Key technology of lymph node dissection along recurrent laryngeal nerve and its associated complication prevention in patients with thoracic esophageal cancer / 中华肿瘤杂志

Esophageal cancer is one of the most prevalent cancers in China. Lymph node metastasis is one of the most important prognostic factors and severely affect the long-term survival after surgical treatment. Therefore, systemic two-field lymph node dissection including thoracic and abdominal draining nodes of the esophagus during surgery is essential in order to improve the long-term survival for the patients with thoracic esophageal cancer, and it is also the basis for precise staging and postoperative adjuvant treatment regimen- making. As reported in the literature, lymph node metastases along bilateral recurrent laryngeal nerve was the highest, therefore, the lymph node dissection along bilateral recurrent laryngeal nerve is the most important manipulation during esophagectomies, however, it is also the most technically difficult procedure during operation. It usually results in postoperative complications especially the respiratory complications due to paralysis of recurrent laryngeal nerves caused by lymph node dissection. Therefore, the gain and loss of lymph node dissection along bilateral recurrent laryngeal nerve has been a disputed and entangle topic for thoracic surgeons, and the purpose of this paper is to summarize author′s experience and the key technology to prevent the associated complications in lymph node dissection along recurrent laryngeal nerve during esophagectomies for the patients with thoracic esophageal cancer.

The relationship and mechanism between accessory renal artery and essential hypertension by CTA / 实用放射学杂志

Objective To explore the relationship between accessory renal artery(ARA)and essential hypertension,and the possible mechanism using CT angiography(CTA).Methods The patients who underwent CTA examination on renal artery were reviewed retrospectively in our hospital.A variety of CTA reconstruction techniques were used to observe the type and number of ARA,as well as the diameter of ARA and the main renal artery.Results A total of 126 ARA(66 left ARA and 60 right ARA)were found in 253 patients. 10% of the patients had more than two ARAs.In 164 patients with essential hypertension,ARA detection rate was 40.2%(66/164).In the non-hypertension patients,the proportion of ARA was 31.5%(28/89).There was higher proportion of young(P=0.002)and male (P=0.022)patients in ARA hypertension group compared with ARA non-hypertension group.There were no significant differences on the prevalence of type(P=0.826)and number of ARA(P=0.501)between these two groups.In all of the patients with single ARA,no significant differences were detected on the ratios of diameter of ARA and main renal artery between the two groups(P=0.32). However,in ARA hypertension group,the diameter of main renal artery on the ARA side was significantly smaller than that on the opposite side(P=0.01).In non-hypertension ARA group,no statistical difference was found between the diameter of bilateral main renal arteries(P=0.06).Conclusion ARA is more prevalent in essential hypertensive patients,especially in young male.The decrease of the diameter of main renal artery in the ARA side may be a possible mechanism for essential hypertension.

Application of TMS in quantitative assessment of full term neonatal brain maturation with HIE / 实用放射学杂志

Objective To investigate the applications of total maturation scores (TMS) in assessment of the hypoxic ischemic encephalopathy (HIE) group and matched group with MRI and to find which patterns of HIE can delay the brain maturation in neonate.Methods MRI were performed on 43 full term neonates (28 HIE newborns and 15 matched controls) who were further divided into three groups,including 37-39 weeks postmenstrualage (PMA) (13 cases),39-41 weeks PMA (16 cases),and 41-44 weeks PMA (14 cases).MRI features and TMS scores were evaluated simulataneously.Results TMS gradually increased with PMA at each stage.While TMS,cortical folding and germinal matrix were all higher in matched group (P＜0.05),myelination and glial cell migration item were lower in HIE group (P＞0.05).Conclusion TMS can reflect brain development in the full term neonates.HIE may delay the brain maturation due to injury of the cortical myelin and neurons.TMS can evaluate the neonatal brain development and injury easily,quantitatively and effectively.

Measurement of lumbar zygapophyseal joints by using spiral CT and its clinical value / 实用放射学杂志

Objective To study the angle and articular facet curvature of lumbar zygapophyseal joints in adults.Methods The lumbar zygapophyseal joints in 120 healthy subjects without lumbar diseases were detected using spiral CT and mutiple planner re-construction.The angle and articular facet curvature of zygapophyseal joints were measured.The differences in the measured param-eters between male and female or different age groups were compared.Results ①There were no significant differences in the angle of the same lumbar zygapophyseal joints between males and females or different age groups (P >0.05);however,the significant differences in the angle between different lumbar segments were found (P 0.05);however, there were significant differences in the curvature between different lumbar segments (P <0.05).The maximum articular facet cur-vature of L3-L4 was 22.1°±6.0°.Conclusion The angle and articular facet curvature of lumbar zygapophyseal joints varies from different lumbar segments with different contributions for the lumbar stability.

Detection of p16 by fluorescence in-situ hybridization and immunohistochemistry in malignant mesothelioma / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the role of p16 gene mutation status as detected by fluorescence in-situ hybridization (FISH) and p16 protein expression as detected by immunohistochemistry in differential diagnosis of malignant mesothelioma and benign mesothelial hyperplasia.</p><p><b>METHODS</b>p16 gene mutation status and protein expression were detected by FISH and immunohistochemistry respectively in 55 cases of pleural malignant mesothelioma and 30 cases of benign mesothelial hyperplasia.</p><p><b>RESULTS</b>FISH study showed that the rate of p16 deletion in malignant mesothelioma (81.8%,45/55) was higher than that in benign mesothelial hyperplasia (3.3%,1/30). The difference was statistically significant (P<0.05). Immunohistochemical study showed that the rate of p16 protein expression in malignant mesothelioma (23.6%) was lower than that in benign mesothelial hyperplasia (76.7%). The difference was also statistically significant. The sensitivity and specificity of FISH in distinguishing between mesothelioma and reactive mesothelial hyperplasia were higher than those of immunohistochemistry.</p><p><b>CONCLUSIONS</b>In contrast to reactive mesothelial hyperplasia, p16 gene is deleted and p16 protein is not expressed in malignant mesothelioma. The sensitivity and specificity of FISH are higher than those of immunohistochemistry in the distinction.</p>

Exploration of lymph node metastasis and appropriate lymph node dissection modes in patients with clinical stage I non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the pattern of lymph node metastasis and evaluate the modes and extent of mediastinal lymph node dissection in patients with ≤ 3 cm, clinical stage I primary non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Data of 270 eligible patients who underwent pulmonary resection with systematic lymph node dissection in our hospital between March 2012 and August 2013 were retrospectively analyzed in order to investigate the relationship between the clinicopathological features and lymph node metastatic patterns. Patients with multiple primary carcinomas or non-primary pulmonary malignancies and those who received any chemotherapy or radiotherapy or did not undergo systematic nodal dissection were excluded. The criteria of systematic nodal dissection included the removal of at least six lymph nodes from at least three mediastinal stations, one of which must be subcarinal. The data were analyzed and compared using Chi-square test.</p><p><b>RESULTS</b>The postoperative morbidity rate was 14.8% and no death occurred in this series. The imaging findings showed 34 cases of pure ground glass opacity lesions, 47 partial solid nodules, and 189 solid nodules. Apart from 34 p-GGO lesions, among the other 236 cases, ≤ 1 cm lesions were in 22 cases, 1 cm- ≤ 2 cm lesions in 138 cases, and >2 cm- ≤ 3 cm lesions in 76 cases based on radiologic findings. The pathological types included adenocarcinoma (n = 245), squamous cell carcinoma (n = 18) and other rare types (n = 7). The overall lymph node metastasis rate was 18.9% (51/270), and the incidence of lymph node involvement was 0(0/34) in cancers with p-GGO, 2.1% (1/47) in mixed solid nodules, 26.5% (50/189) in solid nodules, 18.2% (4/22) in nodules ≤ 1 cm, 14.5% (20/138) in 1 cm < nodules ≤ 2 cm, and 35.5% (27/76) in 2 cm < nodules ≤ 3 cm. The metastasis rates of non-specific tumor-draining region lymph nodes detected in the patients with positive and negative lobe-specific lymph node involvement were 20.0%-50.0% vs. 0-2.9% (P < 0.001).</p><p><b>CONCLUSIONS</b>Usually NSCLC with p-GGO nodules has no lymph node metastasis, therefore, systematic nodal dissection may be not necessary. The larger the tumor size is, the higher the lymph node metastatic rate is for mixed or solid nodules. Intraoperative frozen-section examination of the lobe-specific lymph nodes should be performed routinely in patients with ≤ 2 cm stage I NSCLC, and systematic nodal dissection should be done if positive, but it may be not necessary if negative. However, the effectiveness of the systematic selective lymph node dissection still needs to be further confirmed.</p>