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BACKGROUND@#Lung cancer is still the malignant tumor with the highest morbidity and mortality in China. Lung adenocarcinoma is the most common subtype, and the number of lung cancer presenting as mixed ground glass nodule (mGGN) in imaging is gradually increasing. Visceral pleural invasion (VPI) is an important factor affecting the prognosis of mGGN type lung adenocarcinoma. The aim of the study is to explore and analyze the risk factors for VPI in mGGN type lung adenocarcinoma.@*METHODS@#From November 2016 to November 2019, 128 patients with mGGN lung adenocarcinoma underwent radical surgical resection in the First Affiliated Hospital of Nanjing Medical University. Their clinical data, including imaging, pathological and biological features, were collected and analyzed retrospectively. There were 40 males and 88 females, aged 60.3±9.3 years ranging from 30 to 81 years. Single factor Chi-square test and multivariate Logistic regression were used to analyze the risk factors of VPI in mGGN type lung adenocarcinoma.@*RESULTS@#Among 128 mGGN patients who met the inclusion criteria, 57 cases were pathologically confirmed with pleural invasion. Between the VPI (+) and VPI (-) group (P<0.05), there were significant differences in gender, maximum diameter of solid component, consolidation tumor ratio (CTR), spicule sign, history of lung disease, family history of hypertension, relation of lesion to pleura (RLP), coursing relationship between bronchi and nodules. In multivariate Logistic regression analysis, RLP (OR=3.529, 95%CI: 1.430-8.713, P=0.006) and coursing relationship between bronchi and nodules (OR=3.993, 95%CI: 1.517-10.51, P=0.005) were found to be independent risk factors for VPI (P<0.05).@*CONCLUSIONS@#The possibility of VPI in m GGN lung adenocarcinoma should be evaluated by combining these parameters in clinical diagnosis and treatment. As independent risk factors, RLP and coursing relationship between bronchi and nodules are instructive to identify VPI in mGGN type lung adenocarcinoma.
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Female , Humans , Male , Adenocarcinoma of Lung/pathology , Lung Neoplasms/surgery , Neoplasm Invasiveness , Pleura/pathology , Retrospective Studies , Risk FactorsABSTRACT
Objective To explore the curative effects of unilateral Orthofix external fixation in the treatment of tibial defects.Methods From June 2012 to February 2016,we treated 19 patients with tibial defects using unilateral Orthofix external fixation.They were 14 men and 5 women,aged from 26 to 79 years (mean,43.0 years).The right tibia was involved in 12 cases and the left tibia in 7.The soft tissue defects averaged 6.4 cm × 3.7 cm.The mean bone defect before bone transport was 8.9 cm in length.The anteroposterior and lateral X-ray films of the affected tibia were taken regularly after surgery.Edwards tibial fracture scores were used to evaluate the functional recovery and complications of the affected limb at final follow-ups.Results All the patients were followed up for 10 to 40 months (average,18.5 months).Bone union time ranged from 4 to 16 months (average,9.0 months).Lengths of bone transport ranged from 6 to 10 cm (average,7.8 cm).All the bone defects were reconstructed.According to the Edwards scoring at the final follow-ups,10 cases were rated as excellent,6 as good and 3 as poor.Complications were observed in 4 cases,giving a complication rate of 21.1％.Conclusion Unilateral Orthofix external fixation and bone transport can lead to preferable curative effects in the management of tibial defects.
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ObjectiveTo observe the shape, size, position and vessels of greater omentum. To explore the design of greater omentum and clarify its clinical significance. MethodsThree fresh and 12 formalin-fixed cadaveres were dissected. All of them had no damage nor injury. 1. Macro-micro-dissection: The shape, size and position of greater omentum were observed. The vessels of the greater omentum were studied.2.Lead oxide-gelatin injection technique and three-dimensional reconstruction.Results The length of greater omentum was(24.7±6.9)cm,the width was(28.3+2.8)cm. It could be divided into 3 types: thin type,middle type and thick type, the occurrence rate was 33.3％, 46.7％ and 20.0％ respectively. The blood supply of greater omentum mainly came from the gastroepiploic arch composed of the left gastroepiploic artery and the right gastroepiploic artery.There were 4 main arteries of the greater omentum: ①The right epiploic artery: The external diameter at origination was (1.0±0.4)mm. ② The middle epiploic artery: The external diameter at origination was(0.7 + 0.3)mm. ③The left epiploic artery:The external diameter at origination was (1.2±0.4)mm.④ The accessary epiploic artery:The external diameter at origination was (0.5 ± 0.1)mm.ConclusionAccording to the characteristic of the anterior arch and posterior arch,the position of the middle epiploic artery divarication and the method of spread,the greater omentum is divided into 5 types.It should be according to the characteristic, when the greater omentum is designed and clipped.
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Objective To report the clinical result of island flaps of hand in reparing of hand skin defects Methods According to location of skin defect, thirty eight cases with skin defect in hand were repaired by different types of island flap on hand Results The repair effect was satisfactory, almost all flaps were transplanted successfully, except two flaps The postoperative follow up period was 6 to 18 months, the blood supply, elasticity and texture of flaps were fine Conclusion Transfering of different types of island flap of hand is an easy, safe and reliable method with fewer complication
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Objective For analyzing the outcome of toe transplantation Methods From 1992 to 2001, 24 cases of defect of fingers were treated with toe transplantation, including second toe transplantation for thumb in 19 cases, for index finger in 1 case, and for middle finger 2 cases, as well as second toe and third toe transplantation for middle and ring fingers in 2 cases Results The transplantated toe survived in 23 cases The reconstituted fingers and thumbs showed good shape and excellent function Conclusion Careful examination, reasonable design of reconstrction plan, and fine manipulation to protect blood vessels from trauma induced by operation play a key role in the toe transplantation, especially in the presence of abnormal blood vessels