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@#Objective To investigate the optimal treatment scheme for the first primary spontaneous pneumothorax (PSP) in young patients. Methods The clinical data of 171 patients with the first PSP were retrospectively analyzed who were treated in Huaihe Hospital of Henan University between November 2011 and October 2017. There were 157 males and 14 females with a median age of 18 years at onset and a median body mass index of 18.51 kg/m2. According to the treatment methods, they were classified into two groups, a conservative treatment group (a non-surgical group, n=86) and a surgical group (n=85). The characteristics including clinical data, efficacy evaluation criteria, complications and recurrence of the two groups were analyzed. Results As a result, 73.68% of the patients suffered PSP in their daily routine. The drainage duration in the non-surgical group was longer than that in the surgical group (4 d vs. 3 d, P=0.008). There was no statistical difference in the success rate of lung re-expansion between the two groups (98.85% vs. 100.00%, P=1.000). The proportion of the surgical group using postoperative analgesic drugs was higher than that in the non-surgical group (48.23% vs. 10.46%, P=0.000). The recurrence rate of the surgical group was lower than that of the non-surgical group (3.53% vs. 46.51%, P=0.000). No relationship between smoking and recurrence of pneumothorax was found in both groups (P=0.301, P=1.000). The success rate of lung re-expansion in the non-surgical group was not statistically different between the 24F subgroup and the 12F subgroup (39/39 vs. 33/34, P=0.458). No advantage of intraoperative pleural fixation was found in the surgical group (P=0.693). Conclusion Thoracoscopic surgery is the first choice for the treatment of the first PSP in young patients.
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Objective To explore the protective effect of Siwei-Jianghuangtang powder on kidney of diabetic nephropathy rats and its influences on phosphatidyl inositol 3-kinase/protein kinase B signaling pathway (PI3K/Akt). Methods The SD rats were divided into 6 groups, sham operation group, model group, Siwei-Jianghuangtang powder low, middle and high dose groups (12, 24, 48 mg/kg Siwei-Jianghuangtang powder) and positive group (Captopril, 30mg/kg), with 12 rats in each group. The 24h urinary protein in urine of rats was measured after 4 weeks and 8 weeks of administration. The enzyme linked immunosorbent assay was used to detect serum lipid level and renal function. After the last administration, the renal tissue was obtained, and the renal hypertrophy index was measured. The HE and Masson staining were used to observe the histopathological changes of kidney in rats, and the ultrastructural changes of renal tissue were observed by electron microscope. The western blot (WB) was used to analyze the expressions of IRS-2, p-PI3K and p-Akt in renal tissues, and the immunohistochemistry was used to detect the positive expressions of nephrin and podocin protein in kidney. Results Compared with the model group, the p-PI3K protein (0.42 ± 0.06, 0.61 ± 0.09, 0.76 ± 0.05 vs. 0.21 ± 0.03), the IRS-2 protein (0.34 ± 0.03, 0.61 ± 0.10, 0.78 ± 0.09 vs. 0.24 ± 0.03) and the P-Akt protein (0.28 ± 0.06, 0.43 ± 0.07, 0.69 ± 0.05 vs. 0.15 ± 0.03) in Siwei-Jianghuangtang powder low, middle and high dose group significantly increased (P<0.05). The positive expression rate of Nephrin (31.78% ± 3.14%, 42.54% ± 5.15%, 50.97% ± 7.13% vs. 22.86% ± 3.07%) and the positive expression rate of Podocin (33.67% ± 4.59%, 50.54% ± 11.41%, 61.03% ± 7.55% vs. 22.64% ± 2.97%) significantly increased (P<0.05). Conclusions The Siwei-Jianghuangtang powder can relieve renal injury of diabetic nephropathy rats. Its mechanism may be related to activating PI3K/Akt signaling pathway and alleviating podocyte injury.
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Objective@#To explore the molecular and genetic mechanism of transcription factor GATA-6 in nonsyndromic conotruncal defect (CTD) in order to provide evidence for early prevention and inheritance consultation of CTD.@*Methods@#A total of 32 cases of patients with nonsyndromic CTD and 100 healthy individuals were enrolled in the study.A total of 7 exons and bilateral partial intron-exon boundaries of GATA-6 were amplified by means of polymerase chain reaction (PCR). The PCR products were purified and directly sequenced by using an ABI Genetic Analyzer 3100 Automatic DNA sequence equipment.The acquired GATA-6 gene sequence was compared with standard gene sequence published in National Center for Biotechnology Information database, as well as the healthy control group to observe the GATA-6 gene mutations.The mutations were introduced into pcDNA3.1(+ ) by site-directed mutagenesis PCR on the basis of pcDNA3.1(+ )-GATA-6 in order to generate the GATA6-G245R mutant constructs.Wild type GATA-6, GATA-6-G245R and atrial natriuretic factor-luciferase(ANF-luciferase) were cotransfected into HEK 293T cells in vitro, and the CMV-LacZ were cotransfected as internal reference.Luciferase and galactosidase activity were measured by using luminometer 24 h after transfection and detected in the downstream ANF-luciferase reporter gene.@*Results@#A heterozygous missense mutation in the GATA-6 gene was identified in a patient with double outlets of the right ventricle.The mutation was located in Gly245Arg(G245R) in exon 2 of GATA-6.The mutation of pcDNA3.1(+ )-GATA-6 expression vectors were successfully constructed.Through the detection of luciferase reporter gene activity, it was found that GATA-6-G245R and wild-type GATA-6 decreased by 41.3%, and the comparison between them was statistically significant (P<0.001).@*Conclusions@#Transcription factor GATA-6 gene mutation is associated with the occurrence of nonsyndromic CTD.Transcription factor GATA-6 gene may be susceptible gene in human nonsyndromic CTD.
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Objective To investigate the two kinds if thoracic cavity closed drainage contrast analysis and evaluate the pigtail catheter for treatment of spontaneous pneumothorax in adolescents.Methods This study included 53 adolescent patients with the first spontaneous pneumothorax in Huaihe Hospital of Henan University between January 2013 and December 2015.According to the different operation ways,they were divided into two groups:silicone tube and pigtail catheter group.The following post-operative data was evaluated:pain,subcutaneous emphysema,drainage time,hospital stay,new drain insertion,and wound healing at the site of insertion.Results There were 32 patients in the silicone tube group and 21 ones in the other group.The data revealed a significantly reduced the operation time and pain in the pigtail catheter group compared to the chest tube group(P ＜ 0.05).However,no statistical differences in success rate,postoperative hospital stay and complications incidence were found between the 2 groups.Conclusion Compared to common chest tube,the employment of pigtail catheter in the adolescent patients with pneumothorax significantly reduces the operation time and pain.Nevertheless,no statistically significant differences were discovered in success rate,postoperative hospital stay and the incidence of complications between the two corresponding groups.Thus pigtail catheter is competent in terms of closed thoracic drainage in adolescents who are the first diagnosed as spontaneous pneumothorax.
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Sixty patients with esophageal carcinoma undergoing thoracoscopic-laparoscopic resection were randomly divided into two groups with 30 cases in each group:endobronchial blocker was used during operation in group E and double-lumen tube( DLT) was used in group D.The results showed that compare to group D,intubation time was shorter and the incidence of postoperative hoarseness and sore throat was lower in group E [(27.4 ±8.6) vs.(37.2 ±10.3)s, 1 and 9 cases,5 and 14 cases, all P0.05].The study indicates that application of endobronchial blocker can reduce the incidence of postoperative hoarseness and sore throat and shorten the intubation time;especially, it is easy to operate and there is no need to replace the tube after surgery.
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Objective To compare short-term clinical effect according to the extent of lymphadenectomy.To identify the rational lymph node dissection in patients with esophageal squamous cell carcinoma(ESCC).Methods Between January 2010 and December 2013,160 patients with ESCC received video-assisted laparothoracoscopy esophagectomy plus three-field lymphadenectomy(3FL) (86 cases)or two-field lymphadenectomy(2FL) (74 cases).Retrospectively analyzed the lymph node metastasis, postoperative complications and short-term survival rates between 3FL and 2FL.Results There was significantly differences in the number of lymph node between 3 FL(28.60 ± 3.30) and 2 FL(14.54 ± 5.59) (P ＜ 0.05) , but no significantly differences in postoperative complications between 3FL(22.09％) and 2FL(14.86％) (P ＞ 0.05).There was significantly differences in half-year survival rates between 3FL(93.02％) and 2FL(83.78％) (P ＜ 0.05).Conclusion Three field lymph oode dissection can reduce local recurrence, improve survival rate of some patients with ESCC.We suggest that esophagectomy plus three-field lymphadenectomy should be conventional.
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BACKGROUND:Some scholars believe that for primary spontaneous pneumothorax thoracoscopic surgery and intraoperative pleurodesis can effectively reduce the recurrence rate. ＜br> OBJECTIVE:To study the reliability and validity of video-assisted thoracoscopic entoiodine pleurodesis for treatment of primary spontaneous pneumothorax. ＜br> METHODS:Videothoracoscopy procedures were performed on 64 patients with primary spontaneous pneumothorax, including 46 males and 18 females, with an age ranging from 15 to 30 years. According to the use of pleurodesis, the patients were randomly divided into two groups:experimental group and control group. In the control group, no entoiodine was used;while in the experimental group, entoiodine dipped gauze was used on the visceral pleura. The operation time, intraoperative bleeding, postoperative drainage, postoperative leakage time, postoperative extubation time, postoperative complications and the recurrence rate of pneumothorax within 1 year after operation were compared between two groups. ＜br> RESULTS AND CONCLUSION:No significance was found in the operation time, intraoperative bleeding, postoperative leakage time, postoperative extubation time and postoperative complications between the two groups (P>0.05). Although the experimental group had significantly more postoperative drainage volume than the control group (P＜0.05), there were no consequences of medical intervention. Video-assisted thoracoscopic entoiodine pleurodesis could significantly reduce the recurrence rate of pneumothorax in 1 year after operation (P＜0.05). The results show that video-assisted thoracoscopic operation with entoiodine is a reliable and effective method to reduce the recurrence of pneumothorax after operation in patients with primary spontaneous pneumothorax.
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BACKGROUND:Although thoracoscopy with pleurodesis is regarded as a positive and effective way for the treatment of malignant pleural effusion, the merit and demerit of sclerosants are directly related to postoperative recovery and the success of pleurodesis. OBJECTIVE:To evaluate the therapeutic effect of talc pleurodesisvia thoracoscopy in the treatment of refractory malignant pleural effusions METHODS:There were 14 male and 15 female patients in this study, age ranging from 38 to 79 years. Al patients with refractory malignant pleural effusion underwent talc pleurodesis under thoracoscopy. The postoperative adverse reactions, chest CT scan 1 month after operation and the fluid drainage were observed. RESULTS AND CONCLUSION:Twenty-nine patients with chest pain were observed in this study. Eighteen patients could relieve the pain itself without medications, eight patients required oral Tramadol and three patients took Demerol or morphine oraly to ease the pain. Fever occurred in three cases at 3 days after operation. Neither pneumonedema, acute respiratory failure, nor death ocurred postoperatively. One month later, complete successful pleurodesis was achieved in 24 cases, and partial successful in 3 cases, and unsuccessful in 2 cases. The results indicate that thoracoscopy with talc pleurodesis can be regarded as a positive and effective way for the treatment of malignant pleural effusion.
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Objective To study the effects of injecting recombinant human granulocyte colony stimulating factor (rhG-CSF) and basic fibroblast growth factor (bFGF) alone or combined on actue myocardial infarction(AMI).Methods AMI models were induced by ligation of the left anterior descending artery.The survived rats were divided into four groups randomly:AMI group (MI),rhG-CSF group (G),bFGF group (B),combined group (GB).Respectively,saline,rhG-CSF,bFGF,and rhG-CSF plus bFGF were injected intraperitoneally 24 h after AMI.Also,sham-operated group (S) was established with only chest-opeaned,without ligation,and no drugs intervention. The white blood cells (WBC) and mononuclear cells (MNC) proportion in peripheral blood were counted 1 week before and 1 week after the intervention,and the number of CD34+ cells was observed with immunohistochemical staining 1 week after AMI in order to compare the situation of mobilization in peripheral blood;the capillary density was evaluated by HE staining both 1 and 4 weeks after AMI;their cardiac fuction was determined in vivo,the infarction size in each group was calculated,and the pathological changes in rat myocardium were observed by HE staining 4 weeks after AMI.Results Compared with MI group,the number of WBC and MNC% in peripheral blood 1 week after AMI in G,B and GB groups were higher(P
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Objective To review the experience of surgical management for caustic esophageal stricture and discuss the surgical techniques of transverse colon interposition for esophageal replacement. Methods 106 patients with caustic esophageal stricture were treated surgically. 32 patients underwent colon interposition with colonphargageal anastomosis and others received colon interposition with a cerrical anastomosis. The ascending branch of the left artery of the transverse colon was preserved as the supporting vessel of the interpositioned colon. Results There was no postoperative death. The leakage of cervical anastomosis was observed in 12 patients, anastomosis stenosis in 8 patients, and tracheotomy was performed in 3 patients. All patients were perfectly recovered by the treatment. Conclusion Transverse colon interposition for esophageal reconstruction is an optimal approach in the treatment of caustic esophageal stricture.