BACKGROUND:Patients undergoing esophageal cancer surgery often experience multidimensional preoperative fear. Quantitative assessments alone may not fully capture how these fears are understood and experienced. AIM:To examine the network structure of preoperative fear and explore patients' experiences through integrated quantitative and qualitative findings. METHODS:A convergent mixed-methods design was used. Quantitative data were collected from 584 patients using the Surgical Fear Questionnaire and analyzed with network analysis. Qualitative data were obtained through semi-structured interviews with 18 patients and analyzed using codebook thematic analysis. Findings were integrated through a joint display. RESULTS:FEAR3 (fear of pain) had the highest expected influence and occupied the most central position in the network. The strongest connection was between FEAR3 and FEAR4 (fear of side effects). FEAR5 (fear of health deterioration) showed the highest mean score but lower expected influence. Four themes were identified: fears of deterioration, incomplete recovery, and burden; anticipating surgical pain; fear arising from limited understanding and fragmented information; and loss of bodily control during surgery and anesthesia. Integration showed that fear of pain was both statistically central and experientially salient, while qualitative findings expanded understanding of concerns related to information uncertainty, dignity, bodily control, and vulnerability. CONCLUSION:Preoperative fear in patients with esophageal cancer involves interconnected concerns about pain, side effects, health deterioration, recovery, information uncertainty, and loss of control. Pain-related fear may be an important focus for preoperative nursing assessment and education. Patient-centered preoperative care should address pain expectations, recovery concerns, information needs, and issues of dignity and control.

目的:探讨三联预康复策略对肺移植等待期患者术后结局及短期生活质量的影响.方法:选取2019年1月1日～2020年1月31日收治的98例行肺移植手术患者随机分为观察组和对照组各49例,观察组接受三联预康复策略干预,对照组接受常规护理,比较两组术后结局、生活质量[采用中文版肺移植特异性生活质量量表(LT-QOL)]、心理状态[采用移植评估等级量表(TERS)和移植候选人的心理社会评估量表(PACT)].结果:干预后,两组TERS、PACT评分均低于干预前(P<0.05),且观察组低于对照组(P<0.01);观察组症状维度、情感健康维度、功能维度评分均低于对照组(P<0.05);两组1、2年内生存率比较差异无统计学意义(P>0.05).结论:将三联预康复应用于肺移植患者中,有利于改善患者社会心理状态,提高生活质量.

介绍了体力活动的概念、指南推荐和肺移植病人进行体力活动的必要性,综述了肺移植病人体力活动水平现状、影响肺移植病人体力活动的障碍因素及促进策略,以期为我国肺移植病人体力活动干预方案的制定及临床实践指导提供参考.

目的 探讨Seminar联合以案例为中心的案例教学法(CBT)在胸外科实习护生教学中的应用效果.方法 选取 2021 年 1 月—2022 年 6 月在河南省某三级甲等医院胸外科实习的 86 名护生作为研究对象,按照组间基线资料具有可比性的原则将其分为观察组和对照组,各 43 名.对照组实施传统教学法,观察组实施Seminar联合CBT教学法.两组护生均给予 4 节课时的教学,每周 1 节课时.比较两组教学后护生对教学方法的应用效果评价、教学满意程度和教学前后护生的考核成绩、自我导向学习能力、批判性思维能力、沟通能力、学习积极主动性评分.结果 教学后观察组护生护生理论成绩、操作成绩、批判性思维能力、沟通能力、学习积极主动性评分,以及人际关系技能、学习评价、学习行为、学习策略、学习意识评分和自我导向学习能力总分均高于对照组.教学后观察组护生教学满意程度高于对照组,差异有统计学意义(P<0.05).教学后观察组护生对教学方法各方面的评价持肯定态度且肯定率均超过75.00%.结论 Seminar联合CBT教学模式应用在胸外科实习护生教学中可有效提升护生的批判性思维能力、沟通能力,并促进护生学习积极主动性的提高,提高护生的理论及操作考核成绩,有利于其自我导向学习能力水平的提升,且该教学方法的应用肯定度和教学满意程度较高.

The purpose of this study was to explore the relationship among unmet care needs, social support, and anxiety in patients with lung transplantation. We conducted a cross-sectional study; 173 lung transplant patients who met the inclusion criteria completed questionnaires including the Organ Transplant Recipient Care Needs Scale, the Perceived Social Support Scale, and the Anxiety Self-Rating Inventory. Pearson's correlations and multiple linear regression analyses were used to test the relationship between the selected variables. The results showed a moderate level of unmet care needs at home for lung transplant patients. Education level, transplant-related complications, perceived social support, and anxiety were significantly correlated with unmet care needs of lung transplant patients at home (p < .05), explaining 23.8% of the total variance for unmet care needs. Further research is required to explore interventions to reduce the level of unmet care needs of lung transplant patients.

Over the past few decades, increasing efforts have been made to improve the understanding of, and treatment options for, lung adenocarcinoma (LUAD). However, considering the heterogeneity of LUAD, precise proteomics-based characterization at the molecular level is an urgent clinical requirement for effective treatment. Formalin-fixed, paraffin-embedded (FFPE) tissue is a good option as the working tool for proteomics studies. The present study aimed to obtain a global protein profile using LUAD FFPE tissue samples. Using a quantitative proteomics approach, the study revealed that 360 proteins were significantly more highly expressed in LUAD than in adjacent nontumor lung tissues. Also, 19 differentially expressed membrane proteins were found to be primarily responsible for immune processes. Epidermal growth factor (EGF)-like domain and laminin EGF domain showed markedly different expression levels between cancer tissues and tumor-adjacent normal tissues. Furthermore, Gene Ontology functional enrichment analysis showed that significantly upregulated proteins were associated with the endoplasmic reticulum lumen, protein disulfide isomerase activity, vitamin binding, cell cycle G(1)/S phase transition, to name but a few. Also, numerous kinases and post-translational modification enzymes were significantly upregulated across all eight LUAD samples compared with paracarcinoma tissues. Proteomics analysis revealed that AAA domain containing 3A (ATAD3a), a member of the ATPase family, was highly expressed in LUAD tissues, which was supported by immunohistochemical analysis. Furthermore, the study confirmed that ATAD3a enhanced the cisplatin sensitivity of LUAD cells. Collectively, the findings of the present study provide new potential candidate targets in patients with LUAD, and may aid auxiliary LUAD diagnosis and surveillance in a noninvasive manner.

总结新型冠状病毒肺炎疫情期间肺移植患者的居家管理体会.成立居家随访团队实施线上随访,根据患者病情个体化调整用药方案,做好突发病情时的入院治疗,实施互联网智慧健康服务,做好居家康复护理.共随访32例肺移植患者,未发现新型冠状病毒肺炎疑似病例,患者情绪较为稳定,期间2例患者出现不适症状,经治疗后好转,其他患者病情稳定,继续居家随访.

目的 总结和分析肺移植受者术后早期感染特点及预后.方法 回顾性分析河南省人民医院肺移植科2015年10月至2018年1月实施的30例肺移植受者临床资料.供肺来自于27例心脏死亡器官捐献供者.30例受者中双肺移植2例,单肺移植28例.受者术中予亚胺培南西司他丁,术后联合应用亚胺培南西司他丁+卡泊芬净+更昔洛韦预防感染.术后免疫抑制方案为他克莫司+吗替麦考酚酯+泼尼松.住院期间对受者常规行胸部X线或胸部CT、支气管镜检查和病原学监测等;术后3个月内每1至2周门诊随访1次.结果 2例供者气道分泌物培养阳性,1例考虑为非结核分枝杆菌感染.术后30 d内,22例受者共发生24例次细菌感染(呼吸系统感染21例次,血流感染3例次),感染发生率为73.3％(22/30).呼吸系统感染包括单纯气道感染9例次,气道感染合并侵袭性肺部感染9例次,胸腔感染3例次.呼吸系统感染中16例次为单一病原体感染,5例次为2种及以上病原体混合感染.呼吸系统感染共分离出病原体26株:鲍曼不动杆菌10株(8株为泛耐药),耐碳氢酶烯类肺炎克雷伯杆菌5株,铜绿假单胞菌3株(2株为泛耐药),泛耐药嗜麦芽窄食单胞菌和泛耐药纹带棒杆菌各2株,黏质沙雷菌、阴沟肠杆菌、耐甲氧西林金黄色葡萄球菌和非结核分枝杆菌各1株.血流感染包括耐碳氢酶烯类肺炎克雷伯杆菌2例次和脑膜炎黄杆菌1例次.21例次呼吸系统细菌感染中考虑合并真菌感染3例次.10例鲍曼不动杆菌感染受者经治疗后,7例感染控制,其余3例分别于肺移植术后第40、45和60天死亡.5例耐碳氢酶烯类肺炎克雷伯杆菌感染受者抗感染治疗后,4例感染控制,1例于肺移植术后第50天死亡.随访至2019年7月,9例受者死亡,其余受者均可进行日常活动.结论 肺移植术后早期感染以气道感染和移植肺侵袭性感染多见,感染病原体以泛耐药或多耐药的革兰阴性杆菌为主.

Objective To evaluate the effect of perioperative nutritional support on the prognosis of lung transplant.Methods Retrospective analysis was carried out on nutritional support for 6 lung transplant recipients in the Department of Thoracic Surgery in Henan Provincial People's Hospital between September 2015 and September 2016.The recipients were all males,with ages ranging from 28 to 60 (40± 12.1).The recipients' body mass index (BMI),serum albumin and pulmonary function at the first test after admission (t1),the last test before surgery (t2) and the last test after surgery (t3) were compared.The recipients' nutritional status was assessed with subjective global assessment.Results The 6 patients had successful single-lung transplant,without mortality or severe complications.At t3,all of them had increases in BMI by (2.4±1.4) kg/m2,weight by (3.2±1.2) kg,deltoid skin-fold thickness by (3.0±0.35) mm,prealbumin by (30±10.4) g/L,total protein (15.2±6.4) g/L,albumin by (6.4±4.1) g/L,triglyceride by (0.2± 1.4) mmoL/L,and total cholesterol by (1.4± 0.9) mmol/L (P＜0.01).The patients were followed up for 6 to 12 months.SGA results suggested no abnormality in their nutrition,and the patients were well able to function independently.Conclusion Nutritional support is vital for patients with severe malnutrition during the perioperative period of lung transplant,and can significantly improve the patient's quality of life.

Objective To summarize perioperative lung transplantation patients psychological problems and coping strategies to provide lung transplant team a reference in diagnosis and care for such patients. Methods Visits 3 cases of patients with end -stage lung disease implementation allograft right single lung transplantation surgery,understand the perioperative psychological problems,analyze the reasons and explore coping strategies. Results Lung transplantation patients in perioperative have psychological problems,after targeted intervention of nursing,Patients can actively cooperate with the treatment and perioperative care. The index were stable after 21,27,28,22,25 days, discharged. Conclusion Carrying out targeted nursing interventions to perioperative Lung transplant patients with psychological problems can improve patientsˊs mental health and body function which is benificial for patients with perioperative rehabilitation.

Objective: To evaluate the efficacy of pleural abrasion in treatment of spontaneous pneumothorax with video-assisted thoracic surgery (VATS) for bullae resection. Methods: The clinical data of 158 patients with initial spontaneous pneumothorax who underwent video-assisted thoracic wedge resections with or without pleural abrasion in Henan Provincial People's Hospital from June 2010 to June 2015 were retrospectively analyzed. The patients were assigned to two equal groups according to whether pleural abrasion was applied or not: experimental group (with pleural abrasion) and control group (without pleural abrasion); and there were 79 patients in each group.There were 62 males and 17 females aged 15-60 years (mean age 34 years) in pleural abrasion group. And there were 70 males and 9 females aged 18-60 years (mean age 38 years) in non-pleural abrasion group.After surgery, all patients were evaluated for postoperative pain, chest tube removal time, hospital stay and other complications.Independent samples t test was used to compare the data between groups. Results: Surgeries for 158 patients were performed successfully.No mortality occurred.There was no conversion to thoracotomy.Postoperative pain, operation time, intraoperative blood loss, chest tube removal time, pleural canals flowand average hospital stay in non-pleural abrasion group was significantly lower for 4.4, 19 minutes, 10 ml, 21 hours, 87 ml and 1.4 days respectively when compared with those in pleural abrasion group (t=32.478, 7.140, 11.093, 7.288, 10.246, 8.070, all P<0.05). There was no missing case with a follow-up of 30 months.No complications, such as pneumothorax, was observed. Conclusions: Postoperative pain, chest tube removal time and hospital stay in non-pleural abrasion group are all lower than those in pleural abrasion group.And there is no significant difference in the recurrence of pneumothorax between the two groups after VATS bullae resection.

The MRI findings of 6 small acoustic neuromas proved by surgery and pathology were analyzed in detail and compared with CT air cisternography. The MRI features of small acoustic neuromas include that small lesions produce thickening of the nerve or partial or entire filling of the internal auditory canal. In T1-weighted images, the tumor is of higher signal intensity than CSF, but is the same as the brain in T 2-weighted images, the tumor is brighter than the brain. MRI makes possible the diagnosis of small acoustic neuromas without subjecting the patients to invasive procedures or exposing them to X-radiation. Comparing MRI with CT air cisternography, we conclude that MRI is more convenient than CT and causes no postoperative complications.

11 patients with angiographically occult intracranial vascular malformations proved by surgery and pathology were studied by magnetic resonance imaging (MRI). The chief MRI findings were: On T1-weighted imaging, there was a homogeneous or heterogeneous hyperintensity or isointensity signal at the centre of the lesion with a surrounding rim of hypointensity signal; On T2-weighted imaging, there was a hyperintensity signal at the centre and hypointensity signal at the peripheral region. Differential diagnosis between hemorrhagic tumor and occult vascular malformation lies in that the latter has no edema and is often single. comparing with CT, the size of occult vascular malformation on MRI was equal to that on CT.