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@#Objective To compare the effectiveness and safety of preoperative lung localization by microcoil and anchor with scaled suture. Methods A total of 286 patients underwent CT-guided puncture localization consecutively between October 2019 and December 2020 in our hospital. According to the different methods of localization, they were divided into a microcoil group (n=139, including 49 males and 90 females, aged 57.92±10.51 years) and an anchor group (n=147, including 53 males and 94 females, aged 56.68±11.31 years). The clinical data of the patients were compared. Results A total of 173 nodules were localized in the microcoil group, and 169 nodules in the anchor group. The localization success rate was similar in the two groups. However, the anchor group was significantly better than the microcoil group in the localization time (8.15±2.55 min vs. 9.53±3.08 min, P=0.001), the pathological receiving time (30.46±14.41 min vs. 34.96±19.75 min, P=0.029), and the hemoptysis rate (10.7% vs. 30.1%, P=0.001), but the pneumothorax rate was higher in the anchor group (21.3% vs. 11.0%, P=0.006). Conclusion Preoperative localization of small pulmonary nodules using anchor with suture is practical and safe. Due to its simplicity and convenience, it is worth of promotion in the clinic.
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The RET(REarranged during transfection) gene as a novel has broken the therapeutic deadlock in the last two years, whith is attributed to the rapid approval of targeted therapies and inclusion in treatment guidelines, bringing more hope for the survival of patients with non-small cell lung cancer(NSCLC). Usually, the main activation of the RET proto-oncogene contributes to the development of lung cancer via somatic rearrangements. Thus, this study reviews the biological characteristics of RET gene, the classification of RET fusion in lung cancer and the detection of RET fusion. Meanwhile the pathological and clinical features, targeted therapies, drug resistance, prognosis of lung cancer patients with RET fusion were further discussed.
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Objective:To investigate the safety and effect of the operation of the upper sternum small incision assisted by normothermic cardiopulmonary bypass in the treatment of aortic valve disease.Methods:From March 2014 to June 2016, the clinical data of 25 patients who underwent single incision minimally invasive aortic valve replacement assisted by normothermic cardiopulmonary bypass in The Second Hospital of Hebei Medical University and 25 patients who underwent aortic valve replacement under hypothermia cardiopulmonary bypass were analyzed retrospectively.The former was used as minimally invasive surgery group, and the sternum was sawn in " J" shape through a small incision on the upper sternum.In the latter group, aortic valve replacement was performed under cardiopulmonary bypass.The operation effect and complications of the two groups were compared.Results:There was no death in the two groups.There was no significant difference in operation time between minimally invasive surgery group and routine operation group ( P>0.05). The time of aortic occlusion and cardiopulmonary bypass in minimally invasive surgery group ((50.0±6.8), (69.5±9.7) min) was longer than those in routine operation group ((45.8±7.2), (65.0±8.8) min), the difference was statistically significant ( t=2.120, 2.052, all P<0.05). In the minimally invasive operation group, red cell volume, plasma volume, intraoperative bleeding volume, incision length, postoperative 24-h drainage volume, postoperative 24-h leukocyte count, postoperative 24-h C-reactive protein concentration, postoperative 24-h total blood transfusion volume, ventilator-assisted time, ICU stay time and drainage tube retention time(85.1(42.3, 181.3) ml, 108.5(79.4, 173.8) ml, 186.4(132.6, 307.6) ml, (4.2±0.8) cm, 130.0(88.1, 224.3) ml, 14.2(9.8, 17.1)×10 9/L, 14.0(9.9, 23.2) mg/L, 186.6(135.3, 302.1) ml, 3.7(2.3, 6.8) h, 25.2(20.6, 35.6) h, 31.2(26.4, 41.9) h) were lower than those in the routine operation group (354.2(150.2, 507.2) ml, 211.9(119.2, 281.5) ml, 378.4(220.9, 496.5) ml, (13.8±6.5) cm, 365.8(171.8, 511.3) ml, 20.4(13.6, 24.7)×10 9/L, 28.6(14.4, 39.3) mg/L, 405.1(185.3, 570.1) ml, 7.7(4.2, 10.2) h, 52.8(30.8, 69.3) h, 57.2(37.6, 71.9) h), the difference between the two groups was statistically significant ((the statistical values were Z=3.393, 2.696, 2.781, t=7.329, Z=3.151, 2.638, 2.493, 2.597, 2.472, 3.254, 3.338, respectively; all P<0.05). There was no significant difference between the minimally invasive operation group and the routine operation group( P>0.05). The total incidence of postoperative complications in the minimally invasive operation group and the routine operation group was (12% (3/25) and 44% (11/25)), the difference was statistically significant ( P=0.025). Conclusion:CPB with normal temperature has the advantages of less trauma, fewer complications and faster recovery in the operation of single incision in the upper part of sternum.
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Objective:To assess the potentials for lung donation among 128 donors (deceased citizens) in 2017 from Beijing.Methods:Gender, age, blood type, duration of ventilation, oxygenation index (PaO 2/FiO 2), chest film and bronchoscopy were analyzed. Results:A total of 5135 deceased Chinese citizens were available for donation in 2017. The rate of donation per million population (PMP) was 3.71. And 463 donors from Beijing were recorded in 2017 and the rate of PMP was 21.05. In 2017, 299 lung transplantations were performed with an average rate of donor lung utility at 5.82%. Among 128 cases assessed for potential lung donors in Beijing, 72 were successfully procured with a percentage of lung utilization of 15.55%. There were 110 males (85.94%) and 18 females (14.06%) with an average age of (39.61±10.67) years. Mechanical ventilation duration was (7.59±2.93) days. The oxygenation rate (PaO 2/FiO 2) was (397.38±105.01) mmHg, (450±67.79) mmHg in procurement group and (338.89±116.15) mmHg in non-procurement group ( P=0.020). The median level of procalcitonin (PCT) was 0.195 ng/ml in procurement group versus 0.349 ng/ml in giving-up group ( P=0.042). Conclusions:Oxygenation rate and PCT level are the independent risk factors for reaching a procurement decision of donor lung. The actual PMP and lung procurement rate in Beijing were both higher than average domestic level (15.55% vs. 5.82%, P=0.000) because of excellent cooperation between Organ Procurement Organization (OPO) and lung transplantation centers. The evaluation of donor lungs and lung maintenance protocols from Beijing should be popularized nationwide.
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PURPOSE: Asthma affects approximately 30 million patients in China; however, tiotropium data for Chinese patients is limited. This study aimed to assess the efficacy and safety of tiotropium in Chinese patients with moderate symptomatic asthma. METHODS: A post hoc subgroup analysis was conducted on 430 Chinese patients pooled from two 24-week, replicate phase 3 trials (NCT01172808 and NCT01172821), in which they received once-daily tiotropium 2.5 µg (Tio R2.5) or 5 µg (Tio R5) (n = 106 or 109, respectively), twice-daily salmeterol 50 µg (Sal 50) (n = 110), or placebo (n = 105), while maintaining inhaled corticosteroids (ICS). The co-primary endpoints assessed in week 24 were forced expiratory volume in 1 second (FEV1) peak0–3h response, trough FEV1 response, and responder rate as assessed using the Asthma Control Questionnaire (ACQ). RESULTS: For both FEV1 peak0–3h responses and trough FEV1 responses, the mean treatment differences were greater for Tio R2.5, Tio R5, and Sal 50 compared with placebo at 0.249 L, 0.234 L, and 0.284 L, and 0.172 L, 0.180 L, and 0.164 L, respectively (P< 0.001). The ACQ responder rate in placebo, Tio R2.5, Tio R5, and Sal 50 was 58.7%, 62.3%, 59.3%, and 69.1%, respectively. Furthermore, 11 (2.6%) of 430 patients had serious adverse events (Tio R5, n = 4; Tio R2.5, n = 1; Sal 50, n = 1; and placebo, n = 5). CONCLUSIONS: Once-daily tiotropium, as add-on to medium-dose ICS, was effective and well tolerated for Chinese patients with moderate symptomatic asthma, consistent with the main analysis.
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Adult , Humans , Adrenal Cortex Hormones , Asian People , Asthma , China , Forced Expiratory Volume , Salmeterol Xinafoate , Tiotropium BromideABSTRACT
Objective To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the early diagnosis of non-central small cell lung cancer.Methods 141 patients wereselected from July 1999 to June 2017,who were diagnosed with small cell lung cancer (stage N2 and N3).They were divided into two groups according to the approach of obtaining histopathological tissuefor diagnosis.49 cases in the experimental group were obtained by EBUS-TBNA,92 cases in the control group were done by video assisted thoracic surgery (40 cases,43.5％),mediastinoscopy (1 case,1.1％),and open procedure (51 case,55.4％).Survival outcome,time of waiting for the treatment and lengthof stay were analyzed.Results There werel09 males,32 females,the range of age is from 16 to 79 years old [(56.21 ± 11.48) years].62 lesions located in the upper lobe,12 in the middle lobe,56 in the lower lobe,11 in the middle-lower/-upper lobes.Considering the T stage,there are 7 cases of T1,61 cases of T2,45 cases of T3,and 26cases of T4,2 patients with Tx stage.Compared with conventional approach,EBUS-TBNA saved 10.78 days from admission to the time of receiving treatment [(4.62 ± 0.66)days vs.(15.40 ± 1.61) days,P ＜ 0.05],and saved 18.13 days of length of stay [(5.30 ± 0.76) days vs.(23.43 ± 2.44) days,P ＜0.05].5-year survival rate was 31.0％ for traditional group and 27.5％ for EBUS-TBNA group,there was no significant difference between two groups(P =0.308).Conclusion EBUS-TBNA couldsave the waiting days from admission to the time of receiving treatment,and also shorten the total length of stay.EBUS-TBNA was more efficient than conventional approaches (VATS,mediastinoscopy or open procedure) for diagnosing non-central small cell lung cancer with enlarged mediastinal lymph nodes.
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Objective To explore the effect of measure accuracy of crevasse diameter of atrial septal defect (ASD) by transthoracic echocardiography (TTE) on radiation dose during interventional therapy.Methods 79 cases ASD with interventional therapy in our hospital were analyzed retrospectively,according to the times which we chosen occluder device on the basis of defect diameter by TTE,we divided those cases into three groups:group A,the occluder device chosen well,and it took only one time to block success (50 cases);group B,it took two times to block success (22 cases);group C,because of the measurement error,it needed three times to block success (7 cases).Following data were separately recorded:①measurement values of TTE,size of the occluder device and times of occluder device exchange;② radiation dose [cumulative radiation dose (AK,Gy),area dose product (DAP,Gy · cm2),fluoroscopic time (T,min)];③patient gender,age and body mass.Results All the cases were blocked success,the coincidence rate of TTE and occluder device were 62.67 ％,28 ％,9.33 ％,but there were significantly differences of AK,DAP and T in three groups (FAK=12.119,P=0.000;FDAp=8.241,P=0.001;FT =12.777,P=0.000).It showed that the radiation dose and T of group C were the largest and the longest,and group A were the least and the shortest,while the radiation dose and T of group B ranged between A and C groups.There was no statistically difference between radiation dose for different gender,age,body mass(P≥0.050).Conclusion The times of block and radiation dose is most influenced by the coincidence rate of TTE and occluder device.Increase of the coincidence rate may decrease the times of block and reduce the radiation dose for surgeon and patient.
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Objective To evaluate the clinical application of modified bony landmark measurement ( MBLM ) to deal with leg length discrepancy ( LLD ) during total hip arthroplasty ( THA ). Methods We retrospectively analyzed the 36 patients in whom MBLM was used to deal with LLD during THA from January 2014 to May 2015 at Department of Orthopaedics, The Second Hospital of Fuzhou. They were 17 men and 19 women, aged from 42 to 78 years ( average, 68.7 ± 10.1 years ). They were divided into 3 groups according to their pre-operative LLD value ( d ) : 16 cases in group A with d≤10 mm, 11 cases in group B with 10 mm ＜d≤20 mm and 9 cases in group C with d ＞ 20 mm. After the sizes of prosthetic cup and femoral component and the location of implant were determined using preoperative X-ray, a special formula was used to calculate the prosthetic length of femoral head neck and the osteotomy area at the femoral neck. MBLM was used to measure the leg lengths before hip joint dislocation and after placement of the hip implant. The neck length and depth of the femoral component was adjusted according to the measurements. Post-operative X-ray was used to measure the LLD ( d'). The value of MBLM in judgment of LLD during THA was assessed by comparison of d and d' and analysis of distribution of d' . Results The postoperative d' ( 6.0 ± 3.0 mm) was signifi-cantly shorter than the preoperative d ( 11.0 ± 5.0 mm) ( t＝5.145, P ＜0.001 ). There were 30 cases with d' ≤ 10 mm, 6 cases with 10 mm ＜d'≤ 20 mm and 0 case with d' ＞ 20 mm. The cases with d'≤ 10 mm were significantly more than those with d ≤ 10 mm and the cases with d' ＞ 20 mm significantly fewer than those with d ＞ 20 mm ( χ2＝15.500, P＝0.000 ) . Conclusion MBLM used during THA is a reliable method to judge the leg lengths so that LLD can be effectively reduced after THA.
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Objective To investigate the perioperative effects of simultaneous fixation and staging fixation in polytrauma patients combined with spine injury and long bone fracture.Methods A retrospective case control study was conducted to analyze the clinical data of 41 severe polytrauma patients with unstable spine combined with long bone fracture admitted from June 2009 to June 2015.There were 30 males and 11 females,aged 21-66 years [(41.2 ± 12.2)years].The injured spinal segments included cervical vertebrae in 11 patients,thoracic vertebrae in 15,lumbar vertebrae in 23,sacrococcygeal vertebrae in two,as well as injuries at two or more different segments in 10 patients.The long bone fracture segments included humerus in six patients,radius and ulna in 14,femur in 15,tibia and fibula in 14,as well as injuries at two or more different segments in eight patients.The injury severity score (ISS) were all ≥ 15 points.According to the timing of operation,the patients were divided into the simultaneous operation group (20 patients) and the staging operation group (21 patients).In the simultaneous operation group,there were 16 males and four females,aged (43.1 ± 12.6)years,and internal or external fixations of spine and long bone were performed at stage Ⅰ.In the staging operation group,there were 14 males and seven females,aged (40.1 ± 11.9)years.Spine fixation surgery was performed first,and then surgery for long bone fracture was performed after the conditions were stabilized.Spinal surgery methods included anterior subtotal vertebral resection,bone graft plate internal fixation,posterior laminectomy and decompression,and lateral mass screw or pedicle screw internal fixation.Plate and interlocking nail were used for internal fixation of long bone fracture,and single arm bracket for external fixation.The preoperative hospitalization time,operation time,operative blood loss (intraoperative hemorrhage and postoperative drainage),postoperative complications,hospitalization time and Frankel score of spinal cord injury before and after operation were compared between the two groups.Results The preoperative hospital stay was (9.3 ± 6.7) days in the simultaneous operation group and (5.6 ± 5.0) days in the staging operation group (P ＞ 0.05).The simultaneous operation group had significantly longer operation time [(4.9 ± 2.0) hours] than the staging operation group [(3.2 ± 1.2) hours] (P ＜ 0.01),more operative blood loss [(1 322.6 ± 507.1) ml] than the staging operation group [(1 036.7 ± 233.9) ml] (P＜0.05),and shorter hospitalization stay [(22.8 ± 12.6)days] than the staging operation group [(33.0 ± 15.4) days] (P ＜ 0.05).The complication incidence of the simultaneous operation group [45％ (9/20)] was significantly lower than that of the staging operation group [86％ (18/21)] (P ＜ 0.01).No significant difference was found in Frankel score between the simultaneous operation group [(3.3 ±1.7)points] and the staging operation group [(3.1 ± 1.5)points] (P ＞0.05).Conclusion For polytrauma patients combined with spine injury and long bone fracture,simultaneous operation can reduce hospitalization time and complication incidence compared with staging operation.
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Objective@#To evaluate whether epicardial fat volume (EFV) is related to coronary artery calcification in patients with chronic kidney disease(CKD).@*Method@#Multi-slice computed tomography was performed in 30 healthy subjects and 120 patients with CKD. Cross-sectional tomographic cardiac slices from base to apex were traced semi-automatically using a Volume Viewer of AW4.3 off-line workstation, and EFV was measured by assigning Hounsfield units ranging from -250 to -30 HU to fat.The coronary artery calcification score was assessed by CaScoring software. High density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C) and collecting the body mass index (BMI), dialysis route, history of diabetes and coronary artery disease were used to analyze the relationship between EFV and other risk factors in patients with CKD.@*Results@#There were 60.8%(73/120) male (mean age 62.8 years) and 39.2%(47/120) female (mean age 66.6 years) in the patients cohort, 73.3%(88/120) patients had coronary artery disease, 55.8%(67/120) had diabetes, 21 patients were on peritoneal dialysis and 9 on hemodialysis. EFV was apparently higher in stage 4-5 D CKD group compared with the control group((140.03±54.71), (145.01±64.56)and (141.45±62.04) cm3 vs.(92.42±39.56)cm3, P=0.007, 0.015 and 0.001), was similar between CKD3 and control group, and EFV was significantly higher in peritoneal dialysis group than in hemodialysis group and in coronary artery disease group compared with no coronary artery disease group((140.67±70.31) cm3 vs.(105.22±61.49) cm3, P=0.002). EFV was obviously higher in diabetes group than no diabetes group((148.41±65.78) cm3 vs.(110.53±62.37) cm3, P=0.007). CACS was apparently increased in stage 3-5 CKD group compared with the control group(140.0 vs.4.3, P<0.001). (3)When the patients were divided into four groups according to the eGFR, EFV was positively associated with CACS(rs=0.539, P=0.004) in control group, and the association become more robust in patients with CKD5(rs=0.841, P<0.000 1). EFV was related to age(r=0.662, P=0.005), BMI(r=0.648, P=0.009)and HDL-C(r=-0.433, P=0.024), but not related to eGFR and LDL-C. EFV was related to CACS(r=0.427, R2=0.182 3, P<0.001). CACS was positively correlated to age and BMI (all P<0.05)and negatively correlated with eGFR(P<0.05).@*Conclusions@#Measurement of EFV may provide another useful noninvasive indicator of coronary artery calcification in CKD patients.
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Objective:To investigate the correlation between serum CXCL10 level and the severity of obstructive sleep apnea syndrome(OSAS) in male patients.Methods:52 male patients and 41 control volunteers were enrolled.Polysomnography was processed to monitor the AHI scores.Serum CXCL10 level was determined by ELISA.The correlation between serum CXCL10 level and AHI scores was analyzed statistically.Results:Serum CXCL10 level(ng/ml) in the OSAS groups was significantly higher than that in the control group [99.18 (70.46-158.01) vs 64.13 (53.5-73.6),P ＜ 0.001].Multivariate logistic regression analysis demonstrated that serum CXCL10 level was the only independent predictor of OSAS(OR:1.021;95％ CI:1.009-1.035;P ＜0.001).The serum CXCL10 level was positively correlated with the severity of OSAS [CXCL10 level in mild OSAS:82.7 (56.76-145.51);in moderate:OSAS 113.28 (87.15-162.67)].Serum CXCL10 level was independently correlated with AHI scores(r =0.476,P ＜ 0.001).Conclusion:Serum CXCL10 level was independently associated with the occurrence and the severity of OSAS.Serum CXCL10 level can be used as a biomarker to diagnose the OSAS and further to assess the severity of OSAS.
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Objective To observe the clinical efficacy and adverse reactions between pemetrexed plus cisplatin and paclitaxel plus cisplatin in the treatment of advanced non-small cell lung cancer (NSCLC).Methods Forty-two cases with non-small cell lung cancer in our hospital from June 2013 to June 2015 were selected.Patients were randomly divided into observation group and control group with 21 cases in each group.The observation group was treated with pemetrexed plus cisplatin and the control group was treated with paclitaxel plus cisplatin.The clinical efficacy and adverse reactions were observed after two courses (21 days of a course) and the statistical analysis was performed.Results In the observation group and control group,response rate and clinical benefit rate were33.33％ (7/21),28.57％ (6/21) and76.19％ (16/21),71.43％ (15/21) respectively.No statistical significance were seen between the two groups (P＞0.05).The rate of hair loss (23.81％) (5/21) and the total number of adverse reactions (18.37％) (27/147) in the observation group were significantly lower than the rate of hair loss (47.62％) (10/21) and the total number of adverse reactions (25.17％) (37/147) in the control group (P＜0.05) No statistical significance was found in the incidence rate of leukopenia,neutropenia,erythropenia,thrombocytopenia,nausea and vomiting and phlebitis between the two groups (P ＞0.05) Conclusion Pemetrexed plus cisplatin is as effective as paclitaxel plus cisplatin in the treatment of advanced NSCLC with less adverse reactions and is much safer than paclitaxel plus cisplatin.Pemetrexed plus cisplatin is more valuable in the clinical treatment of advanced NSCLC.
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Objective To evaluate the correlation of the single nucleotide polymorphisms (SNPs) in CDH13 with non-small cell lung cancer (NSCLC) . Methods 115 patients with NSCLC and 110 healthy controls were included in present study. Two SNPs (rs11646213 and rs7195409) in CDH13 were genotyped using TaqMan method. The association of these two SNPs with NSCLC was calculated and assessed. Results The genotypic and allelic frequencies of rs11646213 showed significant difference between NSCLC patients and the control group (P<0.05), (OR=0.464, 95% CI:0.273~0.789) . The genotypic and allelic frequencies of rs7195409 showed significant difference between the stage I+II and stage III+IV groups (P<0.05), (OR=0.491, 95% CI:0.243~0.991) . Conclusions The rs16146213 has a strong association with NSCLC and G allelic showed a protective effect. The rs7195409 has a strong association between stage I+II and III+IV in NSCLC, and G allele may play a protective role in the development of NSCLC.
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Objective To investigate the characteristics and the risk factors of pulmonary function in patients with chronic obstructive pulmonary disease (COPD) for a 3 year follow-up.Methods Subjects diagnosed as COPD were followed up for 3 years in the Management Center of Chronic Respiratory Disease at XINQIAO Hospital from September 2009 to June 2012.This was a retrospective study.Parameters related to respiratory function mainly first second forced expiratory volume (FEV1),COPD assessment test (CAT),6 minutes walking distance (6MWD) and acute exacerbation were recorded during follow-up.Results Although the majority of patients were treated with drugs such as inhaled corticosteroid combined with longterm bronchial dilatation during the three years,FEV1 decreased progressively.The average annual decline of FEV1 was(31.80 ± 61.99) ml,translating into a mean annual decline of(3.74 ± 6.18) ％.However,there were significant differences in changes of FEV1.Approximately,FEV1 in 78.3％ (47/60) patients decreased,only 21.7％ (13/60) patients kept stable FEV1.There was a correlation between decrease of FEV1,FEV1 ％ predicted and the exacerbation (r =0.298,0.361,0.273;P ＜ 0.05).Logistic regression showed that the positive bronchodilator reversibility and the initial FEV1 were the independent factors associated with significant changes in FEV1 (respectively,OR =5.54,95％ CI 1.55-19.73;OR =8.28,95％ CI 1.42-48.32).Conclusion The changes of pulmonary function in patients with COPD are heterogeneous,although most patients are treated in a standard way.Nearly 80％ patients still represent deterioration of pulmonary function.Decline of FEV1 is closely related to the initial pulmonary function and bronchodilator reversibility.
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Objective To explore the operative indication operation time and post-operative care for infants with large ventricular septal defects (VSD).Methods Eighty-eight infants who suffered from large VSD were selected,male 53 cases,female 35 cases,aged from 3 to 18 months[average (7.5-±2.9) months],weight from 5 to 13 kg [average (7.9 ± 1.9) kg].All patients underwent VSD repair and other accompanied anomaly corrections under cardiopulmonary bypass.Fifty-eight cases were operated through right atrium,14 cases through pulmonary artery and 16 cases through right ventricle.Patch repairs were done in all patients,78 cases given bovine pericardium patches,10 cases given self pericardium patches treated by Glutaral.Patients were sent to the intensive care unit after surgery,vasoactive drugs were used as a routine method.Antibotics were selected based on their sputum cultures postoperatively.Nutritional support was given in the earlier stage.Results There were no hospital death,average hospitalization days were (15.2 ± 5.9) days (from 11 to 32 days).The main complication were pneumonia (5 cases),bad coalesce of incision (4 cases),atelectasis (3 cases),minimal residual shunt of VSD (3 cases).All patients were discharged from hospital,76 cases were followed up from 1 to 12 months,2 cases had residual shunt of VSD,the residual shunt of the other case disappeared;76 patients had no clinical symptom,28 patients body weight returned to normal after 6 months of operation.There was no other complication and death.Conclusion Early surgical treatment for infants with large VSD is a safe and effective way with a better prognosis.
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Objective Preliminary study of the cough reflex sensitivity test in chronic cough patients with different gender,disease duration and causes to evaluate the clinical diagnostic significance of the test and further provide some information for the treatment of chronic cough.Methods Totally 108 chronic cough patients in our hospital were enrolled in the study with the final diagnosis of upper airway cough syndrome(UACS),cough variant asthma(CVA)and gastroesophageal reflux cough(GERC).They all went through the cough reflex sensitivity test and the retrospective analysis of the results was made.Results In 108 patients with chronic cough(76 UACS,19 CVA and 13 GERC),lgC5 was significantly slower in the female(1.80)than the male(2.40,P<0.05)and in the patients with cough duration over 12 months(1.80)than those with cough duration under 12 months(2.40,P<0.05).Cough sensitivity in patients with different causes was significantly different(P<0.05)with lower lgC5 in GERC patients(1.49)than CVA (2.40,P<0.05)and UACS(2.40,P<0.05)patients.Conclusion Cough sensitivity is different in chronic cough patients with different gender,disease duration and causes.Cough reflex sensitivity test is of great value in the etiology diagnosis of chronic cough.
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<p><b>BACKGROUND AND OBJECTIVE</b>Fast track surgery (FTS) is a systematical method to accelerate the recovery of surgical patients by reducing the physical and mental trauma stress of them. The research is to investigate the feasibility of FTS application in lung cancer surgery.</p><p><b>METHODS</b>A total of 80 cases of lung cancer patients with single leaf lobotomy resection were randomized into two groups. While the experimental group was treated with the conception of FTS, and the control group was treated with the traditional methods. The incident rate of post-operation pain degrees, telecasts, pleural effusion, the post-operation time stay in hospital time and the total cost during hospitalization in two groups were compared respectively.</p><p><b>RESULTS</b>In FTS group: the VAS score of post-operation pain at 1 h, 6 h, 12 h, 24 h and 48 h all significantly decreased compared to the traditional therapy group. The incidence rate of telecast was 10.53%. The incidence rate of pleural effusion was 26.31%. The length of stay after operation was (4 +/- 1) d and the total cost was RMB 15 600 +/- 7 600. In the control group, the above values were 77.78%, 33.33%, 22.22%, (9 +/- 1) d, RMB 23 600 +/- 5 400, respectively. The post operation pain (VAS method) of FTS group was remarkablely below the control group. There has significant difference of the incident rate of telecasts, stay time in hospital and the total cast in two groups (P < 0.05). No significant difference was observed in the incident rate ofpleural effusion.</p><p><b>CONCLUSION</b>The new methods of FTS can apparently accelerates recovery after lung cancer resection, reduces complications, shorten timestay in hospital and cut down the total cost.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Lung Neoplasms , General Surgery , Pulmonary Surgical Procedures , Treatment OutcomeABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>Approximately 30% of patients who are diagnosed with non-small cell lung cancer (NSCLC) are classified as N2 on the basis of metastasis to the mediastinal lymph nodes. The effectiveness of surgery for these patients remains controversial. Although surgeries in recent years are proved to be effective to some extent, yet due to many reasons, 5-year survival rate after surgery varies greatly from patient to patient. Thus it is necessary to select patients who have a high probability of being be cured through an operation, who are suitable to receive surgery and the best surgical methods so as to figure out the conditions under which surgical treatment can be chosen and the factors that may influence prognosis.</p><p><b>METHODS</b>165 out of 173 patients with N2 NSCLC were treated with surgery in our department from January 1999 to May 2003, among whom 130 were male, 43 female and the sex ratio was 3:1, average age 53, ranging from 29 to 79. The database covers the patients' complete medical history including the information of their age, sex, location and size of tumor, date of operation, surgical methods, histologic diagnosis, clinical stage, post-operative TNM stage, neoadjuvant treatment and chemoradiotherapy. The methods of clinical stage verification include chest X-ray, chest CT, PET, mediastinoscopy, bronchoscope (+?), brain CT or MRI, abdominal B ultrasound (or CT), and bone ECT. The pathological classification was based on the international standard for lung cancer (UICC 1997). Survival time was analyzed from the operation date to May 2008 with the aid of SPSS (Statistical Package for the Social Sciences) program. Kaplan-Meier survival analysis, Log-rank test and Cox multiplicity were adopted respectively to obtain patients' survival curve, survival rate and the impact possible factors may have on their survival rate.</p><p><b>RESULTS</b>The median survival time was 22 months, with 3-year survival rate reaching 28.1% and 5-year survival rate reaching 19.0%. Age, sex, different histological classification and postoperative chemoradiotherapy seem to have no correlation with 5-year survival rate. In all N2 subtypes, 5-year survival rate is remarkably higher for unexpected N2 discovered at thoractomy and proven N2 stage before preoperative work-up and receive a mediastinal down-staging after induction therapy (P < 0.01), reaching 30.4% and 27.3% respectively. 5-year survival rate for single station lymph node metastasis were 27.8%, much higher compared with 9.3% for multiple stations (P < 0.001). Induction therapy which downstages proven N2 in 73.3% patients gains them the opportunity of surgery. The 5-year survival rate were 23.6% and 13.0% for patients who had complete resection and those who had incomplete resection (P < 0.001). Patients who underwent lobectomy (23.2%) have higher survival rate, less incidence rate of complication and mortality rate, compared with pneumonectomy (14.8%) (P < 0.01). T4 patients has a 5-year survival rate as low as 11.1%, much less than T1 (31.5%) and T2 (24.3%) patients (P = 0.01). It is noted through Cox analysis that completeness of resection, number of positive lymph node stations and primary T status have significant correlativity with 5-year survival rate.</p><p><b>CONCLUSION</b>It is suggested that surgery (lobectomy preferentially) is the best solution for T1 and T2 with primary tumor have not invaded pleura or the distance to carina of trachea no less than 2 cm, unexpected N2 discovered at thoractomy when a complete resection can be applied, and proven N2 discovered during preoperative work-up and is down-staged after induction therapy. Surgical treatment is the best option, lobectomy should be prioritized in operational methods since ise rate of complication and morality are lower than that of pneumonectomy. Patients' survival time will not benefit from surgery if they are with lymph nodes metastasis of multiple stations (Bulky N2 included) and T4 which can be partially removed. Neoadjuvant chemotherapy increases long-term survival rate of those with N2 proven prior to surgery. However, postoperative radiotherapy decreases local recurrence rate but does not contribute to patients' long-term survival rate.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung , Mortality , General Surgery , Lung Neoplasms , Mortality , General Surgery , Lymphatic Metastasis , Pathology , Survival Analysis , Thoracic Surgical Procedures , Methods , Treatment OutcomeABSTRACT
<p><b>BACKGROUND AND OBJECTIVE</b>Because radical resection for lung cancer invading the initial borderline of different lobes and carina is difficult, we tried to analyse the variables of successful tracheal carinoplasty and bronchovasculoplasty to discover a proper approach for appropriate early and long-term results.</p><p><b>METHODS</b>Of 1 399 lung resections for primary lung cancer performed in our hospital from April 1985 to December 2006, 133 underwent bronchoplastic surgeries, including 15 carinoplasty cases and 118 sleeve lobectomy (SL) cases, and 118 pneumoectomy (PN) cases were compared at the same time.</p><p><b>RESULTS</b>Complications occurred in 18 cases, with no operative related mortality. For all patients, the 1 year, 3 year, and 5 year survival rates were 79.8%, 56.7% and 31.2%, respectively. The 5 year survival rate by cancer stage was 69.2% for Ib, 40.6% for IIb, 19.6% for IIIa, and 16.6% for IIIa (N2).</p><p><b>CONCLUSION</b>Selection of cases, clearance of lymph nodes, disposal of the bronchus and pulmonary vessel and replacement or restoration of the superior vena cava are the main factors influencing prognosis.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Bronchogenic , Mortality , General Surgery , Lung Neoplasms , Mortality , General Surgery , Lymphatic Metastasis , Survival Rate , Trachea , Pathology , General Surgery , Treatment OutcomeABSTRACT
BACKGROUND: Lung transplantation can improve quality of life of patients who get terminal pulmonary disease and also it can help to get better survival.Now it has become one of the best therapeutic methods for terminal pulmonary disease.However,limited donors leave the development of lung transplantation in dilemma.The emergence of living lobar transplantation and cadeveric lobar transplantation let this procedure much easier.OBJECTIVE: To evaluate the clinical probability of bilateral lobar transplantation.METHODS: Sequential bilateral lobar transplantation was performed for one 26 years old cystic fibrosis female.Cardiac pulmonary bypass was used during operation.Anti-rejection(Tacrolimus,mycophenolate,etc)and anti-infection was used postoperatively.RESULTS AND CONCLUSION: The recovery course postoperatively was smooth,and the recipient got out of hospital 7weeks later.Bilateral lobar transplantation could offer satisfied short-term pulmonary function.The long term results should be further evaluated.