Recent research on extracorporeal carbon dioxide removal / 中国当代儿科杂志

Extracorporeal carbon dioxide removal is an artificial lung auxiliary technique based on extrapulmonary gas exchange and can effectively remove carbon dioxide and provide oxygenation to a certain extent, and it is one of the effective treatment techniques for hypercapnia developed after mechanical ventilation and extracorporeal membrane oxygenation in recent years and has wide application prospect. This article elaborates on the development, working principle, advantages, classification, complications, and clinical application of extracorporeal carbon dioxide removal, so as to provide a new choice for extracorporeal carbon dioxide removal in clinical practice.

Cesarean section does not affect neonatal outcomes of pregnancies complicated with preterm premature rupture of membranes / 中华医学杂志(英文版)

BACKGROUND@#Preterm premature rupture of membranes (PPROM) is associated with high neonatal morbidity and mortality. However, the influences of cesarean section (CS) on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated. The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM.@*METHODS@#A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st, 2011 to December 31st, 2011. A total of 2756 singleton pregnancies complicated with PPROM were included. Adverse neonatal outcomes including early neonatal death, birth asphyxia, respiratory distress syndrome (RDS), pneumonia, infection, birth trauma, and 5-min/10-min Apgar scores were obtained from the hospital records. Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression. Numerical variables were compared by multiple linear regressions.@*RESULTS@#In total, 2756 newborns were involved in the analysis. Among them, 1166 newborns (42.31%) were delivered by CS and 1590 newborns belonged to vaginal delivery (VD) group. The CS proportion of PPROM obviously increased with the increase of gestational age (χ = 5.014, P = 0.025). Compared with CS group, VD was associated with a higher risk of total newborns mortality (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.102-5.118; P = 0.027), and a lower level of pneumonia (OR, 0.32; 95% CI, 0.126-0.811; P = 0.016). However, after multivariable adjustment and stratification for gestational age, only pneumonia was significantly related with CS in 28 to 34 weeks group (OR, 0.34; 95% CI, 0.120-0.940; P = 0.038). There were no differences regarding to other adverse outcomes in the two groups, including neonatal mortality, birth asphyxia, Apgar scores, RDS, pneumonia, and sepsis.@*CONCLUSIONS@#The proportion of CS of pregnant women with PPROM was very high in China. The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.

Familial Nonmedullary Thyroid Carcinoma: A Retrospective Analysis of 117 Families / 中华医学杂志(英文版)

<p><b>Background</b>The first and most important step in characterizing familial nonmedullary thyroid carcinoma (NMTC) is to distinguish the true familial patients, which is the prerequisite for all accurate analyses. This study aimed to investigate whether patients from families with ≥3 first-degree relatives affected with NMTC have different characteristics than patients from families with only two affected members, and to compare these patients with those with sporadic disease.</p><p><b>Methods:</b>We analyzed the clinicopathological features and prognosis of 209 familial and 1120 sporadic cases of NMTC. Familial patients were further divided into two subgroups: families with two affected members and families with ≥3 affected members.</p><p><b>Results:</b>The familial group had a significantly higher risk of bilateral growth, multifocality, extrathyroidal extension, and lateral lymph node metastasis than the sporadic group (P < 0.05). These main features were also different between the group with ≥3 affected members and the sporadic group. The only difference between the two affected members' group and the sporadic group was incidence of multifocality (P < 0.05). The probability of disease recurrence in patients from families with ≥3 affected members was significantly higher than that in sporadic cases (14.46% vs. 5.27%; P = 0.001), while the probability in patients from families with two affected members was similar to that in sporadic patients (6.35% vs. 5.27%; P = 0.610). The Kaplan-Meier survival analysis showed a statistically significant difference in disease-free survival between the two subgroups (85.54% vs. 93.65%; P = 0.045).</p><p><b>Conclusions:</b>Patients from families with ≥3 members affected by NMTC have more aggressive features and a worse prognosis than those from families with only two affected members. Patients from families with ≥3 affected first-degree relatives may be considered to have true familial NMTC.</p>

Is surgical treatment of cancer of the gastric cardia or esophagus associated with a concurrent major pulmonary operation feasible? One center's experience / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pulmonary complications are a major cause of mortality after operation for cancer of the gastric cardia or esophagus. Although the risk involved in gastric cardiectomy or esophagectomy associated with a concurrent major pulmonary operation is expected to be much higher, it has seldom been evaluated on the basis of clinical experience. The aim of this study was to investigate the possibility and feasibility of the gastric cardiectomy or esophagectomy associated with a major pulmonary operation.</p><p><b>METHODS</b>From August 2003 to January 2011, 14 patients underwent concurrent gastric cardiectomy or esophagectomy and a major pulmonary operation in our hospital. This included eight for pulmonary invasion of esophageal carcinoma, and six for synchronous lung tumor. All patients underwent systematic lymph node dissection for cardiac or esophageal cancer. To prevent postoperative complications, the operative approach and dissection procedures for cardiac or esophageal carcinoma were modified according to the associated pulmonary operation and the extent of cancer invasion. All thoracotomies for cardiectomy or esophagectomy were performed on the same side as the major pulmonary operation.</p><p><b>RESULTS</b>All patients underwent a curative operation. There were no deaths or postoperative complications in the six synchronous lung tumor patients. In the eight pulmonary invasion patients, one patient died of respiratory failure 11 days after operation, and postoperative complications developed in four of them, but none was fatal. Six patients were still alive.</p><p><b>CONCLUSIONS</b>Curative gastric cardiectomy or esophagectomy associated with concurrent major pulmonary operation is not contraindicated in patients in good condition. In selected patients, when the operative procedures for cardiectomy or esophagectomy are appropriately modified to minimize the effect of the associated pulmonary operation, the treatment is associated with a low operative morbidity and mortality with an acceptable long-term survival.</p>

Clinical features and surgical treatment of thoracic Castleman's disease / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical features and surgical treatment of thoracic Castleman's disease.</p><p><b>METHODS</b>The clinical symptoms, pathological, laboratory, CT findings and results of surgery in 32 patients with Castleman's disease from June 1996 to November 2008 were evaluated. Among the 32 patients, there were 14 male and 18 female, aged from 16 to 48 years old with a mean age of 34.2 years old. Thirteen cases had symptoms including short of breath, irritable cough, or chest pain, while 14 cases had no symptoms. Mediastinal or hilar tumors were found by CT examination.</p><p><b>RESULTS</b>Tumor was surgically removed in all the 32 patients except one died with anesthetic accident. Castleman's disease was conformed by pathology. Five cases were diagnosed as with paraneoplastic pemphigus, 3 of them were attacked by bronchiolitis obliterans. All 5 cases were failed by the use of prednisone. The signs of PNP were dissolved after operation, but pulmonary lesions failed to improve. There was no recurrence in all cases.</p><p><b>CONCLUSIONS</b>PNP and lung abnormalities are the rare and severe complications of thoracic Castleman's disease. Surgical resection of the tumor is the first choice for treatment.</p>

Surgical treatment of IIIb-T4 lung cancer invading left atrium and great vessels / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>IIIb-T(4) non-small cell lung cancer (NSCLC) is commonly considered a contraindication to surgery, although chemo-radiotherapy also achieves a poor survival rate. We reviewed our experience with T(4) NSCLC patients who underwent surgery to explore the indications and prognostic factors of surgical treatment of lung cancer invading the left atrium and great vessels.</p><p><b>METHODS</b>We investigated a cohort of 105 patients, 79 men and 26 women, who underwent surgery from May 1996 to July 2008. Their pathological staging was T(4)N(0)-(2)M(0). The median age was 59 years, ranging from 36 to 75 years. Patients were grouped based on invading sites: tumors invading the left atrium (LA group), tumors invading the superior vena cava (SVC group), and tumors invading the intrapericardial pulmonary artery (PA group). Patients were further characterized based upon the type of operation, complete resection and incomplete resection groups, and on the lymph node pathological status, N(0), N(1) and N(2) groups. We calculated the overall five-year survival rate.</p><p><b>RESULTS</b>All patients received resection of primary lesions, with partial resection of the left atrium in the LA group (n = 25), angioplasty of superior vena cava in the SVC group (n = 23) and intrapericardial ligation of the pulmonary artery in the PA group (n = 57). Complete resection was possible in 77 patients (73.3%). The overall survival rate of the 105 patients was 41.0% at 5 years; 36.0% for the LA group, 34.8% for the SVC group and 45.6% for the PA group. Pathological N status significantly influenced the overall 5-year survival rate; 61.5% for N(0), 51.1% for the N(1) and 11.8% for the N(2) groups (N(2) group versus N(0) group, P < 0.0001, N(2) versus N(1) group, P < 0.0001). Surgical resection also influenced survival; 49.4% for the complete resection group and 17.9% for the incomplete resection group (P < 0.0001). Cox regression analysis demonstrated that pathological N status was a significant independent predictor of prognosis.</p><p><b>CONCLUSIONS</b>Pathological N status is a significant independent predictor for survival of patients with IIIb-T(4) lung cancer invading the left atrium and great vessels. The completeness of resection has a significant influence on the overall 5-year survival rate. Surgery for T(4) lung cancer may be effective in patients without mediastinal lymph node involvement.</p>

Comparison of two surgical approach for cardiac cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the preferable surgical approach for cardiac cancer.</p><p><b>METHODS</b>One hundred and sixty patients with cardiac cancer underwent operation in two surgical approaches (epigastrium and left chest). Analysis was conducted on lymph nodes resected, stump positive rate, radical resectability rate, perioperative mortality, surgical complication rate, postoperative hospital days, survival rate between the two groups.</p><p><b>RESULTS</b>In the epigastrium group and the left chest group the average number of resected lymph nodes was 15.7 and 10.6, respectively, the upper stump positive rate was 5.0% and 1.2%, and there was significant difference between the two groups (P < 0.05). The lower stump positive rate, perioperative mortality, radical resectability rate, surgical complication rate, postoperative hospital days, survival rate of the two groups were 1.2%, 0.0%, 81.2%, 10.0%, 10 d, 53.7% and 1.2%, 1.2%, 83.7%, 11.2%, 12 d, 56.2%, respectively, and there was no significant difference between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>There was no difference on the radical respectability rate and 5-year survival rate between the two groups. Thus the surgical approaches for cardiac cancer should based on the location and extent of lesions and the state of patients.</p>