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Objective:To compare the effects of thoracoscopic anatomical segmentectomy and thoracoscopic lobectomy on patients' respiratory function.Methods:Retrospective analysis of 326 patients who underwent thoracoscopic surgery from July 2016 to July 2019(209 patients underwent anatomical segmentectomy, 117 patients underwent lobectomy). According to variables including gender, age, tumor location, smoking history and BMI, two propensity score-matched cohorts including 89 patients respectively were constructed. The patients’ baseline data and respiratory function date of the patients pre-operation and post-operation were analyzed. The measurement data that obey the normal distribution were described by mean±standard deviation, and the t-test was used for comparison between groups; the measurement data of non-normal distribution was described by the median value( P25, P75), and the Wilcoxon rank sum test was used for the comparison between groups; The data was described by frequency, and the chi-square test or Fisher's exact probability method was used for comparison between groups. Results:At the first-month follow-up after surgery, there was no significant difference in the variation of FVC[(0.48±0.40)L vs.(0.34±0.37)L, P=0.215)and FEV1[(0.52±0.46)L vs.(0.43±0.77)L, P=0.364), and in the change rate of FVC(%)[15.23(8.74, 21.25) vs. 14.58(7.75, 19.40), P=0.122], FEV1(%)[17.25(9.56, 22.78) vs. 16.42(9.15, 20.28), P=0.154]and DLCO(%)[18.54(10.88, 25.68)vs. 17.45(9.58, 23.75) P=0.245]. Between the segmentectomy group and lobectomy group, there was a significant difference in the alteration of FVC[(0.50±0.47)L vs. (0.29±0.31)L, P=0.031] and FEV1[(0.44±0.34)L vs.(0.24±0.23)L, P<0.001], the change rate of FVC(%)[14.27(7.87, 22.32) vs. 9.95(5.56, 17.24), P=0.008]、FEV1(%)[15.23(8.36, 22.17)vs. 10.05(5.15, 18.54), P<0.001]and DLCO(%)[13.74(6.24, 19.78) vs. 4.45(-2.32, 13.75), P=0.023]in the 6th month after surgery. The lobectomy group had a higher variation of FEV1[(0.34±0.49)L vs.(0.18±0.26)L, P=0.006] and change rate of FVC(%)[9.28(2.15, 18.94) vs. 5.24(0.52, 11.45), P=0.0032] and FEV1(%)[10.45(3.15, 21.32) vs. 6.50(1.55, 14.24), P<0.001] in the first year after surgery. However, the variation of FVC[(0.29±0.36)L vs.(0.21±0.24)L, P=0.176) and the change rate of DLCO(%)[8.35(2.15, 16.45) vs. 6.23(2.12, 14.54), P=0.143] didn't show a significant difference between the two groups. Conclusion:Whether in the short or the middle postoperative period, segmentectomy can preserve postoperative respiratory function than lobectomy.
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@#Objective To assess the correlation of WHO pathological classification and Masaoka stage of thymomas with its prognosis. Methods A total of 468 patients with thymomas who received surgeries during 2009-2019 in Huashan Hospital, Fudan University, were collected. There were 234 males and 234 females with an average age of 21-83 (49.6±18.7) years. A total of 132 patients underwent video-assisted thoracic surgery (VATS) and 336 patients underwent thymectomy with median sternal incision. The follow-up time was 5.7±2.8 years. The clinical data of the patients were analyzed. Results The amount of intraoperative bleeding was 178.3±133.5 mL in the median sternal incision group, and 164.8±184.1 mL in the VATS group (P=0.537). The operative time was 3.3±0.7 h in the median sternal incision group and 3.4±1.2 h in the VATS group (P=0.376). Postoperative active bleeding, phrenic nerve injury and chylothorax complications occurred in 8 patients, 9 patients and 1 patient in the VATS group, respectively, and 37 patients, 31 patients and 7 patients in the median sternal incision group, respectively. There was no statistical difference between the two groups (P=0.102, 0.402, 0.320). The 5-year cumulative progression free survival (PFS) rates of patients with WHO type A, AB, B1, B2, B3 and C thymomas were 100.0%, 100.0%, 95.7%, 81.4%, 67.5% and 50.0%, respectively (P<0.001). The 5-year PFS rates of patients with Masaoka stageⅠ-Ⅳ thymomas were 96.1%, 89.2%, 68.6% and 19.3%, respectively (P<0.001). The 5-year PFS rate was 87.3% in patients with myasthenia gravis (MG) and 78.2% in patients without MG (P<0.001). The 5-year PFS rates of patients with different surgeries were 82.4% and 83.8%, respectively (P=0.904). Conclusion WHO pathological classification and Masaoka stage have significant clinical prognosis suggestive effect. Thymoma patients combined with MG have better prognosis, which suggests early diagnosis and treatment of thymoma are important.
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<p><b>BACKGROUND</b>Cushing's disease (CD) presents a remarkable preponderance in female gender, and a significant minority of patients with CD presented with negative magnetic resonance imaging (MRI) findings. The aim of this study was to evaluate gender-related and MRI classification-related differences in clinical and biochemical characteristics of CD.</p><p><b>METHODS</b>We retrospectively studied 169 patients with CD, comprising 132 females and 37 males, and 33 patients had no visible adenoma on MRI.</p><p><b>RESULTS</b>We observed that male and MRI-positive patients presented with high adrenocorticotropic hormone (ACTH) values (P < 0.05). Female patients presented with higher prevalence of hirsutism and hyperpigmentation and lower prevalence of purple striae (P < 0.05). The prevalence of buffalo-hump and hypertension was greater in MRI-negative patients (P < 0.05). In addition, male patients with CD presented at a younger age compared with females (P < 0.05). Patients with fatigue and hypokalaemia presented significantly higher urinary-free cortisol, ACTH and cortisol levels compared with patients without these symptoms (P < 0.05). The prevalence of LH reduction, hyper total cholesterol (TC) and hyper low-density lipoprotein was more frequent in MRI-positive patients (P < 0.05). Hyper-TC levels and PRL reduction were more frequent in males (P < 0.05). T3, T4 and FT3 levels negatively correlated with age at diagnosis (r = -0.310, P < 0.01; r = -0.191, P < 0.05; r = -0.216, P < 0.05). T3, T4, FT3 and FT4 levels significantly negatively correlated with 8-am plasma cortisol levels (r = -0.328, P < 0.01; r = -0.195, P < 0.05; r = -0.333, P < 0.01; r = -0.180, P < 0.05). Females presented higher total protein level (P < 0.01) and lower blood urea nitrogen and serum creatinine levels (P < 0.01), compared with male patients.</p><p><b>CONCLUSIONS</b>Carefulness and caution are required in all patients with CD, because of the complexity of clinical and biochemical characteristics in CD patients of different gender and MRI classification, particularly male patients and MRI-negative patients.</p>
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Dyslipidemias , Diagnosis , Hypertension , Diagnosis , Hypokalemia , Diagnosis , Magnetic Resonance Imaging , Pituitary ACTH Hypersecretion , Diagnosis , Retrospective Studies , Sex FactorsABSTRACT
Objective To explore the extent of lymphadenectomy by comparing the single left thoracotomy and cervico-right thoracic-abdominal triple incision during esophageal carcinoma radial surgery.Methods The clinical data of 95 patients with thoracic esophageal carcinoma underwent esophagectomy plus lymphadenectomy were studied.They were divided into two groups,left thoracotomy group(62 cases)and triple incision group(33 cases).The rates of lymph node metastasis and postoperative complications were analyzed statistically.Results A total of 1322 lymph nodes were dissected with an average of 13.9 lymph nodes in each case.The rates of lymph node metastasis were 45.3 ％(43/95)of all patients,40.3 ％ of left thoracotomy and 54.5 ％ of triple incision.The rates of lymph node metastasis in the neck for patients with upper or middle thoracic esophageal carcinoma were 25.0 ％(2/8)and 40.0 ％(4/10).The rate of abdominal lymph node metastasis was 53.8 ％(7/13)in lower thoracic carcinoma.The depth of tumor invasion (r =0.315,P =0.007)and tumor differentiation(r =0.239,P =0.017)were correlated to lymph node metastasis.Patients with tumor length ＞2 cm had higher rates of lymph node metastasis(x2 =34.2,P ＜ 0.001).The postoperative complication rates of left thoracotomy and triple incision were 25.8 ％(16/62)and 4.2 ％ (8/33).The mortalities rates of left thoracotomy and triple incision were 1.6 ％(1/62)and 3.0 ％(1/33).There was no significant difference in postoperative complication rates(x2 =0.017,P =0.869)and mortalities rates(x2 =0.047,P =0.651)between the two groups.Conclusion Tumor invasion,differentiation and length should be incorporated in the evaluation of lymph node status.Patients with upper and middle thoracic esophageal carcinoma should receive cervico-right thoracic-abdominal triple incision.Particular attention should be given to the resection of abdominal lymph nodes in patients with lower thoracic esophageal carcinoma.
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Objective To explore the relationship between KAI1 gene expression in papillary thyroid carcinoma and clinicopathological features and prognosis. Methods KAI1 mRNA expression was detected by Real Time Polymerase Chain Reaction in 21 cases papillary thyroid carcinoma tissues and 21 cases adjacent normal tissues, as well as 7 cases benign thyroid disease tissues. KAI1 protein expression was detected by immunohistochemisty in 60 cases papillary thyroid carcinoma tissues and 20 cases thyroid adenoma tissues. Results KAI1 mRNA expression in papillary thyroid carcinoma was significantly higher than that in adjacent normal tissues (P ＜ 0. 05) and benign thyroid lesion tissues (P ＜ 0. 05). Positive expression rate of KAI1 protein was 68. 3% in papillary thyroid carcinoma and 25% in thyroid adenoma tissues. The difference was statistically significant (P ＜0. 01). In papillary thyroid carcinoma, positive expression rate of KAI1 protein in the group without lymph node metastasis was higher than that in group with lymph node metastasis (P＜0.05). There was no difference in positive expression rate of KAI1 protein for male or female patients (P ＞0. 05). KAI1 protein expression in papillary thyroid carcinoma was not related to patients' ages, tumor size, TNM staging or capsule invasion (P ＞ 0. 05). Conclusions The abnormal expression of KAI1 mRNA and protein is correlated to the genesis and progress of papillary thyroid carcinoma,which provides a clue for treatment and prognosis assessment of papillary thyroid carcinoma
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Objective To establish a stable model of rat orthotopic left lung transplantation using direct suture of vessels and bronchi. Methods Ten Sprague Dawley (SD) rats weighted 250 to 350 g were used as lung donors and recipients respectively. Airway and pulmonary vessels were reconstructed microsurgically using continuous running suture technique. Survival time were recorded and donor lungs were checked by autopsy. Results All 10 rats received left lung transplantation were weaned from ventilator successfully. Both of cold ischemia time and warm ischemia time were about 40 minutes. The total procedure took about 130 minutes. Autopsy was used to check the patency of anastomotic sites. No thrombosis or air leak was found. Conclusions Direct microsurgical surture can be used to establish an experimental model of orthotopic left allograft lung transplantation in rats. This method is proved to be stable, reliable and similar to clinical practices.
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Objective To prepare rabbit antibody against mouse AD-004 by AD-004 expressed in the prokaryotic expression system and to identify its distribution in the testis and adrenal. Methods The full-length cDNA of mouse AD-004 was cloned into PET28 plasmid, and the protein was induced in E. coli BL21 bacteria by adding IPTC and then purified by Ni2+ -NTA column. The purified protein was used as an immunogen to prepare polyclonal antibody ( pAb) of AD-004. The specificity of the antibody was detected by Western blotting. Immunohistochemical staining was performed in the mouse adrenal and testis via pAb of AD-004. Results Hisfused AD-004 was expressed efficiently in the prokaryotic system. Western blot analysis showed that the polyclonal antibody was duly bound to purified AD-004 with high specificity and sensitivity. AD-004 could be abundantly identified in the adrenal medulla and mainly expressed in the Leydig cells of testis. Conclusion The mouse protein of AD-004 is obtained from the prokaryotic expression system. The rabbit anti-AD-004 antibody has been prepared successfully. AD-004 protein is mainly localized in the interstitium of testis, suggesting that AD-004 may play a role in the synthesis of sex-steroid hormone.