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@#Chest wall surgery used to be a subspecialty of traditional thoracic surgery, which has an ancient history of research and clinical practice. It has gradually become an independent professional field in recent years. With the change of concept and the progress of interdisciplines, we have deepened our understanding of related diseases, and the treatment of chest wall surgical diseases has also acquired new characteristics. This article reviews the progress in the treatment of chest wall surgical diseases including chest wall trauma, chest wall deformity, chest wall tumor, chest wall infection and chest wall defect from the perspective of chest wall surgery.
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After more than 40 years of development, the techniques of liver transplanta-tion have gradually matured, which make liver transplantation become the effective means for the treatment of patients with end stage liver disease. Preoperative evaluation of donors and recipients, intraoperative management, monitoring and treatment of complications such as postoperative immune rejection and infection are all important contents of perioperative management of liver transplantation. With the development and mature of surgical techniques and the expansion of the scope of indications, perioperative management and complications prevention and treatment of liver transplantation need to be explored and optimized. The authors analyze the latest literature reports at home and abroad, investigate the perioperative management and complications prevention and treatment of recipients in liver transplantation combined with clinical practice.
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Objective: To optimize the extraction conditions of semi-bionic extraction for Gardenia jasminoides Ellis. Methods:The best extraction conditions of the semi-bionic extraction for Gardenia jasminoides Ellis was screened by uniform design with yield of geniposide, total iridoid glycosides and dry extract as the indices. Results:The optimal conditions were as follows:the pH value of wa-ter for the lst, 2nd and 3rd decoction was 2. 0, 6. 5 and 9. 0, respectively, and the extraction time was 2. 0, 1. 0 and 1. 0h according-ly. Conclusion:The optimized extraction conditions by uniform design is scientific and reasonable.
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Objective To investigate whether Ivor-Lewis esophagectomy combined with adjuvant radiotherapy prevents lymphatic metastatic recurrence in esophageal cancer patients.Methods 113 Stage Ⅱ A esophageal squamous cell carcinoma patients after Ivor-Lewis esophagectomy were accpected mRNA expression of Mucin1 gene detection.Positive patients were enrolled into adjuvant radiotherapy group(with postoperative adjuvant radiotherapy).Negative patients were enrolled into control group (without postoperative adjuvant radiotherapy or chemotherapy).The radiotherapy area consisted of the neck,supraclavicular region and the superior mediastinum(including praesophageal and pratracheal region).Survival difference was compared by x2 test,the Kaplan-Meier method was performed to calculate the survival rate and recurrence rate.Logistic regressive analysis was performed to determined independent risk factors.Results The radiotherapy area lymphatic metastatic recurrence rate in adjuvant radiotherapy group(16.7％,5/30) was lower than patients without postoperative adjuvant radiotherapy (45.8％,38/83) (P ＜ 0.05).Only compared to positive patients without postoperative adjuvant radiotherapy(60.0％,6/10),the rate (16.7％,5/30) was significantly lower(P ＜ 0.01).Cancer recurrence was recognized in 48.6％ (55/113) patients within 3 year after operation,including 38.1％ (43/113) patients with radiotherapy area recurrence.In logistic analysis the T status (P＜ 0.01) and adjuvant radiotherapy (P ＜ 0.05) were independent risk factors of lymph node metastasis in the first 3 years after operation.Conclusion In Mucin1 mRNA-positive esophageal squamous cell carcinoma patients,adjuvant radiotherapy could significantly reduce the lymph node metastasis rate in the radiotherapy area after Ivor-Lewis esophagectomy.Compared with traditional therapeutic methods,Ivor-Lewis esophagectomy combined with adjuvant radiotherapy can achieve similar curative effects in Mucin1 mRNA-positive patients.
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Objective:To optimize the conditions of semi-bionic extraction for Jinyin Qingre oral liquids. Methods:The best con-ditions of the semi-bionic extraction for Jinyin Qingre oral liquids was optimized by uniform design with the yield of chlorogenic acid, geniposide and total phenolic acid, and the dried extract weight as the indices in a comprehensive evaluation. Results:The optimal pH of water for the three-time decoction was 2. 89, 6. 50 and 8. 43, respectively, and the total extraction time was 2. 0 h. Conclusion:Combined with the actual production, the pH value of water is 3. 0, 6. 5 and 8. 5 with the decoction time of 1. 0, 0. 5 and 0. 5h, re-spectively.
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Objective To investigate the expression of chemokine receptor CCR7 and its correlation with lymph node metastasis and prognosis in esophageal cancer after esophagectomy. Methods One hundred and eighty-four patients with middle third squamous cell carcinoma of the esophagus were enrolled in this study. All patients underwent operation in Provincial Hospital Affiliated to Shandong University between June, 2003 and June, 2005. The expression of CCR7 was detected by immunohistochemistry. All statistic analyses were performed with SPSS 13.0 statistical software. According to the clinico-patho-logic factors, the difference of CCR7 expression was compared by x2 test. Kaplan-meier method was performed to calculate the survival rate, Cox regression multivariate analysis was performed to determine independent prognostic factors. Results The expression rate of CCR7 in stage Ⅰ , stage Ⅱ and stage Ⅲ patients was 25.0 % , 70.3% and 85.5% , respectively. The difference of CCR7 expression between stage Ⅱ and stageⅢ was statistically significant (x2 =5.0, P =0.02). The CCR7 expression rate in T1, T2 and T3 patients was 33.3% , 64.9% and 80.9% , respectively. The difference of CCR7 expression between T2and T3 was statistically significant (x2 =5.4, P =0.01). The level of expression of CCR7 in patients with lymph node metastasis was significantly higher than those without metastasis (x2 =10.8, P = 0.00). The 5-year survival rate instage Ⅰ , stage Ⅱand stage Ⅲ patients was 100.0% , 38. 3% and 22.4% , respectively. The 5-year survival rate in patients with CCR7 overexpression was significantly lower than those without CCR7 overexpression (x2 = 23.7, P = 0.00). The 5-year survival rate in T2, T3, NO and N1 patients with CCR7 overexpression was significantly lower than those without CCR7 overexpression The result of Cox analysis demonstrated that T , N and CCR7 overexpression were independent prognostic factors. Conclusion CCR7 expression was detected in esophageal squamous cell carcinoma and was found to be significantly associated with T stage,N stage and lymph node metastasis. The patients with CCR7 expression was significantly lower the 5-year survival rate than without CCR7 expression. T stage, lymph node metastasis and CCR7 expression were independent prognostic factors.
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Objective To investigate the risk factors with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy. Methods The subjects were 82 patients with pN0 esophageal cancer who underwent Ivor-Lewis esophagectomy from January 2001 to January 2005. By using RT-PCR, VEGF-C mRNA was detected in tumor issues, and Mucin l( MUC1 )mRNA was detected in lymph nodes. The Kaplan-Meier method was used to calculate the survival rate and lymph nodal metastatic rate. Log-rank test was performed to compare the recurrence rate, and Cox regression multivariate analysis was performed to determine independent prognostic factors. Results VEGF-C mRNA was identified in 42 patients (51.22%), and MUC1 mRNA was identified in 23 patients(28.05% )from at least 1 lymph node station . The diagnosis of lymph node micrometastasis (LNMM) was based on the detection of MUC1 mRNA. The first recurrence exhibiting lymph node metastasis was recognized in 37 patients (45.1%) at the first 3 years after operation and this was significantly associated with T status ( P ＜ 0. 05 ). Lymph node metastatic rate for patients with VEGF-C mRNA expression in tumor issues was significantly higher than that for patients without VEGF-C mRNA expression( P ＜0. 01 ). And lymph node metastatic rate for patients with LNMM was significantly higher than that for patients without LNMM ( P ＜0. 01 ). The results of multivariate analysis confirmed that T status, VEGF-C mRNA expression in tumor issues and LNMM were independent relevant factors. Conclusion Status,VEGF-C mRNA expression in tumor issues and LNMM in patients with N0 esophageal cancer were independent risk factors for 3-year lymph node metastatic recurrence after Ivor-Lewis Esophagectomy.
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Objective: To explore the effect of radiotherapy on preventing the recurrence of lymph node metastasis of esophageal cancer after Ivor-Lewis esophagectomy. Methods: Three hundred and sixty-six pa-tients with middle third squamous cell carcinoma of the esophagus were enrolled in this study. All patients un-derwent Ivor-Lewis esophagectomy with two-field lymph node dissection in our hospital between June 1999 and June 2004. All statistical analyses were performed with SPSS 13.0 statistical software. Kaplan-Meier method was performed to calculate the relapse rate. Log-rank test was performed to compare the relapse rate. Cox regression analysis was performed to identify independent prognostic factors for postoperative lymph node metastasis. Results: Of the 366 cases, lymph node metastasis was found in 105 patients (28.5%)within 3 years after surgery, occupying 52.2% (105/201) of total recurrence. Of the 181 patients treated with postoperative radiotherapy, lymph node metastasis was found in 37 patients. The rate of lymph node metasta-sis was 20.4%, significantly lower than that in patients treated with chemotherapy alone and those without sys-temic adjuvant therapy (P<0.05). Chemotherapy was administered in 103 cases and lymph node metastasis was found in 33 patients. The rate of lymph node metastasis was 32.0%, lower than that in patients without systemic adjuvant therapy, but without statistical significance (P=0.17). The results of Cox analysis demon-strated that T stage, lymph node metastasis and postoperative adjuvant radiotherapy were independent prog-nostic factors. Conclusion: Ivor-Lewis esophagectomy for the middle third thoracic esophageal cancer was a safe surgical procedure. Postoperative radiotherapy is helpful for the control of local recurrence. T stage,lymph node metastasis and postoperative adjuvant radiotherapy are independent prognostic factors. Radio-therapy is helpful for preventing the recurrence of lymph node metastasis of esophageal cancer after Ivor-Lew-is esophagectomy.
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Objective To investigate the expression of MTA1 protein and its relationship to the prognosis in esophageal cancer after esophagectomy. Methods One hundred and sixty-five patients with middle third squamous cell carcinoma of the esophagus were enrolled in this study. All patients underwent operation in Provincial Hospital Affiliated to Shandong University between January 2002 and January 2004. The expression of MTA1 protein was detected by immunohistochemistry. All statistic analyses were performed with SPSS 10.0 statistical software. According to the clinicopathologic factors, the difference of MTA1 protein expression was compared by x2 test. Kaplan-meier method was performed to calculate the survival rate, Cox regression multivariate analysis was performed to determine independent prognostic factors. Results The 5-year survival rate in Ⅰ stage,Ⅱ stage and Ⅲstage was separately 100.0% 、38.3% and 22.4%, and the MTA1 protein expression rate in Ⅰ stage, Ⅱ stage and Ⅲ stage was separately 25.0% 、30.9% and 57.9%, the difference of MTA1 protein expression between Ⅱ stage and Ⅲ stage was statistically significant ( x2 = 11.6, P = 0. 00). The MTA1 protein expression rate in T1 stage, T2 stage and T3 stage was separately 42.9% 、13.3% and 50%. MTA1 protein expression rate in T2 stage patients and T3 stage patients was separately 13.3% and 50%, the difference of MTA1 protein expression between them was statistically significant (x2 = 13.2, P =0.00). The positive expression of MTA1 protein in patients with lymph node metastasis was significantly higher than those without metastasis ( x2 = 8.2, P = 0.04). The 5-year survival rate in patients with MTA1 protein positive expression was significantly lower than those without MTA1 protein positive expression (P =0.00 ), and the 5-year survival rate in T3 stage patients with MTA1 protein positive expression was significantly lower than those without MTA1 protein positive expression ( P =0.01 ), and the 5-year survival rate in N0 stage patients with MTA1 protein positive expression was significantly lower than those without MTA1 protein positive expression (P = 0.03 ), and the 5-year survival rate in N1 stage patients with MTA1 protein positive expression was significantly lower than those without MTA1 protein positive expression ( P =0.04). However, the 5-year survival rate in T2 stage patients with MTA1 protein positive expression was not significantly lower than those without MTA1 protein positive expression (P =0.20). The result of Cox analysis demonstrated that N stage and MTA1 protein positive expression were independent prognostic factors. Conclusion MTA1 protein overexpression was detected in esophageal squamous cell carcinoma and was found to be significantly associated with T stage and lymph node metastasis. The patients with MTA1 protein overexpression was significantly lower the 5-year survival rate than without MTA1 protein expression. Lymph node metastasis and MTA1 protein overexpression were independent prognostic factors.
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Objective:To retrospectively evaluate the therapeutic efficacy of two different surgical approaches, Ivor-Lewis esophagectomy and 2-incision esophagectomy via left thoracic-cervical pathway, in the treatment of middle thoracic esophageal squamous cell carcinoma. Methods:One hundred and two patients from 167 patients with middle thoracic esophageal squamous cell carcinoma received Ivor-Lewis esophagectomy and another 65 patients received 2-incision esophagectomy via left thoracic-cervical pathway. The local recurrence rate of tumor and survival rate were calculated by using Kaplan-Meier method. The difference in the survival rate between the two surgical methods was analyzed by using log-rank test. The prognostic risk factors were assessed by COX regression analysis. Results:Peri-operative complications occurred in 35 patients (21.0%), in which the incidences of recurrent laryngeal nerve (RLN) injury and anastomotic leakage were higher in the left thoracic-cervical group (P0.05). The overall 5-year survival rate of the 167 patients was 34.6%. It was 36.0% in the Ivor-Lewis group and 32.3% in the left thoracic-cervical group, respectively (P>0.05). COX regression analysis revealed that pTNM staging was the independent prognostic factor [P=0.000, HR(hazard ratio)=2.69]. Conclusion:Both Ivor-Lewis esophagectomy and 2-incision esophagectomy via left thoracic-cervical pathway are feasible alternatives in the treatment of middle thoracic esophageal squmamous cell carcinoma. We should choose the rational operative method based on the patients'individual condition.
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Objective: To diagnose occult micrometastasis of mediastinal lymph node in patients with non small cell lung cancer (NSCLC) and to evaluate its prognostic significance. Methods: Using assays of reverse transcriptase polymerase chain reaction (RT PCR), two hundred and forty two stations of mediastinal lymph node, which were free from tumor determined by routine histopathological examination (pN 0), from fifty eight patients were studied to detect mRNA for MUC1 gene and diagnose nodal occult micrometastasis. Survival rate was calculated by method of Kaplan Meier and survival difference between patients with and without nodal occult micrometastasis was compared with Log Rank test; Logistic regression analysis was carried to determined independent predictive factors of prognosis. Results: The mRNA for MUC1 gene was identified in twenty three stations of lymph node from sixteen patients (27 6%), and nodal occult micrometastasis was diagnosed in those patients. TNM staging for those patients was up regulated from stage I A～II B to stage III A. The survival rate of 3 year in patients with nodal occult micrometastasis (43.7%) was lower than that in patients without nodal occult micrometastasis (73.8%) (P
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Purpose:To investigate the correlation between early postoperative metastasis with occult micrometastasis of mediastinal lymph nodes in patients with stageⅠa non small cell lung carcinoma (NSCLC).Methods:Using RT PCR assay, detection of the expression of MUC1 mRNA was used to diagnose occult micrometastasis in mediastinal lymph nodes. All the patients underwent checked up at least once a year to detect early metastatic lesions after surgery, by means of CT scan of chest and brain, ultrasound examination of liver and adrenal glands, and bone scanning. The patients with and without occult nodal micrometastasis were divided into two different groups. Difference in early metastatic rate between two groups of patients was compared by ? 2 test, and odds ratio (OR) was calculated.Results:Occult nodal micrometastasis was diagnosed in sixteen patients (32.0%). Early metastatic rate (31.25%) in the patients with occult nodal micrometastasis was higher than that (5.88%) in the patients without occult nodal micrometastasis ( P
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Purpose:To investigate genetically a diagnostic method of occult metastasis of lymph node in patients with squamous cell carcinoma of the esophagus.Methods:Using assays of reverse transcriptase polymerase chain reaction technique (RT PCR), MUC1 gene mRNA in thirty negative and thirty positive control lymph nodes was detected to evaluate diagnostic sensitivity and specificity. Eighty seven negative regional lymph nodes by conventional histologic examination (pN 0 ) from thirty patients with esophageal carcinoma were studied to detect MUC1 gene mRNA to diagnose lymph node occult metastasis.Results:MUC1 mRNA was not identified in any specimen of negative control group (specificity =100%); MUC1 mRNA was identified in twenty five of positive control specimen (sensitivity =83%). MUC1mRNA was identified in nine lymph nodes (10.3%) from eight patients with pN 0 esophageal carcinoma. Conclusions: Nodal occult metastasis could be diagnosed by the detection of expression of MUC1mRNA of lymph node in patients with pN 0 esophageal carcinoma.
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Objective To inverstigate the effect and safety of refractory intrahepatic and extrahepatic bile duct stones treated by choledochoscope holmium laser combined with electrohydraulic lithotripsy.Methods The cllnical data of 67 cases of postoperative intrahepatic and extrahepatic bile duct stones treated with combined endoscopic holmium laser and electrohydraulic lithotripsy were analysed retrospectively.Results After 1 to 7 times of biliary endoscopic holmium laser electrohydraulic lithotripsy treatment,65 patients had complete removal of all residual stones with the success rate of 97%,and without complications.Conclusions After holmium laser combined with electrohydraulic lithotripsy,the effect of choledochoscopic removal of intrahepatic and extrahepatic bile duct residual stones can be greatly improved It is a safe method for treatment of refractory intra-and extra-hepatic bile duct stones.
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AIM: To clarify the possible mechanism of decrease in coronary flow (CF) after long-term hypothermic storage of the isolated rat hearts. METHODS: The isolated rat hearts preserved in different solutions (SDMC-1,2 S., Stanford S., Collin's S.) at 0℃ for 8 hours were reperfused with 5-hydroxytryptamine (5-HT)(10 -4 mmol/L) and adenosine(Ade)(5 mmol/L) respectively, and the coronary flow(CF), coronary vascular resistance(CVR) and the weight of heart were measured before and after reperfusion. RESULTS: CF decreased while CVR increased in all groups after storage-reperfusion. When endothelium-dependent vasodilator (5-HT) was used, CF in SDMC-2 group was highly increased and CVR decreased. Whereas CF was significantly decreased and CVR increased in Collin's group( P