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@#Objective To explore the causes of conversion to thoracotomy in patients with minimally invasive esophagectomy (MIE) in a surgical team, and to obtain a deeper understanding of the timing of conversion in MIE. Methods The clinical data of patients who underwent MIE between September 9, 2011 and February 12, 2022 by a single surgical team in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The main influencing factors and perioperative mortality of patients who converted to thoracotomy in this group were analyzed. Results In the cohort of 791 consecutive patients with MIE, there were 520 males and 271 females, including 29 patients of multiple esophageal cancer, 156 patients of upper thoracic cancer, 524 patients of middle thoracic cancer, and 82 patients of lower thoracic cancer. And 46 patients were converted to thoracotomy for different causes. The main causes for thoracotomy were advanced stage tumor (26 patients), anesthesia-related factors (5 patients), extensive thoracic adhesions (6 patients), and accidental injury of important structures (8 patients). There was a statistical difference in the distribution of tumor locations between patients who converted to thoracotomy and the MIE patients (P<0.05). The proportion of multiple and upper thoracic cancer in patients who converted to thoracotomy was higher than that in the MIE patients, while the proportion of lower thoracic cancer was lower than that in the MIE patients. The perioperative mortality of the thoracotomy patients was not significantly different from that of the MIE patients (P=1.000). Conclusion In MIE, advanced-stage tumor, anesthesia-related factors,extensive thoracic adhesions, and accidental injury of important structures are the main causes of conversion to thoracotomy. The rate varies at different tumor locations. Intraoperative conversion to thoracotomy does not affect the perioperative mortality of MIE.
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Objective:To investigate the clinicopathological characteristics and prognostic factors of patients with esophageal cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 447 patients with esophageal cancer who were admitted to the Fourth Hospital of Hebei Medical University from January 1, 2017 to December 31, 2020 were collected. There were 312 males and 135 females, aged 60(range, 37?82)years. Observation indica-tors: (1) clinicopathological characteristics; (2) treatment; (3) follow-up; (4) analysis of prognostic factors for esophageal cancer. Follow-up using telephone interview or outpatient examination was conducted to detect survival of patients up to December 2021. The total survival time was from the surgery date to death or the last follow-up. Patients with duration of follow-up more than 2 years were included for survival and prognostic analysis. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers. Kaplan-Meier method was used to draw survival curves and calculate survival rates. Log-Rank test was used for survival analysis. Univariate analysis was conducted using the Log-rank test. Multivariate analysis was conducted using the COX hazard regression model. Results:(1) Clinicopathological characteristics. Of the 447 patients, 69.80%(312/447) were males and 30.20%(135/447) were females, and there were 3, 18, 101, 229, 93, 3 cases aged 30?39 years, 40?49 years, 50?59 years, 60?69 years, 70?79 years, 80?89 years, respectively. About the pathological type, there were 424 cases with squamous carcinoma, 11 cases with small cell carcinoma, 4 cases with adenosquamous carcinoma, 3 cases with sarco-matoid carcinoma, 2 cases with adenocarcinoma, 1 case with neuroendocrine carcinoma, 1 case with undifferentiated carcinoma, and 1 case with adenoid cystic carcinoma. There were 2 cases with tumor located at cervicothoracic segment, 49 cases with tumor located at upper thoracic segment, 273 cases with tumor located at mid-thoracic segment, and 123 cases with tumor located at lower thoracic segment. There were 6, 24, 74, 59, 192, 80, 12 cases in stage pT0, pT1a, pT1b, pT2, pT3, pT4a, pT4b of pathological T staging, respectively. There were 207, 63, 142, 28, 7 cases in stage pN0, pN1, pN2, pN3, pN4 of pathological N staging by Japan Esophagus Society (JES), respectively. There were 207, 128, 76, 36 cases in stage pN0, pN1, pN2, pN3 of pathological N staging by Union for International Cancer Control (UICC), respectively. About TNM staging, there were 25, 53, 127, 174, 68 cases in stage 0, Ⅰ, Ⅱ, Ⅲ, Ⅳa of JES staging, and 16, 9, 53, 35, 108, 96, 45, 85 cases in stage 0, Ⅰa, Ⅰb,Ⅱa, Ⅱb, Ⅲa, Ⅲb, Ⅲc of UICC staging, respectively. (2) Treatment. Of the 447 patients, 63 cases underwent neoadjuvant therapy(12 cases combined with immunotherapy), 384 cases underwent no neoadjuvant therapy. There were 347, 97, 2, 1 cases with surgical approach as right thoracic approach, left thoracotomy approach, cervical abdominal approach, left thoracoabdominal approach, respectively. There were 316, 5, 126 cases with surgical platform as totally endoscopic esophagec-tomy, Hybrid surgery, open surgery, respectively. There were 350 and 97 cases with digestive recons-truction as posterior mediastinal approach and intrathoracic approach, respectively. Surgical margin as R 0, R 1, R 2 resection was detected in 323, 116, 8 cases, respectively. Six of 447 patients died during the hospital stay. (3) Follow-up. All the 447 patients were followed up for 25(range, 2?48)months, including 233 cases with the follow-up more than 2 years. The median survival time of 233 patients was unreached, and the postoperative 2-year survival rate was 76.8%. (4) Analysis of prognostic factors for esophageal cancer. Results of univariate analysis showed that gender, neoadjuvant therapy, surgical margin, pT staging, pN staging by JES, pN staging by UICC, TNM staging by JES, TNM staging by UICC were related factors influencing prognosis of 233 patients with esophageal cancer ( χ2=6.62, 17.81, 32.95, 37.93, 27.06, 35.56, 45.24, 37.84, P<0.05). Results of multivariate analysis showed that gender, surgical margin, TNM staging by JES were independent factors influencing prognosis of 233 patients with esophageal cancer ( hazard ratio=0.48, 1.94, 1.46, 95% confidence intervals as 0.25?0.91, 1.07?3.52, 1.16?1.84, P<0.05). Conclusions:The incidence of esophageal cancer is relatively high in males, with the onset age mainly distribute in 60?69 years and the mainly pathological type as squamous carcinoma. Patients with esophageal cancer have advanced tumor staging, low proportion of neoadjuvant therapy, high R 0 resection rate of surgical treatment. Gender, surgical margin, TNM staging by JES are independent factors influencing prognosis of patients with esophageal cancer.
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BACKGROUND@#Video assisted thoracic surgery (VATS) is the main surgical method for lung cancer. The aim of this study was to analyze the reasons for conversion to thoracotomy in 83 cases among 1,350 consecutive cases who underwent video-assisted thoracic surgery (VATS) lobectomy by a single surgical team, in order to achieve a deeper understanding of the rules and the opportunity for conversion to thoracotomy in VATS lobectomy under normal conditions.@*METHODS@#The clinical data of 1,350 patients who underwent VATS lobectomy between September 21, 2009 and June 1, 2020, by a single surgical team in the Fifth Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. There were 773 males and 577 females, aged 8-87 years, with a median age of 61.3 years, including 83 cases of benign diseases, 38 cases of lung metastases, and 1,229 cases of primary lung cancer. The cases with stage I, II and IIIa were 676, 323 and 230, respectively. The cases of left upper, left lower, right upper, right middle, right lower, right middle and upper and right middle and lower lobectomy were 301 (22.30%), 231 (17.11%), 378 (28.00%), 119 (8.81%), 262 (19.41%), 16 (1.19%) and 43 (3.19%), respectively.@*RESULTS@#In the cohort of 1,350 consecutive patients with VATS lobectomy, 83 patients (6.15%) were converted to thoracotomy for different reasons. The conversion rate of benign lesions was significantly higher than that of malignant tumors (P<0.05). The conversion rate in stage IIIa was significantly higher than that in stage I and II (P<0.05). The conversion rate of combined lobectomy was significantly higher than that of single lobectomy (P=0.001). The conversion rate of left upper lobectomy was significantly higher than that of other single lobectomy (P<0.001). The conversion rate of right middle lobectomy was significantly lower than that of other single lobectomy (P=0.049). The main reasons for conversion were vascular injury (38.55%), lymph node interference (26.51%) and dense adhesion in thoracic cavity (16.87%). In the conversion group, the total operation time was (236.99±66.50) min and the total blood loss was (395.85±306.38) mL. The operation time in patients converted to thoracotomy due to lymph node interference was (322.50±22.68) min, which was significantly longer than that in the other groups (P<0.05). The intraoperative blood loss in patients converted to thoracotomy due to vascular injury was (560.94±361.84) mL, which was significantly higher than that in the other groups (P<0.05). With the increase in surgical experience, the number of vascular injuries gradually decreased at the early stage, mid-stage and late stage (P=0.045).@*CONCLUSIONS@#In VATS lobectomy, benign lung lesions and more advanced malignant tumors led to more surgical difficulties and higher conversion rate. The conversion rate was different in different lobectomy sites, with the highest in left upper lobectomy, and the lowest in right middle lobectomy. Vascular injury, lymph node interference and dense adhesion were the main reasons for conversion to thoracotomy, which led to prolonged operation time and increased blood loss. With the increasing number of surgical cases, the rate of conversion to thoracotomy in VATS lobectomy continues to decline, which may be mainly due to the more advanced treatment of pulmonary vessels.
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Objective To investigate the effect of vasopressin injection technique on ovarian reserve in patients with laparoscopic cystectomy of unilateral ovarian endometrioma .Methods 70 patients with unilateral ovarian endometrioma were randomly allocated into study group (37 cases) and control group(33 cases) according to the digital table .Diluted vasopressin was injected into the space between the normal ovarian cortex and the cyst wall before stripping in the study group , and ordinary laparoscopic cystectomy without injection was adopted in control group.The average contents of anti -mullerian hormone(AMH),follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),antral follicle count(AFC) and peak systolic velocity(PSV) were compared in two groups before and after surgery .Results The operative time of the study group was (37.6 ±8.6) min,which was significantly shorter than (42.8 ±9.1)min of the control group(t=2.46,P<0.05).The blood loss of the study group was (23.2 ±12.1)mL,which was significantly less than (31.4 ±17.3)mL of the control group(t=2.32,P<0.05).In the control group,the E2 levels preoperation and postoperative were (201.46 ±7.51)pmol/L,(153.94 ± 8.72)pmol/L,respectively,the difference was statistically significant between preoperation and postoperation (t =23.72,P<0.05).The AMH levels in the control group preoperation and postoperation were (2.31 ±0.79)ng/mL, (1.67 ±0.75)ng/mL,respectively,there was statistically significant difference between preoperation and postoperation (t=3.38,P<0.05).The FSH levels in the control group preoperation and postoperation were (6.58 ±2.70)U/L, (10.24 ±1.21)U/L,respectively,there was statistically significant difference between preoperation and postoperation (t=7.12,P<0.05).The LH levels in the control group preoperation and postoperation were (5.87 ±1.76)U/L, (6.15 ±2.14) U/L,respectively,there was no significant difference between preoperation and postoperation (t =0.58,P>0.05).The F0 levels in the control group preoperation and postoperation were (8.7 ±2.8),(4.6 ±0.7), respectively,there was significant difference between preoperation and postoperation (P<0.05).The PSV levels in the control group preoperation and postoperation were (13.8 ±5.9)cm/s,(7.5 ±2.4)cm/s,respectively,there was significant difference between preoperation and postoperation (P<0.05).The E2 levels in the study group preopera-tion and postoperation were (199.36 ±8.42)pmol/L,(197.12 ±8.33)pmol/L,respectively,there was no significant difference between preoperation and postoperation (t=1.15,P>0.05).The AMH levels in the study group preopera-tion and postoperation were (2.23 ±0.85) ng/mL,(2.19 ±0.83) ng/mL,respectively,there was no statistically significant difference between preoperation and postoperation (t=0.20,P>0.05).The FSH levels in the study group preoperation and postoperation were (6.27 ±2.35)U/L,(6.73 ±2.23)U/L,respectively,there was no statistically significant difference between preoperation and postoperation (t=0.86,P>0.05).The LH levels in the study group preoperation and postoperation were (5.92 ±2.32) U/L,(5.57 ±2.31) U/L,respectively,there was no statistically significantl difference between preoperation and postoperation (t=0.65,P>0.05).The F0 levels in the study group preoperation and postoperation were (9.2 ±2.4),(8.9 ±2.7),respectively,there was no statistically significant difference between preoperation and postoperation (P>0.05).The PSV levels in the study group preoperation and postoperation were (14.7 ±5.4) cm/s,(14.0 ±4.7) cm/s,respectively,there was no statistically significant difference between preoperation and postoperation (P>0.05).Conclusion Vasopressin injection technique used in unilateral ovarian endometrioma laparoscopic cystectomy is safe and effective ,and it can protect the ovarian reserve .
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Objective To investigate the effect of maintenance hemodialysis on regulatory T cells (Treg) and helper T cells (Th17) in uremic patients.Methods One hundred and eighty-five patients with uremia from February 2014 to February 2017 in our hospital were selected,including 102 cases of hemodialysis as the dialysis group and 83 cases without conducting hemodialysis as the non-dialysis group.Contemporaneous 100 healthy volunteers were selected as the control group.The levels of Treg,Th17,interleukin-6 (IL-6),IL-10 and IL-17 were detected in each group.Results The levels of Treg,Th17,IL-6 and IL-17 in the control group were significantly lower than those in the non-dialysis group and dialysis group (P＜0.05),while the level of IL-10 was significantly higher than that in the non-dialysis group and dialysis group (P＜0.05);the levels of Treg,Th17,IL-6 and IL-17 in the dialysis group were (5.02±1.80)％,(20.16±7.04)％,(28.78± 4.18) pg/mL and (40.38±9.03) pg/mL,which were significantly lower than those in the non-dialysis group (P＜0.05),and the IL-10 level in the dialysis group was (18.52±2.19) pg/ml,which was significantly higher than that in the non-dialysis group (P＜0.05).Conclusion The imbalance of Treg and Th17 levels exist in uremic patients,and hemodialysis can help to improve the imbalance of Treg and Th17 levels.
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One hundred and forty-two patients on maintenance hemodialysis were enrolled in the study.According to the guideline of American Society of Echocardiography 97 patients (68.3％) were classified as pulmonary artery hypertension [PAH,pulmonary artery systolic pressure (PASP) ＞ 35 mmHg (1 mmHg =0.133 kPa)] and 45 patients (31.7％) as non-PAH (PASP ≤ 35 mmHg).High sensitivity Creactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) were measured by automatic analyzer and enzyme linked immunosorbent assay (ELISA),respectively.There were significant differences in CRP and TNF-α levels between PAH and non-PAH patients (P ＜ 0.05).Multivariate linear regression showed that TNF-α and interdialytic weight gain were positively correlated with PAH and left ventricular ejection fraction was negatively correlated with PAH (P ＜ 0.01).In the multivariate Cox proportional hazards models,PAH and TNF-α level were independently associated with higher risk for all-cause death (HR =1.06,95％ CI:1.03-1.09 and HR =1.31,95％ CI:1.17-1.46,respectively).In Kaplan-Meier survival analysis,the risk of all-cause mortality increased in parallel with PASP.The risk of death in patients with PASP ＞45 mmHg was higher than that in patients with PASP ≤45 mmHg (log-rank test:x2 =6.58,P =0.010),the risk was 2.82-fold (HR =2.82,95％ CI:1.38-5.77,P =0.004).
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Objective To explore the feasibility of laparoscopic resection of large uterus .Methods Patients with large uterus ( volume such as 12~20 weeks pregnant size ) by the implementation of laparoscopic hysterectomy were collected in our hospital and Dongguan Tung Wah Hospital from January 2010 to December 2012 .The uterus was carried out a complete hysterectomy through intra-operation by upward into the abdominal puncture point , ligation cutting tumor , and reduction of the uterine body method .Results A total of 38 patients was carried out hysterectomy operation .According to the size of uterus , the lens opening and operating hole was cor-responding upward to expand the horizons and operating space under microscope , and the use of stepwise ligation method to gradually cut reduced uterine body and release the operation space for overcoming the narrow operation space .Each hysterectomy operation was smoothly completed , and no case was converted to laparotomy .Conclusions Laparoscopic hysterectomy with the puncture point , and moving after ligation cutting shrink small palace body method can effectively create space for operation , and safety and feasibility of lap-aroscopic resection is helpful to improve the large uterus .
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BACKGROUND:Conventional ophthalmic delivery of ciliary neurotrophic factor (CNTF) is extremely difficult to pass the blood-retinal barrier, resulting in a very low bioavailability and the need of long-term drug delivery. To solve the problem, the CNTF can be encapsulated in a semi-permeable membrane to form a microcapsule, which may then achieve the release of bioactive substances encapsulated, or bioactive molecules secreted by living cels and smal molecular metabolites through semi-permeability of the special membrane. OBJECTIVE:To prepare a special structural CNTF sustained-release microcapsule. METHODS: A selected poly(ether sulfone) holow fiber was cut into 1 cm long with its two ends sealed by 1181-M medical adhesive using UV curing. To prepare CNTF encapsulated microcapsule, one end was first sealed, and then the CNTF was loaded to poly(ether sulfone) microcapsule from the other end which then was sealed. The leaching liquor of sustained-release microcapsule was co-cultured with mouse fibroblast L929, to observe the cytotoxicity of the microcapsule. The sustained-release microcapsule was co-cultured with mouse retinal pigment epithelial cels, to observe the celladhesion ability of the microcapsule. The CNTF sustained-release microcapsule was immersed in physiological saline, to observe the degradability. Moreover,in vitro release behavior of immunoglobulin and CNTF were evaluated. RESULTS AND CONCLSION:The CNTF sustained-release microcapsule had an inner diameter of about 398 μm and a membrane thickness of about 145 μm. The microcapsule presents a lot of macropores in the outer wal and many 10 nanometers micropores in the inner wal. The sustained-release microcapsule was not degraded in saline within 4 months, indicating good cellcompatibility. The microcapsule can selectively release CNTF while protecting against invading of antibodies (IgG), showing its good selective permeability. Meanwhile, the sustained-release microcapsule improved the initial burst release of traditional drug delivery vesicles. The microcapsule presents a mild sudden release in the middle stage, and then a sustained release.
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Objective To investigate the effectiveness and surgical techniques of the improved laparoscopic treatment of ovarian dermoid cyst to prevent the occurrence of intraoperative rupture of teratomat, so to preserve the ovarian function at the maximum. Methods The modified laparoscopic extra-cavity and cavity outside the teratoma removed surgical suture treatment from February 2005 to February 2009,39 cases with large dermoid cyst were trea-ted by improved surgery and 45 cases treated by normal removal of laparoscope. The rupture, surgery time, bleeding volume,frequency of use of electrocoagulation and the effect of body temperature on intestinal canal and hospitaliza-tion day after operation as well. Results 39 cases of dermoid cyst were successfully managed by improved laparo-scopie surgery, during which no cyst contents broke into the abdominal cavity, no one was placed on electrocoagula-tion to stop bleeding, bleeding volume was (35.13±5.49) ml, operative time was (36.07±12.53) min, significantly leas than that of normal laparoscopic surgery group [the cyst rupture rate was 46.7% (21/45), the frequency of elec-trocoagulation was (5.0±3.0) times, the duration of electrocoagulatian was (5.5±2.5) s, bleeding loss was (40.73±6.04) ml and the time for operation was (67.47±20.73) min], with significant difference between the two groups (P<0.05 or 0.01);howevere, there was no remarkable difference in the effect of the two types of surgery on postoperative body temperature,anal exhaust time,postoperative hospitalization day. Conclusions In addition to minimally invasive laparoscopic surgery in the treatment of gastro-intestinal effects of small, quick recovery, the im-proved laparoscopic surgery for dermoid cyst shortens the operation time. The improved abdominal cavity and suture outside the strip surgical method can effectively prevent the complication caused by intraoperative tumor capsule rup-ture,reduce electrocoagulation injury,and preserve the ovarian function at the maximum.
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Porous nano-hydroxyapatite/polyamide 66 (n-HA/PA66) composite was developed by injection molding method. Uniformly distributed and interconnected pores with an average size of about 500 microm in matrix were obtained. The evaluation of biological safety of the porous composite including cell cytoxicity test, sensitivity test, pyrogen test, haemolysis test was carried out according to GB/T16886 and GB/T16175. The results showed that the porous n-HA/PA66 composite was of no cytotoxicity, no allergen and pyrogen reactions as well as no hemolytic effect.