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@#Objective To analyze the perioperative safety and the short-term prognosis of non-small cell lung cancer (NSCLC) patients with preoperative arrhythmia. Methods The clinical data of NSCLC patients treated in the Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University from August 2020 to March 2021 were collected and observed. The patients were divided into an arrhythmia group and a control group according to whether there was arrhythmia in the 24 h ambulatory electrocardiogram examination report before operation. The incidence of intraoperative and postoperative cardiovascular events and short-term prognosis were compared between the two groups. Results A total of 466 patients were included in this study, including 338 patients in the arrhythmia group, 176 males and 162 females, with a median age of 68.0 (63.0, 72.0) years, and 128 patients in the control group, 59 males and 69 females, with a median age of 66.5 (60.0, 72.0) years. A total of 26 patients (7.7%) in the arrhythmia group were placed with temporary pacemakers before operation. There was no significant difference in the incidence of cardiovascular related events between the two groups [100 (29.6%) vs. 28 (21.9%), P=0.096]. The incidence of postoperative arrhythmia events in the arrhythmia group was higher than that in the control group [112 (33.1%) vs. 11 (8.6%), P<0.001]. The average postoperative ICU stay in the arrhythmia group was longer than that in the control group (1.1±0.7 d vs. 1.0±0.6 d, P=0.039). Conclusion Preoperative arrhythmia does not increase the risk of intraoperative cardiovascular events in NSCLC patients, but increases the incidence of postoperative arrhythmia events and prolongs ICU stay.
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@#Objective To provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease (COPD) through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy. Methods The clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed, including 124 males and 39 females, with a median age of 64 years (IQR: 23.8 years). They were divided into a COPD group (n=87) and a non-COPD group (n=76) according to the presence of COPD before operation. The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed. Results The incidence of major postoperative complications (pulmonary infection, respiratory failure, arrhythmia and anastomotic leakage) in the COPD group were higher than those in the non-COPD group (all P<0.05). Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer (r=0.437, P<0.001). The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD. The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group (56.1%vs. 78.5.%, P=0.001), and the severity of COPD was negatively correlated to the survival rate. Conclusion COPD significantly increases the incidence of postoperative complications in patients with esophageal cancer, which is not conducive to the prognosis of patients, and the severity of COPD is correlated with postoperative complications and 2-year survival rate.
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Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.
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@#Objective To analyze the effect of type 2 diabetes (T2DM) on the short-term prognosis of patients with non-small cell lung cancer (NSCLC) after resection surgery. Methods Clinical data of 207 NSCLC patients who underwent resection surgery in our hospital from January 2016 to January 2019 were retrospectively analyzed. The 100 NSCLC patients with T2DM were allocated to a T2DM group (58 males and 42 females, with an average age of 65.26±7.26 years), and 107 patients without T2DM were allocated to a non-T2DM group (66 males and 41 females, with an average age of 64.21±7.51 years). The short-term prognosis of the patients was compared between the two groups. Results Compared with the non-T2DM group, the postoperative atelectasis (P=0.012) and pulmonary infection (P=0.040) were statistically different in the T2DM group. The postoperative complication rate in the T2DM group was significantly higher than that in the non-T2DM group (66.0% vs. 33.6%, P<0.001). The postoperative hospitalization time in the T2DM group was longer than that in the non-T2DM group (9.83±6.35 d vs. 8.09±4.40 d, P=0.007). Conclusion T2DM will increase the incidence of postoperative complications, prolong the length of hospital stay and increase the economic burden of the NSCLC patients, which is not conducive to the postoperative prognosis of patients.
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Objective To investigate the expression change and their clinical role of triggering receptor expressed on myeloid cells-1 (TREM-1) in patients with severe thoracic trauma.Methods A prospective cohort study was conducted to analyze the clinical data of 52 patients with severe thoracic trauma (trauma group) hospitalized from October 2016 to May 2017.The peripheral anticoagulant blood samples were collected at days 1,3,5,7 and 14 after trauma.Meanwhile,10 healthy volunteers were enrolled in control group and their blood samples were collected once.According to injury severity score (ISS),the patients were divided into ISS low-score group (＜ 20 points,n =15) and high-score group (≥20 points,n =37).The patients were assigned to traumatic non-sepsis group (n =34) and traumatic sepsis group (n =18) by the latest definition and standard of sepsis 3.0 issued by the Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM).The expressions of TREM-1 on neutrophils and monocytes were measured by flow cytometry.Pairwise comparisons were done between trauma group and healthy volunteers,ISS low-score group and ISS high-score group,and traumatic sepsis group and non-sepsis group,respectively.The accuracy of traumatic sepsis prediagnosis by TREM-1 was evaluated by the area under receiver operating characteristic curve (AUC).Results Trauma group had 41 males and 11 females,with age of (45.9 ± 12.4) years,Abbreviated Injury Scale (AIS) of (3.5 ± 0.6) points and Injury Severity Score (ISS) of (23.6 ± 8.5) points.Control group had eight males and two females,with the age of(29.1 ± 2.8) years.Compared to control group,trauma group had slightly lower TREM-1 expressions in neutrophils and significantly higher expressions in monocytes at days 1 to 14 (all P ＜ 0.01).ISS high-score group had slightly lower TREM-1 expressions in neutrophils than ISS low-score group at days 1 to 7,with significant difference at day 1 (P ＜ 0.05).ISS high-score group had slightly higher TREM-1 expressions in monocytes than ISS lowscore group at days 1 to 14,with significant difference at day 14 (P ＜ 0.05).Compared to traumatic non-sepsis group,traumatic sepsis group had significantly lower TREM-1 expressions in neutrophils at days 1 to 14 (all P ＜ 0.05).Traumatic sepsis group had slightly lower expressions in monocytes than traumatic non-sepsis group at days 1 to 7,with significant difference at day 3 (P ＜ 0.05).AUC and 95％ CI evaluating the role of neutrophils TREM-1 in traumatic sepsis prediagnosis were 0.852 (0.738,0.966) at day 1,0.835 (0.721,0.948) at day 3,0.797 (0.654,0.939) at day 5,0.756 (0.599,0.914) at day 7,and 0.707 (0.525,0.888) at day 14,respectively.Conclusions After severe thoracic trauma,the expressions of TREM-1 are decreased in neutrophils but increased in monocytes.TREM-1 might be used to assess the injury severity and has certain value in prediagnosis for traumatic sepsis.
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Objective To investigate the effects of glucocorticoid on the changes of serum cortisol and 24-hour urinary cortisol in patients undergoing rheumatic valve replacement.Methods 86 patients undergoing rheumatic valve replacement were respectively given 1000 mg methylprednisolone during extracorporeal circulation and intravenously injected 10 mg dexamethasone on the first three days after operation.The enzyme-linked immunosorbent assay (ELISA) was taken to detect the serum cortisol concentration and 24-hour urinary cortisol on the day before operation,the 1st,3rd,5th,and 7th day after surgery.The postoperative complications such as the surgical incision and pulmonary infection were observed during the recovery days.Results Serum cortisol concentrations for patients with different preoperative cardiac function classifications had no significant difference at each observation point during the perioperative period (P＞0.05).Serum cortisol concentration showed a downward trend during the first 3 days after surgery.The serum cortisol level on the 3rd day after surgery was lower compared with that before surgery (P＜0.05),whereas 3 days later the serum cortisol concentration increased gradually and got back to the preoperative levels on the 5th day after surgery.The 24-hour urinary cortisol rose to the peak level on the 1st day after surgery,then decreased to the preoperative level on the 3rd day after surgery (P＞0.05).All the patients recovered.No one died or had complications such as pulmonary infection or incisions healing problems.Conclusions The effects of corticosteroids on perioperative serum cortisol levels in patients with rheumatic heart disease were not clearly correlated with preoperative cardiac function classification.Using glucocorticoid in the first three days after surgery reveals transient inhibitory effect on serum cortisol secreting,however,the cortisol level can quickly go back to the preoperative level after stopping giving glucocorticoid.
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Objective To investigate the prognostic factors in patients with esophygectomy after oncologic esophagectomy by analyzing the long-term survival .Methods 104 patients underwent esophagectomy for cancer were retrospectively reviewed from 2007 to 2008 in this hospital ,and the investigation was carried on in questionnaire ,following up 3 years .Various ways ,such as Life Tables ,Kaplan-Meier and Cox regression analysis ,were used to evaluate long-term survival .Results (1)A total of 61 patients died in 3 years .The median survival time was 35 .23 months .The cumulative survival rates at 1 ,2 and 3 year after surgery were 87% , 62% ,and 48% respectively ,and death hazard in 24th month after surgery was the highest .(2)In univariate analysis :drinking ,pres-ence of lymph node metastasis and TNM staging were significant factors that influenced long-term survival .(3)Multivariate analy-sis :lymph node(RR = 2 .399 ,P= 0 .002 ,95% CI :1 .385 to 4 .154) ,drinking(RR = 0 .470 ,P = 0 .008 ,95% CI :0 .269 to 0 .882) ,di-gestive tract construction(RR= 1 .910 ,P= 0 .018 ,95% CI :1 .118 to 3 .262) were the isolated factor influencing the prognosis .Con-clusion Patients after oncologic esophagectomy generally suffer poor survival .The presence of lymph node metastasis ,drinking and different methods of reconstraction are statistically significant factors influencing long-term survival .
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Objective To investigate the ipratropium bromide combined with Ambroxol Aerosol Inhalation on preventive effect of pulmonary complications after thoracotomy. Method 115 patients undergoing thoracic operation were randomly divided into 2 groups, 2 groups were given routine nursing before operation, the control group on the basis of Mucosolvan atomization inhalation, the observation group in the conventional nursing combined with ipratropium bromide and atomization inhalation of ambroxol. Results the curative effect of therapeutic group was signiifcantly better than the control group (P<0.05); lung infection in the observation group was significantly lower than that of the control group (P<0.05). Conclusion ipratropium bromide and Mucosolvan aerosol inhalation signiifcantly on the prevention of pulmonary complications after thoracotomy and effect, will help the patient restore.
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<p><b>OBJECTIVE</b>To investigate the effect of 1,25-dihydroxyvitamin D(3) and 5-fluorouracil, either alone or in combination, on the expression of IGFBP-3 in human esophageal carcinoma 109 cell xenograft in nude mice.</p><p><b>METHODS</b>In vitro cultured esophageal carcinoma Eca-109 cells were inoculated subcutaneously in BALB/c mice. The tumor-bearing mice were randomly divided into control group (A), 1,25-dihydroxyvitamin D(3) group (B), 5-fluorouracil group (C), and 1,25-dihydroxyvitamin D(3) plus 5-fluorouracil group (D). 1,25-dihydroxyvitamin D(3) and 5-fluorouracil were administered at the doses of 2.5 ug/kg and 25 mg/kg via intraperitoneal injections, respectively, and the mice in the control group received saline injection only. The tumor growth was observed and the expression of IGFBP-3 in the tumor xenograft was detected using immunohistochemistry. An automatic biochemistry analyzer was used to determine serum calcium levels, and Von Kossa staining was utilized for observation of calcium deposition in the kidneys.</p><p><b>RESULTS</b>Compared with that in group A, the xenograft in groups B, C, and D all showed a lowered growth rate with a smaller tumor volume, and presented with stronger IGFBP-3 positivity and significantly higher levels of IGFBP-3 protein expression (P<0.05). In group D, the protein expression of IGFBP-3 was significantly increased compared with that in groups B and C (P<0.05). Compared with that in group A, serum calcium level was slightly increased in groups B, C, and D, , but no obvious calcium deposition was found in the kidney tissue sections.</p><p><b>CONCLUSION</b>Both 1,25-dihydroxyvitamin D(3) and 5-fluorouracil can inhibit the growth of the tumor xenograft in nude mice, and their combination is more effective. This effect is probably associated with increased protein expression of IGFBP-3 in the xenograft tumor. No calcium deposition occurs in the kidney tissue of the tumor-bearing mice.</p>
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Animals , Humans , Male , Mice , Cell Line, Tumor , Fluorouracil , Pharmacology , Insulin-Like Growth Factor Binding Protein 3 , Metabolism , Mice, Inbred BALB C , Mice, Nude , Vitamin D , Pharmacology , Xenograft Model Antitumor AssaysABSTRACT
Objective To evaluate the surgical treatment for renal cell carcinoma with inferior vena cava tumor thrombus and the clinical significance of multidisciplinary treatment. Methods Two cases of renal cell carcinoma with inferior vena cava thrombus diagnosed by Doppler ultrasonography and CT were included in this retrospective analysis. The tumor thrombus was in level Ⅱ in one case and in level Ⅳ in the other. Coagulation test and complete blood count were done again before surgery. Human albumin, fibrinogen, prothrombin complex, plasma, platelet, UW and irrigating solution were prepared before the operation.Under general anesthesia, surgery was performed using abdomen inverted Y shaped incision. Right radical nephrectomy was finished by the urological surgeon; the vena cava was completely dissected from the renal vein level to the secondary porta of the liver by the hepatobiliary surgeon, the vena cava and the surrounding branch vein were blocked in the upper and lower vena cava tumor thrombus; tumor thrombus was removed completely by the vascular surgeon. In one case (patient with level Ⅳ thrombus ) where the tumour thrombus invaded the wall of the vena cava, the thrombus was found to be extending to the cavo-atrial junction but not into the right atrium. The left femoral venous-right atrial bypass was established, the cardiopulmonary bypass lasted for 241 mia, and the aorta was blocked for 18 min. Salvage autotransfusion was used during surgery, and the hepatic vein of the secondary liver porta was anastomosed to artificial vascular graft.The data for surgical indication, operation time, operative blood loss and postoperative hospital stay were analyzed. Results Right radical nephrectomy and inferior vena cava thrombectomy were performed successfully, and the two patients were discharged on the 15th and 27th day after surgery, respectively. The two patients were followed up for 1 and 16 months after surgery, respectively, and both survived without local recurrence and distant metastasis. Conclusion Radical nephrectomy and inferior vena cava thrombectomy is the preferred method for patients without metastasis, and multidisciplinary cooperation could shorten the operation time, reduce the tumor recurrence and increase the survival rate of patients.
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<p><b>BACKGROUND</b>Most studies about FHIT protein expression were performed in normal tracheal epithelium, precancerous lesions and lung cancer tissues respectively, but not in the course of malignant transformation of lung cancer. The aim of this study is to detect the changes of FHIT protein expression during malignant transformation of immortalized human bronchial epithelial cells (BEAS-2B) induced by tobacco-specific nitrosamine (NNK), and to explore its significance.</p><p><b>METHODS</b>BEAS-2B cells were induced to malignantly transform (BEAS-2B NNK) by 500mg/L NNK, and FHIT protein expression was detected in the different passages of BEAS-2B NNK and BEAS-2B cells by SP immunocytochemistry.</p><p><b>RESULTS</b>Part 1: Model of malignant transformation of BEAS-2B cells induced by NNK was established. (1) The serum resistance was significantly increased in the 5th passage of BEAS-2B NNK cells. (2) The anchorage independent growth (soft agar colony formation) appeared in the 15th passage of BEAS-2B NNK cells. (3) The ultrastructure of the 20th passage of BEAS-2B NNK cells showed obvious heteromorphy characterization. (4) The 25th passage of BEAS-2B NNK cells developed into tumors in nude mice, which were well differentiated squamous cell carcinoma. Part 2: FHIT protein was steadily expressed in the different passages of BEAS-2B cells (P > 0.05). FHIT protein expression was obviously decreased from 5th to 15th passage of BEAS-2B NNK cells, but it was unexpectedly overexpressed in the 25th passage.</p><p><b>CONCLUSIONS</b>(1) The model of malignant transformation of BEAS-2B cells induced by NNK (500mg/L) can be established successfully and may be used for investigation of molecular biological mechanisms of lung cancer, especially for smoking-related cases. (2) Decrease of FHIT protein expression might be an early event, however, its overexpression in the late passages should be further studied.</p>
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Objective:To explore the selection of the treatment methods for acute aortic dissection.Methods:Thirteen patients with acute aortic dissection were studied and analyzed.Results:Of the 13 patients,2 received pharmacotherapy;6 underwent surgical treatment;2 were treated with inplantation of intravascular stent-grafts;1 experienced no treatment because of the ischemic necrosis of the abdominal organs,and 2 suddenly died of the rupture of aortic dissection in the course of emergent management.Conclusion:The emergent pharmacotherapy is essential to all patients with acute aortic dissection.The emergent surgical treatment of acute aortic dissection is selected mainly according to the Debakey Classification.Patients with Debakey Type Ⅰ and Ⅱaortic dissection should undergo operation as early as possible.The outcome of pharmacotherapy is similar to that of surgical treatment based on suitable indications for Debakey Type Ⅲ aortic dissection.Debakey Type Ⅲ aortic dissection can be treated by the intravascular stent-grafts too.
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Objective:To study the clinical results and the hospitalization cost of video-assisted thoracoscopic surgery (VATS) with ligation and suture for the treatment of spontaneous pneumothorax.Methods:Thirteen patients were treated by VATS with ligation and suture.The consumed time of operation,duration of the chest drainage,amount of the chest drainage,percentage of patient discontinuing anodyne within the postoperative 24 hours,the average length of hospitalization and the hospitalization cost were analysed.Results:Satisfactory therapeutic effects were found in all cases without postoperative death and complications. The average hospitalization time was 3 days.VATS with ligation and suture was preferable to transaxillary minithoracotomy (TAMT) in the clinical results.The hospitalization cost is less for VATS with ligation and suture (7372.47?871.3) than that with Endo-GIA (12524.32?2962.18) (P
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OBJECTIVE: To study the effects ethanol extract of Zingiber officinale against myocardial ischemia-reperfusion injury in rats. METHODS: 50 female SD rats were randomly divided into sham group, model group, ethanol extract of Z. officinale groups (low, medium, high-dose group). Acute regional myocardial ischemia-reperfusion injury model was induced with ligation of rat heart left anterior descending coronary artery for 30 min and 90 min of reperfusion. The content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) were measured while transmission electron microscopy (TEM) was applied to detect the changes in myocardial ultrastructure. RESULTS: As compared with sham group, the content of MDA in model group was significantly increased but the activity of SOD was decreased (P
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Objective:To explore the diagnosis and management of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after thoracotomy.Methods:The clinical data of three patients with SIADH after thoracotomy (1 radical operation of esophageal carcinoma,1 radical operation of cardia carcinoma,1 pulmonary lobectomy) were analyzed retrospectively.Results:All 3 patients were males with an average age of 71.4(67.5～74)years.Psychiatric symptoms (the state of delirium) were manifestated by all patients during 3rd to 4th day after thoracotomy,and meanwhile their serum sodium decreased significantly(125～126mmol/L);urine sodium increased abnormally(74.9～101 mmol/L);plasma osmolality decreased(255～280mosm/kg H_2O) and osmolality of urine rised(540～695mosm/kg H_2O).The psychiatric symptoms of 3 patients disappeared and their serum sodium,urine sodium,plasma osmolality,osmolality of urine reversed to normal after water restriction(800～1000ml/24h) for 4 to 6 days.Conclusion:The causes of SIADH after thoracotomy may be related to positive pressure respiration,fierce mental stress,and severe pain that can cause ADH secretion.
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Objective:To summarize the clinical experience in CABG,so as to look for the optimal perioperative management procedure and improve the operative outcome.Methods:The data of coronary artery bypass were analyzed in 9 patients with coronary heart disease.Results:CABG of all patients was performed on hypothermia cardiopulmonary bypass (CBP).Myocardial preservation was carried out by cold blood cardioplegia with potassium.The average length of time of CPB was 178(70～222) minutes,and that of aortic cross clamp was 111(70～150) minutes.A total of 23 cases of coronary artery bypass were performed using 8 left internal mammary arteries and 15 long saphenous veins.One patient with rheumatic valvular disease associated with coronary heart disease received coronary artery bypass grafts and double valve replacement at the same operation.One patient died of respiratory function failure and the rest were discharged with angina disappearing.Conclusion:The success of coronary artery bypass lies in obtaining of grafts,identifying adequate target vessel,complete revascularizing ischemic myocardium and refining blood vessel anastomosis.Good myocardial protection and perioperative management are also important.
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Objective:To evaluate therapeutic effect of membrane-covered self-expanding metallic stent on high-positioned advanced esophageal carcinoma,esophagotracheal fistula and anastomotic stricture,and relevant problems to stent implantation.Methods:23 membrane-covered self-expandable stents were implanted in 23 patients with high-positioned advanced esophageal carcinoma (12 cases),esophagotracheal fistula (6 cases) and high-positioned anastomotic stricture (5 cases).The implantation of the stents was performed under endoscope or perorally.Results:The severity of dysphagia was reduced,and life quality of the patients was improved significantly.One stent had to be taken out for severe pain. The positions of 3 stents were successfully adjusted by endoscope for improper position after the first implantation.6 patients suffered from the disorder of pharyngeal function after implantation,among which 5 were cured,and 1 had the stent taken out.Conclusion:Membrane-covered self-expanding metallic stent is effective,safe and easy to insert,especially for patients with the stricture of the high-positioned advanced esophageal carcinoma,and the esophagotracheal fistula.However stent is not the first choice for the treatment of anastomotic stricture.Post-implantation pain,improper position of stent and the disorder of pharyngeal function can be solved by active management.