No abstract

Objective To investigate the effect and clinical significance of different thoracic surgical approaches for patients with stage IIB–IVA esophageal squamous cell carcinoma on the survival and prognosis of postoperative radiotherapy patients. Methods One hundred thirty-two patients with stage IIB–IVA esophageal squamous cancer who received radiotherapy after surgery were screened for baseline characteristics and survival analysis. The Kaplan-Meier method was used to draw the survival curve for the follow-up data, and the log-rank test was used to compare the difference in survival rate between the two groups. The Cox regression model was used for multivariate survival analysis. Result For stage IIB–IVA esophageal squamous cell carcinoma, the results of multivariate analysis showed that different surgical methods and clinical staging were independent factors affecting the survival and prognosis of patients after radiotherapy. The 1-, 3-, and 5-year survival rates of patients with advanced esophageal cancer through the left chest approach were 84.2%, 61.4%, and 36.8% respectively. The 1-, 3-, and 5-year survival rates of patients with advanced esophageal cancer through the right chest approach were 73.3%, 40.0%, and 21.3% respectively. There was no significant difference in the 1-year survival rate (P = 0.135) between the two surgical procedures. The 3-year survival rate (P < 0.05) and the 5-year survival rate (P < 0.05) were significantly different. Conclusion For patients with stage IIB–IVA esophageal squamous cell carcinoma undergoing radiotherapy after surgery, the long-term survival prognosis of patients after the left thoracic approach is significantly higher than that of the right thoracic approach.

Background As China's aging population continues to grow, the prevalence of mental illness among the elderly has been steadily increasing.The aim of this study is to reveal the changing trends and characteristics of economic burden among elderly patients with long-term hospitalization for mental illness, and to analyze the influencing factors. Methods In a retrospective analysis, The data for this study was gathered from elderly patients with mental illness who were hospitalized and aged 60 years or older. The patients were admitted to four specialized and general hospitals located in Dalian city between January 2018 and December 2020. Firstly, This study analyzed the basic characteristics of elderly patients with mental illness, with a focus on their personal characteristics. Secondly, the study examined the disease status of elderly patients by analyzing disease-related information of those who were hospitalized for an extended period. Finally, the study analyzed the influencing factors of hospitalization costs for elderly patients with different diseases, based on the differences in hospitalization costs for elderly patients with mental illness among various factors. Results Among the 3871 study subjects, the average length of hospital stay was 127.51 days (median 104.00, interquartile range 77.00-154.00).The average hospitalization expenses per case were 33,656.07 yuan (median 27,789.79, interquartile range 19,208.48-38,424.27). Patients were primarily hospitalized in specialized hospitals, and their subaverage hospitalization costs decreased year by year.The primary diagnosis for patient discharge was affective disorders (mood disorders) (ICD-10: F30-F39), and the hospitalization expenses for this disease increased annually over the three-year period.the length of hospital stay was found to be a significant factor affecting all six types of mental illnesses and had the most significant impact on the hospitalization costs of elderly patients with different mental illnesses. Moreover, the hospital category also had a significant impact on the hospitalization costs of elderly patients with all six types of mental illnesses. The payment method of medical insurance had a significant impact on the hospitalization costs of elderly patients with five types of mental illnesses, except for affective disorders. When compared to other types of medical insurance, employee medical insurance had a more significant impact on the hospitalization costs of elderly patients with two types of mental illnesses. Additionally, age only had a significant impact on the hospitalization costs of elderly patients with organic (including symptomatic) mental disorders. The presence of a 31-day readmission plan had a significant impact on the hospitalization costs of elderly patients with four types of mental illnesses. Moreover, the number of physical illnesses had a significant impact on the hospitalization costs of elderly patients with neurotic, stress-related, and somatoform disorders. Conclusions Elderly patients with mental illness who receive treatment in specialized hospitals have higher hospitalization costs. Long-term hospitalization increase the total hospitalization costs. Age have an impact on hospitalization costs for patients with organic mental disorders. Patients with two types of mental illnesses who are covered by urban employee medical insurance have higher hospitalization costs.Patients with severe mental illnesses who have a 31-day readmission plan tend to have higher hospitalization costs.Patients with somatic symptom disorders and concurrent physical illnesses often incur higher hospitalization costs.These findings provide a basis for the development of prevention and control measures for elderly mental illness, and offer a reference for the development of health services and security systems for elderly mental illness.

Right atrial thrombosis, which occurs alone, is rare in clinical practice. Its incidence and mechanism are unclear, but susceptibility factors are usually present at its occurrence: ischemic heart disease, heart failure, atrial fibrillation, and chronic kidney disease. Complete isolated right atrial thrombosis rarely occurs. We report here a 47-year-old male patient with a right atrial mass on cardiac ultrasound and chest computed tomography (CT) and a history of previous right heart surgery with type 2 diabetes mellitus and atrial fibrillation, complaining of “chest tightness and shortness of breath after activity for half a month.” The patient was admitted to the hospital and underwent right atrial mass resection, and the postoperative pathology showed “right atrial thrombus.” As right atrial thrombus is very rare and can be a serious threat to life when it occurs in the heart, the prevention and treatment of right atrial thrombus are very important. Based on the analysis of this case, we believe that for patients with special medical history such as “post right heart surgery and atrial fibrillation,” we need to be vigilant for atrial thrombosis.