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Objective:To investigate clinical outcome and the risk factors for death in acute pancreatitis (AP) patients complicated with acute kidney injury (AKI).Methods:The clinical data of 232 AP patients complicated with AKI admitted to the Center of Severe Pancreatitis of Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2016 to December 2020 were retrospectively analyzed. Patients were divided into survival group ( n=162) and death group ( n=70) based on the survival status. The two groups' clinical characteristics, biochemical indexes, and renal function indexes were compared. Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors for death in AP patients complicated with AKI. Results:Sixteen patients(6.9%) among the 232 had AKI Ⅰ, 15(6.5%) had AKI Ⅱ, and 201(86.6%) had AKI Ⅲ. Forty-one patients (17.7%) became AKI with a disease course <7 days, 184 patients (79.3%) gradually progressed to acute kidney disease with a disease course of 7-90 days, and 7 patients (3.0%) eventually progressed to chronic kidney disease with a disease course >90 days. Renal replacement treatment (RRT) was administered in 179 patients (77.2%), lasting an average of 14 (7-25) days. 138 patients (59.5%) had their renal function recovered while they were hospitalized, including 9 patients (6.5%) who did so within 7 days, 69 patients (50.0%) within 30 days, and 127 patients (92.0%) within 90 days. The average recovery time was 16 (7-28) days. Seventy patients (30.2%) died during hospitalization, including 8(3.5%) within 7 days, 42(18.1%) within 30 days, and 68(29.3%) within 90 days. Univariate analysis revealed that the proportions of biliary etiology, neutrophil to lymphocyte ratio (NLR), serum cystatin C, sequential organ failure assessment(SOFA) score, AKI Ⅲ proportion, number of patients undergoing RRT, and duration of AKI were significantly higher in the death group compared to the survival group. The number of patients complicated by infected pancreatic necrosis (IPN) and having surgical intervention was also significantly greater than that in the survival group, while the proportion of patients whose renal function recovered was much lower than that in the survival group. The differences were all statistically significant (all P value <0.05). Multivariate logistic analysis showed that SOFA( OR=1.182, 95% CI 1.000-1.396, P=0.049), and IPN( OR=8.403, 95% CI 3.748-18.838, P<0.001) were independent risk factors for death. Conclusions:SOFA score and IPN at admission were independent risk factors for death in AP patients with AKI. Vigilance should be given as soon as possible to improve the outcome of patients through clinical intervention.
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ObjectiveTo investigate the effects of ginsenoside Rg1 and ginsenoside Rb1 on the release of inflammatory factors of human myeloid leukemia monocytes （THP-1） induced by lipopolysaccharide （LPS） and their protective effects on the inflammatory injury of intestinal epithelial cells （Caco-2） induced by THP-1 cell activation based on the co-culture system of THP-1 and Caco-2. MethodFirstly，the microfluidic chip of co-culture of THP-1 and Caco-2 cells was prepared. In the experiment， a blank group， an LPS group， and drug intervention groups were set up.The cells in the blank group were cultured conventionally. In the LPS group，LPS （1 mg·L-1） was added to the lower THP-1 cells after the upper Caco-2 cells formed a monolayer barrier. On the basis of the LPS group， 33 mg·L-1 ginsenoside Rg1 and 33 mg·L-1 ginsenoside Rb1 were added to THP-1 cells respectively. After the co-culture of THP-1 cells and Caco-2 cells for 24 hours， the fluorescein isothiocyanate （FITC）-Dextran fluorescence value in the lower chip channel was detected by FITC-Dextran tracer method. A blank group， an LPS group，and drug intervention groups were set up in the THP-1 cell experiment. THP-1 cells in the blank group were cultured conventionally. In the LPS group， LPS （1 mg·L-1） was added to THP-1 cells.Ginsenoside Rg1 and ginsenoside Rb1 of the corresponding doses （11，33，100 mg·L-1） were added to the drug intervention groups respectively on the basis of the LSP group. After 24 hours of cell culture， the activity of THP-1 cells was detected by cell counting kit-8 （CCK-8）. Real-time quantitative polymerase chain reaction （Real-time PCR） was used to detect the expression of inflammatory cytokines such as interleukin-6 （IL-6）， interleukin-1β （IL-1β）， and tumor necrosis factor （TNF）-α of THP-1 cells. A blank group， an LPS group， and drug intervention groups were set up in the Caco-2 cell experiment. Caco-2 cells in the blank group were cultured conventionally， and in other groups， the corresponding cell supernatant in the second part of the THP-1 cell experiment was employed in Caco-2 cells. After 24 hours of cell culture，the activity of Caco-2 cells was detected by CCK-8. Real-time PCR was used to detect the expression of IL-6，interleukin-8 （IL-8）， TNF-α， and Occludin of Caco-2 cells. The expression of tight junction protein Occludin in Caco-2 cells was detected by Western blot. ResultBoth ginsenoside Rg1 and ginsenoside Rb1 could effectively protect LPS-induced intestinal epithelial barrier permeability in the co-culture system of THP-1 and Caco-2 cells （P<0.01）. Ginsenosides Rg1 and Rb1 antagonized LPS-induced increased expression of IL-6，IL-1β， and TNF-α in THP-1 cells （P<0.05）. When the supernatant of THP-1 cells treated with ginsenosides Rg1 and Rb1 was co-cultured with Caco-2 cells， the expression of IL-6，IL-8， and TNF-α in Caco-2 cells was significantly reduced （P<0.01）， and the expression of tight junction protein Occludin was up-regulated. ConclusionIn the co-culture system of THP-1 and Caco-2 cells simulating the intestinal epithelial barrier function in vitro，ginsenosides Rg1 and Rb1 play a protective role against LPS-induced intestinal epithelial barrier injury by regulating the release of inflammatory cytokines by THP-1 cells， thereby regulating the inflammatory response and cell barrier integrity of Caco-2 cells.
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Objective:To study the reliability and validity of extended Barthel Index (EBI) in the assessment of activities of daily living (ADL) for stroke patients. Methods:From January, 2018 to October 2019, 136 stroke inpatients from the First Affiliated Hospital of Soochow University were conveniently sampled. They were assessed with EBI by rater A twice within 48 hours after admission, with interval above twelve hours; and by rater B within 24 hours. They were also assessed with modified Barthel Index (MBI) and Function Independence Measure (FIM) within 48 hours after admission by rater C. The intraclass correlation coefficient (ICC) of retest and inter-rater of EBI were calculated, as well as the Cronbach's α coefficient, Spearman correlation coefficient between scores of items and total, and Spearman correlation coefficient of EBI to MBI or FIM. The construct validity of EBI was tested with factor analysis. Results:The retest ICC of items was 0.766 to 0.953; the retest ICC of motor and cognitive items was 0.938 and 0.845, respectively; the retest ICC of total was 0.891. The inter-rater ICC of items was 0.728 to 0.976, the inter-rater ICC of motor and cognitive items was 0.948 and 0.717, respectively; the inter-rater ICC of total was 0.866. The Cronbach's α coefficient of EBI was 0.885. The correlation coefficients were above 0.4 in all the items (P < 0.001) to the total, except the item of vision (r = 0.215, P < 0.05). The correlation of items of EBI to MBI was significant (r = 0.648 to 0.958, P < 0.01), as well as those of EBI to FIM (r = 0.722 to 0.976, P < 0.01). Four components were extracted with principal component analysis, accumulated to 72.19% of the variable; after the vision item was removed, three principal components were extracted, accumulated to 69.09% of the variable. The component 1 was mainly about sphincter control and some advanced brain functions (communication and social cognition), component 2 mainly about ADL related to lower extremities, and component 3 mainly about ADL related to upper extremities. Conclusion:EBI is reliable and valid in the assessment of ADL for stroke patients.
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Objective:To investigate the discriminant function of optical coherence tomography angiography (OCTA) in the diagnosis of primary open angle glaucoma (POAG) and to evaluate the correlation between vessel density, as measured by OCTA, and visual field mean defect (MD) in patients with POAG.Methods:A case control study was designed.Ninety-five eyes of 54 patients with POAG and ninety-six eyes of 48 healthy subjects in Changsha Aier Eye Hospital were included in this study.The vessel density in the radial peripapillary capillary (RPC) network, the macular vessel density, the ganglion cell complex (GCC) layer thickness, the macular thickness, and the retinal nerve fiber layer thickness were tested for correlation with MD.The aera under the receiver operating characteristic (ROC) curves (AUC), as well as sensitivities at fixed vessel density specificities in the RPC network, and macular regions were analyzed.ROC regression was used to evaluate the effect of covariates on the diagnostic abilities.The study protocol was approved by the Ethics Committee of Changsha Aier Eye Hospital.Written informed consent was obtained from all subjects prior to entering the study cohort.Results:Compared with the normal control group, the macular area and vessel density in the RPC network were significantly decreased in the POAG group ( P<0.001). Also in the POAG group, except for the capillary density inside the disc, all other measurements including the density of superficial capillaries in the macula, the density of deep capillaries in the macula, the density of RPC layers around the optic disc, the average capillary density of the optic disc RPC layer, the capillary density of the optic disc RPC layer (above, below, nasal, and temporal), the thickness of the retinal nerve fiber layer, the thickness of the whole macular layer, and the thickness of the GCC layer of the macula area were positively correlated with the MD value ( r=0.586, 0.352, 0.610, 0.592, 0.598, 0.589, 0.445, 0.587, 0.578, 0.530, 0.609; all at P<0.01). The AUCs of vessel densities ranged from 0.623 to 0.927.The highest diagnostic efficiency was the RPC vessel density (whole image), the AUC value was 0.927. Conclusions:The OCTA parameters have a high diagnostic ability for POAG, except for the capillary density of inside the disc, all other vascular parameters are positively correlated with the MD value.
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Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the gastrointestinal tumor.It has attracted much attention in recent years and become a targeted therapy of precision medical era′s most successful examples. Surgical operation has always been one of the main ways to treat gastric GIST. The surgical methods are multiplex, the skills are complex and the application of laparoscopy is controversial. In combination with recent studies, a brief review is made on the surgical indications, surgical principles and surgical methods of gastric GIST.
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With the widespread use of high-resolution multislice spiral computed tomography and the popularization of regular physical examinations, the prevalence of clinically diagnosed subcentimeter pulmonary nodules is increasing. Subcentimeter pulmonary nodules have low malignant probability, however, the diagnosis and management are of high difficulty and it is likely to misdiagnose and miss malignant nodules. Therefore, the evaluation and management of subcentimeter pulmonary nodules have always been the key points of clinical work. This article reviews and summarizes the progress in the evaluation and management of subcentimeter pulmonary nodules.
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Objective:To observe the macular vascular density and the area of foveal avascular zone(FAZ) in the follow eyes of monocular retinal vein occlusion (RVO) patients.Methods:Retrospective case-control study. From May to November 2018, 78 follow eyes of 78 monocular RVO patients who were clinically diagnosed in Changsha Aier Eye Hospital were included in the study. Among them, 44 were male and 34 were female. The average age was 53.17±10.12 years. There were 42 patients with central retinal vein occlusion(CRVO group) and 36 patients with branch retinal vein occlusion (BRVO group). Forty-two eyes of 33 gender and age matched healthy volunteers were selected as the control group. Among them, 17 were male (22 eyes) and 16 were female (20 eyes), with the mean age of 53.48±10.84 years. OCT angiography was performed on all eyes in CRVO group, BRVO group and control group. The scanning region in the macular area was 6 mm× 6 mm. Macular vascular density and FAZ area in the superficial and deep retinal capillary plexi were measured.Results:The mean overall vascular density measured in the entire scan was lower in the CRVO group( t=-4.26, -4.93) and BRVO group ( t=-4.79, -4.74) compared with the control group in both the superficial and deep capillary plexus ( P<0.05). The reduce degree of vascular density in the deep capillary plexus (CRVO group:5.51%, BRVO group:4.58%) was higher than that in the superficial plexus (CRVO group:4.13%, BRVO group:3.50%). In the CRVO group, the FAZ area decreased compared with the control group ( t=-3.43, P<0.05). There was no statistically significant difference in the area of FAZ between the BRVO group and the control group ( t=-0.10, P>0.05). Conclusions:The macular vascular density in the follow eyes of monocular RVO patients is lower than that of normal healthy eyes. The reduce degree of vascular density in the deep capillary plexus is higher than that in the superficial plexus. Compared with normal healthy eyes, the FAZ area in the follow eyes of monocular CRVO patients decreased, while it did not change significantly in the follow eyes of monocular BRVO patients.
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Objective@#To investigate the feasibility and safety of stent-assisted percutaneous endoscopic necrosectomy (SAPEN) in the treatment of infected pancreatic necrosis (IPN).@*Methods@#The patients with severe acute pancreatitis (SAP) who received the treatment of SAPEN for IPN were sequentially included from January 2018 to September 2018 in the Eastern Theater General Hospital of People′s Liberation Army. The demographic and clinical data were analyzed. The mortality and incidence of major organ dysfunctions were used as the primary observation endpoints.@*Results@#A total of 40 IPN patients were enrolled including 27 men and 13 women. The percutaneous covered stent placement procedures were successful in all cases; the median number of SAPEN operations was 1 (range 1-3), and no operation-related complications occurred. 32 patients were successfully cured by SAPEN, and the treatment effective rate was 80.0%. 5 patients (12.5%) required further open surgery after SAPEN. 12 patients developed new important organ dysfunction and 6 patients eventually died.@*Conclusions@#SAPEN was an effective and feasible minimally invasive method for the treatment of IPN, but its technical advantages still need to be further validated in large scale studies.
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BACKGROUND@#Lung cancer is the cancer with the highest morbidity and mortality at home and abroad at present. Using computed tomography (CT) to screen lung cancer nodules is a huge workload. To test the effect of artificial intelligence in automatic identification of lung cancer by using artificial intelligence to find the lung cancer nodules automatically in the chest CT of 1 mm and 5 mm thick.@*METHODS@#5,000 cases of T1 stage lung cancer patients with 1 mm and 5 mm layer thickness were respectively labeled and learned by computer neural network, the algorithm of forming pulmonary nodules was carried out. 500 cases of chest CT in T1 stage lung cancer patients with 1 mm and 5 mm thickness were tested by artificial intelligence formation, and the sensitivity and specificity were compared with artificial reading.@*RESULTS@#Using artificial intelligence to read chest CT 500 in 5 mm, the sensitivity was 95.20%, the specificity was 93.20%, and the Kappa value of two times repeated read was 0.926,1. For 1 mm chest CT 500 cases, the sensitivity is 96.40%, the specificity is 95.60%, and the Kappa reads two times is 0.938,6. Compared with 5 doctors, the same CT sets with 1 mm thickness were read. The detection rates of artificial intelligence and artificial reading were similar to those of lung cancer nodules and negative control read films, and there was no significant difference between them. In the comparison of the same CT slices with 5 mm thickness, the number of detection of lung cancer nodules by artificial intelligence is better than that of artificial reading, and the sensitivity is higher, but the number of false messages is increased and the specificity is slightly worse.@*CONCLUSIONS@#The automatic learning of early lung cancer chest CT images by artificial intelligence can achieve high sensitivity and specificity of early lung cancer identification, and assist doctors in the diagnosis of lung cancer.
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Humans , Artificial Intelligence , Lung Neoplasms , Diagnosis , Pathology , Medical Informatics , Methods , Neoplasm StagingABSTRACT
Objective To investigate the feasibility and safety of stent-assisted percutaneous endoscopic necrosectomy (SAPEN) in the treatment of infected pancreatic necrosis (IPN). Methods The patients with severe acute pancreatitis ( SAP) who received the treatment of SAPEN for IPN were sequentially included from January 2018 to September 2018 in the Eastern Theater General Hospital of People's Liberation Army. The demographic and clinical data were analyzed. The mortality and incidence of major organ dysfunctions were used as the primary observation endpoints. Results A total of 40 IPN patients were enrolled including 27 men and 13 women. The percutaneous covered stent placement procedures were successful in all cases;the median number of SAPEN operations was 1 ( range 1-3 ) , and no operation-related complications occurred. 32 patients were successfully cured by SAPEN, and the treatment effective rate was 80. 0％. 5 patients (12. 5％) required further open surgery after SAPEN. 12 patients developed new important organ dysfunction and 6 patients eventually died. Conclusions SAPEN was an effective and feasible minimally invasive method for the treatment of IPN, but its technical advantages still need to be further validated in large scale studies.
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Objective@#To investigate the effect of exposure to particulate matter ≤10 μm in aerodynamic diameter (PM10) on sperm quality in different stages of sperm development.@*Methods@#This cross-sectional study included 1 827 patients attending the reproductive medicine center in Renmin Hospital of Wuhan University during April 2013 to January 2015. Air pollution data from January 2013 to January 2015 was obtained from the database of Wuhan Municipal Environmental Protection Bureau. The generalized linear model was employed to assess the association between each exposure variables and sperm parameters for several exposure windows (0-9, 10-14, 15-69, 70-90, 0-90 days before sampling) .@*Results@#The average levels of PM10 was (116.2±71.6) μg/m3 during the research period. Sperm volume was (75.4±49.1) ×106/ml in sample population, (29.4±16.2) % in progressive motility and (51.8±21.6) % in total motility. Exposure to PM10 was inversely associated with sperm concentration (β:-0.319; 95%CI:-0.529,-0.046) during 70-90 lag days. PM10 exposure during the 0-90 lag days was significantly associated with progressive motility (β:-0.312; 95%CI:-0.527,-0.097) and total motility (β:-0.347; 95%CI:-0.636,-0.059) after adjusted for age, education level, BMI, smoking, abstinence time, temperature, humidity and season.@*Conclusion@#Exposure to PM10 was associated with statistically significant decrements in sperm concentration and motility, and the adverse impact on sperm concentration was significantly in early phases of spermatogenesis.
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Objective@#To evaluate the safety and effectiveness of esophageal replacement with ileocolon graft.@*Methods@#Totally 34 cases of esophageal replacement with ileocolon graft from July 2015 to November 2017 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University were analyzed retrospectively, including 24 male and 10 female, aging from 7 to 72 years old. Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route except one subcutaneous route. The primary esophageal disease, postoperative complication rate and quality of life were analyzed.@*Results@#The overall postoperative complication rate was 23.5% (8/34), cervical anastomotic leakage rate of 5.9% (2/34), necrosis of colon graft of 5.9% (2/34). There were 3 patients experienced re-operation including 2 patients with colon graft necrosis and 1 patient with intestinal obstruction after ERC. One patient with colon graft necrosis died of septic shock after reoperation. Six cases of cervical esophago-jejunal anastomosis stenosis and 1 case of diarrhea occurred in the later time. All patients were followed up for a median time of 9 months (range: 1 to 28 months), 32 cases survived but 1 patient died until last follow-up by the end of December 2017.@*Conclusion@#Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route was safe and effective.
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Objective To investigate the safety and efficacy of definitive chemoradiotherapy(dCRT) in esophageal cancer.Methods A retrospective analysis of 18 consecutive cases ofsalvage esophagectomy after dCRT by the single operation groupin department of Thoracic surgery,Shanghai chest hospital affiliated to Shanghai Jiaotong University from December 2014 to March 2017.Results 16 males and 2 females.There were 6 cases and 12 cases of recurrent and persistent tumor after dCRT respectively.All the patients were treated with McKeown operation stytle combing thoracic and abdominal lymph nodes dissection.Esophagus was replaced by stomach of 15 cases and colon of 3 cases respectively.Radical resection (R0) was performed in 12 cases,palliative resection (R2) in 6 cases.There were 4 cases of pathological complete response (pCR).The incidence of postoperative complications was 11 cases,including 6 cases of pulmonary infection,4 cases of anastomotic leak,2 cases of incision infection,one case of respiratory insufficiency,one case of recurrent laryngeal nerve paralysis,one case of chylothorax,one case of aortic bleeding caused by empyema.One patient died in perioperative period because of aortic bleeding due to empyema.The follow-up period was from 2 to 26 months,and the median follow-up time was 9 months.There were 13 patients survived and 5 patients died at the last follow-up date including one death in perioperative period,2 cases died of local-regional recurrence and metastasis respectively.Conclusion Salvage esophagectomy is a treatment option for the recurrent or persistent disease after dCRT,but the incidence of postoperative complications is high.Accurate clinical staging is especially important after dCRT and ycT4,ycN + patientsshould be avoided.R0 resection and recurrence after long disease free period are favorable prognostic factors.
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Objective To investigate the macular vascular density after successful repair of rhegmatogenous retinal detachment (RRD) for one year using optical coherence tomography angiography (OCTA),and discuss the correlation between the macular vascular density and visual acuity.Methods Totally 42 patients of the RRD (42 eyes),their contralateral eyes (A group) and 42 patients of the normal eyes (B group) were recruited into this study.All participants underwent examination with best corrected visual acuity (BCVA) and OCTA.The difference in macular vascular density was compared and the correlation between BCVA and the vascular density was analyzed.Results The macular vascular density of superficial layer,deep layer and choroidal capillary layer was 0.422 4 ±0.089 3,0.4836 ±0.0748,0.527 1 ±0.039 0 in RRD group,respectively,0.469 3 ±0.112 5,0.550 0 ±0.074 0,0.546 2 ±0.034 3 in A group,respectively,0.5619 ±0.053 7,0.611 2 ±0.035 2,0.562 6 ±0.030 4 in B group,respectively.The macular vascular density was significantly decreased in RRD group when compared with A and B groups (all P ＜ 0.05).There was a positive correlation between BCVA and the macular vascular density in the deep layer and choroidal capillaries layer (r =0.629,0.654,both P =0.000).However,there's no correlation between the macular vascular density of superficial layer and BCVA (P =0.103).Conclusion All the macular vascular densities are decreased in patients of RRD after successful repair of retinal detachment one year later,which indicated that the blood flow does not completely recover.And there is a positive correlation between BCVA and macular vascular densities in deep layer and choroidal capillaries layer.And meanwhile,OCTA can objectively and effectively quantify the status of macular region blood flow.
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Objective To explore the association between prognostic nutritional index(PNI) and prognosis of nasopharyngeal carcinoma (NPC) patients before radiochemotherapy.Methods A total of 153 newly diagnosed NPC patients in Sichuan Cancer Hospital were retrospectively reviewed.The hematological parameters and clinical characteristics before radiochemotherapy were collected,and the follow up for these patients was conducted.The effects of pretreatment hematological parameters and PNI on overall survival were analyzed with Kaplan-Meier method.The variables identified as statistically significant differences were further analyzed with multivariate Cox regression analysis.Results The 3,5 and 10-year overall survival were 89.54％,83％ and 75.16％.Both PNI and white blood cell count (WBC) before radiochemotherapy were the independent prognostic indicators for NPC in Cox regression analysis.The 3,5 and 10-year overall survival of NPC in PNI ≤49.45 group were lower than those of PNI ＞ 49.45 group.Conclusion PNI and WBC should be the independent prognostic indicators for NPC and closely relate to overall survival of NPC patients.
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Objective To analyze the optimal timing of endoscopic stone extraction combined with extracorporeal shock wave lithotripsy (ESWL) in the treatment of chronic pancreatitis (CP) with pancreatic stones. Methods Data regarding 170 pancreatic stone patients receiving ESWL and endoscopic stone extraction at Shanghai Changhai Hospital from February 2014 to February 2015 were retrospectively analyzed. Based on the the prior history of endoscopic treatment,patients were divided into group A and B,and then sub-divided into three groups according to the timing of endoscopic intervention after ESWL including <12 h,12~36 h and >36 h subgroup. The success of pancreatic ductal cannulation, clearance of stone in the main pancreatic duct, and ERCP-related complications were evaluated. Results Among all the enrolled 170 patients,107 previously received ERCP(group A) while the others didn't(group B). The overall success rate of cannulation and clearance rate of stones at different times showed no significant difference. The success rate and clearance rate in group A in <12 h,12~36 h and >36 h subgroup were 91.7%,95.2%,78.0%,and 91.7%,95.2%,80.0%,and no significant difference existed. In group B, the success rate and clearance rate in <12 h, 12~36 h and >36 h subgroup were 66.7%, 71.4%, 96.3%, and 60.0%, 76.2%, 92.6%, and the differences were statistically different. The success rate and clearance rate of >36 h subgroup in group B were obviously higher than that in <12 hours (P=0.025) and 12~36 h subgroup (P=0.04). The timing of endoscopic stone extraction did not influence ERCP-related complications. Conclusions Early endoscopic stone extraction after ESWL can be considered in patients with pancreatic stones who previously underwent ERCP. Delayed endoscopic stone extraction after ESWL is recommended in patients without prior ERCP,which can help promote the therapeutic efficacy.
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Objective To study the relativity between imageology and pathology during lung cancer,and estimate whether the lung cancer is preinvasive lesions,which can support evidences for the operation methods.Methods Clinical data of 624 patients who were diagnosed as lung adenocarcinoma and had solitary pulmonary nodule(diameter≤3 cm) were collected,all of them were scanned by thin layer CT scan(1 mm).The correlation between imageology and pathology data were analyzed.Results In 125 cases of GGO,the ratio of invasive lesions were 0 (0/72),6.1％ (3/49) and 100％ (4/4) in stage T1a,T1b and T1c respectively.In 285 cases of mGGO,if solid component was less than 0.5 cm,the ratio of invasive lesions were 1.7％ (1/58),6.9％ (2/29) and 50.0％ (2/4) in stage T~,T1b and Tic;but the ratio of invasive lesions were 81.3％ (13/16),94.1％ (96/102) and 97.4％ (74/76) respectively when the solid component was more than 0.5 cm.In 214 cases with solid nodules,the ratio of invasive lesions were 87.1％ (27/31),98.8％ (84/85) and 99.0％ (97/98) in stage T1 a,T1b and T1c.Conclusion The ratio of invasive lesions and solid component increased gradually along with the growing of tumor diameter in stage T1 lung cancer.CT imaging was highly correlated with the pathology diagnosis of preinvasive lesions and invasive lesions,which can be used as the guidance for operation methods.
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Objective To study the relativity between imageology and pathology during lung cancer,and estimate whether the lung cancer is preinvasive lesions,which can support evidences for the operation methods.Methods Clinical data of 624 patients who were diagnosed as lung adenocarcinoma and had solitary pulmonary nodule(diameter≤3 cm) were collected,all of them were scanned by thin layer CT scan(1 mm).The correlation between imageology and pathology data were analyzed.Results In 125 cases of GGO,the ratio of invasive lesions were 0 (0/72),6.1％ (3/49) and 100％ (4/4) in stage T1a,T1b and T1c respectively.In 285 cases of mGGO,if solid component was less than 0.5 cm,the ratio of invasive lesions were 1.7％ (1/58),6.9％ (2/29) and 50.0％ (2/4) in stage T~,T1b and Tic;but the ratio of invasive lesions were 81.3％ (13/16),94.1％ (96/102) and 97.4％ (74/76) respectively when the solid component was more than 0.5 cm.In 214 cases with solid nodules,the ratio of invasive lesions were 87.1％ (27/31),98.8％ (84/85) and 99.0％ (97/98) in stage T1 a,T1b and T1c.Conclusion The ratio of invasive lesions and solid component increased gradually along with the growing of tumor diameter in stage T1 lung cancer.CT imaging was highly correlated with the pathology diagnosis of preinvasive lesions and invasive lesions,which can be used as the guidance for operation methods.
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Objective To investigate our early results of robot-assisted esophagectomy (RAE) and present our learning curve experience with the largest study from one-single institution of China.Methods Between November 2015 and April 2017,a series of consecutive patients undergoing RAE at Shanghai Chest Hospital were reviewed.The patients'demographics,operative and postoperative outcomes were demonstrated.Results A total of 154 patients underwent RAE during the study.All patients received Mckeown esophagectomy and extensive thoraco-abdominal two-field lymph node dissection.Of these,122 were male and 32 were female.The mean total operative duration was 179-445 (271.0 ±61.5) min and the operative duration of the thoracic phase was 51-142 (96.7 ± 27.0)min.The mean estimated blood loss was 100 -1 000 (230.4 ±74.4)ml.The pathological results showed that 150 had squamous cell carcinoma,2 had adenocarcinoma,and 2 had small cell carcinoma.The R0 resection was 92.2％.The mean number of lymph node dissection was 11-64 (20.4 ± 8.5) and the lymph node sampling rate along left and right recurrent laryngeal nerve (RLN) were 92.2％ and 88.3％.The morbidity was present in 64 of 154 patients (41.6％).The major complications rate was anastomotic leak (12.3％),and vocal cord paralysis (16.9％).Intensive care unit (ICU) hospital stay time was 0-27 (2.7 ± 3.6) d,the median length of hospital stay was 7-81 (15.8 ± 11.6)days.There was no 90-day mortality.Conclusions RAE is a safe and feasible alternative for treatment of esophageal cancer.RAE can improve the efficacy of lymph node dissection,especially for the lymphadenectomy along recurrent laryngeal nerve.
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Objective To compare the clinical efficacy of Da Vinci robot-assisted esophagectomy and combined thoracoscopy-and laparoscopy-assisted esophagectomy for esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 116 patients who underwent minimally invasive radical resection of esophageal cancer in the Shanghai Chest Hospital of Shanghai Jiaotong University between November 2015 and September 2016 were collected.Fifty-eight patients undergoing combined thoracoscopy-and laparoscopy-assisted esophagectomy and 58 undergoing Da Vinci robot-assisted esophagectomy were respectively allocated into the thoracoscopy-and laparoscopy-assisted and Da Vinci robot-assisted groups.Patients received esophagectomy by right thorax-left cervico-abdominal triple incisions,thorax-cervico 2-field lymph node dissection of esophageal cancer and digestive tract reconstruction via assisted incision.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were described as (x)±s.Measurement data with skewed distribution were described as M (range).Comparison between groups was analyzed by the nonparametric test,and comparisons of count data were done by the chi-square test and Fisher's exact probability.Results (1) Surgical and postoperative situations:all patients received successful surgery,without conversion to open surgery.The number of lymph nodes dissected along the recurrent laryngeal nerve (RLN) and duration of postoperative hospital stay were 2.8±2.2,13 days (range,9-131 days) in the thoracoscopy-and laparoscopy-assisted group and 4.8±3.7,11 days (range,7-81 days) in the Da Vinci robot-assisted group,respectively,with statistically significant differences between the 2 groups (t =3.480,Z =2.361,P＜0.05).The total operation time,numbers of patients with overall complications,anastomotic leakage,injury of the RLN,pleural effusion,pulmonary infection,respiratory failure,chylothorax,arrhythmia and tracheoesophageal fistula were respectively (276±61)minutes,24,15,7,6,5,4,2,1,0 in the thoracoscopy-and laparoscopy-assisted group and (261±50)minutes,21,8,10,4,2,2,1,1,1 in the Da Vinci robot-assisted group,with no statistically significant difference (t =1.296,x2 =0.327,2.657,0.620,0.438,1.368,0.703,0.342,1.009,P＞0.05).Some of the patients had postoperative multiple complications.Patients with anastomotic leakage received local dressing changes,continuous gastrointestinal decompression and vacuum aspiration.The pronunciation and bucking response were observed in patients with injury of the RLN (unilateral injury).Patients with pleural effusion received pleural puncture fluid or closed thoracic drainage.Patients with pulmonary infection underwent antibiotic therapy and regular aerosol inhalation.Patients with respiratory failure underwent tracheotomy and assisted breathing with ventilator.Patients with chylothorax received fasting and closed thoracic drainage.Patients with arrhythmia were treated by drug.Patients with tracheo-esophageal fistula underwent conservative treatment.All the patients with complications were improved or cured.There were no wotmd infection,deep venous thrombosis of lower extremity,pulmonary embolism,reoperation and death within 30 days postoperatively in patients of 2 groups.(2) Follow-up and survival situations:all the 116 patients were followed up for 5-15 months,with a median time of 8 months.Numbers of patients with tumor-free survival,tumor recurrence and tumor metastasis were 50,6,4 (2 with simultaneous tumor recurrence and metastasis) in the thoracoscopy-and laparoscopy-assisted group and 51,5,4 (2 with simultaneous tumor recurrence and metastasis) in the Da Vinci robot-assisted group,respectively,showing no significant difference between the 2 groups (x2=0.077,1.000,P＞0.05).Conclusions Da Vinci robot-assisted esophagectomy is safe and feasible in the treatment of esophageal cancer.Compared with combined thoracoscopy-and laparoscopy-assisted esophagectomy,Da Vinci robot-assisted esophagectomy has comparable operation time,and is associated with a greater yield of lymph nodes along the RLN.