Objective
To explore the incidence and severity of symptoms of the lung cancer patients undergoing concurrent chemoradiation therapy, and reveal the influence of symptom clusters on the patients’ daily activities.
Method
From December 2016 to June 2017, a total of 150 patients with lung cancer who underwent concurrent chemoradiation therapy were investigated by using M. D. Anderson Symptom Inventory of Chinese Version and the revised lung cancer module.
Results
For the patients during the period of concurrent chemoradiation therapy, the symptoms with severity score >5 were fatigue, nausea, poor appetite, cough, distress, disturbed sleep, vomiting, expectoration, and grief; the symptoms with incidence >80% were fatigue, nausea, disturbed sleep, poor appetite, grief, and cough. Joy of life (87.33%), emotion (74.38%), and work (72.67%) were the top three in terms of high incidence of symptom distress. Exploratry factor analysis revealed 4 major symptom clusters, which were fatigue-related symptom cluster, gastrointestinal symptom cluster, emotion symptom cluster, and respiratory symptom cluster.
Conclusions
During the period of concurrent chemoradiation therapy, lung cancer patients suffer from multiple symptom clusters. Medical staff should assess symptoms timely, and provide effective interventions, to improve the patients’ quality of life.
Objective To investigate the differences in clinical characteristics and polysomnographic characteristics between the elderly obstructive sleep apnea-hypopnea syndrome ( OSAHS) patients and the young and middle-aged OSAHS patients. Methods The clinical manifestations and the polysomnographic characteristics of 37 elderly OSAHS patients and 294 young and middle-aged patients were analyzed. The differences in polysomnographic indicators between two groups were compared according to the body mass index.Results The nocturia frequency in the elderly OSAHS patients was higher( P =0. 01) ,however, the othert clinical manifestations between the elderly group and the young and middle-aged group were not different significantly. The elderly group had a lower body mass index ( P =0. 018) , a smaller neck circumference ( P =0. 003) , and a larger chance of diabetes ( P = 0. 001) and hypertension( P lt; 0. 001) .The phase Ⅰ and phase Ⅱ sleep of the elderly group took a longer duration ( P lt; 0. 001) and a larger proportion( P lt;0. 001) . The sleep apnea-hypopnea index between two groups did not show any significant difference( P =0. 082) . The lowest night oxyhemoglobin saturation of the elderly group was higher than that of the young and middle-aged group( P =0. 009) , but such difference disappeared after adjustment by weight ( P =0. 114) . Conclusions The major clinical manifestations of the elderly OSAHS patients are similar to the young and middle-aged patients. The elderly patients are thinner than the young and middle-aged patients, but have more complications and a higher frequency of nocturia. The night oxyhemoglobin saturation is lower in young and middle-aged patients which is associated with higher body mass index.
ObjectiveTo explore coronary angiographic characteristics in patients with symptomatic recurrence after coronary artery bypass grafting (CABG). MethodsWe performed a retrospective study of 997 patients with symptomatic recurrence after CABG in Beijing Anzhen Hospital from 2010 to 2020. There were 762 males and 235 females, with an average age of 62.41±8.70 years.ResultsThere was a high prevalence of risk factors like hypertension, diabetes and a history of smoking. Diseased arterial grafts accounted for 27.44% while saphenous vein graft 54.40%; 240 (24.07%) patients had all patent grafts. The main lesion characteristics of diseased grafts were chronic total occlusion lesions (79.57%). Most patients had more diseased native vessels after CABG than before. The type C coronary artery disease in native vessels relevant to ischemic area occurred in 674 (67.60%) patients; 525 (52.66%) patients with recurrent symptom after CABG had both diseased grafts and diseased native vessels. Conclusion Graft status in patients with symptomatic recurrence after CABG is worse than we expected. The majority have newly developed lesions both in grafts and native vessels. Native vascular lesions will continue to progress after CABG.
ObjectiveTo observe and analyze the fundus of pregnancy-induced hypertension syndrome (PIHS) and optical coherence tomography (OCT) characteristics and its correlation with ocular symptoms and degree of the systemic disease.
MethodsA total of 132 PIHS patients (264 eyes) received the examinations of corrected visual acuity, slit lamp microscope, direct ophthalmoscope, OCT and fundus color photography after obtaining informed consent in the study. There were 10 cases of gestational hypertension, 29 cases of preeclampsia (mild), 82 cases of pre-eclampsia (severe) and 11 cases of eclampsia. 91 patients (180 eyes) felt blurred vision and visual fatigue. 102 patients were examined at an average gestational age of (37.00±2.14) weeks and 30 patients were examined at an average (10.00±8.22) days postpartum. The ocular fundus was divided into normal fundus and abnormal fundus; the abnormal fundus had 3 stages, including stageⅠ(retinal arterial spasm), stageⅡ(retinal arteriosclerosis) and stageⅢ(retinopathy). If the OCT results seems to be abnormal, these patients were further selected to observe the changes of neurosensory serous retinal detachment, retinal pigment epithelium (RPE) and junction of inner and outer segment of photoreceptor (IS/OS). Kappa test was used to analyze the consistency between fundus performance and OCT results, and that of ocular symptoms with fundus changes and OCT results. Rank correlation test was used to analyze the degree of PIHS and OCT examinations.
ResultsThere were 32 eyes with normal fundus (12.12%) and 232 eyes with abnormal fundus (87.88%). The 232 eyes with abnormal fundus were divided into three stages: stageⅠfor 16 eyes (6.90%), stageⅡfor 31 eyes (13.36%) and stageⅢfor 185 eyes (79.74%). 92 of 264 eyes (34.85%) had normal OCT findings, 172 eyes (65.15%) were abnormal, including 94 eyes with serous retinal neurosensory detachment (54.65%), 40 eyes with changes of RPE and IS/OS (23.26%) and 38 eyes with other manifestations (22.09%). Kappa test analysis showed highly consistency between OCT results and ocular symptoms (K=0.728, Po=0.591), and poor consistency between fundus abnormalities and ocular symptoms (K=-0.129, Po=0.879), and between fundus abnormalities and OCT results (K=0.174, Po=0.682). OCT results were positively correlated with the degree of PIHS (C=0.374, χ2=74.011; P=0.000).
Conclusions87.88% of PIHS eyes had various degrees of retinal hemorrhage, cotton wool spots, retinal bumps or detachment, optic disc edema and other retinal abnormalities. 65.15% of that showed OCT abnormal results such as neurosensory retinal detachment, cystoid edema, RPE changes etc. The consistency was poor between the OCT results and fundus abnormalities. OCT results are positively correlated with the degree of PIHS.
ObjectiveTo summarize the clinical features and imaging features of CT in the omental torsion, and in order to reduce the misdiagnosis and missed diagnosis rate of imaging features.
MethodsThe data of 16 cases of omental torsion (secondary 15 cases, primary 1 case) and 286 cases of acute appendicitis (eliminated the subhepatic and retroperitoneal ectopic appendix) in our hospital from 1998 to 2014 were retrospectively analyzed.
ResultsEleven cases of omental torsion suffered from the shifting pain in right lower quadrant. No obvious shifting abdominal pain was observed in other 4 cases whose main manifestations were abdominal tenderness and rebound tenderness around umbilicus. The patient of the remaining 1 case had enclosed mass in the area of left groin with pain and suffered from continuous periumbilical pain. Abdominal spiral CT examination was performed in 16 patients before operation. Increased signal intensity of globular soft tissue, which deviating from McBurney's point, was found at level of distal umbilicus by preoperative spiral CT in 13 cases. One case of omental torsion associated with ncarcerated inguinal hernia was missed.
ConclusionsOmental torsion manifests chiefly shifting pain in right lower quadrant, abdominal tenderness, and rebound tenderness around umbilicus. It is easily confused with appendicitis. Abdominal spiral CT should be chosen as a preferred means in preoperative diagnosis of omental torsion.
Objective To evaluate the applicability of the cut-off points of different versions of the Asthma Control Questionnaire (ACQ) in the Chinese population and their consistency with the symptom control criteria of the Global Initiative for Asthma (GINA), so as to provide strategies for cut-off point selection in clinical practice. Methods Based on baseline data from a multicenter prospective cohort study, asthma patients who completed pulmonary function tests, GINA symptom control assessments, and the ACQ-7 questionnaire were included. Taking the GINA symptom control level as the gold standard, the Receiver Operating Characteristic Curve (ROC) was used to determine the optimal cut-off points of the ACQ for discriminating the GINA symptom control levels, and the consistency was analyzed by kappa statistics. Results Among 399 patients (58.9% female; mean age 44.5 ± 12.8 years), asthma symptom control, partial control, and uncontrolled rates were 61.7%, 27.6%, and 10.8%, respectively. ROC analysis revealed the following optimal cutoffs for identifying symptom control: ACQ-5 (0.5), ACQ-6Res (0.42), ACQ-6PFT (0.92), and ACQ-7 (0.93); for identifying uncontrolled symptoms: ACQ-5 (0.9), ACQ-6Res (1.08), ACQ-6PFT (1.42), and ACQ-7 (1.36). All corresponding areas under the ROC curve (AUC) exceeded 0.9. Consistency between ACQ and GINA symptom control levels was moderate (Fleiss’ κ = 0.453–0.531). Performance characteristics varied between traditional (0.75/1.5) and optimized cutoffs. After optimization, ACQ-5 emerged as the only version achieving balanced sensitivity-specificity (Youden index = 0.75) in dual tasks: ACQ-5 ≤ 0.5 demonstrated sensitivity (91%) and specificity (84%) for symptom control, while ACQ-5 ≥ 0.9 showed sensitivity (95%) and specificity (80%) for uncontrolled status. Conclusions Region-specific calibration of ACQ cutoffs enhances clinical utility in the Chinese population. A stratified application strategy is recommended: high-sensitivity cutoffs for initial screening to reduce underdiagnosis, high-specificity cutoffs for resource-constrained settings to minimize overtreatment, and optimized ACQ-5 cutoffs (≤0.5/≥0.9) for comprehensive management to balance sensitivity and specificity. Flexible combination of cutoff protocols tailored to screening objectives may optimize hierarchical asthma management.
Objective To develop a preliminary "pulmonary nodule symptom scale" based on the Delphi method, providing a tailored, standardized, normalized, and promotable symptomatic evaluation tool for the efficacy assessment of pulmonary nodule patients treated with traditional Chinese medicine or integrated traditional Chinese and Western medicine interventions. Methods A preliminary pool of scale items was formed through literature review, interviews with doctors and patients, and reference to guidelines and consensus on pulmonary nodules and patient-reported outcome (PRO) scales related to lung cancer. Two rounds of expert consultation were conducted using the Delphi method. Based on the concentration and variation indicators of expert evaluations, and considering experts’ suggestions for specific item deletions and modifications, a core group meeting was held to screen and refine the scale items. Results Invitations were sent to 54 experts, with 51 accepting the consultation. The active coefficient for the first round of consultation was 94.4%, and for the second round, it was 100%. The average authority coefficient for the 51 experts was 0.896. The Kendall’s coefficient of concordance and the average coefficient of variation for the first and second rounds of consultation were 0.215 (P<0.001) and (0.34±0.07), 0.162 (P<0.001) and (0.24±0.05), respectively. Through two rounds of Delphi expert consultation, a preliminary "pulmonary nodule symptom scale" covering 17 items across four dimensions - respiratory symptoms, systemic manifestations, psychological state, and overall assessment - was formed. Conclusion The experts participating in this Delphi consultation had high authority and enthusiasm, and they have a good level of acceptance and consistency for the preliminary "pulmonary nodule symptom scale". Subsequent empirical research will be conducted on a large sample cohort of pulmonary nodule patients to verify the scale’s stability and effectiveness.
Objective?To explore the clinical and imaging features of cranial venous sinus thrombosis (CVST).
MethodsThe clinical data of 20 patients with CVST treated between January 2008 and December 2012 were retrospectively analyzed, including the clinical manifestations, neuroimaging characters and treatment outcomes.
ResultsAmong the 20 patients, there were 10 infected cases; D-dimer was detected positively in only 2 cases; cerebrospinal fluid pressure increased in 13 patients; and red blood cell population of cerebrospinal fluid increased in 12 patients. The common clinical symptoms included headache in 16 cases, eye symptoms in 12 cases, and vomiting in 10 cases. CT showed the direct signs of CVST in 3 cases, and MRI showed the direct signs of CVST in 6 cases. The common disease regions were in left transverse sinus and sigmoid sinus in 5 cases, superior sagittal sinus in 5 cases, and multiple venous sinus in 5 cases. Eighteen patients only received anticoagulation, and 2 received anticoagulation and local thrombolytic treatment. Fourteen cases recovered fully, 6 had dysfunctions.
ConclusionThe clinical manifestations of CVST are nonspecific. This disorder predominantly affects childbearing women. Infection is a common cause of CVST. The occlusive venous sinus can be confirmed by enhanced magnetic resonance venography or digital subtraction angiography. Anticoagulation and local thrombolytic therapy are both proved to be safe and effective in the treatment of CVST. The early diagnosis rate of CVST remains to be improved.
Objective To investigate the mental status of medical staffs in the orthopedics department during the earthquake, providing evidence for psychological intervention. Methods Choosing 104 staffs in the orthopedics department as eligible subject with convenient sampling; the research tool was Symptom Checklist-90. The questionnaire was done by the participants with the same instruction from psychological professionals; analyze the results. Results The score in somatization, anxiety and phobic anxiety of staffs in the orthopedics department was significantly higher than the national norm. Conclusion There exists disorder in mental health of medical staffs in orthopedics department, it is necessary to implement mental intervention.
Objective
To explore the effect of kidney transplantation on chronic prostatitis-like symptoms.
Methods
A total of 300 male renal transplant recipients between January 2015 and January 2017 were collected in the study. All recipients received the questionnaire survey of the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) preoperatively and at 3 months after transplantation. The score and relevant risk factors were statistically analyzed.
Results
A total of 210 recipients (70.0%) completed questionnaire effectively, in whom 150 (71.4%) had preoperative and 90 (42.9%) had postoperative chronic prostatitis-like symptoms, respectively. In the 210 patients, the preoperative and postoperative pain score was 6.57±3.12 vs. 3.57±3.16 (P<0.001), voiding score was 3.71±2.38vs. 3.29±2.66 (P=0.116), quality of life score was 7.57±1.60 vs. 5.14±2.75 (P<0.001), and the total NIH-CPSI score was 17.86±3.81vs. 12.00±6.65 (P<0.001), respectively. The severity of chronic prostatitis-like symptoms was alleviated significantly after kidney transplantation.
Conclusion
Kidney transplantation can alleviate the chronic prostatitis-like symptoms significantly, and improve the quality of life in uremia patients.
