Survival Analysis of Patients with Thoracic Duct Ligation during Thoracoscopic Esophagectomy.

OBJECTIVE: To determinate the effect of thoracic duct ligation during thoracoscopic esophagectomy on esophageal cancer patients survival. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Tai'an City Central Hospital, Tai'an, Shandong, China, from June, 2016 to June, 2021. METHODOLOGY: All cT1b-3N0M0 stage esophageal cancer patients were randomly divided into thoracic duct ligation group and non-ligation group. In addition to thoracoscopic esophagectomy, thoracic duct ligation was also performed in the experimental group. The general data of two groups were compared by Chi-square test, with statistical significance at p <0.05. The effect of thoracic duct ligation on disease-free survival (DFS) and overall survival (OS) was analysed by Kaplan-Meier and Cox regression. RESULT: There was no significant difference in gender, age, tumor location, depth of invasion, degree of differentiation and presence of tumor thrombus between the ligation group (33 cases, 47.8%), and the non-ligation group (36 cases, 52.2%). Cox regression analysis showed that depth of invasion (p = 0.0014), degree of differentiation (p = 0.0036), presence of tumor thrombus (p = 0.0367) and thoracic duct ligation (p = 0.0057) were independent factors affecting DFS. Meanwhile, the depth of invasion (p <0.0001), presence of tumor thrombus (p = 0.0073) and age (p = 0.0129) were independent factors affecting OS. CONCLUSION: Thoracic duct ligation during thoracoscopic esophagectomy can affect DFS in patients with pT1b-3N0M0 esophageal squamous cell carcinoma, and the thoracic duct ligation, depth of invasion, degree of differentiation and presence of tumor thrombus are independent factors. Meanwhile, the depth of invasion, presence of tumor thrombus and age were independent factors affecting OS. Key Words: Esophageal cancer, VATS, Esophagectomy, Thoracic duct ligation, DFS, OS.

Can dietary patterns prevent cognitive impairment and reduce Alzheimer's disease risk: Exploring the underlying mechanisms of effects.

Alzheimer's disease (AD) is one of the fastest growing cognitive decline-related neurological diseases. To date, effective curative strategies have remained elusive. A growing body of evidence indicates that dietary patterns have significant effects on cognitive function and the risk of developing AD. Previous studies on the association between diet and AD risk have mainly focused on individual food components and specific nutrients, and the mechanisms responsible for the beneficial effects of dietary patterns on AD are not well understood. This article provides a comprehensive overview of the effects of dietary patterns, including the Mediterranean diet (MedDiet), dietary approaches to stop hypertension (DASH) diet, Mediterranean-DASH diet intervention for neurological delay (MIND), ketogenic diet, caloric restriction, intermittent fasting, methionine restriction, and low-protein and high-carbohydrate diet, on cognitive impairment and summarizes the underlying mechanisms by which dietary patterns attenuate cognitive impairment, especially highlighting the modulation of dietary patterns on cognitive impairment through gut microbiota. Furthermore, considering the variability in individual metabolic responses to dietary intake, we put forward a framework to develop personalized dietary patterns for people with cognitive disorders or AD based on individual gut microbiome compositions.

The influence of gut microbiome on bone health and related dietary strategies against bone dysfunctions.

The link between the gut microbiome and bone health has begun to attract widespread interest in recent years. The gut microbiome are vital in many diseases involving bone loss. Probiotics, prebiotics, and dietary supplements have been suggested to protect bone health by altering the composition of the gut microbiota. Notably, studying the relationship between the gut microbiome and bone health can provide a basis for the prevention and treatment of bone diseases. This review focuses on the link between the gut microbiome and bone diseases, exploring current knowledge of the mechanisms by which gut bacteria affect bone health. In addition, the influences of dietary supplements on the interactions between the gut microbiome and bone health are discussed. This knowledge will promote new ideas for gut microbiota-mediated dietary interventions in patients with bone diseases.

Mechanistic biosynthesis of SN-38 coated reduced graphene oxide sheets for photothermal treatment and care of patients with gastric cancer.

The graphene-based nanomaterials have been measured as a most promising nanomaterials in the various fields. Graphene oxide having attractive and effective attention in the modified of medicine. Also, graphene oxide is one of the distinct bio-chemical properties with minimum cytotoxicity compared to the other nanomaterials. Up to till date, gastric treatments with reduced graphene oxide not studied so far. In this report, 7-ethyl- 10-hydroxycamptothecin (SN-38) coated graphene oxide synthesized (SN-rGO) effectively and are characterized using various analytical methods. The hydroxyl and carbonyl gatherings of oxidized SN38 will in general ingest onto GO by means of hydrogen bond arrangement with their leftover oxygen functionalities and offers steadiness to SN38. The morphological analyses showed the foldable fields of SN38-rGO NPs with acquire transparency, thin sheets and the crumpled structures. Further the photothermal efficiency and cytotoxicity of the SN-rGO were examined by MTT assay using two NCI-N87 and SGC-791 gastric carcinoma cells. In addition, the morphological changes were examined through the live and dead cells and nuclear staining biochemical techiniques and apoptosis were evaluated through flow cytometry analysis. Our result's suggested that the SN-38 coated reduced graphene oxide can be used for the photothermal treatment of gastric carcinoma for the future nanotechnology cancer therapies without using functionalized polymeric nanoparticles.

[Establishment of an evidence-based protocol for tracheotomy care in adult patients].

PURPOSE: To establish a clinical practice protocol for tracheotomy care of adult patients. METHODS: Though constructive document retrieval, personnel interview and brain-storming, protocol draft was constructed. Delphi method was used in the study, and the final protocol was based on two rounds of consultation among 15 experts from 10 tertiary general hospitals. SPSS 16.0 software package was used for statistical analysis. RESULTS: The effective rates of two rounds of questionnaire were 100% and 93.3%, the authority coefficient was 0.83, and the P value of expert coordination coefficients W was less than 0.05. The final evidence-based protocol for tracheotomy care in adult patients consists of 5 sections, 16 dimensions and 61 items. CONCLUSIONS: The evidence-based tracheotomy care protocol was combined with Chinese clinical status and experts' opinion. The protocol was scientific and credible, which may play an important role in clinical practice.

[Real-time CT of upper airway in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To explore the technology and clinical application of real-time CT scan in obstructive sleep apnea hypopnea syndrome during awake and drug induced sleep state. METHODS: Sixty-two patients with OSAHS diagnosed by polysomnography underwent 256 layer spiral CT scan during awake and drug-induced sleep apnea state, and multiplanar reconstruction and volume rendering of computed tomography images were performed. To observe the dynamic changes of upper airway and locate the sites of airway obstruction in patients with OSAHS, the minimum section area, diameter and volume of pharynx cavity were measured on reconstructed 3-dimensional computed tomography. RESULTS: Real-time CT scans were completed successfully in all of the patients. It was revealed that airway obstruction frequently occurred at retropalatal and retroglottal region. Real-time CT scans revealed 29 cases with airway obstruction at isolated retropalatal region, 19 cases with airway obstruction at retropalatal and retroglottal region simultaneously, 6 cases with airway obstruction at retropalatal and epiglottal region simultaneously, 7 cases with airway obstruction at retropalatal, retroglottal and retroglottal region simultaneously, 1 case without airway obstruction. There was no airway obstruction at retroglottal or retroglottal region isolatedly. Rate of single region airway obstruction was 46.8% (29/62), and rate of multiple regions airway obstruction 51.6% (32/62). The real-time CT results showed that starting from Friedman tongue position I to IV, the percentage of obstruction at retroglottal and (or) retroglottal region simultaneously were increasing, the percentage of obstruction were 0/6, 8/25, 13/20, 11/11, respectively (χ(2) = 22.00, P < 0.005). The minimum section area, volume, minimum anteroposterior diameter and left-right diameter of pharynx cavity between awake and drug-induced sleep apnea state had statistically significant difference in all region. CONCLUSIONS: Real-time CT scans in drug-induced sleep state could get more information about the anatomical and pathological changes of upper airway, providing relatively objective morphological basis for the diagnosis and treatment of patients with OSAHS. Therefore, real-time CT scans have important value in practical application.

[Reliability and validity of the simplified Chinese version of Epworth sleepiness scale].

OBJECTIVE: To investigate the reliability and validity of the simplified Chinese version of Epworth sleepiness scale(ESS). METHODS: Five hundred and eighty-five patients with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and 103 OSAHS patients who underwent operations were included in this study. The ESS was filled before polysomnography (PSG) monitoring under the direction of professional technicians. The patients who underwent operations did both PSG and ESS tests more than 6 months after operation. Fifty-one patients who underwent PSG at our hospital from July to August, 2010 were chosen to assess the ESS test-retest reliability on two separate occasions at least more than one week. RESULTS: The total Cronbach's Alpha of ESS was 0.814. The test-retest reliability of ESS total scores was 0.679 and for each item was from 0.473 to 0.698(P < 0.01). Split-half reliability was 0.817 (P < 0.01). In the analysis of discriminant validity with apnea hypopnea index (AHI), the ESS total scores and each item's scores had significant differences in severity in OSAHS patients and simple snoring patients (P < 0.05), and this was also true in different degrees of lowest saturation of arterial oxygen (LSaO(2)) patients and normal LSaO(2) patients (P < 0.05). The factor analysis of construct validity showed that 4 factors were extracted. The cumulative proportion was 74.270%. The loading was higher than 0.4 among every item. The correlation coefficiency of overall ESS scores and each item's scores was relatively high except the last item. The ESS had low consistency with clinical diagnosis(κ = 0.099, P < 0.01) and the predictive validity was not good (r = 0.138, P < 0.01).As for 103 patients who had operations, the initial assessment of total ESS scores were 15.0[10;20] (M[P(25); P(75)]), and improved to 4[1;6] after operation. The patients who got effective results had significant difference in the total ESS scores before and after operation (Z = -7.528, P < 0.01), so was the patients who got ineffective results (Z = -4.382, P < 0.01) . CONCLUSIONS: The simplified Chinese version of ESS had a good reliability and validity. It can be used to evaluate the chance of dozing in the daytime.