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Objective: To investigate the long-term efficacy and safety of left cardiac sympathetic denervation(LCSD) for long QT syndrome(LQTS) patients with either recurrence on drug therapy intolerance/refusal. Methods: This study was a retrospective cohort study. The cases selected from 193 patients with LQTS who were enrolled in the Chinese Channelopathy Registry Study from November 1999 to November 2012. This study selected 28 LQTS patients with either recurrence on drug therapy intolerance/refusal and underwent LCSD surgery in the Peking University People's Hospital or Beijing Tongren Hospital. The patients were allocated into 3 groups: high-risk group(n=13, baseline QTc ≥550 ms or symptomatic in the first year of life or highly malignant genetics); intermediate-risk group(n=10, 500 ms≤baseline QTc<550 ms, symptomatic after the first year and without highly malignant genetics); low-risk group(n=5, baseline QTc<500 ms, symptomatic after the first year and without highly malignant genetics). LCSD was performed with the traditional supraclavicular approach or video assisted thoracoscopic surgery (VATS). Patients were regularly followed up until 20 years after the surgery. Data were collected before and 1 year after surgery and at the last follow-up. Patients' electrocardiograph(ECG), cardiac events and surgery-related complications were recorded. Kaplan-Meier survival analysis was used to determine the cardiac event-free survival based on different risk stratification and genotypes. Results: A total of 28 LQTS patients, aged 20.5 (15.0, 37.5) and underwent LCSD surgery, were enrolled in this study, including 23(82.1%) women. There were 11(39.3%) patients treated with traditional approach while 17(60.7%) with VATS-LCSD. There were 19(67.9%) patients had positive genetic test results, including 4 LQT1, 12 LQT2, 1 LQT1/LQT2 mixed type, and 2 Jervell-Lange-Nielsen (JLN) syndrome. The median follow-up period was 189.3(138.7, 204.9) months. The dropout rate was 10.7%(3/28) while 3 patients in the intermediate-risk group were lost to follow-up. Horner syndrome occurred in 1 patient (in the high-risk group). Sudden cardiac deaths were observed in 3 (12.0%) patients (all in the high-risk group), and 12 patients (48.0%) had syncope recurrences (2 in low-risk group, 3 in intermediate-risk group and 7 in high-risk group). A significant reduction in the mean yearly episodes of cardiac events was observed, from (3.5±3.3) before LCSD to(0.2±0.1) at one year after LCSD and (0.5±0.8) at last follow up(P<0.001). The mean QTc was shortened from (545.7±51.2)ms before the surgery to (489.0±40.1)ms at the last follow-up (P<0.001). Among the 20 patients with basic QTc ≥500 ms and completing the follow-up, the QTc intervals of 11(55.0%) patients were shortened to below 500 ms. The event free survival rates for any cardiac events after LCSD decreased sequentially in the low-, intermediate- and high-risk groups, and the difference was statistically significant (χ²=7.24, log-rank P=0.026). No difference was found in the event free survival rates among LQT1, LQT2 and undefined gene patients (χ²=5.20, log-rank P>0.05). Conclusions: LCSD surgery can reduce the incidence of cardiac events and shorten the QTc interval in patients with LQTS after the long-term follow-up. LCSD surgery is effective and safe for patients with LQTS ineffective or intolerant to drug therapy. However, high-risk patients are still at a high risk of sudden death after surgery and should be actively monitored and protected by combined therapies.
Subject(s)
Female , Humans , Male , Electrocardiography , Heart , Long QT Syndrome , Retrospective Studies , Sympathectomy/methodsABSTRACT
Aptamers are kinds of short single-stranded deoxyribonucleic acid(ssDNA)or ribonucleic acid(RNA)selected in vitro using SELEX(systematic evolution of ligands by exponential enrichment). They can effectively bind various targets such as ami-no acids,carbohydrates,proteins,cells and viruses,with the advantages of simple operation,high sensitivity and low cost. This arti-cle outlines the basic principles,advantages and applications of aptamer technology. It also summarizes the features and hazards of ma-rine biotoxins,and introduces the application prospects of aptamer technology in the detection of marine biotoxins.
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Objective To investigate the effect of Xihuang Pill on the curative effect of paclitaxel combined with platinum based neoadjuvant chemotherapy in patients with advanced cervical cancer after operation.Methods 80 cases of patients with advanced cervical cancer treated in our hospitalfrom January 2014 to January 2017 were enrolled in the study.By random number table method,the patients were divided into the observation group and the control group with 40 cases in each group,and all patients were treated with radical hysterectomy.After operation,the control group were treated with paclitaxel and platinum (cisplatin) based neoadjuvant chemotherapy,while the observation group were treated with Xihuang Pill and platinum based neoadjuvant chemotherapy.The effective rate of chemotherapy,survival rate and recurrence rate were compared between the two groups.The levels ofT lymphocyte subsets (CD3+,CD4+,CD8+) and immunoglobulin (IgA,IgG,IgM) in two groups were determined before and after chemotherapy.The quality of life and cancer pain degree were evaluated with the Kamofsky Performance Scale (KPS) and the numeric rating scale (NRS),and adverse reactions were recorded.Results The effective rate of chemotherapy was slightly higher in the observation group than the control group (87.50％ vs 77.50％).Three months and six months after chemotherapy,the survival rate and recurrence rate showed no significant difference between the two groups.After chemotherapy,percentages of CD3+ and CD4+,levels of IgA,IgG and IgM were significantly higher in the observation group than the control group (P ＜ 0.05),and the percentage of CD8+ was lower than the control group (P ＜ 0.05).After treatment,KPS score of the observation group was significantly higher than the control group,and NRS score was significantly lower than the control group (P ＜ 0.05).The incidence of adverse reactions was significantly lower in the observation group than the control group (7.50％ vs 25.00％) (P ＜ 0.05).Conclusion Xihuang Pill combined with cisplatin based neoadjuvant chemotherapy is effective in the treatment of advanced cervical cancer after operation.The regimen can improve the immune function and quality of life,relieve pain degree and reduce adverse reactions.It will not increase the short-term survival rate and recurrence rate,and long-term efficacy needs further study.
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Objective To investigate the effect of Xihuang Pill on the curative effect of paclitaxel combined with platinum based neoadjuvant chemotherapy in patients with advanced cervical cancer after operation.Methods 80 cases of patients with advanced cervical cancer treated in our hospitalfrom January 2014 to January 2017 were enrolled in the study.By random number table method,the patients were divided into the observation group and the control group with 40 cases in each group,and all patients were treated with radical hysterectomy.After operation,the control group were treated with paclitaxel and platinum (cisplatin) based neoadjuvant chemotherapy,while the observation group were treated with Xihuang Pill and platinum based neoadjuvant chemotherapy.The effective rate of chemotherapy,survival rate and recurrence rate were compared between the two groups.The levels ofT lymphocyte subsets (CD3+,CD4+,CD8+) and immunoglobulin (IgA,IgG,IgM) in two groups were determined before and after chemotherapy.The quality of life and cancer pain degree were evaluated with the Kamofsky Performance Scale (KPS) and the numeric rating scale (NRS),and adverse reactions were recorded.Results The effective rate of chemotherapy was slightly higher in the observation group than the control group (87.50％ vs 77.50％).Three months and six months after chemotherapy,the survival rate and recurrence rate showed no significant difference between the two groups.After chemotherapy,percentages of CD3+ and CD4+,levels of IgA,IgG and IgM were significantly higher in the observation group than the control group (P ＜ 0.05),and the percentage of CD8+ was lower than the control group (P ＜ 0.05).After treatment,KPS score of the observation group was significantly higher than the control group,and NRS score was significantly lower than the control group (P ＜ 0.05).The incidence of adverse reactions was significantly lower in the observation group than the control group (7.50％ vs 25.00％) (P ＜ 0.05).Conclusion Xihuang Pill combined with cisplatin based neoadjuvant chemotherapy is effective in the treatment of advanced cervical cancer after operation.The regimen can improve the immune function and quality of life,relieve pain degree and reduce adverse reactions.It will not increase the short-term survival rate and recurrence rate,and long-term efficacy needs further study.
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<p><b>BACKGROUND AND OBJECTIVE</b>The sensitivity and accuracy of white light bronchoscopy (WLB) in airway examination are low. Autofluorescence bronchoscope (AFB) can determine early lesions in bronchial mucosa more sensitively, but it has seldom performed in China. To assess the clinical value of the AFB in airway examination, we compared the sensitivity and specificity of the AFB and WLB in detecting cancer of the airway mucosa.</p><p><b>METHODS</b>Between September 2009 and May 2010, bronchoscope examinations using both the AFB and WLB were performed on 136 patients, 95 men and 41 women with a median age of 61.5 years (ranged from 25 to 84 years). There were 46 lesions located in the central airway, 84 in the peripheral lung parenchyma, and 6 in the mediastinal region. All patients received local and general anesthesia and were subsequently examined with the WLB and AFB in tandem. All procedures were completed safely. Abnormal visual findings were recorded, and biopsies of the affected regions were collected for pathologic examination.</p><p><b>RESULTS</b>Of 241 regions sampled for biopsy, 76 sites contained malignant lesions, whereas 165 sites contained benign lesions. The AFB detected 72 of the 76 malignant lesions, but the WLB detected only 50. The sensitivities of the AFB and WLB were 94.7% and 65.8%, respectively, and the specificities were 57.0% and 83.6%, respectively. The negative predictive values of the AFB and WLB were 95.9% and 84.1%, respectively.</p><p><b>CONCLUSIONS</b>The AFB is more sensitive than the WLB in detecting cancerous lesions in the mucosa, and is an effective airway examination.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma , Diagnosis , Pathology , Biopsy , Bronchoscopy , Methods , Carcinoma, Squamous Cell , Diagnosis , Granuloma , Diagnosis , Inflammation , Diagnosis , Lung Diseases , Diagnosis , Lung Neoplasms , Diagnosis , Sensitivity and Specificity , Small Cell Lung Carcinoma , DiagnosisABSTRACT
<p><b>OBJECTIVE</b>To review the technology of completely thoracoscopic lobectomy procedures.</p><p><b>METHODS</b>From September 2006 to July 2007, 40 patients (23 male and 17 female) underwent completely thoracoscopic lobectomy. The median age was 59.5-years-old, with a range from 24 to 79-years-old. The lobectomy was completed through 3 incision in the 5th, 8th and 7th intercostal space. The procedures were similar with conventional open lobectomy.</p><p><b>RESULTS</b>All procedure were carried out safely, including lung cancer (n = 34), lymphoma(n = 1), pulmonary cyst (n = 1), middle lobe syndrome (n = 1) , bronchiectasis (n = 2) and renal carcinoma metastasis to lung (n = 1). There were no operative mortality or serious complications. There was one patient opposed to open thoracotomy because of the mediastinal lymph nodes metastasis. The average surgical duration was 206 min (range from 60 to 300 min). The average blood loss was 221 ml (range from 100 to 400 ml) with no blood transfusion required. The average length of stay was 8.9 d. No recurrence and metastasis was observed in a follow-up range from 1 to 10 months except one patient with adenocarcinoma occurred metastasis of tumor 3 months postoperation.</p><p><b>CONCLUSION</b>The completely thoracoscopic lobectomy is a safe and feasible surgical procedure compared with conventional open lobectomy for selected patients.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Follow-Up Studies , Lung Diseases , General Surgery , Pneumonectomy , Methods , Thoracoscopy , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To determine the current role of mediastinoscopy in the diagnosis and differential diagnosis of stage I thoracic sarcoidosis.</p><p><b>METHODS</b>The clinical data of 60 patients with a presumptive diagnosis of stage I thoracic sarcoidosis underwent mediastinoscopy from November 1999 to June 2007 were analyzed retrospectively. All the patients had hilum of lung and/or mediastinal lymphadenopathy with normal lung parenchyma on thoracic CT scan. Typical stage I sarcoidosis was defined as presence of bilateral hilum of lung lymphadenopathy with/without mediastinal lymphadenopathy.</p><p><b>RESULTS</b>All the patients had definitive pathologic diagnosis. Among the 33 patients with typical presentation of stage I sarcoidosis, 32 patients were confirmed by pathology. One patient was reactive lymph node. Among the 27 patients with atypical patterns on CT, 17 patients were confirmed by pathology. No postoperative complication and mortality occurred.</p><p><b>CONCLUSION</b>For the patient with a presumptive diagnosis of typical stage I thoracic sarcoidosis after clinical and radiological evaluation, confirmation of the diagnosis by mediastinoscopy and lymph node biopsy is unwarranted.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Diagnosis, Differential , Mediastinoscopy , Retrospective Studies , Sarcoidosis , DiagnosisABSTRACT
<p><b>BACKGROUND</b>Compensatory sweating (CS) is one of the most common postoperative complications after thoracic sympathectomy, sympathicotomy or endoscopic sympathetic block (ESB) for palmar hyperhidrosis. This study was conducted to examine the relevance between CS and the sympathetic segment being transected in the surgical treatment of palmar hyperhidrosis, and thus to detect the potential mechanism of the occurrence of CS.</p><p><b>METHODS</b>Between October 2004 and June 2006, 163 patients with primary hyperhidrosis were randomly divided into two groups, T(3) sympathicotomy (78 patients) and T(4) sympathicotomy (85), who were operated upon under general anesthesia via single lumen intubation and intercostal video-mediastinoscopy (VM).</p><p><b>RESULTS</b>No morbidity or mortality occurred. Palmar hyperhidrosis was cured in all patients. Follow-up (mean (13.8 +/- 6.2) months) showed no recurrence of palmar hyperhidrosis. The difference of rates of mild CS in groups T(3) and T(4) was of no statistical significance. The rate of moderate CS was significantly lower in group T(4) than in group T(3). No severe CS occurred.</p><p><b>CONCLUSION</b>The rates of occurrence and severity of CS are lowered with the lower sympathetic chain being transected.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Follow-Up Studies , Hyperhidrosis , General Surgery , Postoperative Complications , Prospective Studies , Sweating , Sympathectomy , Methods , Thoracic Surgery, Video-AssistedABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility, safety and prospect application value of video-assisted thoracoscopic sympathectomy utilized in the treatment of craniofacial hyperhidrosis.</p><p><b>METHODS</b>Eighteen patients with craniofacial hyperhidrosis underwent sympathectomy from January 2003 to December 2004, including 10 cases combined with palmar hyperhidrosis. There were 17 males and 1 females with a mean age of 36.5 years (ranges, 25-42). Sympathetic chain was transected just below the stellate ganglion in pure craniofacial hyperhidrosis. Additional T(3) sympathectomy was performed in those patients combined with palmar hyperhidrosis.</p><p><b>RESULTS</b>There were no surgical complication or surgical mortality cases. Seventeen patients achieved improvement of craniofacial hyperhidrosis without recurrent symptoms, but one had partial remission due to thoracic adhesion and false location of the ganglions. The effective rate was 97% (35/36). No recurrent symptoms occurred after a mean of 8.3 months of follow-up. No relapse occurred. Fifteen patients (83%) developed compensatory sweating of the trunk and lower limbs. Six patients (33%) presented palmar dry (severe hypohidrosis) and they all can tolerate the condition. All patients were satisfied with the outcomes of their operations.</p><p><b>CONCLUSION</b>The initial results show that thoracoscopic sympathectomy is a safe and effective method for the treatment of craniofacial hyperhidrosis.</p>
Subject(s)
Adult , Female , Humans , Male , Face , Pathology , Follow-Up Studies , Head , Hyperhidrosis , General Surgery , Sympathectomy , Methods , Thoracic Surgery, Video-Assisted , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To assess the feasibility, safety and effectiveness of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of congenital long QT syndrome.</p><p><b>METHODS</b>Under general anaesthesia, pleural cavity was entered via two or three small incisions in the left intercostal space. The left thoracic sympathetic chain was identified and resected from T2 approximately T5. The lower one at the third of the left stellate ganglion was also resected.</p><p><b>RESULTS</b>VATS resulted in a significant shortening in corrected QT intervals in three patients. The average QT interval of the four patients was 537.5 ms before VATS and 512.5 ms after VATS. The heart rate of the patients remained unchanged. There were no major peri-operative complications apart from mild ptosis of the left upper eyelid in one patient who recovered in the following days. The syndrome recurred in one patient in syncopal events in four months after VATS.</p><p><b>CONCLUSION</b>VATS is a safe as well as an effective technique for the treatment of congenital long QT syndromes.</p>