Objective To discuss influence of spinal surgery on quality of life (QOL) of patients with late-period spinal metastatic tumor and to explore if spinal surgery could influence on survival time of patients or not. Methods From July 2007 to March 2009, we identified patients who were eligible for the observational study hospitalized in Changzheng Hospital, the Second Military Medical University in Shanghai, China. All eligible patients were divided into two groups depending on whether they would receive spinal surgery or not. Then, all eligible patients completed five QOL assessments using the Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire when they were diagnosed as late-period spinal metastatic tumor, after 1-month treatment, after 3-month treatment, after 6-month treatment, and after 9-month treatment. Survival time of each patient was also recorded. Results We identified 312 patients who were eligible for the study (surgery group, 147 cases; and non-surgery group, 165 cases). There was no significant difference in survival time between the two groups (χ2=3.167, P=0.075). Within 9 months, the surgery group had significantly higher physical well-being scores, emotional well-being scores, functional well-being scores and total QOL scores than the non-surgery group. Conclusion The results of this study suggest that spinal surgery can significantly improve the QOL of patients with late-period spinal metastatic tumor, but cannot prolong the survival time.
Objective To approach the surgical therapeutic efficacy of local recurrence of rectal cancer. Methods Fifty-six patients with local recurrence of rectal cancer suffered from reoperation from January 2003 to January2011 in this hospital were collected. Chi-square test was performed to analyze the complete excision rates of reoperation for different recurrent time after radical resection and different surgical procedures after primary radical resection of rectalcancer. The method of log-rank test was used for survival analysis of the Miles and Dixon procedure. Results ①The opera-tion time and intraoperative bleeding of reoperation for local recurrence of rectal cancer were more than those of the primary radical resection of rectal cancer （P＜0.05）. ②The complete resection rate of the local recurrence of rectal cancer in 5 years after primary radical resection of rectal cancer was higher than that of the local recurrence of rectal cancer within 2 years after primary radical resection of rectal cancer， and the difference was statistically significant （P＜0.01）. ③The complete resection rate of the local recurrence of rectal cancer of the technique of Dixon in the primary radical resection of rectal cancer was higher than that of Miles， and the difference was statistically significant （P＜0.05）. ④The median survival time and 2-year survival rate and 5-year survival rate of the technique of Dixon in the reoperation were longer or higher than those of Miles， and the differences were statistically significant （P＜0.05）. Conclusions Surgical procedure and postoperative recurrence time after primary operation can both influence complete excision rate of reoperation for local recurrence of rectal cancer. And reoperation for local recurrence of rectal cancer can prolong the survival time.
ObjectiveTo find out the possible factors that may affect the survival time of patients undergoing return of spontaneous circulation (ROSC) within seven days of cardio-pulmonary resuscitation. MethodWe retrospectively collected 20 clinical indicators from 51 patients who underwent ROSC after cardio-pulmonary resuscitation in Emergency Department between August 2013 and February 2015. The indicators included gender, age, duration of cardio-pulmonary resuscitation, blood pressure acquired immediately after ROSC, heart rate, respiration, lactic acid, creatinine, prothrombin time, bilirubin, pH, arterial partial pressure of carbon dioxide, potassium, sodium, blood glucose, atrial natriuretic peptides, leukocyte, platelets, and hemoglobin. Then we analyzed the correlation of these indicators with survival time through Cox regression model. ResultsThe results showed that duration of cardiopulmonary resuscitation[RR=1.053, 95% CI (1.020, 1.088), P=0.002] and systolic blood pressure acquired immediately after ROSC[RR=0.991, 95% CI (0.982, 0.999), P=0.038] significantly affected the survival time of patients after ROSC. ConclusionsDuration of cardiopulmonary resuscitation and systolic blood pressure acquired immediately after ROSC may be useful in predicting the survival time of patients after ROSC.
ObjectiveTo analyze the influence of different surgical methods on survival and relapse-free survival in colorectal liver metastases. MethodsClinical data of 71 cases of colorectal liver metastases who treated in PLA General Hospital from January 2002 to may 2013 were collected retrospectively, to analyzed the effect of different surgical methods on survival and relapse-free survival of this kind of cases. ResultsAll of primary lesions underwent radical resection. And for the liver metastases, 20 cases didn't received any intervention (non-intervention group), 20 cases underwent resection of liver metastases, 20 cases underwent radiofrequency ablation, and 11 cases underwent radiofrequency ablation and resection of liver metastases (all 61 cases who received intervention were classified to intervention group). Results of Cox proportional hazards model showed that, in the condition of controlling other confounding factors, intervention can improve the survival (HR=1.724, P=0.043) and relapse-free survival (HR=0.701, P=0.048) of cases of colorectal liver metastases, cases who received intervention had better survival situation and the relapse-free survival situation. ConclusionFor cases of colorectal liver metastases, in condition of radical operation for colorectal cancer, the intervention for liver metastases can prolong the survival time and relapse-free survival time.
ObjectiveTo study the value of revised trauma scores (RTS), major trauma outcome study (MTOS)-RTS scores and point of care test (POCT) in the early forecast of survival time in severe multiple trauma patients. MethodsMultiple trauma patients treated in the Emergency Department of our hospital between September and December 2015 were included in our study. We collected such data as the basic information on admission, physical signs (breath, blood pressure, state of consciousness) and POCT indexes, including pH value, hemoglobin, base excess, hematocrit value, lactic acid, sodium, anion gap, and blood glucose. We calculated each patient's RTS and MTOS-RTS scores. According to the 30-day prognosis, the patients were divided into survival group and death group. Risk factors for survival time were screened by Cox regression risk model. ResultsSeventy-five multiple trauma patients were included in our study. Among them, there were 51 males and 24 females. Fourteen of them died. The multivariate analysis in the Cox regression risk model showed that the risk factors for the death of multiple trauma patients included MOTS-RTS score [RR=0.726, 95%CI (0.608, 0.867), P < 0.001) and POCT lactic acid level [RR=1.139, 95%CI (1.010, 1.324), P=0.037]. ConclusionMOTS-RTS combined with lactic acid level may be used in the early forecast of survival time in severe multiple trauma patients.
Objective To analyze the influencing factors of short-term curative effect and long-term survival time of patients with tumor-induced malignant central airway obstruction (MCAO) after airway stent implantation. Methods A total of 120 patients with tumor-induced MCAO who underwent airway stent implantation in the hospital from January 2017 to June 2019 were enrolled. According to the cause of stenosis, the patients were divided into two groups: external pressure stenosis group (n=72) and non-external pressure stenosis group (n=48). The general data such as types and staging of tumor, differentiation degree, sites of airway obstruction, obstruction degree and preoperative level of lactate dehydrogenase (LDH). Before and at 7d after stent implantation, partial pressure of oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2) and saturation of arterial blood oxygen (SaO2) were detected. Before and at 1 month after stent implantation, diameter at airway obstruction segment, degree of airway obstruction and forced expiratory volume in the first second (FEV1) were detected. Dyspnea index (DI) and scores of Karnofsky performance status (KPS) were evaluated. The survival status at 1 year after surgery was followed up. The survival at 1 year after surgery was analyzed by Kaplan-Meier. The influencing factors of survival after stent implantation were analyzed by COX proportional hazard regression analysis. Results After stent implantation, PaO2, SaO2, diameter at airway obstruction segment, FEV1 and KPS score were significantly increased (P<0.05), while PaCO2, degree of airway obstruction and DI were significantly decreased in external pressure stenosis group and non-external pressure stenosis group (P<0.05). After stent implantation, the KPS score was significantly higher in external pressure stenosis group than that in non-external pressure stenosis group, and the shortness of breath index was significantly lower than that in non-external pressure stenosis group (P<0.05). The survival rate of patients with external pressure stenosis group was 29.17%, and the median survival time was 7.35 months, the survival rate and median survival time in non-external pressure stenosis group was 22.92%, and the median survival time was 6.10 months, and there was no significant difference between the two groups (log-rank χ2=1.542, P=0.214). COX proportional hazard regression analysis showed that tumor staging at stage IV (OR=2.056, P=0.020), preoperative KPS score lower than 50 points (OR=2.002, P=0.027) and no postoperative chemoradiotherapy (OR=4.292, P=0.039) were independent influencing factors of 1-year survival time after stent implantation in MCAO patients. Conclusions The clinical curative effect of airway stent implantation is good on patients with tumor-induced MCAO. Tumor staging at stage IV, preoperative KPS score lower than 50 points and no postoperative chemoradiotherapy are risk factors that affect survival time.