Expert consensus on the clinical application of totally implantable venous access devices in the upper arm (2022 Edition).

With the widespread adoption of ultrasound guidance, Seldinger puncture techniques, and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years, an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices (TIVADs) in the upper arm. This approach has the advantage of completely avoiding the risks of hemothorax, pneumothorax, and neck and chest scarring. Medical specialties presently engaged in this study in China include internal medicine, surgery, anesthesiology, and interventional departments. However, command over implantation techniques, treatment of complications, and proper use and maintenance of TIVAD remain uneven among different medical units. Moreover, currently, there are no established quality control standards for implantation techniques or specifications for handling complications. Thus, this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach, reduce complication rates, and ensure patient safety. This consensus elaborates on the technical indications and contraindications, procedures and technical points, treatment of complications, and the use and maintenance of upper-arm TIVAD, thus providing a practical reference for medical staff.

Identification of psychological stressors in cancer patients based on a computer decision support nursing system.

OBJECTIVE: We aim to improve the decision-making process of nursing evaluation, and the purpose of this paper was to introduce nursing outcome classifications based on standardized nursing language, as well as build a comprehensive nursing evaluation decision-making system model based on an artificial neural network and fuzzy comprehensive evaluations. METHODS: Based on the principle and method of the decision support system (DSS), this paper proposed a framework of DSS and developed an intelligent nursing decision support system which integrates expert systems, data, models and knowledge. RESULTS: Taking cancer patients as examples, based on the analysis and comparison of cancer stressors and their frequency of occurrence, this paper found that the 5 major factors for cancer patients' stress events were lack of privacy, attitude of the medical workers, unfamiliar medical workers and uncomfortable temperature in wards. In addition, through the single factor analysis of the stressors, it was found that "the impact of hospitalization on individuals and their families", "the professional level and service attitude of medical workers", and "partial loss of free social contact in the hospital" were all positively correlated with stress level. The degree of cancer patients' participation in treatment decision-making was lower than the expectation of the patients. There was a statistically significant difference between the actual participation and the anticipated participation of cancer patients in nursing decision-making (P < 0.0001). In addition, the system helped patients adapt to the hospital environment as quickly as possible, so that they could feel comfortable in the hospital environment, as well as a relaxed and pleasant with the humanistic environment. CONCLUSION: Cancer patients have a variety of stressors, and the pressure is high. Our computer decision support nursing system assisted nurses to help patients to take positive coping measures to relieve pressure as soon as possible, so as to improve their quality of life.

Pretreatment BAN Score Based on Body-mass-index, Albumin and Neutrophil-lymphocyte Ratio Could Predict Long-term Survival for Patients with Operable Esophageal Squamous Cell Carcinoma.

Background: The present study was designed to examine the prognostic value of a systemic inflammation marker-BAN score, which was established based on body-mass-index (BMI), albumin (ALB) and neutrophil-lymphocyte ratio (NLR) in resectable esophageal squamous cell carcinoma (ESCC) patients. Methods: A total of 420 newly diagnosed ESCC patients in our hospital between January 2008 and December 2013 were included. Their baseline characteristics were retrospectively reviewed and collected. BAN score was calculated as (BMI × ALB/ NLR). The optimal cutoff value for BAN score was defined as 28.0 in terms of survival. Patients were then allocated to high BAN (≥ 28.0) and low BAN (< 28.0) score groups. Results: Pretreatment BAN score was significantly associated with tumor length, white blood cell count, BMI, ALB and NLR levels. However, no significant difference was observed in patients' age, gender, tumor location, degree of differentiation, depth of invasion, lymph node involvement, tumor-node-metastasis (TNM) stage or other variables between groups. Moreover, those with high pretreatment BAN scores (≥ 28.0) tended to have favorable disease free survival (DFS) [hazard ratio (HR), 0.650; 95% confidence interval (CI), 0.481-0.877; P = 0.005] and overall survival (OS) (HR, 0.608; 95% CI, 0.445-0.829; P = 0.002) by univariate analysis. Furthermore, multivariate Cox regression analysis suggested that high BAN score (≥ 28.0) could serve as an independent predictor for both DFS (HR, 0.726; 95% CI, 0.532-0.993; P = 0.045) and OS (HR, 0.670; 95% CI, 0.485-0.927; P = 0.016). Conclusions: Pretreatment BAN score could independently predict long-term survival for resectable ESCC patients.

Spatial Ability and Theory of Mind: A Mediating Role of Visual Perspective Taking.

This research tests the role of visual perspective taking (VPT) in mediating the relation between spatial ability and theory of mind (ToM). Study 1 demonstrated such mediation correlationally in seventy 3.5- to 4-year olds. In Study 2, twenty-three 3.5- to 4-year-olds were trained on using play blocks to copy preassembled models as a way to promote spatial ability. Resultant increases in VPT and ToM were compared to those from a control group learning to draw instead (n = 23). Both studies showed that the effect of spatial ability on ToM depended on VPT, suggesting a role of embodiment in ToM development in early childhood. These findings provide an alternative way to think about ToM development and the psychological mechanism that may be involved.

A randomized controlled study of single-agent cisplatin and radiotherapy versus docetaxel/cisplatin and radiotherapy in high-risk early-stage cervical cancer after radical surgery.

BACKGROUND: This study explored whether docetaxel/cisplatin and radiotherapy (TP-R) increases overall survival (OS) and recurrence-free survival (RFS) compared to single-agent cisplatin and radiotherapy (C-R) in patients with high-risk early-stage cervical cancer post surgery. METHODS: Patients with clinical stage IB and IIA carcinoma of the cervix, initially treated with radical hysterectomy and pelvic lymphadenectomy, and who had positive pelvic lymph nodes and/or positive margins and/or the diameter of the primary tumor ≥4 cm and/or depth of interstitial infiltration ≥1/2 and/or lymphovascular space invasion were eligible for this study. Patients were randomized to receive C-R or TP-R. Radiotherapy in both groups was external radiation (46-54 Gy) followed by high-dose rate brachytherapy (12-24 Gy). Patients were given cisplatin (40 mg/m(2)) every week for five cycles (C-R group) or docetaxel (30 mg/m(2)) and cisplatin (30 mg/m(2)) every week for five cycles (TP-R group). RESULTS: Between 2003 and 2008, 320 patients were entered onto the study. Final analyses included 285 patients. One hundred and forty patients comprised the C-R group and 145 were in the TP-R group. The 5-year OS were 74.3 % in the C-R group and 82.8 % in the TP-R group. The hazard ratio (HR) for death was 0.65 in the TP-R group (95 % CI: 0.39-1.09, P = 0.098). The RFS were 69.3 % in the C-R group and 79.3 % in the TP-R group, and the HR for recurrence was 0.64 in the TP-R group (95 % CI: 0.40-1.03, P = 0.061). Recurrence rates were similar in both groups (27 in the C-R group and 18 in the TP-R group, P = 0.112). The seriousness of late side effects was similar in the two groups, with a higher rate of reversible hematological effects in the TP-R group. CONCLUSIONS: Compared with single-agent cisplatin and radiotherapy, docetaxel/cisplatin in combination with radiotherapy does not increase OS but has the trend of increasing RFS in patients with high-risk early-stage cervical cancer. However, docetaxel/cisplatin in combination with radiotherapy is associated with a higher incidence of side effects, this effect was reversible, and the incidence of late side effects was similar in the two treatment groups.

A randomized, controlled, multicenter study comparing intensity-modulated radiotherapy plus concurrent chemotherapy with chemotherapy alone in gastric cancer patients with D2 resection.

BACKGROUND AND PURPOSE: The role of postoperative chemoradiotherapy in the treatment of patients with gastric cancer with D2 lymph node curative dissection is not well established. In this study, we compared postoperative intensity-modulated radiotherapy plus chemotherapy (IMRT-C) with chemotherapy-only in this patient population. MATERIALS AND METHODS: We randomly assigned patients with D2 lymph node dissection in gastric cancer to IMRT-C or chemotherapy-only groups. The adjuvant IMRT-C consisted of 400 mg of fluorouracil per square meter of body-surface area per day plus 20mg of leucovorin per square meter of body-surface area per day for 5 days, followed by 45 Gy of IMRT for 5 weeks, with fluorouracil and leucovorin on the first 4 and the last 3 days of radiotherapy. Two 5-day cycles of fluorouracil and leucovorin were given 4 weeks after the completion of IMRT. Chemotherapy-only group was given the same chemotherapy regimens as IMRT-C group. RESULTS: The median overall survival (OS) in the chemotherapy-only group was 48 months, as compared with 58 months in the IMRT-C group; the hazard ratio for death was 1.24 (95% confidence interval, 0.94-1.65; P=0.122). IMRT-C was associated with increases in the median duration of recurrence-free survival (RFS) (36 months vs. 50 months), the hazard ratio for recurrence was 1.35 (95% confidence interval, 1.03-1.78; P=0.029). COX multivariate regression analysis showed that lymph node metastasis and TNM stage were both the independent prognostic factors. Rates of all grade adverse events were similar in the two treatment groups. CONCLUSIONS: IMRT-C improved RFS, but did not significantly improve OS among patients with D2 lymph node dissection in gastric cancer. Using IMRT plus chemotherapy was feasible and well tolerated in patients with gastric cancer after D2 resection.