Jiaxing (simplified Chinese: 嘉兴; traditional Chinese: 嘉興; pinyin: Jiāxīng; Wade–Giles: Chia-hsing), alternately romanized as Kashing or Kiahsing, is a prefecture-level city in northern Zhejiang province, China. Lying on the Grand Canal of China, Jiaxing borders Hangzhou to the southwest, Huzhou to the west, Shanghai to the northeast, and the province of Jiangsu to the north. As of the 2020 census, its population was 5,400,868 and its built-up (or metro) area made of 2 urban districts was home to 1,518,654 inhabitants.
This secondary analysis of a randomized clinical trial reports the long-term survival rates and cancer- and noncancer-related causes of death associated with concurrent chemoradiotherapy with S-1 in older patients in China. QuestionIs concurrent chemoradiotherapy (CCRT) with S-1 associated with differences in survival compared with radiotherapy alone in older patients with esophageal cancer (EC)?FindingsIn this secondary analysis of a randomized clinical trial involving 298 patients with EC, the first prospective long-term data (median follow-up of 87 months) on treatment outcomes were reported. Patients in the CCRT with S-1 group showed significantly better overall survival than those in the RT-alone group, and long-term follow-up revealed no increase in noncancer-related mortality among patients receiving CCRT with S-1.MeaningThese results support CCRT with S-1 as an effective and tolerable treatment option for older patients with EC, addressing the critical evidence gap for this underrepresented population. ImportanceMost older patients with esophageal cancer (EC) are unable to complete standard platinum-based concurrent chemoradiotherapy (CCRT) due to reduced organ reserve, comorbidities, and malnutrition. A new treatment option-CCRT with S-1-has been found to have high efficacy and fewer toxic effects for this population, yet long-term data supporting its use remain limited.ObjectiveTo evaluate the long-term outcomes of CCRT with S-1 vs radiotherapy (RT) alone in older patients with EC.Design, Setting, and ParticipantsThis secondary analysis of a phase 3 randomized clinical trial conducted at 23 centers in China was not prespecified in the trial protocol. Patients aged 70 to 85 years with histologically confirmed EC were enrolled between June 1, 2016, and August 31, 2018. Data cutoff date was February 1, 2025, with an additional follow-up of 54 months beyond the primary analysis. Data were analyzed from February 1 to April 1, 2025.InterventionsPatients were randomly assigned 1:1 to receive CCRT with S-1 consisting of 54 Gy in 30 fractions with S-1, 70 mg/m2 per day on days 1 to 14 and 29 to 42, or RT alone consisting of 60 Gy in 30 fractions, 2.0 Gy per day 5 days per week.Main Outcomes and MeasuresThe primary outcome was overall survival (OS). Secondary outcomes were progression-free survival (PFS), cause-specific mortality, cumulative incidence of death from EC or other reasons, and cumulative incidences of locoregional or distant metastasis during treatment or relapse after treatment.ResultsA total of 298 patients (median [IQR] age, 77 [74-79] years; 180 males [60.4%]) were enrolled. There were 151 patients (50.7%) clinically diagnosed with stage III to IV disease. With a median (IQR) follow-up of 87 (85-92) months, the median OS was 24.7 (95% CI, 21.2-37.6) months in the CCRT group and 15.1 (95% CI, 12.4-18.6) months in the RT group (hazard ratio [HR], 0.69; 95% CI, 0.53-0.90; P = .005). The 5-year OS rates were 33.5% (95% CI, 26.7%-42.1%) and 24.4% (95% CI, 18.3%-32.4%) for the CCRT and RT groups, respectively; the 8-year OS rates were 26.2% and 16.1%, respectively. The median PFS was 18.7 (95% CI, 13.1-25.8) months in the CCRT group and 9.2 (95% CI, 7.9-12.7) months in the RT group (HR, 0.69; 95% CI, 0.54-0.90; P = .005). Cause-specific analyses showed reduced EC-related mortality with CCRT (HR, 0.67; 95% CI, 0.50-0.89; P = .005), with 8-year absolute risks of 58.5% vs 72.9%, respectively, and no excess noncancer-related mortality.Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial, long-term results showed that CCRT with S-1 was associated with a sustained survival benefit compared with RT alone, without increased noncancer-related mortality. This finding supports CCRT with S-1 as the preferred regimen for patients aged 70 to 85 years with EC.Trial RegistrationClinicalTrials.gov Identifier: NCT02813967
BackgroundBlood metabolites are crucial in various aspects of human health. However, current evidence regarding the role of circulating metabolites in various cardio-cerebrovascular diseases (CVDs) is limited. Mendelian randomisation (MR) can be used to provide information about these metabolites.ObjectivesOur primary aim was to investigate the causal relations between human blood metabolites and the risk of 10 CVDs.MethodsWe conducted a two-sample MR study. Data on 486 human blood metabolites were obtained from a genome-wide association study (GWAS) involving 7824 participants. Outcome data were sourced from the most recent large-scale GWAS meta-analysis by FinnGen (R9) on various CVDs. The inverse variance-weighted (IVW) model was used as the primary method for this analysis. Moreover, we performed sensitivity analyses, which included heterogeneity testing, horizontal pleiotropy testing and leave-one-out analysis, to evaluate the robustness and credibility of the findings.ResultsThis study identified 36 known metabolites potentially associated with 10 CVDs, and sensitivity analyses showed no significant heterogeneity or pleiotropy.ConclusionsOur study utilised systematic MR analyses and provides evidence for the causal relations between blood metabolites and CVDs. This sheds new light on the potential mechanisms underlying various CVDs and holds significant implications for screening, preventing and treating these conditions.
ABSTRACT Primary cardiac lipomas are rare benign tumors that are usually indolent but may cause compression or arrhythmia when large. We sought to describe the safety and feasibility of a totally thoracoscopic, off‐pump approach for their resection. A 33‐year‐old asymptomatic woman was found to have a 5.1 × 3.6 cm fat‐density mass at the roof of the right atrium compressing the superior vena cava. Under general anesthesia, a three‐port right‐sided thoracoscopic resection was performed on the beating heart without cardiopulmonary bypass. The tumor was completely excised with an intact capsule. Operative time was 120 min and blood loss was 50 mL. Histopathology confirmed a mature cardiac lipoma. The patient was discharged on postoperative day 5 and remained recurrence‐free at 1‐month echocardiographic follow‐up. A totally thoracoscopic, off‐pump technique is a safe, minimally invasive alternative to median sternotomy for selected right‐atrial lipomas, providing shorter recovery and superior cosmesis. Early elective resection is warranted when the tumor reaches ≥ 5 cm or causes compression, even in asymptomatic patients.
Reflective ability is widely regarded as an important competency in clinical nursing education and may be related to nurses’ professional growth and continuing development. Clinical nurse preceptors serve as an important link between nursing education and clinical practice while simultaneously undertaking clinical and teaching responsibilities. Their reflective ability may therefore be relevant not only to their own educational practice but also to the reflective learning and professional development of the nurses they supervise. However, evidence regarding factors associated with reflective ability among clinical nurse preceptors remains limited. Guided by the Teacher Onion Model of Reflection, this study aimed to examine the associations among leisure crafting, work stress, emotional intelligence, and reflective ability among clinical nurse preceptors. A cross-sectional study using convenience sampling was conducted among clinical nurse preceptors from four tertiary hospitals in Jiaxing and Ningbo, Zhejiang Province, China. Data were collected using the Leisure Crafting Scale, the Challenge–Hindrance Work Stress Scale, the Emotional Intelligence Scale, and the Clinical Nurse Reflective Ability Scale. Model-based path analysis with bootstrap estimation was used to examine whether the observed associations were consistent with the hypothesized indirect pathways among the study variables. The mean reflective ability score among clinical nurse preceptors was 55.09 ± 18.58. In the path model, leisure crafting was directly and positively associated with reflective ability (β = 0.122, P < 0.01). The model-estimated indirect associations involving challenge stress and hindrance stress were statistically significant (β = 0.073 and 0.120, respectively; both P < 0.01), as was the indirect association involving emotional intelligence (β = 0.081, P < 0.01). The observed data were also consistent with statistically significant sequential indirect associations involving work stress and emotional intelligence, including the leisure crafting–challenge stress–emotional intelligence–reflective ability pathway and the leisure crafting–hindrance stress–emotional intelligence–reflective ability pathway (β = 0.034 and 0.022, respectively; both P < 0.01). The findings suggest that reflective ability among clinical nurse preceptors may be related to both contextual and psychological factors. Leisure crafting was directly associated with reflective ability, and the model also showed indirect associations involving work stress and emotional intelligence. Applying the Teacher Onion Model of Reflection to clinical nurse preceptors provides an integrated perspective on factors associated with reflective ability and may inform multidimensional approaches to supporting reflective practice in clinical nursing education. Not applicable.
