Pulmonary Carcinosarcoma: A Surveillance,Epidemiology, and End Results (SEER) Analysis

IntroductionPulmonary carcinosarcoma (PC) is a rare malignant neoplasm composed of epithelial and mesenchymal components. It accounts for < 1% of thoracic cancers and is not fully understood. This study examined Surveillance, Epidemiology, and End Results (SEER) data to describe demographic and clinical characteristics of patients with PC and assessed survival outcomes by treatment modality and stage.Patients and MethodsSEER data were reviewed to identify patients diagnosed with primary PC (1973-2012). Overall survival (OS) and disease-specific survival (DSS) were analyzed by univariate/multivariable Cox proportional hazards models and Kaplan-Meier methods.ResultsA total of 411 patients were included. Median age was 67 (range, 24-96) years. Disease stage at the time of initial diagnosis was known for 74.7% of the identified patients (307/411). Of these patients, 23.1% had localized disease. Survival was significantly better for patients with localized disease (OS: 31 vs. 6 months, P < .001; DSS: 54 vs. 8 months, P < .001). Additionally, patients who received surgery alone had significantly improved OS (20 months; P < .001) and DSS (32 months; P < .001) compared to patients who received combined surgery and radiotherapy (OS: 7 months; DSS: 8 months) or radiotherapy alone (OS: 4 months; DSS: 4 months).ConclusionTreatment with surgery alone resulted in superior survival outcomes compared to other treatment modality combinations, regardless of patient age and disease stage. Within the limitations of this study, providers may wish to consider these findings when devising patient treatment plans.     

The effect of Benson’s relaxation response on sleep quality and anorexia in cancer patients undergoing chemotherapy: A randomized controlled trial

Background and objectivesPatients with cancer experience many side effects due to its nature and usual treatments. Sleep disorders and anorexia are the most commonly reported symptoms in cancer patients undergoing chemotherapy. The present study aimed to investigate the effect of Benson's Relaxation Response (BRR) on sleep quality and anorexia in cancer patients undergoing chemotherapy.Methodology and participantsIn the present clinical trial, a total of 84 patients were enrolled and randomly divided into two groups of experimental and control. Benson's relaxation response was administered to the experimental group twice a day over 5 consecutive days. Data was collected using St. Mary's Hospital Sleep Questionnaire (SMHSQ) and anorexia questionnaire with Visual Analog Scale (VAS).ResultsThe results of our study showed a significant improvement in the sleep quality in the experimental group at 24 (p = 0.02) and 48 (p = 0.001) hours after the intervention compared to the control group. Benson's relaxation response (BRR) also had a significant effect on the anorexia in the experimental group at 24 (7.5 ± 1.6) and 48 (6.9 ± 2.1) hours after the intervention compared to the control group. No side effects were reported during the study and follow-up period.ConclusionBenson's relaxation response as a complementary method may improve sleep quality and anorexia in cancer patients undergoing chemotherapy. Further studies with greater sample size and longer follow-up period are needed to confirm the current findings.     

癌症患者心理韧性质性研究的系统评价

目的 系统评价有关癌症患者心理韧性发展的真实体验,为更好地制定心理韧性干预方案提供理论依据。方法 计算机检索Cochrane Library、Medline、CINAHL、Embase、PubMed、Web of Science、Psyc INFO以及中国生物医学文献数据库、中国知网、维普、万方数据库从建库至2019年6月相关的质性研究。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准（2016）对文献进行评价,采用汇集性整合方法进行结果整合。结果 共纳入10篇文献,提炼42个明确的结果,形成8个类别,汇总成3个整合结果。①心理韧性发展是动态循环的过程：危机负性期,调节成长期,积极转化期,循环强化期;②心理韧性的阻碍因素：个体（消极应对,错误认知,症状和体象困扰）,环境（传统社会文化,医疗环境,家庭负担）;③心理韧性的保护因素：个体（积极心理与应对方式,复原经历,宗教信仰,自我表露,利他主义与行为）,环境（家庭因素,医疗照护,人际支持）。结论 心理韧性的发展是动态循环过程,受个体和环境因素影响,医护人员应根据不同阶段的影响因素给予针对性护理措施,促进患者心理韧性的形成和发展,提高患者的生活质量。     

Long-term health-related quality of life of breast cancer survivors remains impaired compared to the age-matched general population especially in young women. Results from the prospective controlled BREX exercise study

ObjectiveTo investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial.MethodsSurvivors (aged 35–68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age ≤ 50) and older (age >50) survivors’ HRQoL was compared to that of the age-matched general female population (n = 892). The analysis included 342 survivors.ResultsThe decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p = 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference −0.017, 95% CI: −0.031 to −0.004). The older survivors’ mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference −0.019, 95% CI: −0.031 to −0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up.ConclusionsHRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.     

肺癌胸膜早期种植转移:螺旋CT与手术病理对照研究

目的:评价CT诊断肺癌胸膜早期种植转移的价值,并分析漏诊原因。方法:回顾性分析43例经手术病理确诊肺癌胸膜种植转移的CT、手术病理资料,作对照研究。结果:43例中,术前CT仅诊断8例,其中Ⅲ级5例,Ⅱ级3例,诊断符合率19%(8/43),CT实际显示胸膜转移结节28例,其中Ⅰ级10例、Ⅱ级13例,Ⅲ级5例,未显示Ⅰ级15例,CT检出率为65%(28/43)。28例中,术前CT漏诊Ⅰ级和Ⅱ级各10例,漏诊率71%(20/28)。20例中,CT漏诊叶间胸膜、肺表面脏层胸膜、纵隔胸膜、肋胸膜、膈胸膜转移,漏诊率分别为0%、33%、36%、43%、80%。结论:CT能准确检出、诊断肺癌中晚期胸膜转移,但检出胸膜早期微小病灶有明显局限性,在CT诊断中,忽视对膈胸膜、肋胸膜、肺表面脏胸膜上Ⅰ、Ⅱ级较早转移灶的观察,是导致漏诊的原因之一。     

螺旋CT导引下肺部肿瘤射频热消融治疗的应用研究

目的 通过对肺肿瘤射频热消融（RFA）治疗效果的观察，评价其技术特点、安全性和疗效。方法 30例肺肿瘤患者共46个肿瘤接受了RFA治疗（其中肺部原发性肿瘤20例，转移瘤10例），在CT引导下将消融电极刺入到距肿瘤边缘组织1cm处，根据病灶大小，将子针打开至合适直径，达到靶温度后，持续7～15min。对患者进行1～9个月的随访，通过胸部X线片和增强螺旋CT观察治疗效果。结果 30例患者46个肿瘤，共做消融灶123个，治疗区域坏死率为100％。（1）随访1个月30例，46个肿瘤瘤体完全消融41个，占89.13％；部分消融5个，占10.87％。（2）随访3～9个月26例，40个肿瘤病灶完全缓解（CR）33个，部分缓解（PR）4个，无变化（NC）2个，进展（PD）1个，总有效率达925％（37／40）。结论 RFA治疗肺部肿瘤疗效肯定、安全，是1种应用前景较好的方法。     

经肺动脉与支气管动脉血管造影的CTA观察原发肺癌的血供

目的用支气管动脉(BA)和肺动脉(PA)造影CTA观察肺癌血供情况。方法前瞻性观察6例支气管肺癌患者,分别行体循环动脉和肺动脉数字减影血管造影(DSA)后,留置BA导管与PA导管行CTBA与CTPA,观察BA与PA对肺癌的血供。结果CTPA上,无体动脉与左心强化的图像上肿瘤未见强化,有体动脉或左心强化的图像上见肿瘤边缘强化,CT强化值为10.0~45.6 Hu。CTBA上肿瘤部分明显强化,CT强化值为150.3~320.7 Hu,可见杂乱无章的肿瘤血管影,3例见纵隔淋巴结强化。结论本组病例观察表明原发性肺癌由BA为主的多发体循环动脉供血,未发现PA参与供血。     

A new bioabsorbable sleeve for lung staple-line reinforcement (FOREseal™): report of a three-center phase II clinical trial

Objective: To investigate on the feasibility, safety, and effectiveness of a new bioabsorbable material for lung staple-line reinforcement. Methods: This prospective open trial included 66 patients (mean age of 56 ± 17 years) who underwent various types of lung resection using staplers with knitted calcium alginate sleeves for buttressing (FOREseal™, Laboratoires Brothier, Nanterre, France) at three academic centers: 29 lobectomies, 22 emphysema surgeries, 15 wedge resections or lung biopsies. Intraoperative air leakage was assessed at a mean respiratory peak pressure of 30 cmH₂O, and rated as grade 1, 2, or 3. Persistent air leakage in the postoperative course, as well as any relevant event, was assessed daily. The follow-up period was of 6 months. Results: No technical problem linked to the device occurred. Hemostasis of the cutting edges was completed in all patients. Fifty-six percent of the patients had no intraoperative air leak and 27.3% had grade 1 leaks. Mean postoperative air leaks and thoracic drainage times were 1.9 ± 2.3 days and 6 ± 5.3 days, respectively. In-hospital mortality was nil. There was no empyema. Mean hospital stay was 9.1 ± 6.6 days. At follow-up, one patient underwent lung transplantation, and pathology of the explanted specimen showed the absence of device-related foreign-body inflammation. One patient complained from metalloptysis, and another one, with a metastatic invasive aspergillosis, developed an infectious recurrence that required reoperation. Conclusions: FOREseal is an ergonomic, safe, and promising new material instead of nonabsorbable materials and xenomaterials for staple-line reinforcement. A randomized comparative study is now in progress.