-261页

作者： Zvi C. Jacob Stephanie Rashewsky Ruth A. Reinsel Thomas V. Bilfinger William Moore Department of Anesthesiology Stony Brook University School of Medicine New York USA Department of Anesthesiology Stony Brook University School of Medicine New York USA Department of Radiology Stony Brook University School of Medicine New York USA. Department of surgery Stony Brook University School of Medicine New York USA

Lung tumors represent a major health impact globally. Pulmonary cryoablation treatment as a palliative measure for patients with non-operable pulmonary lesions has gained popularity over the last decade. With increasing case load and patients medical status becoming more complex, preparation for pulmonary cryoablation requires the implementation of an enhanced perioperative anesthetic plan. Current literature as well as our institutional experience shows that this patient population presents with multiple comorbidities raising the challenge of providing anesthetic care. These procedures are done under challenging conditions with limited resources and in remote locations in the hospital. A team approach by the anesthesiologist, thoracic surgeon, and interventional radiologist is critical to the success of this treatment. The present review examines our institution’s anesthetic management of percutaneous cryoablation treatment (PCT) in the treatment of non-operable lung cancer and metastases. The objective of this article is to review the current literature guidelines and to discuss our retrospective institutional experience in anesthesia management of PCT procedures.

关键词： Anesthesia Care Percutaneous Cryoablation Treatment Lung Cancer Pulmonary Complications Pneumothorax Hemoptysis

Aggressive surgical resection does not improve survival in operable esophageal squamous cell carcinoma with N2-3 status

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World Journal of Gastroenterology 2015年第28期21卷 8644-8652页

作者： Yu-Zhen Zheng Wei Zhao Yi Hu Xiao-Xiao Ding-Lin Jing Wen Hong Yang Qian-Wen Liu Kong-Jia Luo Qing-Yuan Huang Jun-Ying Chen Jian-Hua Fu Department of thoracic Oncology Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangdong Esophageal Cancer Institute Department of Medical Oncology Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Department of Oncology Sun Yat-sen Memorial Hospital Department of Experimental Research Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine

AIM:To investigate the influence of nodal status on response and clarify the optimal treatment for operable esophageal squamous cell carcinoma(OSCC).METHODS:We retrospectively analyzed 1490 OSCC patients who underwent transthoracic esophagectomy and lymphadenectomy between December 1996 and December 2009 at the Sun Yat-sen University Cancer *** surgical approach and the number of resected lymph nodes(LNs) were considered in the assessment of *** were classified according to their nodal statuses(NO vs N1 vs N2-3).Overall survival was defined as the time from the date of death or final *** analysis was performed using the Kaplan-Meier method and differences between curves were assessed by the logrank *** and multivariate Cox regression analyses were used to identify factors associated with *** significance was assumed at a Psurgery to the last censoring date for the entire cohort of 72.2 mo,a total of 631 patients were still alive at the last follow-up and the median survival time was 35.5 *** surgical approach(left transthoracic vs Ivor-Lewis/tri-incisional)was verified as independent prognostic significance in patients with NO or N1 status,but not in those with N2-3 *** results were also observed with the number of resected LNs(≤14 vs ≥15).Compared with surgery alone,combined therapy achieved better outcomes in patients with N1 or N2-3 status,but not in those with NO *** those with N2-3status,neither the surgical approach nor the number of resected LNs reached significance by univariate analysis,with unadjusted HRs of 0.826(95%CI:0.644-1.058) and 0.849(95%CI:0.668-1.078),respectively,and aggressiveness of surgery did not influence the outcome;the longest survival was observed in those patients who received the combined ***:Combined therapy has a positive role in OSCC with LN metastasis,and aggressive surgical resection does not i

关键词： Esophageal neoplasm Lymph nodes Prognosis surgery

Envonalkib versus crizotinib for treatment-naive ALK-positive non-small cell lung cancer: a randomized, multicenter, open-label, phase III trial

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Signal Transduction and Targeted Therapy 2023年第9期8卷 4338-4345页

作者： Yunpeng Yang Jie Min Nong Yang Qitao Yu Ying Cheng Yanqiu Zhao Manxiang Li Hong Chen Shou’an Ren Jianying Zhou Wu Zhuang Xintian Qin Lejie Cao Yan Yu Jian Zhang Jianxing He Jifeng Feng Hao Yu Li Zhang Wenfeng Fang Department of Medical Oncology Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou 510060China Department of Oncology The Second Affiliated Hospital of Air Force Medical UniversityXi’an 710038China Department of Medical Oncology Lung Cancer and Gastrointestinal UnitHunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of MedicineCentral South UniversityChangsha 410013China Department of Medical Oncology of Respiratory Affiliated Tumor Hospital of Guangxi Medical UniversityGuangxiNanning 530021China Department of thoracic Medical Oncology Jilin Provincial Cancer HospitalChangchun 130012China Department of Medical Oncology The Affiliated Cancer Hospital of Zhengzhou UniversityZhengzhou 450003China Department of Respiratory First Affiliated Hospital of Xian Jiaotong UniversityXi’an 710061China Department of Respiratory and Critical Care Medicine The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400050China Department of Respiratory The First Hospital of Shanxi Medical UniversityTaiyuan 030001China Department of Respiratory Disease The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Department of Medical Oncology Fujian Cancer HospitalFuzhou 350014China The First Department of Oncology The First Affiliated Hospital of Guangdong Pharmaceutical UniversityGuangzhou 510699China Department of Respiratory and Critical Care Medicine Anhui Provincial HospitalHefei 230000China Department of Respiratory Medicine Affiliated Cancer Hospital of Harbin Medical UniversityHarbin 150000China Department of Respiratory Medicine The First Affiliated Hospital of Air Force Medical UniversityXi’an 710032China Department of Cardiothoracic surgery The First Affiliated Hospital of Guangzhou Medical CollegeGuangzhou Research Institute of Respiratory Disease and China State Key Laboratory of Respiratory DiseaseGuangzhou 510120China Department

Anaplastic lymphoma kinase(ALK)rearrangements are present in about 5–6%of non-small cell lung cancer(NSCLC)cases and associated with increased risks of central nervous system(CNS)***,a novel ALK inhibitor,demonstrated promising anti-tumor activity and safety in advanced ALK-positive NSCLC in the first-in-human phase I *** phase III trial(*** NCT04009317)investigated the efficacy and safety of first-line envonalkib in advanced ALK-positive NSCLC *** 264 participants were randomized 1:1 to receive envonalkib(n=131)or crizotinib(n=133).Median independent review committee(IRC)-assessed progression-free survival(PFS)times were 24.87(95%confidence interval[CI]:15.64–30.36)and 11.60(95%CI:8.28–13.73)months in the envonalkib and crizotinib groups,respectively(hazard ratio[HR]=0.47,95%CI:0.34–0.64,p<0.0001).IRC-assessed confirmed objective response rate(ORR)was higher(81.68%vs.70.68%,p=0.056)and duration of response was longer(median,25.79[95%CI,16.53–29.47]vs.11.14[95%CI,9.23–16.59]months,p=0.0003)in the envonalkib group compared with the crizotinib *** participants with baseline brain target lesions,IRC-assessed CNS-ORR was improved with envonalkib compared with crizotinib(78.95%vs.23.81%).Overall survival(OS)data were immature,and median OS was not reached in either group(HR=0.84,95%CI:0.48–1.47,p=0.5741).The 12-month OS rates were 90.6%(95%CI,84.0%–94.5%)and 89.4%(95%CI,82.8%–93.6%)in the envonalkib and crizotinib groups,***≥3 treatment-related adverse events were observed in 55.73%and 42.86%of participants in the envonalkib and crizotinib groups,*** significantly improved PFS and delayed brain metastasis progression in advanced ALK-positive NSCLC.

关键词： crizotinib randomized cancer

Medical expenditures for colorectal cancer diagnosis and treatment: A 10-year high-level-hospital-based multicenter retrospective survey in China, 2002-2011

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Chinese Journal of Cancer Research 2019年第5期31卷 825-837页

作者： Jufang Shi Guoxiang Liu Hong Wang Ayan Mao Chengcheng Liu Lanwei Guo Huiyao Huang Jiansong Ren Xianzhen Liao Yana Bai Xiaojie Sun Xinyu Zhu Jialin Wang Bingbing Song Jinyi Zhou Lin Zhu Haike Lei Yuqin Liu Yunyong Liu Lingbin Du Yutong He Kai Zhang Ni Li Wanqing Chen Min Dai Jie He Office of Cancer Screening National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Health Economics School of Health Management/Public HealthHarbin Medical UniversityHarbin 150081China Office of Public Health Strategic Information Institute of Medical InformationChinese Academy of Medical SciencesBeijing 100020China Department of Cancer Epidemiology Henan Office for Cancer Control and ResearchThe Affiliated Cancer Hospital of Zhengzhou UniversityHenan Cancer HospitalZhengzhou 450008China Hunan Office for Cancer Control and Research Hunan Provincial Cancer HospitalChangsha 410006China Institute of Epidemiology and Health Statistics Lanzhou UniversityLanzhou 730000China Center for Health Management and Policy Key Lab of Health Economics and PolicyShandong UniversityJinan 250012China Department of Public Health Shandong Cancer Hospital Affiliated to Shandong UniversityJinan 250117China Heilongjiang Office for Cancer Control and Research Affiliated Cancer Hospital of Harbin Medical UniversityHarbin 150081China Institute of Chronic Non-communicable Diseases Prevention and Control Jiangsu Provincial Center for Disease Control and PreventionNanjing 210009China Teaching and Research Department Affiliated Cancer Hospital of Xinjiang Medical UniversityUrumqi 830011China Department of Cancer Research and Control Office Chongqing University Cancer HospitalChongqing 400030China Cancer Epidemiology Research Center Gansu Provincial Cancer HospitalLanzhou 730050China Cancer Prevention and Control Office of Liaoning Province Cancer Hospital of China Medical UniversityLiaoning Cancer Hospital and InstituteShenyang 110042China Department of Cancer Prevention Cancer Hospital of the University of Chinese Academy of SciencesHangzhou 310022China Cancer Institute The Fourth Affiliated Hospital of Hebei Medical UniversityShijiazhuang 050011China Department of thoracic Surg

Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in ***: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 ***: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.

关键词： Colorectal neoplasms health expenditures diagnosis therapeutics China

三维经胸超声心动图定位诊断二尖瓣脱垂的评价

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中华麻醉学杂志 2009年第7期29卷 636-638页

作者：张晶李立环 Tasneem Z Naqvi 北京市心肺血管疾病研究所首都医科大学附属北京安贞医院麻醉科 100029 中国医学科学院北京协和医学院阜外心血管病医院麻醉科 Non-Invasive Diagnostic Services and Echocardiography Laboratory Cardiovascular Thoracic Institute Keck School of Medicine University of Southern California

目的评价三维经胸超声心动图（3DTYE）定位诊断二尖瓣脱垂的可靠性。方法接受二尖瓣修补成形术的二尖瓣脱垂患者30例，性别不限，年龄15—64岁，体重43—118kg，ASAII一Ⅳ级“患者术前进行3DTrE检查，术中行多平面二维经食管超声心动图... 详细信息

目的评价三维经胸超声心动图（3DTYE）定位诊断二尖瓣脱垂的可靠性。方法接受二尖瓣修补成形术的二尖瓣脱垂患者30例，性别不限，年龄15—64岁，体重43—118kg，ASAII一Ⅳ级“患者术前进行3DTrE检查，术中行多平面二维经食管超声心动图（2DTEE）检查，以术中探查为标准计算3DTrE定位诊断二尖瓣脱垂的敏感度、特异度、准确度，3DTYE与2DTEE的定位诊断结果进行Kappa一致性检验。结果3DTYE图像满意率为93％，2DTEE图像满意率为100％；3DTrE定位诊断二尖瓣脱垂的敏感度88％、特异度95％、准确度93％；3DTIE与2DTEE定位诊断二尖瓣脱垂的结果一致性满意（K=0．88，P〈0．01）。结论3DTTE定位诊断二尖瓣脱垂的敏感度、特异度和准确度较高，临床上可考虑作为2DTEE的替代方法。

关键词：超声心动描记术三维超声心动描记术经食管二尖瓣脱垂

Management of Spinal Schwannomas in Gabriel TouréHospital: Review of 11 Cases

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Surgical Science 2018年第8期9卷 256-261页

作者： Youssouf Sogoba Boubacar Sogoba Drissa Kanikomo Seybou Hassane Diallo Djenè Kourouma Oumar Coulibaly Issa Amadou Moustapha Mangané Hamidou Almeimoune Madani Thierno Diop Youssoufa Maiga Broulaye Samaké Djibo M. Diango Department of Neurosurgery H&#244 pital Gabriel Touré Bamako Mali Department of Neurology H&#244 pital Gabriel Touré Bamako Mali Department of Neurosurgery H&#244 pital du Mali Bamako Mali Department of Pediatric surgery H&#244 pital Gabriel Touré Bamako Mali Department of Anesthesiology and ICU H&#244 pital Gabriel Touré Bamako Mali

Background: Spinal schwannomas are common tumors of spinal neoplasm and account for about 25% of intradural spinal cord tumors in adults. They are generally benign and slow-growing. Advanced in radiologic and surgical techniques have brought about better surgical results. The goal of surgical treatment must be total resection if possible. In this report, the authors present the incidence, clinical presentation, localization, and results of surgically treated spinal schwannomas. The results of a literature review are also presented. Methods: Eleven consecutive patients with histologically confirmed spinal schwannomas were treated from January 2013 to December 2016 in the neurosurgical department of Gabriel Touré Hospital, Bamako, Mali. Neuroradiological diagnosis was made, CT scan in 7 patients, and MRI in 4 patients. All patients were operated on via the posterior approach. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists. The patients were followed for 6 to 38 months (mean 28 months). Functional outcome was assessed using the motor grade and sensory change. Results: There were 11 patients with 7 (63.6%) males and 4 (36.4%) females. The mean age was 40.3 years (range 23 - 62 years). The most common symptom at the time of diagnosis was radicular pain in 9 (81.8%) patients followed by motor weakness in 8 (72.7%) patients. The most frequent site of spinal schwannomas was the thoracic region in 5 (45.5%) patients. During surgery, Gross-total resec-tion was achieved in 8 patients (72.7%) and subtotal removal in 3 (27.3%) patients. Histological findings were benign schwannoma in all cases. Postoperative complications developed in two patients, including one with cerebrospinal fluid leakage and other one with wound infection. In the short-term follow-up period, most of the patients (90.9%) appeared to be improved in comparison with their preoperative neurological status. There was no operative mortality. Conclusion: In this study

关键词： Spinal Schwannoma Spine surgery Recurrence