Effectiveness of lymphadenectomy of 1 061 patients based on the grouping of esophageal cancer lymph nodes by Chinese expert consensus: A retrospective analysis in a single center / 中国胸心血管外科临床杂志

@#Objective    To assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus. Methods    The medical records of 1 061 patients (886 males and 175 females with a median age of 60 (54, 65) years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed. According to the pathological report, the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer. The metastasis rate of each group of lymph nodes, the 5-year survival rate of metastatic patients and efficacy index (EI) were calculated. Results    The upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups. The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups. The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes. According to the metastasis rate, the mediastinal lymph nodes were divided into three regions: an upper mediastinum (C201-204), a middle mediastinum (C205-206), and a lower mediastinum (C207-209). The EIs of lymph nodes of C201-203 and C205-207 groups were higher. For patients with C201-207 groups metastasis, the 5-year survival rates ranged from 13.39% to 21.60%. For patients with positive lymph nodes in each region, tumors at different primary locations had no statistical difference in long-term survival (P>0.05). Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs. Conclusion    The effect of lymph node dissection in each area varies with the location of the tumor. No matter where the tumor is, it is necessary to dissect the upper mediastinal lymph nodes, especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves. Group C205 should be classified into the lower mediastinal lymph nodes.

Comparison of Recovery Phase CT Features between Mild/moderate and Severe/critical Coronavirus Disease 2019 Patients / 中国医学科学院学报

To investigate the computed tomographc(CT)features of mild/moderate and severe/critical cases of coronavirus disease 2019(COVID-19)in the recovery phase. Totally 63 discharged patients in Wuhan,China,who underwent both chest CT and reverse transcription-polymerase chain reaction(RT-PCR)from February 1 to February 29,2020,were included.With RT-PCR as a gold standard,the performance of chest CT in diagnosing COVID-19 was assessed.Patients were divided into mild/moderate and severe/critical groups according to the disease conditions,and clinical features such as sex,age,symptoms,hospital stay,comorbidities,and oxygen therapy were collected.CT images in the recovery phase were reviewed in terms of time from onset,CT features,location of lesions,lobe score,and total CT score. There were 37 patients in the mild/moderate group and 26 in the severe/critical group. Compared with the mild/moderate patients,the severe/critical patients had older age [(43±16) years (52±16) years; =2.10, =0.040], longer hospital stay [(15±6)d (19±7)d; =2.70, =0.009], higher dyspnea ratio (5.41% 53.85%; =18.90, <0.001), lower nasal oxygen therapy ratio (81.08% 19.23%;=23.66, <0.001), and higher bi-level positive airway pressure ventilation ratio (0 57.69%; =25.62, <0.001). Time from onset was (23±6) days in severe/critical group, significantly longer than that in mild/moderate group [(18±7) days] (=3.40, <0.001). Severe/critical patients had significantly higher crazy-paving pattern ratio (46.15% 10.81%;=4.24, =0.039) and lower ground-glass opacities ratio (15.38% 67.57%; =16.74, <0.001) than the mild/moderate patients. The proportion of lesions in peripheral lung was significantly higher in mild/moderate group than in severe/critical group (78.38% 34.61%; =13.43, <0.001), and the proportion of diffusely distributed lesions was significantly higher in severe/critical group than in mild/moderate group (65.38% 10.81%; =20.47, <0.001). Total CT score in severe/critical group was also significantly higher in severe/critical group than in mild/moderate group [11 (8,17) points 7 (4,9) points; =3.81, <0.001]. The CT features in the recovery stage differ between mild/moderate and severe/critical COVID-19 patients.The lung infiltration is remarkably more severe in the latter.

Comparative study of one stage and bilateral uniportal-video-assisted thoracic surgery versus traditional video-assisted thoracic surgery in the treatment of myasthenia gravis / 中华胸心血管外科杂志

Objective To investigate the security and efficacy of one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by uniportal-video-assisted thoracic surgery(VATS) to cure patients with myasthenia gravis(MG).Methods A number of 131 patients with MG who underwent resection of thymic tissue and clearance of mediastinal fat by VATS in one single center from February 2009 to December 2013 were selected in this retrospective study.76 patients underwent unilateral resection of thymic tissue and clearance of mediastinal fat by three portal VATS from February 2009 to March 2012 and 55 patients underwent one stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS from April 2012 to December 2013.The time for operation,the bleeding volume during operation,the volume of postoperative drainage and drainage time,the improvement of symptoms,the postoperative pain,hospital stays and the occurrence of myasthenia gravis crisis were compared between the two groups.Results The general condition and pathological type did not have significant statistical differences between the two groups.The operating time in the uniportal-VATS group was significantly longer than that in three portal VATS group,but the pain was lighter,and the hospital stay was shorter.There were no significant differences between groups in terms of blood loss,postoperative drainage time,and volume of drainage.The follow-up was from 32 to 90 months,and 118 (90.08％)patients completed the follow up.94.5 ％ of the patients in uniportalVATS group acquired complete stable remission(CSR),while it was 84.2％ in three portal VATS group(P ＜ 0.05),and the uniportal-VATS group had lower rate of myasthenic crisis (P ＜0.05).Conclusion One stage and bilateral resection of thymic tissue and clearance of mediastinal fat by small uniportal-VATS is safe and effective with shorter hospital stay and less pain,and it can get higher CSR and less myasthenic crisis,its efficacy is superior to traditional three portal VATS.

Analysis of differentially expressed miRNA in early esophageal squamous cancer and normal esophageal tissues / 实用医学杂志

Objective To investigate the expression profiles of microRNA in early esophageal squamous cancer and normal esophageal tissues and verify the significantly different expression miRNAs , further to study the effects on proliferation of EC109. Methods The microarray assay was performed to analyze miRNA expression profiles in three pairs of early esophageal squamous cancer and the corresponding normal esophageal tissues. Quantitative real-time polymerase chain reaction (qRT-PCR) was used in another 38 pairs samples to further verify the differentially expressed miRNAs . Three verified miRNAs ( miR-29a, miR-221 and miR-222) mimics were transfected into EC109 respectively and CCK8 method was used to study the effect of cell proliferation in each miRNA. Results Microarray technique selected 53 miRNAs that differentially expressed in early esophageal squamous cancer and normal esophageal tissues , 32 miRNAs were up-regulated and 21 miRNAs were down-regulated. qRT-PCR verified that miR-29a was significantly down-regulated (P < 0.05) and miR-221, miR-222 were significantly up-regulated (P < 0.05) in early esophageal squamous cancer tissue. Over-expression of miR-29a could significantly inhibit the proliferation of EC109 (P < 0.05) whereas over-expression of miR-221 or miR-222 could both significantly promote the proliferation of EC109 (P < 0.05). Conclusion There was significant difference of miRNAs expression between early esophageal squamous cancer and normal esophageal tissues, and the differentially expressed miRNAs could be used as new biomarkers for early diagnosis of esophageal squamous cancer.

The risk analysis of acute renal insufficiency in perioperative of non-small cell lung cancer / 中华胸心血管外科杂志

Objective To discover the risk factors of acute renal insufficiency(ARI) in perioperative of non-small cell lung cancer(NSCLC).Methods We took a retrospective study to analysis and summarize the clinical features of 33 ARI cases and 721 controls,all subjects were histopathologically confirmed NSCLC from January 2007 to October 2013.Logistic regression analysis was conducted to analyze the association between the risk factors and ARI.Results There were significant differences between the two groups in operation age,level of preoperative creatinine,preoperative rehydration and the use of plasma substitutes.After adjustment by confounding factors,operation age older than 60 years old and the use of plasma substitutes had higher risk of ARI [adjusted OR was 2.93 (1.30-6.62),95 ％ CI was 6.04 (1.41-25.87),respectively].Preoperative rehydration was protective factor of ARI(adjusted OR was 0.37,95％ CI was 0.17-0.83).Conclusion Operation age (≥ 60 years old) and the use of blood substitutes are independent risk factors of ARI,while preoperative rehydration can reduce the incidence of ARI after surgery.

The exploration about how to improve the accuracy of 18F-FDG PET/CT in the diagnosis of lung lesions / 实用医学杂志

Objective In order to improve the diagnosis accuracy , 18F-FDG PET/CT results of 169 cases of lung lesions were analyzed. Methods The data of 169 pathological diagnosed patients were collected. SPSS 18.0 was used for the data analysis. Results In 169 cases, 122 cases were proved malignant by patholog-ical diagnosis, in which 110 cases were correctly diagnosed by PET/CT. 47 cases were proved benign by patho-logical diagnosis, in which 15 cases were correctly diagnosed by PET/CT. The sensitivity was 90.2%, specificity was 31.9%, and the accuracy was 74.0%. Conclusion In order to improve the accuracy rate of PET/CT exam-ination and reduce the existence of false positive cases and false positive cases , we should estimate SUV (max) objectively and diagnose according to the size of the lesion , clinical history and laboratory results.

Multiple metallic foreign bodies accidentally detected in different body cavities: a case report / 中华创伤杂志(英文版)

We accidentally found an unusual case of a middle aged Tibetan woman who had eight metallic foreign bodies (eight needles) in her head, chest and abdomen. These needles were not related to any surgical intervention or trauma. The diagnosis "metallic foreign bodies" cannot usually be made in an acute setting. Some patients may present chronic symptoms, such as infection or pain. However, in some cases, the patients do not have any symptoms.

Operation mode and evolution of full thoracoscopic esophagectomy in treatment of esophageal carcinoma / 中华胸心血管外科杂志

Objective The difficulty of full thoracoscopic Ivor-Lewis is the lack of a safe and low cost anastomosis.By improving the surgical process,to explore the application of circular stapler in the intrathoracic esophagogastric anastomosis.The thoracoscopic operation mode of esophageal cancer changes from simply following the McKoewn procedure to Ivor-Lewis and McKoewn procedure.Methods Retrospective analysis 123 cases of implementation thoracoscopic esophageal cancer from July 2009 to February 2013,which including the cases of intrathoracic anastomosis and cervical anastomosis.Divided it into two groups:intrathoracic anastomosis groups,which including thoracoscopic esophagectomy resection,gastroesophageal anastomosis and anastomotic pedicled omentum embedding,the cervical anastomosis groups,which including thoracoscopic esophageal free and gastroesophageal neck anastomosis.To comparing the incidence of ARDS,postoperative hoarseness,anastomotic complications (Anastomotic leakage and anastomotic strictures within two months after surgery),guardianship time of ICU and postoperative hospital stay between the two groups.Results All the patients were no deaths.The cervical anastomosis group operative time was significantly lower than the intrathoracic anastomosis group.The incidence of anastomotic fistula and anastomotic stricture of intrathoracic anastomosis group was significantly lower than that of the cervical anastomosis group,total hospitalization time of the intrathoracic anastomosis group were significantly lower than that of the cervical anastomosis group,there is no significant differences in postoperative hoarseness and ARDS incidence between the two groups.Conclusion For the lower esophageal carcinoma,it is technically mature and safe to apply the circular stapler for Ivor-Lewis surgery and sleeve omentumembedding anastomotic technique in full thoracoscopic,and the technology should be widely applied; for the upper esophagealcarcinoma,McKoewn procedure should be applied.

Flowcytometry DNA analysis of oral and maxillofacial non-Hodgkin's lymphoma / 华西口腔医学杂志

<p><b>OBJECTIVE</b>The purpose of this study was to investigate the relationship between the results of flowcytometry analyses of different clinical stage, location, pathologic grade and cell origin of oral and maxillofacial non-Hodgkin's lymphoma (NHL), and the diagnostic value of flowcytometry analysis in lymphoma.</p><p><b>METHOD</b>This study analyzed 50 oral and maxillofacial NHL cases and 10 reactive lymph nodes (formalin fixed and paraffin embedded) by flowcytometry (FCM).</p><p><b>RESULTS</b>Reactive lymph nodes were all diploid. The diploid rate of NHL was 54%, and aneuploidy rate was 46%. There was statistically significant difference between reactive lymph nodes and NHL in the DNA ploidy status and cell cycle data (SPF, CV, S + G2/M, DI). The S phase fraction (SPF) and S + G2/M had close relationship with the grade of NHL. SPF value and DNA ploidy status had no obvious relationship with the prognosis.</p><p><b>CONCLUSION</b>The results suggested that the FCM had diagnostic value in NHL, especially when the morphological diagnosis was difficult. Although the cell cycle data had no prognostic value, SPF and SPF + G2/M can show the proliferative status of NHL, which can help clinical doctor select therapeutic method.</p>