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@#Objective To explore the distribution pattern of respiratory symptoms and relevant factors in patients with pulmonary nodules. Methods Demographic and clinical information were collected from patients who visited the Thoracic Surgery Outpatient Clinic of Guangdong Provincial People’s Hospital from January 2021 to January 2022. Hospital Anxiety and Depression Scale (HADS) was used to assess their anxiety and depression level. Results A total of 1 173 patients were enrolled, including 449 males and 724 females, with an average age of 46.94±11.43 years. Among the patients with pulmonary nodules, 37.7% of them had at least one respiratory symptom; 24.4% had cough, 14.0% had expectoration, 1.3% had hemoptysis and 14.9% had chest pain. Old age, male, exposure to second-hand smoking or environmental smoke, hair coloring and history of tuberculosis were major risk factors for respiratory symptoms (P<0.05). Middle age, old age, male, exposure to environmental smoke were major risk factors for cough (P<0.05); old age, smoking, larger maximum nodules diameters, exposure to environmental smoke and history of pneumonia were major risk factors for expectoration (P<0.05); male, multiple nodules, hair coloring, exposure to second-hand smoking and history of tuberculosis were major risk factors for chest pain (P<0.05). Symptomatic patients showed generally higher HADS scores than asymptomatic patients (P<0.001). Conclusion Cough, expectoration and chest pain are the predominant respiratory symptoms for patients with pulmonary nodules. The presentation of respiratory symptoms increases patients' anxiety and depression.
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@#Objective To explore the timing and safety of limited-period lung cancer surgery in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Clinical data of of patients infected with COVID-19 undergoing lung cancer surgery (an observation group) in the Department of Thoracic Surgery of Guangdong Provincial People's Hospital, the Department of Thoracic Surgery of General Hospital of Southern Theater Command of PLA, and the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Guangdong Pharmaceutical University from December 2022 to January 2023 were retrospectively analyzed and compared with patients who underwent surgery during the same period but were not infected with COVID-19 (a control group), to explore the impact of COVID-19 infection on lung cancer surgery. Results We finally included 110 patients with 73 patients in the observation group (28 males and 45 females at age of 52.62±12.80 years) and 37 patients in the control group (22 males and 15 females at age of 56.84±11.14 years). The average operation time of the observation group was longer than that of the control group, and the incidence of anhelation was higher than that of the control group (P<0.05). There were no statistcal differences in blood loss, length of hospital stay, moderate or above fever rate, degree of cough and chest pain, or blood routine between the two groups. Conclusion It is safe and feasible to perform lung cancer surgery early after recovery for COVID-19 patients with lung cancer.
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@#Objective To identify the potential factors for psychological burdens and to better understand how the patients’ psychological status affect their treatment preferences. Methods A questionnaire survey was conducted among 996 patients with pulmonary nodules who visited the Thoracic Surgery Clinic of Guangdong Provincial People's Hospital from January to November 2021, including 381 males and 615 females, aged 47.26±11.53 years. A self-administrated questionnaire was used to investigate the sociodemographic and clinical characteristics of the patients, and the Hospital Anxiety and Depression Scale (HADS) was used to evaluate the psychological status of the patients, with a score>7 points of each subscale indicating potential anxiety or depression. Results Among the 996 patients with pulmonary nodules, the incidence of anxiety was 42.4% and the incidence of depression was 26.4%, while the incidence of both anxiety and depression was 24.7%. There was a significant correlation between anxiety and depression (ρ=0.834, P<0.05). Age, purpose of CT examination, number of pulmonary nodules and symptoms were independent factors for anxiety, while symptoms and number of pulmonary nodules were independent factors for depression (P<0.05). For treatment preferences, there was a statistical difference in educational level, symptoms, nodule size and anxiety level (P<0.05). Conclusion Anxiety and depression are common in patients with pulmonary nodules. Symptoms are associated with anxiety and depression, which also make an impact on treatment preferences.
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Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.
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Epigenetic changes are closely related to carcinogenesis, tumor progression and prognosis, which have a considerable potential in assisting the precision and minimally invasive management of cancers. The progress of detection techniques for DNA methylation, hydroxymethylation and histone modification has promoted the research works of liquid biopsy targeting epigenetic markers, and recently, important progress has been made in tumor location, early diagnosis, clinical staging, evaluation of treatment response, monitoring of recurrence and prognostic prediction of solid tumors.
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The biological role of N 6-methyladenine (m 6A) methylation modification has been gradually identified, and it has shown increasing value in tumor. In recent years, with the accumulated explore of epigenetics in RNA modification, many studies have reported that m 6A methylation modification contributes to development and progression of lung cancer. m 6A-related modified regulator has potential application value as a clinical target for diagnosis and treatment of lung cancer.
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@#Adherence to reporting guidelines contributes to report methodology and outcomes of research distinctly and transparently. There are some checklists with specific study types related to surgery on the EQUATOR Network’s website. However, the IDEAL framework focuses on stepwise evaluation of surgical innovation through all stages with some key elements, which those existing guidelines may not mention. This likely results in the inaccuracy in reporting in studies attempting to follow the IDEAL recommendations and suggests a pressing need for IDEAL reporting guidelines. Considering these limitations, the IDEAL developed the IDEAL reporting guidelines between October 2018 and May 2019. The paper aimed to provide interpretation of IDEAL reporting guideline, and promote its understanding and use among Chinese researchers.
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@#Surgical innovation is an important part of surgical research and practice. The evaluation of surgical innovation through the stages is similar to those for drug development, but with important differences. The Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) Framework and Recommendations represent a new paradigm for the evaluation of surgical intervention and devices which was developed in 2009. The IDEAL is a five-stage framework involving the nature stages of surgical innovation, together with recommendations for surgical research pathway. The Framework and Recommendations were updated and published in 2019, which added a pre-IDEAL stage if necessary. The updated IDEAL also underlines the purpose, key question and ethical issues for each stage. In the first paper of IDEAL Framework and Recommendations series, we conducted a comprehensive introduction of IDEAL (e.g. the development, updates and application of IDEAL) to promote the dissemination and application of IDEAL in China.
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@#Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
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The incidence of non-small cell lung cancer (NSCLC) is the highest among malignant tumors. StagesⅡtoⅢA patients are potentially treatable. Perioperative chemotherapy is the standard treatment for NSCLC; however, in patients with the EGFR mutation, neoadjuvant or adjuvant targeted therapy can improve disease-free survival (DFS). Despite this, the survival benefit is not clear. Postop-erative adjuvant radiotherapy can enhance survival in patients with stageⅢA (N2) NSCLC. Durvalumab maintenance therapy, after concurrent chemoradiotherapy, has become the new standard for patients with locally advanced and unresectable NSCLC. Immuno-therapy requires additional investigation in patients with driver gene mutations, as does the combination of immunotherapy plus che-motherapy. Notably, anti-angiogenesis therapy has failed as a postoperative adjuvant therapy.
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Objective To investigate the application value of enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding in minimally invasive radical resectionof esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 126 patients who underwent minimally invasive McKeown surgery in the General Hospital of Southern Theatre Command of PLA between March 2016 and October 2017 were collected.There were 80 males and 46 females,aged from 52 to 82 years,with an average age of 64 years.Of 126 patients,82 undergoing "li's anastomosis" with no gastrointestinal decompression tube and receiving early postoperative oral feeding were allocated into non-tube no fasting group,and 44 undergoing end-to-side gastroesophageal anastomosis with tubular stapler,conventionally indwelling gastrointestinal decompression tube,and beginning oral feeding at 1 week after surgery were allocated into traditional treatment group.Observation indicators:(1) surgical and postoperative recovery situations;(2) results of pathological examination;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor recurrence and metastasis up to October 2018.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was analyzed using independent sample t test.Measurement data with skewed distribution were expressed as M (range),and comparison between groups was analyzed by rank sum test.Count data were described as absolute number or percentage,and comparison between groups was analyzed using chi-square test.Ordinal data were analyzed by rank sum test.Results (1) Surgical and postoperative recovery situations:patients in the two groups underwent minimally invasive McKeown surgery successfully.Operation time,volume of intraoperative blood loss,incidence of anastomotic fistula,incidence of pulmonary complications,and duration of postoperative hospital stay were respectively (326±41) minutes,(225±96) ml,7.3 ％ (6/82),24.4％ (20/82),and 10 days (range,6-90 days) in the non-tube no fasting group and (317± 37) minutes,(214 ± 66) mL,9.1％ (4/44),20.5％ (9/44),and 14 days (range,10-42 days) in the traditional treatment group;there was a statistically significant difference in duration of postoperative hospital stay between the two groups (Z =-7.129,P ＜ 0.05) and no statistically significant difference in operation time,volume of intraoperative blood loss,incidence of anastomotic fistula,and incidence of pulmonary complications between the two groups (t =1.311,0.703,x2 =0.000,0.077,P＞0.05).(2) Results of pathological examination:the number of lymph node dissected,cases in postoperative TNM stage Ⅰ,Ⅱ and Ⅲ were respectively 27±5,12,55,15 in the non-tube no fasting group and 26±5,9,28,7 in the traditional treatment group,with no statistically significant difference between the two groups (t =0.549,Z =-0.747,P＞0.05).(3) Follow-up:of 126 patients,116 were followed up for 12-31 months,with a median time of 20 months,including 76 in the non-tube no fasting group and 40 in the traditional treatment group.During the follow-up,no tumor recurrence or metastasis was found in the 116 patients.Conclusion The enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding is safe and feasible in the McKeown surgery,which can significantly shorten the postoperative hospitalization time compared with the traditional treatment.
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Liquid biopsy is a kind of emerging pathological detection technique, which has shown certain value in the diagnosis and treatment of lung cancer. Detections of circulating tumor cells, circulating tumor DNA, DNA methylation, microRNA, exosomes and tumor educated platelets in patients′ body fluids can be used for the early diagnosis and predicting the progress of lung cancer. At recent, the application of liquid biopsy still has some shortcomings. However, with the continuous development of detection technology, it may become an effective auxiliary or alternative method for imaging examination such as CT in the near future, and will provide a new direction for the diagnosis and treatment of lung cancer.
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Liquid biopsy is a kind of emerging pathological detection technique,which has shown certain value in the diagnosis and treatment of lung cancer.Detections of circulating tumor cells,circulating tumor DNA,DNA methylation,microRNA,exosomes and tumor educated platelets in patients' body fluids can be used for the early diagnosis and predicting the progress of lung cancer.At recent,the application of liquid biopsy still has some shortcomings.However,with the continuous development of detection technology,it may become an effective auxiliary or alternative method for imaging examination such as CT in the near future,and will provide a new direction for the diagnosis and treatment of lung cancer.
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Objective To evaluate economic benefits and clinical effects of internal fixation treatment of severe rib fracture so as to provide objective basis for improving medical treatment for rib fracture.Methods A retrospective review was made on clinical data of 50 patients with severe rib fracture hospitalized from January 2009 to April 2014.With varied treatment modalities,the patients were assigned to operative group (n =13) and non-operative group (n =37).Variables were recorded including length of stay,total hospital charges,length of ventilatory support,off-bed time,duration of antibiotic use and incidence of complications and used to perform cost-efficiency analysis.Results Between operative and non-operative groups,length of hospital stay was (25.9 ± 8.2) days vs (35.4 ± 7.0) days,total hospital charges were (121 676.2 ± 10 991.1) yuan vs (148 724.5 ± 21 254.3) yuan,length of ventilatory support was (7.9 ± 2.8) days vs (14.1 ± 3.3) days,off-bed time was (14.3 ± 4.9) days vs (26.1 ± 6.5) days,duration of antibiotic use was (12.4 ± 3.3) days vs (21.2 ± 6.2) days and complications occurred in 2 cases vs 13 cases respectively.The findings were length of ventilatory support,off-bed time and duration of antibiotic use differed significantly between the two groups (P ＜ 0.05).Cost-effectiveness ratios based on subjective and objective measures were superior in operative group (1 962.52 and 3 925.03) over those in non-operative group (1 931.48 and 3 718.10),suggesting operative treatment could yield higher economic returns.Conclusion Internal fixation can accelerate bone healing in patients with severer rib fracture and cut down medical expense,which should be promoted in medical treatment.
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Objective To evaluate the clinical effects of memory alloy embracing fixators in fixation of the rib fractures and investigate the related surgical indications and surgical techniques.Methods Retrospectively review was conducted on the clinical data of 30 patients with rib fractures treated with memory alloy embracing fixators from October 2010 to April 2011 at General Hospital of Guangzhou Military Command.The number of memory alloy embracing fixators used in operation,the number of fixed positions,and operation time were recorded.The pain scores before and after operation were comparatively studied.Operation efficacy and complications were analyzed.Results Of the 30 patients,the total operation time,number of fixators,and number of fixed ribs were (111.9±48.0) minutes,4.3±2.1 and 3.5±1.3,respectively.Meanwhile,the difference between pre-operative and post-operative pain scores was significant (6.93±0.88) points vs (4.04±0.62) points,P＜0.05).The ambulation perlod was (4.6±1.9) days and length of hospital stay was (27.2±10.8) days.Incisional and thoracic wall hematoma was detected in three patients and pulmonary infection in six post-operatively but none presented intractable chest pain,foreign body rejection or wound infection.Conclusion Memory alloy embracing fixators for rib fractures is reliable,easy,and effective in alleviating pain,improving lung function,reducing the frequency of ventilator use and preventing complications like lung infection.
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<p><b>BACKGROUND</b>RRM1 may be a prognostic factor in non-small cell lung cancer (NSCLC). The aim of this study is to evaluate RRM1 expression and prognosis in NSCLC by the means of tissue microarray.</p><p><b>METHODS</b>A total of 417 paraffin-embedded specimens of NSCLC from Lung Cancer Study Center in Guangdong Provincial People's Hospital were collected and tissue microarray was constructed. RRM1 expression was detected by SP method and its correlation with prognosis was evaluated.</p><p><b>RESULTS</b>No statistic difference was found in RRM1 expression in different gender, age, tumor site, histology, differentiation, T stage, N stage, M stage and pTNM stage groups (P > 0.05). Univariate analysis showed that RRM1 was not an independent prognostic factor (P > 0.05). At the multivariate analysis, differentiation and N stage were considered independent prognostic factors.</p><p><b>CONCLUSIONS</b>RRM1 expression detected by immunohistology is not an independent prognostic factor in NSCLC. TNM stage is still the best prognostic factor up to now.</p>
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The conflicts among medical doctors,patients,medical administration,and health insurance corporations are becoming more and more serious.Additionally,novel medical techniques and methods are unprecedented challenges during the clinical activities for thoracic tumors.Here we emphasize that medical doctors who specialize in thoracic tumors should be proficient at managing these special and complex disorders.In order to effectively prevent and deal with a variety of ethical conflicts,all clinical practice should strictly abide by the principles of evidence-based medicine,and medical doctors should be held responsible for their patients from both technical and moral aspects.