Discussion of the process of conducting an investigator-initiated research / 中国胸心血管外科临床杂志

@#The number of investigator initiated research (IIR) is increasing. But the recognition and management of IIR in China is still in its infancy, and there is a lack of specific and operable guidance for the implementation process. Based on our practical experiences, previous literature reports, and current policy regulations, the authors took prospective IIR as an example to summarize the implementation process of IIR into 14 steps, which are as the following: study initiation, ethical review, study registration, study filing, case report form design, database establishment, standard operating procedure making, investigator training, informed consent, data collection, data entry, data verification, data locking and data archiving.

Several suggestions on the classification management process and countermeasures of pulmonary surgery during the COVID-19 / 中华胸心血管外科杂志

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.

Predictive value of volatile organic compounds in exhaled breath on pulmonary nodule in people aged less than 50 years / 中国胸心血管外科临床杂志

@#Objective    To investigate the predictive value of volatile organic compounds (VOCs) on pulmonary nodules in people aged less than 50 years. Methods    The 147 patients with pulmonary nodules and aged less than 50 years who were treated in the Department of Thoracic Surgery of Sichuan Cancer Hospital from August 1, 2019 to January 15, 2020 were divided into a lung cancer group and a lung benign disease group. The lung cancer group included 36 males and 68 females, with the age of 27-49 (43.54±5.73) years. The benign lung disease group included 23 males and 20 females, with the age of 22-49 (42.49±6.83) years. Clinical data and exhaled breath samples were collected prospectively from the two groups. Exhaled breath VOCs were analyzed by gas chromatography mass spectrometry. Binary logistic regression analysis was used to select variables and establish a prediction model. The sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve of the prediction model were calculated. Results    There were statistically significant differences in sex (P=0.034), smoking history (P=0.047), cyclopentane (P=0.002), 3-methyl pentane (P=0.043) and ethylbenzene (P=0.009) between the two groups. The sensitivity, specificity and area under the ROC curve of the prediction model with gender, cyclopentane, 3-methyl pentane, ethylbenzene and N,N-dimethylformamide as variables were 80.8%, 60.5% and 0.781, respectively. Conclusion    The combination of VOCs and clinical characteristics has a certain predictive value for the benign and malignant pulmonary nodules in people aged less than 50 years.

Personality and depression: A review of theory model and behavior and neural mechanism / 生理学报

The analysis of the relationship between personality and depression can facilitate the development of subclinical preventive measures and clinical treatment schemes. Moreover, the personality is associated with a variety of mental diseases, and there is substantial comorbidity between depression and some other mental diseases. So, to reveal pathological relationships between personality and depression is helpful to understand the etiology of the comorbidity between depression and multiple mental disorders. In this review, we first summarize the empirical researches on the relationship between personality and depression from the aspects of behavior and neural mechanisms, and then discuss the hypothetical model to explain the relationship between personality and depression. In a word, high neuroticism, low extroversion and conscientiousness, and other related traits (rumination, self-criticism, dependency, etc.) have a moderate to strong correlation with depression. Among them, neuroticism is the most concerned. To a certain extent, it can predict the onset of depression and affect the duration and treatment outcome of depression. Other traits, such as positive emotionality/ extroversion and effortful control/responsibility, can moderate the relationship between negative emotionality/neuroticism and depression. And after the onset of depression, the neuroticism may change, but the extroversion does not seem to change.

Acupuncture combined with cinesiotherapy cupping for knee osteoarthritis with stagnation and blood stasis syndrome: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between acupuncture combined with cinesiotherapy cupping and acupuncture combined with conventional cupping for knee osteoarthritis (KOA) with stagnation and blood stasis syndrome, and to seek a better solution for KOA.@*METHODS@#A total of 78 patients of KOA with stagnation and blood stasis syndrome were randomly divided into an observation group and a control group, 39 cases in each group (3 cases in the observation group and 2 cases in the control group lost contact). Both groups were treated with acupuncture at Neixiyan (EX-LE 4), Dubi (ST 35), Xuehai (SP 10), Liangqiu (ST 34), Heding (EX-LE 2), Zusanli (ST 36), Yinlingquan (SP 9), Yanglingquan (GB 34) and Xuanzhong (GB 39). Based on the acupuncture treatment, the control group was treated with conventional cupping. The No. 4 cupping glass was used for Xuehai (SP 10), Liangqiu (ST 34) and Fengshi (GB 31), while the No. 3 cupping glass was used for Yinlingquan (SP 9), while the cupping with appropriate size was used for points; the cupping glass was retained for 5 min. Based on the acupuncture treatment, the observation group was treated with cinesiotherapy cupping. The selection of acupoint and cupping glass was identical as the control group. The patients were instructed to perform knee flexion-extension, hip abduction-adduction, weight-bearing and other active exercise while cupping; the treatment was given once a day, 10 times as a course of treatment; totally three courses were given with an interval of 2 days between the courses. The patient's symptom scores, pain scores and knee function scores were recorded before and after treatment. The amount of joint effusion was measured by ultrasound; the level of interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) in joint effusion were measured by ELISA.@*RESULTS@#After treatment, the total effective rate in the observation group was 94.4% (34/36), which was significantly higher than 86.5% (32/37) in the control group (0.05).@*CONCLUSION@#The acupuncture combined with cinesiotherapy cupping could alleviate pain, improve joint function and reduce joint effusion, which is superior to acupuncture combined with conventional cupping.

Surgical management of mediastinal lymph node metastasis of thyroid carcinoma / 中华内分泌外科杂志

Objective To explore the surgical technique for mediastinal lymph node metastasis of thyroid cancer.Methods We retrospectively reviewed clinical records of 46 patients with metastatic thyroid cancer in mediastinal lymph nodes and having received surgical treatment in Department of Head Neck Surgery and Thoracic Surgery of Sichuan Cancer Hospital from Feb.2004 to Apr.2015.We analyzed the diagnosis,surgical treatment methods,operative approach,and postoperative complications of these patients.Results The main metastatic region was superior mediastinum especially level 2 (2R/2L,lower parathymic lymph nodes) according to AJCC-UICC standard in 31 patients (67.39％);16 patients (34.78％) had level 3 and level 4 (4R/4L lower parathymic) lymph node netastasis and 4 patients (8.696％) had level 5 (subaortic lymph node) and level 6 (para-aortic lymph node) metastasis.39 patients were pathologically diagnosed with papillary carcinoma,6 patients were diagnosed with medullary carcinoma,and 1 patient was diagnosed with follicular carcinoma.There were 14 patients with stage Ⅰ disease,5 patients with stage Ⅱ disease,3 patients with stage Ⅲ disease,22 patients with stage Ⅳa disease,and 2 patients with stage Ⅳc disease.The most common complications were hoarseness,chylous fistula,hypocalcaemia,and airway obstruction.Patients were followed-up from 1 to 8 years.During the follow-up period,4 cases were lost to follow-up and 2 patients died.Conclusions The main treatment approach for mediastinal lymph node metastasis of thyroid cancer is surgical operation.Pre-operative CT or MRI is needed to evaluate the metastatic region of the lymph nodes and to choose appropriate operative approach.

Comparison of perioperative outcomes and lymphadenectomy after thoracoscopic esophagectomy in semi prone position and open esophagectomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Thoracoscopic esophagectomy has gained worldwide popularity. This study compared the perioperative outcomes and lymphadenectomy after thoracoscopic esophagectomy in semi prone position and open esophagectomy.</p><p><b>METHODS</b>Sixty-two consecutive patients after thoracoscopic esophagectomy were compared with 62 patients who underwent open esophagectomy. Outcomes included surgical time, blood loss, length of hospital stay, 30-day mortality, complications and gained lymph nodes.</p><p><b>RESULTS</b>The mean length of hospital stay of the thoracoscopic group was 12.4 ± 7.4 days, and 13.6 ± 6.7 days in the open esophagectomy group (P > 0.05). The median total operation time and median thoracic operation time were 270 and 130 min, the median total blood loss and median thoracic blood loss were 300 and 180 ml in the thoracoscopic group, while the results in open esophagectomy group were 290, 150 min and 300, 180 ml. The median total operation time and median thoracic operation time were of statistically significant difference (P < 0.01). But there were no significant differences between the two groups in total blood loss and thoracic blood loss (P > 0.05) . The numbers of obtained lymph nodes in the thoracoscopic group and open esophagectomy group were 20.5 and 16.9 (P < 0.01). Among them, the median numbers of mediastinal lymph nodes in the thoracoscopic group and open esophagectomy group were 12.4 and 8.8, the left recurrent laryngeal nerve lymph nodes were 1.8 and 1.0, and the right recurrent laryngeal nerve lymph nodes were 2.9 and 1.2 (P < 0.01 for all). There were 8 positive recurrent laryngeal nerve lymph nodes (12.9%) in the thoracoscopic group, while 5 in the open esophagectomy group (8.1%, P > 0.05). There were no peri-operative period death, heavy bleeding, or thoracic gastric fistula in both groups.</p><p><b>CONCLUSIONS</b>Thoracoscopic esophagectomy in semi prone position may achieve good surgical field exposure, therefore, to make esophagectomy, lymph node dissection and digestive tract reconstruction possible. These findings suggest that with further technical refinement, thoracoscopic esophagectomy may have the upper hand on reducing postoperative complications and performing mediastinal lymph node dissection.</p>

Systematic video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable non-small cell lung cancer / 中华胸心血管外科杂志

Objective This study was performed to assess the clinical feasibility of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer.Methods Between March 2011 and May 2012,we retrospectively analyzed the data from 56 patients who underwent video-assisted mediastinoscopic lymphadenectomy(VAMLA).In patients receiving tumour resection subsequently,radicality of the previous mediastinoscopic dissection was controlled during thoracotomy.Results Mean operative time of video-assisted mediastinoscopic lymphadenectomy was(42.0 ± 13.5) min(range of 26-86 min).Mean number of resected lymph nodes was 12.4 ± 6.7 (range of 5-24).In video-assisted mediastinoscopic lymphadenectomy,the rates of lymph node dissection of stations 2,4,5,7,8 were 54.5％,92.7％,58.2％,100％,61.8％,respectively,there was no operative mortality and morbility.90.9％ patients achieved radical dissection.Conclusion Video-assisted mediastinoscopic lymphadenectomy is a clinically feasible procedure and provides more accurate staging of mediastinal node in lung cancer patients.It also plays an important role in minimal invasive surgery and neoadjuvant therapy.

Effect of environmental factors on chemoresistance of HepG2 cells by regulating hypoxia-inducible factor-1α / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Accumulating evidence demonstrates that the microenvironment of the host has an important effect on the chemoresistance of tumors. We also found that the formation of intrinsic multidrug resistance is related to environmental factors that are common with tumor growth of hepatocellular carcinoma. The aim of this study was to explore the molecular mechanisms by which multidrug resistance of hepatocellular carcinoma is induced by the microenvironment. In particular, the regulation of nuclear transcription factor (hypoxia-inducible factor-1α, HIF-1α) activation in the process of multidrug resistance formation was investigated.</p><p><b>METHODS</b>HepG2 cells were exposed to different microenvironmental conditions respectively, such as hypoxia, stimulation of glucose deprivation and transfection of plasmid PcDNA3/HBx. In the HepG2 cells, the expression of the related MDR proteins, HIF-1α protein expression and localization, activity of extracellular signal-regulated kinase/mitogen-activated protein kinase (ERK/MAPK) were detected. Specific inhibitor U0126 was used to block ERK/MAPK signal pathway, the alteration of HIF-1α and the related MDR proteins were investigated. Multivariate analysis of variance (MANOVA) repeated measures and one-way analysis of variance (ANOVA) followed by Tukey test or t-test were used to determine differences over time and effects of the treatments.</p><p><b>RESULTS</b>The above three microenvironment factors increase the expression of the related MDR proteins (including P-gp, LRP, and MRP1) and induce MDR of HepG2 cells. HIF-1α was induced at the protein and mRNA levels and the nuclear translocation was also increased. The activity of ERK/MAPK was also increased in HepG2 cells. But when ERK/MAPK pathway was inhibited, the mRNA and protein expression of MDR1, MRP1, and LRP was to some extent decreased. Inhibition of ERK/MAPK significantly reduced activated HIF-1α protein and the nuclear translocation of HIF-1α, whereas HIF-1α mRNA levels were not affected.</p><p><b>CONCLUSIONS</b>The microenvironmental factors could induce MDR of HepG2 cells by the activity of HIF-1α. The activity of HIF-1α is regulated by the ERK/MAPK pathway at the phosphorylation level. As an important nuclear transcription factor, HIF-1α controls the transcription of MDR-related genes and the synthesis of their corresponding proteins by ERK/MAPK signal pathway in HepG2 cells.</p>

A phase II prospective randomized controlled trial of weekly paclitaxel combined with S-1 or fluorouracil for advanced gastric carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of weekly paclitaxel combined with S-1 or fluorouracil in the first line treatment of advanced gastric carcinoma.</p><p><b>METHODS</b>Two hundred and forty patients with untreated advanced gastric carcinoma were randomized into two arms, patients in the experimental arm were given paclitaxel and S-1, while those in the control arm received paclitaxel and fluorouracil. The regimen of experimental arm was paclitaxel 60 mg/m(2) by intravenous infusion, day 1, 8, 15; S-1 80 - 120 mg/day given by oral administration, day 1 - 14. The regimen of control arm was fluorouracil 500 mg/m(2) by intravenous infusion continuously, day 1 - 5; CF 20 mg/m(2) by intravenous infusion, day 1 - 5. The regimens in both arms were repeated every 28 days. The efficacy and safety of both arms were assessed.</p><p><b>RESULTS</b>Two hundred and twenty-eight patients were analyzed in the full analysis set, and 192 patients were analyzed in per-protocol set (experimental arm 100 patients, control arm 92 patients). The overall response rates of experimental and control arms were 50.0% and 28.3% (P = 0.002), and the disease control rates were 82.0% and 70.7% (P = 0.064), respectively. The primary endpoints of experimental arm were non-inferior to that of the control arm. The secondary endpoint of experimental arm in terms of median progression free survival was significantly better than that of control arm (5 months versus 4 months, P = 0.006). The experimental arm had a higher incidence of grade III-IV bone marrow suppression than the control arm, but the incidence of fever in both arms was not significantly different.</p><p><b>CONCLUSIONS</b>Oral administration of S-1 is an alternative option of venous infusional fluorouracil. Weekly paclitaxel combined with S-1 is a safe regimen and has a promising efficacy.</p>

Radical surgery of lung cancer with chest wall invasion and reliable methods of chest wall reconstruction / 中华医学美学美容杂志

Objective To study the efficacy of radical surgery for the invasion of chest wall by lung cancers and the different methods of chest wall reconstruction. Methods A retrospective analysis of clinical data was conducted in 27 cases of lung cancer with chest wall invasion in this hospital. 24 cases received lobectomy, 3 cases received pneumonectomy, and all cases received wall reconstruction. The size of chest wall defect after resection ranged from 6.5 cm × 5.4 cm × 5.0 cm to 15.5 cm × 12.5 cm ×10.0 cm. The number of rib resection for each patient ranged from 1 to 4. The reconstructive methods were as follows: using polyester fabric to reconstruct costal pleura, using plexiglass, stainless steel wire and grid-like titanium plate to reconstruct bone defect, and using nearby muscle flap and pedunculated muscle flap to reconstruct muscle defect. Results Pathologic diagnosis was non-small cell lung cancer,including 22 cases of squamous cell carcinomas and 5 adenocarcinomas. There were pulmonary infections in 6 cases, chest hemorrhage in 1 case and chest purulence in 1 case. One-year survival was 77. 9 %,3-yearsurvival was 58.3 %, and 5-year survival was 29. 1 %. Conclusion The lung cancer with chest wall invasion is advisable to make active use of radical surgery. The different methods and repair materials are chosen to reconstruct the chest wall defect, supplemented by comprehensive treatments.

A multicenter, randomized, double-blind, placebo-controlled safety study to evaluate the clinical effects and quality of life of paclitaxel-carboplatin (PC) alone or combined with endostar for advanced non-small cell lung cancer (NSCLC) / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the efficacy and quality of life and safety for paclitaxel and carboplatin (TC) and TC combined with endostar in the treatment of advanced non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>This is a prospective, multicenter, randomized, double-blind, placebo-controlled clinical study. A total of 126 cases of untreated advanced NSCLC were enrolled in this study. There were 63 patients in the TC control arm and TC combined endostar arm, respectively. All enrolled patients were continuously followed-up for disease progression and death.</p><p><b>RESULTS</b>The objective response rate (ORR) of TC combined with endostar arm was 39.3%, and that of TC control arm was 23.0%, P = 0.078. The progression-free survival rates for TC combined with endostar arm and TC control arm were 78.3% and 58.8%, respectively, in 24 weeks (P = 0.017). The hazard ratio for the risk of disease progression was 0.35 (95%CI 0.13 to 0.90, P = 0.030). The median time to progression (TTP) of the TC combined with endostar arm was 7.1 months and TC arm 6.3 months (P > 0.05). The follow-up results showed that the median survival time (mOS) of the TC + Endostar arm was 17.6 months; (95%CI 13.4 to 21.7 months), and the TC + placebo arm 15.8 months (95%CI 9.4 to 22.9 months) (P > 0.05). The quality of life scores (LCSS patient scale) after treatment of the TC combined with endostar arm was improved, and that of the TC group was improved after completion of two cycles and three cycles of treatment. The quality of life scores compared with baseline after the completion of one cycle treatment was significantly improved for both the TC combined with endostar arm (P = 0.028 and), and TC arm (P = 0.036). It Indicated that TC combined with endostar treatment improved the patient's quality of life in the early treatment. The difference of adverse and serious adverse event rates between the two groups was not significant (P > 0.05).</p><p><b>CONCLUSIONS</b>Compared with TC alone treatmrnt, TC combined with endostar treatment can reduce the risk of disease progression at early time (24 weeks), increase the ORR, and can be used as first-line treatment for advanced NSCLC. The TC combined with endostar treatment has good safety and tolerability, improves the quality of life, and not increases serious adverse effects and toxicity for patients with advanced NSCLC.</p>

Auto-dendritic cell vaccines pulsed with PSA, PSMA and PAP peptides for hormone-refractory prostate cancer / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinical safety and effects of auto-dendritic cells pulsed with HLA-A201-binding peptides prostate-specific antigen (PSA) , prostate-specific membrane antigen (PSMA) and prostatic acid phosphatase (PAP) in the treatment of hormone-refractory metastatic prostate cancer (HRPC).</p><p><b>METHODS</b>Sixteen HRPC patients with positive HLA-A201 were enrolled and their monocytes isolated and induced into dendritic cells with the combination of rhGM-CSF and rhIL4. The patients were inoculated subcutaneously near the inguinal region with auto-DCs pulsed with peptides PSA (KLQCVDLHV) , PSMA (ALDVYNGL L) and PAP (LLHETDSAV) every 2 weeks for 4 times, and the immunological and clinical responses were examined within 1 -2 weeks after the final vaccination.</p><p><b>RESULTS</b>Vaccination of dendritic cells was well tolerated and no toxicity was observed. The cytokine levels in the serum such as IL-2, IL-12 and IFN-gamma were significantly increased after the vaccination (P < 0.01). The delayed type hyper- sensitivity (DTH) test was positive in 4 of the patients (4/11), the percentage of antigen-special IFN-gamma+ CD8+ T increased in 5 (5/11), the level of the tumor marker PSA decreased in 6 (6/16) , hydrops abdominis reduced in 1 (1/16), and the size of the cervical lymph node lessened in 1 (1/16). Three patients showed partial remission (PR), 7 stability of the disease (SD), and the other 6 progression of the disease (PD).</p><p><b>CONCLUSION</b>Auto-DC vaccines loaded with PSA, PSMA and PAP peptides, capable of eliciting specific immune responses in HRPC patients, is a safe and effective option for the treatment of advanced HRPC.</p>

Effect of local testicular heating on spermatogenic cell apoptosis in rat / 中华男科学杂志

<p><b>OBJECTIVES</b>To study the effect of testicular local heating on spermatogenic cell apoptosis in rat.</p><p><b>METHODS</b>Seventy male SD rats were divided into heat treatment group (43 degrees C) and control group (22 degrees C). Each group was further divided into seven sub-groups respectively according to the time of 12 hours and 1 days, 3 days, 6 days, 10 days, 50 days and 80 days after testicular local treatment. The spermatogenic cell apoptosis in all sub-groups was examined by means of electron microscopy, flow cytometry and terminal deoxynucleotidyl transferase-mediated dUDP-nick end labeling(TUNEL) method.</p><p><b>RESULTS</b>In the groups of heat treatment, spermatogenic cell apoptosis was detected by electron microscopy; flow cytometry showed that the percentage of cells with sub-haploid increased(P < 0.01); the percentage of positive TUNEL cells in the heat treatment groups was higher than that in the control group(P < 0.01). Initiation of spermatogenic cell apoptosis after testicular heating was not random but was highly selective.</p><p><b>CONCLUSIONS</b>Local testicular heating could increase the spermatogenic cell apoptosis. The most sensitive cell is spermatocyte. Spermatid and sperm also display apparent changes. Heating can increase the apoptosis of spermatogonia in a long period.</p>

Clinical value of video-mediastinoscopy in the diagnosis and treatment of intrathoracic diseases / 中国癌症杂志

Purpose:Discuss the clinicat value of video-mediastinoscopy in the diagnosis and treatment of intrathoracic diseases. Methods:From Oct.2002 to Jun.2003, 58 cases were examined and treated by video-mediastinoscopy. Of these patients,48 case were examined(the examination group) and 10 cases were treated(the treatment group). In the examination group, standard mediastinoscopy was applied in 40 cases, extended mediastinoscopy was applied in 8 cases. In the treatment group,9 cases of palmar hyperhidrosis were treated by thoracic sympathectomy,1 case of pericardial liparomphalus was resected. Results:In the examination group, 47 cases obtained definite pathological diagnoses, and 5 cases had complications. In the treatment group,no complications occurred. Conclusions:Video-mediastinoscopy is a valuable procedure to clarify diagnosis and to stage lung cancer, or in the diagnosis of mediastinal mass. It can also be used in the treatment of palmar hyperhidrosis, pericardial liparomphalus and pericardial cyst.