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Objective:To summarize the experience and technical difficulties of complete thoracoscopic lobectomy(segmental) in the treatment of congenital pulmonary airway malformation in children.Methods:The clinical data, surgical videos and follow-up results of 38 children suffering from congenital pulmonary airway malformation and underwent complete thoracoscopic lobectomy in Children′s Hospital of Fudan University Xiamen Branch from January 2017 to December 2019 were retrospectively analyzed.A statistical comparisons of operative time, intraoperative blood loss, postoperative pain (the first time of getting out of bed), incision length and postoperative pulmonary complications were made between 28 children who underwent the total thoracoscopic lobectomy and 21 children who accepted open surgical lobectomy before January 2017 in Children′s Hospital of Fudan University Xiamen Branch.Results:Thirty-eight children with congenital pulmonary airway malformation were successfully operated by complete thoracoscopy.There were 28 lobectomies, 6 segmental lobectomies and 4 wedge lobectomies.Postoperative follow-up was conducted for more than 3 months, and no serious surgical complications occurred.Chest radiograph of 2 children with the right lower lobectomy at 48 hours after surgery had the elevation of the right diaphragm (2-3 intercostal), and it returned to normal 3 months after surgery.The CT review of 1 child with pulmonary wedge resection 1 month after surgery displayed a little residual lesion.Thoracoscopic lobectomy was significantly different from open surgery in terms of incision length[(2.0±0.5) cm vs. (10.0±0.5) cm], postoperative pain (the first time of getting out of bed)[(24.0±2.0) h vs. (48.0±1.5) h] and pulmonary complications (0 vs. 5 cases). The operative time of single lung ventilation was remarkably different from that of double lung ventilation in thoracoscopic lobectomy[(96.0±6.0) min vs. (118.0±7.0) min, t=106.501, P<0.001]. Compared with thoracoscopic lobectomy, thoracoscopic pulmonary segmentectomy has a long time and a large amount of blood loss. Conclusions:Complete thoracoscopic lobectomy (segmental) is the first choice for the treatment of congenital pulmonary airway malformation in children, with clear operative field, little trauma, less postoperative pain, quick recovery and fewer respiratory complications.Single-lung ventilation is beneficial for surgical completion.
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Objective:To explore the independent risk factors that predict 10-year mortality in patients with stable chronic obstructive pulmonary disease(COPD).Methods:The baseline data from a prospective cohort study were analyzed and long-term follow-up were performed. Patients with confirmed diagnosis of stable COPD were consecutively enrolled in the outpatient clinic from January 2010 to December 2010, and were followed up until December 31, 2020. Cox regression analysis was used to determine the independent risk factors for all-cause mortality and mortality from respiratory causes in stable COPD patients.Results:A total of 182 stable COPD patients were enrolled and followed up for a median of 89 months. The 10-year mortality was 51.1%(93/182), and 9 patients died within one year. The leading cause of death was respiratory disorder, followed by cardiovascular and cerebrovascular diseases. The risk factors independently associated with all-cause mortality included old age( HR=1.936,95% CI: 1.610~2.328, P<0.01), increased baseline COPD Assessment Test(CAT)( HR=1.331,95% CI: 1.049-1.689, P=0.02) and the increased CAT in one year( HR=1.314,95% CI: 1.197-1.420, P<0.01). The risk factors independently associated with respiratory cause mortality included increased baseline CAT( HR=1.719,95% CI: 1.026-2.880, P=0.04), emphysema index(LAA%)( HR=1.062,95% CI: 1.007-1.120, P=0.03), and one year inecreased CAT( HR=1.342,95% CI: 1.198-1.505, P<0.01)was a protective factor. Conclusions:Old age, baseline CAT, one year increased in CAT and LAA% were independent influencing factors for 10-year mortality of stable COPD patients.
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Objective To investigate the effect of PDCA circulation method in training of neonatal resuscitation from asphyxia.Methods Fifty medical staff in the department of pediatrics were trained on neonatal resuscitation from asphyxia with the PDCA circulation method.The performances in the examination after training were compared with those before training.Result The performances in the post-training examination were significantly better than that in the pre-training examination(P<0.01). Conclusion PDCA circulation method used for the training of neonatal resuscitation from asphyxia is effective in improving the theoretical knowledge as well as the practical manipulation.
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10?m cytochalasin D (CD) was used to treat cardiocytes from adult human atrium and adult rat atrium and ventricle in long-term primary cultures. Durations of treatment were 0.5, 1, 6, 12, 24 and 48h. In some cultures, the medium containing CD was removed at the planned time to be replaced with the medium without CD.These dishes were then cultured for an additional 48h. Control cultures were exposed to dimethyl sulfoxide (DMSO), the vehicle used to dissolve CD. All cultured cells were first stained with rhodamine-labelled phalloidin to show F-actin and then stained with fluoreseein-labelled antitubulin to show microtubles. The freshly isolated and rounded cardiocytes did not respond to CD, while the spreading cells responded apparently. The actin filament bundles in the peripheral zone of spreading cells were cut into segments. Most segments were gathered into aggregates and granules. Some aggregates were lodged on the inner aspect of the sarcolemma. Small vacuoles were seen between the myofibrils or somewhere along the course of the myofibrils. The CD response from the atrial spreading cells, especially the human atrial spreading cells, were more obvious than that from the rat ventricular cells. Cells exposed to CD and then cultured in normal medium for 48h did not return to normal. Microtubules were not directly affected by CD, but in places where vacuolization occured they made way for vacuoles. All the control cultures made no response to DMSO. The above-mentioned results suggest that different sensitivity to CD existed in cultured adult cardiocytes between different species and that a difference also existed in the contractile machinery between the atrial culturing cells and ventricular cultureing cells of the same species.