Objective To evaluate the impact of total thyroidectomy on health-related quality of life （HRQOL） in patients with nodular goiter. Methods The patients who underwent total thyroidectomy from Jan. 2009 to Dec. 2011 in our hospital were retrospectively analyzed with regard to the quality of life （total thyroidectomy group）. The patients with similar demographic features who underwent hemithyroidectomy during the same period were matched as control （hemi-thyroidectomy group）. The validated HRQOL instrument， which was the Euro quality of life-5D （EQ-5D）， was applied to measure the HRQOL. Comparison of HRQOL in patients of 2 groups was performed， meanwhile， the data of total thyroidectomy group was compared with data of normal population who were obtained from The Forth National Health Survey. Results There were 26 and 28 valid questionnaires returned for the total thyroidectomy group and hemithyroi-dectomy group respectively. The demographic features of patients in 2 groups were comparable. No significant variancecould be found between the 2 groups that there were no significant differences on the mobility， self-care， usual activities，pain/discomfort， anxiety/depression， and visual analogous scales （P＞0.05）. Furthermore， no significant differences in HRQOL were found in EQ-5D questionnaire compared with normal population derived from The Forth National Health Survey （P＞0.05）， except that there were more patients complained of moderate and severe pain/discomfort in the total thyroidectomy group 〔30.8% （8/26） vs.9.2% （16 330/177 501）， P＜0.01〕. Conclusion Total thyroidectomy appears to have little impact on the quality of life in the patients with nodular goiter.
European system for cardiac operative risk evaluation(EuroSCORE) is one of the widely used and influential cardiac surgery risk assessment system. It was originally used to predict the quantitative score of probability of death after cardiac surgery. After that, it has been developed to predict long-term mortality and survival rate, ICU residence time, treatment costs, main complications and so on. EuroSCORE Ⅱ is the latest version, which is more accurate in predicting mortality, long term survival rate than the old one. But there are also some limitations as predicting limited range of the end, underestimating the mortality of critically endangered patients, lacking adequate preoperative risk factors and so on. This review article focuses on the production, development and clinical application of EuroSCORE.
Local treatment improves the outcomes for oligometastatic disease, an intermediate state between locoregional and widespread disease. However, consensus about the definition, diagnosis and treatment of oligometastatic oesophagogastric cancer is lacking. The first edition "Definition, diagnosis and treatment of oligometastatic oesophagogastric cancer: A Delphi consensus study in Europe" was published on February 15, 2023 by 65 European medical specialists. In this article, the consensus will be interpreted to provide new idea for the diagnosis and treatment of oligometastatic oesophagogastric cancer for Chinese clinicians.
The diagnosis and management of congenital heart disease (CHD), the most common inborn defect, has been a tremendous success of modern medicine. With the development of diagnostic techniques, surgical procedures and interventional techniques, more than 90% of CHD children can survive to adulthood. Consequently, the prevalence of patients with CHD has shifted away from infancy and childhood towards adulthood. Adult CHD cardiology is now encompassing not only young or middle-aged adults but also patients aged above 60 years. Standardized guidelines can provide good theoretical support for the comprehensive management of adult CHD. Ten years after the European Society of Cardiology guidelines for the management of grown-up CHD released in 2010, the new version was officially released in August 2020. The new version of guidelines updated the classification and stratification of diseases, comprehensive intervention methods and intervention timing, and put forward some new concepts, new intervention standards and methods. For adult CHD that has not been repaired or needs to be repaired again, the indication and mode of surgical intervention and perioperative management have a great impact on the prognosis. The new version of the guidelines provides a detailed description of the surgical and intervention indications and methods for different diseases, and clarifies the management methods for high-risk groups. This article attempts to interpret this newly updated guideline from the perspective of a surgeon, sort out several key diseases introduced by the guideline, and strives to provide a concise and actionable guideline for domestic counterparts.
Objective To analyze the early clinical outcome of high-operative-risk coronary artery bypass grafting （CABG） classified according European System for Cardiac Operative Risk Evaluation （EuroSCORE）. Methods Classified eighty-four patients accepted CABG from Feb. 2004 to Sep. 2004 in our ward to high-operativerisk group （≥6, n=40） and low-medium-operative-risk group （0-5, n=44） according EuroSCORE. Record the operative schemes, complications after operation and evaluate the severe state with acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） and sequential organ failure assessment（SOFA） for all patients. Compare the early clinical outcome between the two groups. Results The operative mortality, ratio of long ICU-staying time, incidence of complications and severe degree of high-operative-risk group were higher than those in the low-mediumoperative-risk group. Standard EuroSCORE had significant positive correlation with either of A0, A1, Amax or S1, Smax counted in total patients （P〈0. 01）, and the same as logistic EuroSCORE （P〈 0. 05）. But when compared the relationships in certain risk ranks, only in high-operative-risk group the positive correlation was found between standard EuroSCORE and A1, Amax, S1 and Smax （P〈 0. 05）, between logistic EuroSCORE and Amax （P〈 0. 05）. Conclusion EuroSCORE could evaluate overall operative risk perfectly in our patients, and maybe more sensitively in the high-operative-risk patients. Many factors could improve the prognosis of high-operative-risk patients： accurate evaluation of the operative risk before surgery; perfect myocardial protection, effective myocardial revascularization and thorough correction of malformation in operation, and proper postoperative management in time.
ObjectiveTo evaluate the validity of European System for Cardiac Operative Risk Evaluation (EuroSCORE) Ⅱ for predicting in-hospital mortality and prolonged ICU stay after Sun's procedure (total aortic arch replacement with stented elephant trunk implantation) for Stanford type A aortic dissection (STAAD). MethodsClinical data of 384 STAAD patients undergoing Sun's procedure in Beijing Anzhen Hospital between February 2009 and February 2012 were retrospectively analyzed, including 228 (59.38%) patients with acute STAAD. Accoding to EuroSCORE Ⅱ to predict postoperative mortality, all the patients were divided into a low-risk group, a medium-risk group, a high-risk group and an extremely-high-risk group. There were 296 patients including 52 females in the low-risk group with their age of 45.39±10.75 years, 70 patients including 19 females in the medium-risk group with their age of 47.67±11.26 years, 13 patients including 5 females in the high-risk group with their age of 53.08±4.94 years, and 5 patients including 1 female patient in the extremely-high-risk group with their age of 41.60±11.08 years. All the patients received Sun's procedure under deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. EuroSCORE Ⅱ was used to predict postoperative mortality and prolonged ICU stay. ResultsIn-hospital mortality was 8.07% (31/384). Mean length of ICU stay was 3.06 days. Length of ICU stay of 42 patients was longer than 7 days. For low-risk group, the predicted mortality was lower than the actual mortality. For medium-risk, high-risk and extremely-high-risk groups, the predicted mortality was higher than the actual mortality. EuroSCORE Ⅱ showed unsatisfactory discriminatory ability to predict postoperative mortality and prolonged ICU stay. The area under ROC curve were 0.49 and 0.52 respectively. The calibration was also poor for predicting postoperative mortality and prolonged ICU stay (P<0.001). ConclusionsEuroSCORE Ⅱ is not satisfactory for predicting mortality and prolonged ICU stay after Sun's procedure for the treatment of STAAD. A new risk evaluating system specific for STAAD is needed.
Peripheral artery disease (PAD) of the lower extremities, which poses a major challenge in the field of global public health, has seen a rising trend in its incidence and disability rate year by year. With the continuous innovation of new diagnostic techniques, imaging evaluation methods, and treatment strategies, profound changes have taken place in the diagnosis and treatment paradigm in this field. Based on the “European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication” issued by the European Society for Vascular Surgery in 2024, we systematically reviewed the relevant international guidelines in recent years and conducted horizontal comparisons. Combining with the latest clinical research evidence, we conducted an in-depth analysis from the perspective of evidence-based medicine on the strategic evolution, technical key point updates, and clinical evidence levels of endovascular treatment for lower extremity PAD. The aim is to provide an evidence-based medical basis for clinical decision-making.
The European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines showed us venous thrombosis management in January 2022. In terms of iliac vein diseases, it retained some guiding views, upgraded some guiding views, and added some new views compared with the version 2015. It has good guidance and reference significance for medical staff and patients. The part of the guidelines about iliac vein disease is worth our interpretation.
ObjectiveTo assess the accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in predicting the in-hospital mortality of Uyghur patients and Han nationality patients undergoing heart valve surgery. MethodsClinical data of 361 consecutive patients who underwent heart valve surgery at our center from September 2012 to December 2013 were collected, including 209 Uyghur patients and 152 Han nationality patients. According to the score for additive and logistic EuroSCORE models, the patients were divided into 3 subgroups including a low risk subgroup, a moderate risk subgroup, and a high risk subgroup. The actual and predicted mortality of each risk subgroup were studied and compared. Calibration of the EuroSCORE model was assessed by the test of goodness of fit, discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. ResultsThe actual mortality was 8.03% for overall patients, 6.70% for Uyghur patients,and 9.87% for Han nationality patients. The predicted mortality by additive EuroSCORE and logistic EuroSCORE for Uyghur patients were 4.03% and 3.37%,for Han nationality patients were 4.43% and 3.77%, significantly lower than actual mortality (P<0.01). The area under the ROC curve of additive EuroSCORE and logistic EuroSCORE for overall patients were 0.606 and 0.598, for Han nationality patients were 0.574 and 0.553,and for Uyghur patients were 0.609 and 0.610. ConclusionThe additive and logistic EuroSCORE are unable to predict the in-hospital mortality accurately for Uyghur and Han nationality patients undergoing heart valve surgery. Clinical use of these model should be considered cautiously.