High risk factors in images for infiltrating lung adenocarcinoma manifesting as peripheral ground-glass nodules / 中国胸心血管外科临床杂志

@#Objective     To explore the correlation between the imaging features of peripheral ground-glass pulmonary nodules and the invasion degree of lung adenocarcinoma, and the high risk factors for infiltrating lung adenocarcinoma under thin-slice CT, which provides some reference for clinicians to plan the surgical methods of pulmonary nodules before operation and to better communicate with patients, and assists in building a clinical predictive model for invasive adenocarcinoma. Methods    Clinical data of the patients with peripheral ground-glass pulmonary nodules (diameter≤3 cm) in thin-slice chest CT in the First Affiliated Hospital of Soochow University from January 2019 to January 2020 were continuously collected. All patients underwent thin-slice CT scan and thoracoscopic surgery in our center. According to the pathological examination results, they were divided into two groups: an adenocarcinoma lesions before infiltration group, and an invasive lung adenocarcinoma group. The thin-slice CT imaging parameters of pulmonary nodules were collected. The nodular diameter, mean CT value, consolidation tumor ratio (CTR), nodular shape, vacuolar sign, bronchial air sign, lobulation sign, burr sign, lesion boundary, pleural depression sign, vascular cluster sign and other clinical data were collected. Univariate and multivariate analyses were conducted to analyze the independent risk factors for the infiltrating lung adenocarcinoma, and to analyze the threshold value and efficacy of each factor for the identification of infiltrating lung adenocarcinoma. Results     Finally 190 patients were enrolled. There were 110 patients in the adenocarcinoma lesions before infiltration group, including 21 males and 89 females with a mean age of 53.57±10.90 years, and 80 patients in the invasive lung adenocarcinoma group, including 31 males and 49 females with a mean age of 56.45±11.30 years. There was a statistical difference in the mean CT value, nodular diameter, CTR, gender, smoking, nodular type, nodular shape, vacuolar sign, lobulation sign, burr sign, lesion boundary, pleural depression sign, vascular cluster sign between the two groups (P<0.05). However, there was no statistical difference between the two groups in age (P=0.081), lesion site (P=0.675), and bronchial air sign (P=0.051). Multiple logistic regression analysis showed that nodular diameter, mean CT value, CTR and lobulation sign were independent risk factors for differentiating preinvasive adenocarcinoma from invasive adenocarcinoma. At the same time, the threshold value was calculated by Youden index, indicating that the CTR was 0.45, the nodal diameter was 10.5 mm and the mean CT value was –452 Hu. Conclusion     In the peripheral ground-glass pulmonary nodules, according to the patient's CT imaging features, such as mixed ground-glass nodules, irregular shapes, vacuoles, short burrs, clear boundaries, pleural indentations, and vascular clusters, have a certain reference value in the discrimination of the invasion degree of ground-glass pulmonary nodules. At the same time, it is found in this research that peripheral ground-glass pulmonary nodules with diameter greater than 10.5 mm, CT value greater than –452 Hu, CTR greater than 0.45 and lobulation sign are more likely to be infiltrating lung adenocarcinoma.

Analysis use different diameter thoracic drainage tube with negative pressure drainage ball on the chest drainage effect after biportal thoracoscopic radical resection for lung cancer / 中华胸心血管外科杂志

Objective:To explore the chest drainage effect of use different diameter thoracic drainage tube after biportal thoracoscopic radical resection for lung cancer.Methods:300 patients with lung cancer who received biportal thoracoscopic radical resection were divided into group A and group B from January 2018 to September 2020. Group A: 150 patients with single 28# thoracic drainage tube after surgery. Group B: 150 patients with single 20# thoracic drainage tube and a negative pressure drainage ball after surgery. The postoperative drainage volume, drainage time, postoperative pain, postoperative thoracic puncture, hospital stay and total hospital expenses were compared.Results:No significant difference between the two groups in terms of sex, age, postoperative pathological type and resection range. There no significant difference between the two groups in total drainage volume [(1 010.31±525.29)ml vs.(985.35±403.93)ml] and total drainage time [(5.69±2.55)days vs.(5.42±1.94)days]. The difference of different diameter thoracic drainage tube used [(5.69±2.55)days vs.(2.88±0.64)days] was statistically significant. There were significant differences between two groups in terms of hospital stay[(12.64±2.89)days vs.(11.25±1.62)days] and total hospital expenses[(62 899.00±1 588.82) yuan vs.(64 327.00±3 587.04)yuan]. No significant differences on the postoperative first day, second day and third day in VAS pain scores. However, on the postoperative fifth day, the difference was statistically significant. In addition, the rate of group A postoperative thoracic puncture was 10%, group B was 0, the comparison was statistically significant.Conclusion:Using a single thin thoracic drainage tube and plus a negative pressure drainage ball after biportal thoracoscopic radical resection for lung cancer will not cause pain increase, shorten hospital stay days, control the rate of postoperative thoracic puncture and then reduce patients total hospital expenses.

Research progress of iron metabolism and iron homeostasis imbalance / 公共卫生与预防医学

Iron is an important trace element in human body. It is involved in heme synthesis, myelin sheath formation, mitochondrial respiratory chain electron transfer, DNA replication, repair，epigenetic control and so on. In order to maintain iron homeostasis, the body maintains iron balance by regulating the absorption of dietary iron by intestinal cells, recovery of iron by macrophages and storage of iron in liver cells. These iron metabolism regulation processes involve sophisticated cellular and molecular regulatory systems. When iron homeostasis is broken, both iron deficiency and iron overload will result in damage to the body. In this review, we review the research progress on the absorption, distribution and recovery of iron, the cellular and molecular regulatory mechanisms of iron metabolism and the consequences of iron homeostasis imbalance.

Research advances in exosomes in primary biliary cholangitis / 临床肝胆病杂志

Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by cholestasis. In recent years, a number of studies in China and globally have shown that exosomes play an important role in the development and progression of PBC, which is currently a hotspot in the field of medical research. This article reviews the role of exosomes in the pathogenesis of PBC and related research advances in the diagnosis and treatment of PBC. It is believed that exosomes have wide application prospect in PBC, and in-depth research on exosomes may bring new opportunities for the diagnosis and treatment of PBC.

Chinese expert consensus on diagnosis, treatment and prevention of venous thrombus embolism associated with chest trauma (2022 version) / 中华创伤杂志

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

Analysis of the effect of different chest drainage after uniportal video-assisted thoracoscopic radical operation for lung cancer / 中华胸心血管外科杂志

Objective@#To investigate the effect of different thoracicdrainage methods afte single holethoracoscopicsurgery for lung cancer.@*Methods@#200 patents with lung cancer undergoing single holethoracoscopicsurgery were divided into two groups : group A and group B in the first affliliated Hospital of Suzhou University from April 2014 to December 2016. Group A: 100 patients with 30#single thoracic drainage tube after operation. Groupe B: 100 patients with 30#thoracic drainage tube plus a negative pressure drainage tube after operation. The amount of thoracic drainage tube , drainage time , postoperative chest puncture, postoperative pain, hospital stay and total costs of hospitalization were observed in both groups.@*Results@#There was no difference in age, sex, pathological type and pulmonary lobectomy between the two groups. Total thoracic drainage[(1 007.4±512.95)ml vs.(982.35±359.93)ml]and totaltube time[(5.71±2.61)days vs.(5.43±1.91) days] had no significant difference between the two groups. There was a significant difference in the length of 30#thoracic drainage tube [(5.71±2.61)days vs.(2.9±0.61)days]between the two groups. The difference of hospitalization time[(12.05±2.93)days vs.(13.45±4.15)days]and hospitalization expenses[(63 376.47±1 615.82)yuan vs.(64 449.82±3 650.04)yuan]was statistically significant. The rate of rethoracotomy in gruop A was 7%, the rate of rethoracotomy in group B was 0, the comparison between the two groups was statistically significant. VAS pain scores were compared on the first day and the second day, there was no significant difference on the third day after operation. On the fifth day after operation, the difference was statistically significant.@*Conclusion@#Adding a negative pressure drainage tube on the basis of using a single thoracoscopic drainage tube for radical resection of lung cancer after single hole thoracoscopic surgery will not increase postoperative pain of patients, significantly shorten postoperative hospitalization time, effectively control postoperativerethoracopunchure rate, thus effectively reduce postoperative hospitalization costs of patients.

Analysis of the effect of different chest drainage after uniportal video-assisted thoracoscopic radical operation for lung cancer / 中华胸心血管外科杂志

Objective To investigate the effect of different thoracicdrainage methods afte single holethoracoscopicsurgery for lung cancer. Methods 200 patents with lung cancer undergoing single holethoracoscopicsurgery were divided into two groups :group A and group B in the first affliliated Hospital of Suzhou University from April 2014 to December 2016. Group A:100 patients with 30#single thoracic drainage tube after operation. Groupe B:100 patients with 30#thoracic drainage tube plus a negative pressure drainage tube after operation. The amount of thoracic drainage tube , drainage time , postoperative chest puncture, postoperative pain, hospital stay and total costs of hospitalization were observed in both groups. Results There was no difference in age, sex, pathological type and pulmonary lobectomy between the two groups. Total thoracic drainage [(1007.4±512.95)mlvs.(982.35±359.93)ml]andtotaltubetime[(5.71±2.61)daysvs.(5.43±1.91)days]hadno significant difference between the two groups. There was a significant difference in the length of 30 # thoracic drainage tube [(5.71±2.61)daysvs.(2.9±0.61)days]betweenthetwogroups. Thedifferenceofhospitalizationtime[(12.05±2.93) daysvs.(13.45±4.15)days]andhospitalizationexpenses[(63376.47±1615.82)yuanvs.(64449.82±3650.04)yuan] was statistically significant. The rate of rethoracotomy in gruop A was 7％, the rate of rethoracotomy in group B was 0, the comparison between the two groups was statistically significant. VAS pain scores were compared on the first day and the second day, there was no significant difference on the third day after operation. On the fifth day after operation, the difference was sta-tistically significant. Conclusion Adding a negative pressure drainage tube on the basis of using a single thoracoscopic drain-age tube for radical resection of lung cancer after single hole thoracoscopic surgery will not increase postoperative pain of pa-tients, significantly shorten postoperative hospitalization time, effectively control postoperativerethoracopunchure rate, thus ef-fectively reduce postoperative hospitalization costs of patients.

Diagnosis and treatment for intrathoracic gastroesophageal anastomotic leak: investigation of a new mode / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of a new mode to diagnose and treat intrathoracic gastroesophageal anastomotic leak.</p><p><b>METHODS</b>From January 2007 to December 2014, fifty-five patients were confirmed intrathoracic gastroesophageal anastomotic leak among those were performed surgical operation due to esophageal or cardiac carcinoma in the First Affiliated Hospital of Soochow University. To retrospectively analyze the clinical data of these patients, thirty-six male and nineteen female were included with the ages from 49 to 81 years (average age of (67±6)years). Among them, forty-two were middle esophageal carcinoma, eleven were lower esophageal carcinoma and two were cardiac carcinoma. According to the differences of diagnosis and treatment methods for anastomotic leak, fifty-five patients were divided into two groups. Thirty-one patients distributed from January 2007 to November 2011 were received conventional management (conventional group): to definitively diagnose by contrast swallow when suspected to be developing anastomotic leaks, to place an esophageal stent when the drainage was sufficient and the infection was controlled. Twenty-four patients distributed from March 2011 to December 2014 were received new-mode management (new-mode group): to perform a anastomotic radioscopy under digital subtraction angiography -guidance instantly when suspected anastomotic leak and find out the fistula, search the shape and size, place a drainage tube into the fistula to drain or lavage the vomica according to the exploration results, pull back the tube gradually and close the leak by clips under endoscope later. The pathoclinical features, the confirmation time (time from clinical signs emergence to leak confirmation), the hospital duration after confirmation, the incidence of severe complications and total mortality were compared between the two groups by t-test and χ(2) test or Fisher's exact test.</p><p><b>RESULTS</b>There was no significant statistical differences in pathoclinical features between two groups (P>0.05). The confirmation time was significantly reduced in new-mode group than that in conventional group ((1.2±0.8) d vs. (3.6±2.2) d, t=5.212, P=0.000), and so was the hospital duration after confirmation ((26±12) d vs. (55±25) d, t=4.992, P=0.000) and the incidence of severe complications (16.7% vs. 48.4%, χ(2)=6.019, P=0.014), although there was no statistical differences in total mortality (4.2% vs. 22.6%, P=0.119).</p><p><b>CONCLUSION</b>The new mode of early interventional diagnosis, early fistula drainage through nose and clipping under endoscope later is able to shorten diagnosis and treatment period, reduce incidence of severe complications.</p>

Effect and function mechanism of Galanin on neonatal rat locus coeruleus neurons / 中国生化药物杂志

Objective To explore the effect of galanin ( GAL) on locus coeruleus ( LC) neurons from neonatal rat and mechanism with its receptor GalR and potassium channel.Methods Brain slices from neonatal rats were prepared and the resting membrane potential and spontaneous action potential of LC neurons were recorded with whole cell patch-clamp configuration.GAL, AR-M1896 and potassium channel blockers were bath applied with different concentration.Results Bath application GAL induced hyperpolarization and inhibited firing rate of LC neurons.However, AR-M1896 ( a selective GalR2 agonist) did not induce significant effect on LC neurons, only at very high concentration(1μM) it induced slight hyperpolarization and reduced firing rate.The inhibitory effect of GAL was partially blocked by TEA ( an antagonist of voltage-dependent potassium channel) and significantly blocked by BaCl2(an antagonist of inward-rectifying potassium channels), while other potassium channels blockers such as Glybenclamide(ATP-sensitive potassium channel blocker),Charybdotoxin(large-conductance Ca2 +-activated K + channels blocker),Apamin(small-conductance Ca2 +-activated K +channels blocker) failed to block it.Conclusion GAL inhibits LC neurons from neonatal rats, mainly through GalR1.TEA-sensitive potassium channels and inward-rectifying potassium channels, but not ATP-sensitive potassium channel and calcium-activated potassium channel, are involved in this inhibition.

A prospective randomized control study about indication of chest tube removal following a VATS lobectomy / 中华胸心血管外科杂志

Objective This study assesses a feasible and safe volume threshold for chest tube removal following a VATS lobectomy.Methods The study included 168 consecutive patients who underwent VATS lobectomy or bilobectomy with two insicion between August 2012 and February 2014.Eligible patients were randomized into 3 groups:Group A (chest tube removal at the drainage volume of 150 ml/d or less.n =49) ; Group B (chest tube was removed when the drainage volume was less than 300 ml/d.n =50) ; Group C(chest tube removal when the drainage was less than 450 ml/d.n =51).And there were 18 patients who were excluded.All patients got the same postoperative care with a clinical pathway,and all patients were followedup 7 days after discharge from hospital.The time of extracting drainage tube,postoperative hospital stay,postoperative VAS values,dosage of analgesic,incidence of complications and thoracocentesis were measured.Results There were no statistically significant differences among 3 groups with general information and incidence of complication (P ＞ 0.05).And there were statistically significant differences between Group A and Group B with the time of extracting drainage tube,postoperative hospital stay,postoperative VAS values,dosage of analgesic(P ＜ 0.05).But there were no statistically significant differences between Group A and Group B with incidence of thoracocentesis(P ＞0.05).Analysis of data showed no statistically significant differences between Group B and Group C with postoperative hospital stay,postoperative VAS values and dosage of analgesic (P ＞ 0.05),but there were statistically significant differences for incidence of thoracocentesis (P ＜ 0.05).Conclusion A 300 ml/d volume threshold for chest tube removoal after VATS lobectomy is feasible and safe,and it can bring more advantages than the 150 ml/d volume threshold.On the other hand,a 450 ml/d volume threshold for chest tube removoal after VATS lobectomy may increase the risk of thoracocentesis.

Combination of autologous bone marrow stem cell transplantation anddanggui huoxue tang for treatment of diabetic foot / 中国组织工程研究

BACKGROUND:In recent years, the incidence of diabetic foot is sharply increasing, which tends to cause foot ulcers, amputation and death. OBJECTIVE:To investigate the clinical therapeutic effect of autologous bone marrow stem cel transplantation combined withdanggui huoxue tangon diabetic foot. METHODS:Sixty patients with diabetic foot accompanied by chronic lower limb ischemia were randomly divided into conventional treatment group including 20 cases with 38 affected limbs, and autologous bone marrow stem cel transplantation group (cel transplantation group) including 20 cases with 36 affected limbs, and combined group (autologous bone marrow stem cel transplantation combined withdanggui huoxue tang) including 20 cases with 39 affected limbs. After 12 weeks of treatment, indicators such as limb cold-feeling, pain, skin temperature, claudication distance and ankle brachial index were measured, and meanwhile, complications and adverse reactions were observed in the folow-up visit. RESULTS AND CONCLUSION: In the conventional treatment group, there was no significant change before and after treatment (P > 0.05). However, these indicators were significantly improved in the other two groups after treatment (P < 0.05) as wel as compared with the conventional treatment group (P < 0.05). In addition, there was no adverse reaction in the cel transplantation group. These findings indicate that the combination of autologous bone marrow stem cel transplantation anddanggui huoxue tang has effective effects on diabetic foot.

Surgical treatment of invasive pulmonary fungal infections in patients with hematologic malignancies / 中华胸心血管外科杂志

Objective To summarise the experience of surgical treatment of invasive pulmonary fungal infection in patients with hematologic malignancies.Methods From Jan.2000 to Dec.2012,78 hematologic patients with invasive pulmonary fungal infections,including 49 males and 29 females with average age of 29.6 years,underwent surgical treatment.Preoperatively,all patients with 1 to 3 courses of chemotherapy had received average 4 weeks antifungal treatment.There were 58 cases received conventional open thoracic surgery and 20 cases received VATS including lobectomy,segmentectomy,wedgectomy.Results The procedures were successful,the average operation time w as(125.3 ± 35.7) min and intraoperative blood loss was(253.1 ± 42.8) nl.There were no severe postoperative complications.The main complications were excessive effusion (10.2％) and persistence airleak (7.7％).The hospital days was(7.8 ± 2.5) days,no reoperation and death case in 30 days after operation.The follow-up was from 6 to 24 months,38 cases(48.7％) received prophylaetic antifungal treatment,no ease with fungi spread and recurrence.Conclusion The surgical treatment is safe and useful for the hematologic patients with invasive pulmonary fungal infections,when internal medicine conservative treatment is invalid.

Nine miRNAs expression differences and its significance in serum and peripheral blood mononuclear cell of lung cancer / 中华检验医学杂志

Objective To investigate the change of expression patterns of miRNA in the serum and peripheral blood mononuclear cells (PBMC) of lung cancer and its significance.Methods Clinical case control study was employed.Establish the method of microRNA(miRNA) detection by real time quantitative PCR (RT-qPCR).peripheral blood of the study subjects were collected in First affiliated hospital of SooChow University from November 2011 to September 2012.Gender and age matched subjects whose median age was 64(40-85) included 61 lung cancer cases,48 healthy control and benign lung diseases.We used quantitative RT-PCR to assess miRNA expression pattern of-miR-20a,21,-25,-29,-31,-126,-129,-145 and -205 in peripheral blood.U6 was taken as reference,and the expression of miRNA were indicated as F =2-△Ct,ACt =CtmiRNA--CtU6.F represents relative change of miRNA expression compared to U6 in the same sample.SPSS 19.0 was used as statistical software; t test was used for comparison of two sets of samples One way ANOVA was used for multiple groups' comparison,and make multiple comparison by the S-N-K method if the result with a significant difference.Pearson correlation analysis were used for the relationship between two variables,Brown-Forsythe test was used for Ct value equality testing among multiple samples.P ＜ 0.05were regarded as statistically significant.Results miR-20a (F =271.64,P ＜ 0.01),miR-21 (F =2232.51,P＜0.01),miR-205 (F=45.13,P＜0.01),miR-29a (F=19.98,P ＜0.01),miR-25 (F=313.19,P ＜ 0.01) and miR-126 (F =32.38,P ＜ 0.01) were differently expressed in the serum of lung cancer patients and healthy control or benign disease control.miR-29a,miR-25,miR-126 was down regulated in the development of malignant lung disease; miR-31 elevated in lung cancer compared with healthy control,while miR-145 fell; miR-31 expression changed with various differentiation of lung cancer (F =5.22,P ＜ 0.01)itwas significantly increased in the moderate-differentiated cancer,but decreased when distant metastasis existed (especially bone metastasis).But in PBMC paired with the serum samples above,statistically significance was shown in lung cancer and healthy control group and benign lung diseases group in miR-126 (F=690.58,P＜0.01),miR-129 (F=26.66,P＜0.01),miR-145 (F=48.57,P＜0.01),miR-205 (F=308.61,P＜0.01).miR-25 (F=218.57,P＜0.01) and miR-31 (F=48.05,P＜0.01),were down regulated in the development of malignant lung disease.miR-20a,miR-29a were elevated in lung cancer compared to healthy controls,miR-21 was up-regulated when distant metastasis existed; the expression of miR-31 in serum and PBMC was negatively correlated (r =-0.369,P ＜ 0.05).Areas under ROC curve of miR-25 (S =0.906,P ＜ 0.01) and miR-126 (S =0.969,P ＜ 0.01) were statistically different.Conclusions miRNA may contribute to several steps of metastasis,including local invasion,extravasation or initial survival at a distant site,and metastatic colonization,or can affect the prognosis of lung cancer.The detection of miRNA in lung cancer provides a new clue to the research of its chronic progress.

Analysis of the effect of intercostal nerve cryoanalgesia for post-thoracotomy pain control and the chronic discomfort of the incision / 中华胸心血管外科杂志

Objective To evaluate the effect of intercostal nerve cryoanalgesia for post-thoracotomy pain control and the chronic discomfort of the incision.Methods A prospective analysis was carried out in 200 patients after standard posterolateral thoracotomy.Then the patients were randomly divided into five groups after gender stratification,each group with 40 patients.Group A was the control group,which was received no advanced method to prevent the pain after operation,only with Pethidine injected while patient require.Group B was PCIA group.Group C was PCEA group.Group D was cryoanalgesia group.Group E was cryoanalgesia and PCEA group.VAS score was used in the consecutive 7 days after operation.And we recorded the doses of pethidine injected in the 7 days,as well as the complications and the side effects.On the third and sixth month,patients were followed up by telephone or clinic review for their pain control and discomfort of the incision.Results The VAS score and the average doses of using Pethidine were lower in group D and group E than that in other groups.Group D had a lower ratio of nausea,vomiting,pruritus and lethargy than any other group.Group A,group D and group E had a higher ratio of pain of incision and other adverse reactions than group B and group C.Conclusion Intercostal nerve cryoanalgesia could effectively relief the postoperative pain,reduce the ratio of traumatic stress reaction and side effect.Cryoanalgesia may be a factor that could add the chronic discomfort of the incision.

Optimal computer aided measure for screw internal fixation in the cavitas glenoidalis through human coracoid process of scapula / 解剖学报

Objective To investigate a special optimization technique for computer aided measure, and provide anatomical basis for screw internal fixation in the cavitas glenoidalis through the coracoid process of scapula. Methods Thirty accurate scapula models were reconstructed from CT data sets. First, special optimization objective function was designed for single screw internal fixation configuration, and the optimal placement of screw was found automatically under constraints. Then, the placements of double screws internal fixation configuration were searched taking advantage of principal component analysis. Finally, statistical measure data were provided according to new anatomical reference landmarks for clinical use. Results For single screw internal fixation configuration, the distance from the optimal screw entry point P to the acromion process point X was (39.15±2.28) mm, to the coracoid process point Y was (28.66±2.68) mm, to the angulus superior point Z was (61.13±6.57) mm;The angle was (81.27±7.15)° between PX and PY, and (133.27±6.84)° between PX and PZ. The mean inclination of the lag screw was (104.08±4.41)° for the angle with line PX, (101.29±3.51)° with line PY, and (76.23±5.03)° with line PZ. For double screws configuration, the distance from the original single screw entry point P to the screw entry point E was (5.12±1.37)mm,to the screw entry point F was (3.88±0.94)mm. The angle between the long axis of coracoid process and line EF was (27.41±3.51)°. Conclusion The automatic optimization technique for computer aided measure is very efficient and has many advantages over the conventional manual dissection methods, and is convenient to design new anatomical reference landmark system for clinical use.

A comparative study of two operations of sternal fracture / 中国医师进修杂志

Objective To compare the efficacies of the treatment of sternal fracture with wire fixation and the titanium sternal fixation system. Methods Thirty patients with sternal fracture from May 2003 to July 2009 were followed up. Among them,there were 20 patients with wire fixation (wire fixation group), 10 patients with the titanium sternal fixation system (titanium sternal fixation system group). The conditions before, during and after operation,complications and effects were compared to evaluate the effieaeies of titanium sternal fixation system. Results The operative time of titanium sternal fixation system group and wire fixation group were (67.0 ± 7.9) min and (90.0 ± 8.6) min, the blood loss were (11.0 ± 5.4) ml and (48.0 ± 8.4)ml,the duration of drainage were (0.5 ± 0.4) days and (1.9 ± 0.7) days,the amount of drainage were (1.9 ± 1.3) ml and (19.0 ± 4.6) ml, the average hospitalized days were (2.3 ± 0.5) days and (6.9 ± 0.9) days, the duration of pain were (1.5 ± 0.5) days and (3.8 ± 1.1) days, there were all significant difference between two groups (P < 0.05). The rates of wound infection, delayed union or nonunion, re-fracture,plate fracture or plate shift of wire fixation group were 5% (1/20) ,5% (1/20) ,5% (1/20), 10% (2/20). But the rates of titanium sternal fixation system group were 0, there were all significant difference between two groups (P < 0.05). Conclusion The treatment of sternal fracture with titanium sternal fixation system is a simple and stable fixation,high bone union rate and few complications,especially for the sternal fracture.

The role of tissue factor in tumor's invasion and progress in experimental targeted therapy / 国际外科学杂志

Tissue factor(TF)is the most important factor in the physiological coagulation process.TF also plays important roles in tumor growth,angiogenesis,invasion and metastasis by combining with factor VII.In recent years,targeted therapy for the TF has made remarkable progress,showing its significant inhibition of tumor tissue and metastasis.

Analysis of key factors for the successful chest operation in elderly patients with esophageal cancer or carcinoma of gastric cardia / 中华老年医学杂志

Objective To explore the operative treatment of esophageal carcinoma or carcinoma of gastric cardia in patients aged 70 years or older. Methods　One thousand and eighty eight patients with esophageal cancer or carcinoma of gastric cardia were retrospectively reviewed.These patients were divided into 4 groups:aged 41～69,70～74,75～79 and 80～90 years.The postoperative complications,hospjtalization time,prognosis, operative selection and perioperative treatment were analyzed. Results　Incidences of complications of pulmonary infection,arrhythmia,psychiatric symptom and unhealing of surgical incision were obviously increased,and the average hospitalization time were significantly prolonged in patients aged 70 years or older.Incidence of pulmonary infection and the average hospitalization time were significantly increased in patients aged 80～90 years compared with other groups.There were 4 death cases and 1084 cured cases. Conclusions　With regard to elderly patients for esophageal carcinoma or carcinoma of gastric eardia,handling the occurrence of postoperative complications,selecting suitable patients to take operation and appropriate perioperative treatments are the keys for successful operation.

Thoracoscopic Nuss procedure for the correction of pectus excavatum in 21 patients / 中国综合临床

Objective To summarize the experiences of Nuss procedure with thoracoscope for repairing pectus excavatum.Methods 21 cases of pectus excavatum were treated by Nuss procedure with thoracoscope.In these patients,10 had symmetric pectus excavatum and 11 had asymmetric one.Results The operation in all patients were successful.The mean operating time wag(70.7±9.6)min and the mean intraoperative blood loss was(20.3±10.9)ml.The average hospital length of stay was(5.3±1.1)days,the average durante dolors was(6.9±4.0)days.The exceUent rate was 81.0%(17/21),including 90.0%(9/10)in symmetric pectus excavatum and 72.7%(8/11)in asymmetric pectus cxcavatum.Conclusion Nuss procedure is easy to perform,with minimal invasion,short operating time,and less blood loss.Nuss procedure is suitable for the symmetric pectus excavatum.

Significance of mediastinum drainage tube in prevention and treatment of intrathoracic anastomotic leak after esophagectomy / 中国综合临床

Objective To explore the significance of mediastinum drainage tube in prevention and treatment of intrathoracic anastomotic leak after esophagectomy. Methods The morbidity and prognosis of intrathoracic anas-tomotic leak after esophagectomy in 180 patients with esophageal or cardia carcinoma (group A) who used mediasti-num drainage tube in operation from 2006 to 2008 was studied retrospectively,and were compare with 154 patients (group B) without mediastinum drainage tube from 2004 to 2006. Results The morbidity of intrathoracic anasto-motic leak after esophagectomy was 1.67% (3/180) in group A,and 4.55% (7/154) in group B,but no difference between them(χ2=1.4807, P>0.05) were found. Compared to group B, the final diagnosis of anastomotic leak in group A was early [(6.7±0.6) vs (10.0±2.1) days after operation (t=2.62, P<0.05)] and the duration of fe-ver was short [(5.3±1.5)vs (43.0±20.9) hours (t=4.39, P<0.01)]. The prognosis of 3 cases in group A was well, who all recovered without operation and had shorten hospital days than group B [(23.7±5.9)d vs (45.3± 5.0)d,t=4.86,P<0.01)]. In 7 cases of group B,there were 5 cases underwent second operation,but only 3 cases recovered, the case fatality rate was 2.60% (4/154), higher than in group A (0, Fisher, P<0.05). Conclusions Although the mediastinum drainage tube used or not used in esophagectomy is unrelated with the occurrence of anas-tomotic leak, and the significance to use it is that it can help to discover anastomotic leak early, and control mediasti-num infection effectively without reoperation,and improve patients' prognosis.