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@#Objective To evaluate the feasibility and safety of single utility port video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for lung diseases. Methods We performed a retrospective review of 155 patients undergoing single utility port VATS anatomic segmentectomy from January 2015 to December 2016. There were 62 males and 93 females with a mean age of 53 (24–82) years. Two ports were used. The camera was through the port for observation which was about 1.5 cm in length and located at the 7th or 6th intercostal space. The instruments were through port for operation that was about 3–4 cm in length and located at the 4th or 3th intercostal space. Pulmonary segment vessel and segmental bronchi were cut and stitched by Hemolock or linear cut stapler. Different segments were separated by linear cut stapler. Perioperative data were collected and analyzed. Results One patient was performed suture under the auxiliary operating hole (three holes) because of pulmonary artery bleeding. The remaining 154 patients underwent single utility port VATS anatomic segmentectomy successfully. No conversion to open procedure or lobectomy was found and there was no perioperative mortality. The median operative time was 102 (65–150) min and the median blood loss in operation was 118 (50–300) ml. The thoracic drainage time was 3.8 (2–7) d and the median hospital stay after operation was 5.6 (3–9) d . Major morbidity occurred in 8 patients (5.2%) including hemoptysis (in 2 patients), pneumonia (in 2 patients), aerodermectasia (in 1 patient), pleural effussion (in 1 patient) and local atelectasis (in 1 patient). All of them above healed after symptomatic treatment. Patholocal examination showed there were 139 patients of primary lung carcinoma (pathologically staged as Tis-T1bN0M0), 9 patients of benign diseases and 7 patients of metastasis tumor. Conclusion Single utility port VATS anatomic segmentectomy procedure is safe and feasible. It can be utilized as an option for those with non-small cell lung cancer staged Ⅰa and those unable to tolerate pulmonary lobectomy.
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@#Objective To explore the feasibility and efficacy in therapy of pectus excavatum using novel modified Nuss procedure after congenital heart disease (CHD) operation. Methods Thirty-six children (including 22 males and 14 females with an average age of 4.5±2.2 years ranging 2.8-18.0 years) with pectus excavatum after CHD operation from January 2011 to March 2015 were selected as an observation group. Thirty-eight pectus excavatum children (including 24 males and 14 females with an average age of 4.0±2.5 years ranging 2.8-20.0 years) without CHD from July to September 2013 were selected as a control group. The novel modified Nuss procedure was performed on the patients in both groups. The operation time, intraoperative blood loss, hospital stay as well as postoperative complications between two groups were reviewed and analyzed. Results In the observation group, the operation time was 50-72 (60.50±3.60) min and hospital stay was 4-6 (4.41±0.80) d. Meanwhile, the intraoperative blood loss was 5-10 (5.82±0.35) ml. In the control group, the operation time was 12-45 (20.15±0.68) min, hospital stay was 4-7 (4.61±0.63) d and the intraoperative blood loss was 3-8 (4.62±0.28) ml. The operation time was significantly longer in the observation group than that in the control group (P<0.05). But there was no significant difference in intraoperative blood loss or hospital stay between the two groups (P>0.05). No cardiac rupture happened in the two groups. Conclusion The novel modified Nuss procedure is safe and feasible for pectus excavatum after CHD operation with optimal outcomes.
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@#Objective To introduce the surgical and perioperative strategy for giant mediastinal mass. Methods The clinical data of 21 patients with giant mediastinal mass who underwent surgical treatment in Xinhua Hospital of Shanghai from January 2007 to July 2016 were retrospectively reviewed. There were 14 males and 7 females, with a mean age of 34.62 ± 22.95 years (range: 11 months to 79 years), and mean weight of 58.07±22.24 kg (range: 10.8 to 90.5 kg). Their clinical manifestation, anesthesia methods, surgical treatment and the prognosis were analyzed. Results The tumor volume ranged from 8 cm×6 cm×6 cm to 25 cm×25 cm×8 cm. For surgical approach, 12 patients received median sternotomy, 5 anterior lateral incision, 1 posterior lateral incision, 2 "L"-shape sternotomy, 1 cervical and thoracic "]"-shape incision. All patients were given mass radical resection, except one patient with two-stage resection. Twelve patients needed other tissues resection besides the single tomor resection. The operation time was 55-480 (207.86±87.67) min, blood loss volume 700 (10-4 000) ml, intraoperative blood transfusion 800 (0-4 100) ml, postoperative mechanical ventilation time 4.75 (0-87) h, postoperative drainage time 3-12 (7.43±2.66) d, the total drainage volume 295-4 940 (1 584.76±1 173.98) ml, average daily drainage volume 62-494 (204.90±105.76) ml, and postoperative hospital stay 7-47 (11.86±8.51) d. The postoperative complications included pericardial effusion in 1 patient, Horner syndrome in 1, left recurrent laryngeal nerve injury with the left phrenic nerve injury in 1, right phrenic nerve injury in 1 and delayed wound healing in 1. The remaining patients recovered well. All patients were followed up for 1 month to 9 years. Till September 1, 2016, 5 patients died and 2 suffered recurrent tumor. Conclusion It is safe to perform surgical treatment after comprehensive evaluation of patients with giant mediastinal mass, perioperative mortality is low, and prognosis in patients with benign tumor is good.
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Objective To improve the preparation of bronchoalveolar lavage fluid(BALF)in mice. Methods BALB/c mice were divided into 3 groups. In the first and second groups, the whole lung lavage was performed with the traditional method,using a vein detained needle and lavaged with sterile saline. The mice in the third group got whole lung lavage by the improved method, namely, using a self-made plastic rigid pipe connected with a syringe. Each mouse was lavaged for 3 times,with 0.5 mL of sterile saline for each time, and the time consumption was recorded. The collected BALF was centrifuged,the supernatant was separated and its volume was measured accurately. Results The time spent for BALF collection in each mouse in the third group was(4 ± 0.62)min, significantly shorter than that of(10 ± 0.75) and(12 ± 0.88)min,respectively in the first and second groups(P< 0.05). The volume of BALF collected in each mouse of the third group was(1.34 ± 0.16)mL,significantly higher than that of(1.03 ± 0.25)and(1.13 ± 0.22)mL, respectively in the first and second groups(P< 0.05). Conclusions The improved method of BALF collection described in our study is simple,economical and efficient,and is useful for beginners especially.
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OBJECTIVE Oxidative sress is one of the key factor responsible for occurrence and development of hepatic fibrosis, a common consequence of chronic liver injury of multiple etiology. Nuclear factor erythroid 2-related factor 2 (Nrf2) serves as a major regulator of a celular defense system against oxidative stress. Xiaochaihutang (XCHT), a compound of seven botanical extracts used for liver diseases traditionally in East Asia. However, few studies have investigated its anti-hepatic fibrosis effects and pathophysiological mechanism of action. The present study was designed to confirm the anti-hepatic fibrosis effects and explore its potential mechanism of action by investigating the intervention of Nrf2 pathway. METHODS Liver fibrosis was induced by repeated injection of Carbon tetrachloride (CCl4) over a period of 9 weeks. Starting from the 6th week, the animals in treatment groups were given the appropriate dose of XCHT granules and silybin. Biochemical parameters, histological changes of the liver and alpha-smooth muscle actin (α-SMA) were determined. The expressions of Nrf2, Keap1, Nqo1, HO-1, Gclc and Gclm were assessed by RT-PCR and Western blot. RESULTS CCl4 caused a significant fibrosis damage in the rat liver and the liver functions and fibrosis degree were significantly improved by XCHT (5 g·kg- 1 and 10 g·kg- 1). XCHT (5 g·kg- 1 and 10 g·kg- 1) treatment significantly decreased the number of cells labeled with α-SMA antibodies. Moreover, XCHT (5 g·kg-1 and 10 g·kg-1) significantly increase Nqo1, HO-1, Gclc and Gclm expressions in the liver. CONCLUSION These studies establish XCHT is a potentially useful therapeutic agent for treatment of hepatic fibrosis and it might be via regulation of Nrf2 pathway in rats against oxidative stress, making further efforts to inhibiting the activated HSCs. Activation or up-regulation of Nrf2 pathway may be an alternative treatment strategy for liver fibrosis.
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<p><b>OBJECTIVE</b>To investigate the clinical results of pedicle-screw placement and reduction on the level of injured vertebrae in treating thoracolumbar fractures.</p><p><b>METHODS</b>From March 2006 to May 2009, 27 patients with thoracolumbar fractures were treated with short-segment fixation system and pedicle-screw placement on injured vertebrae through posterior approach. There were 19 males and 8 females with an average age of 36 years old ranging from 24 to 68 years. Eleven patients were injuried by traffic accident, 9 patients were injuried by falling from high, 5 patients were injuried by crush from weighty object, 2 patients were others injuries. Thoracolumbar fractures were classified according to Gertibein classification: 2 cases were of type A1, 3 cases A2, 12 cases A3, 5 cases B1, 5 cases B2. Among them, 14 cases were accompanied with spinal cord injuries,functional assessment of nerves was assessed according to Frankel criteria: 5 cases were of grade B, 3 cases C, 6 cases D. Lumbago according to Denis standard, grade P5 was in all cases. The injured level of 5 cases was in T11, 11 cases in T12, 8 cases in L1, 3 cases in L2. From injury to operation it was 2-15 days with an average of 4 days. The ratio of vertebral height between anterior and posterior border, anteroposterior Cobb angle were compared before and after operation. Function of nerves and index of lumbago were evaluated by Frankel and Denis classification.</p><p><b>RESULTS</b>All patients were followed up from 14 to 17 months with the mean of 15.5 months. At final follow-up,according to Frankel score system to evaluate function of nerve,2 cases were of grade B, 4 case grade C, 3 cases grade D, 5 cases grade E; according to Denis score system to evaluate index of lumbago, there was P1 (without pain) in 17 cases, P2 (between whiles minute pain, need not treatment) in 8 cases, P3 (moderate pain, between whiles need medication) in 2 cases. The ratio of vertebral height between anterior and posterior border from preoperatively 0.32 +/- 0.14 to postoperatively 0.85 +/- 0.03 (P<0.01); anteroposterior Cobb angle from preoperatively (25.3 +/- 7.8) degrees to postoperatively (11.1 +/- 1.5) degrees (P<0.01). At final follow-up, the ratio of vertebral height between anterior and posterior border, anteroposterior Cobb angle were respectively 0.81 +/- 0.06 and (11.8 +/- 1.9) degrees, there was no significant difference between postoperative and at final follow-up (P>0.05). No complications such as infection, internal fixation failure,nerve injuries were found during follow-up.</p><p><b>CONCLUSION</b>Posterior short-segment fixation system and pedicle-screw placement on level of injured vertebrae is one kind of effective method in treating thoracolumbar fracture, which can maintain corrective effect and obtain better clinical outcomes.</p>