Chinese clinical expert consensus on surgical treatment of myasthenia gravis / 中国胸心血管外科临床杂志

@#Myasthenia gravis (MG) is an autoimmune disease with indefinite pathogenesis. MG is closely related to thymic diseases, and thymectomy is an important way for MG treatment. However, there are some controversies regarding thymectomy, including indications, operation opportunities, operative procedures, surgical approaches, perioperative managements, and efficacy evaluations, etc. Therefore, based on the literature and the experience of Chinese experts, this consensus has been written after careful discussion and inquiry and 29 recommendations have been made, aiming to guide surgical treatment of MG and improve the clinical outcomes.

Clinical analysis of the feasibility and safety of single utility port robot-assisted lung resection / 中国胸心血管外科临床杂志

@#Objective    To investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach. Methods    The clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed. Results    All patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points. Conclusion    Single utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.

Chinese consensus on surgical treatment of traumatic rib fractures (2021) / 中华创伤杂志

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

The effects of robotic versus thoracoscopic lobectomy on body trauma and lymphocyte subsets in patients with non-small cell lung cancer / 中国胸心血管外科临床杂志

@#Objective    To investigate the effects of robotic versus thoracoscopic lobectomy on body trauma and lymphocyte subsets in patients with non-small cell lung cancer (NSCLC). Methods    The clinical data of 120 patients with NSCLC who underwent lobectomy in the same operation group at the same period were collected and divided into a robot group (n=60) and a thoracoscope group (n=60) according to different surgical methods. The operation time, intraoperative blood loss, postoperative drainage time, drainage volume, postoperative hospital stay, complication rate, pain visual analogue scale (VAS) and other perioperative indicators were recorded in the two groups. Inflammatory markers: C-reactive protein (CRP), interleukin-6 (IL-6) and lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) levels were measured before and 1 d, 3 d after surgery. The effects of the two surgical methods on the body trauma and lymphocyte subsets were compared. Results    The operation time, intraoperative blood loss, postoperative drainage time, drainage volume and VAS of the robot group were lower than those of the thoracoscope group, and the differences were statistically significant (P<0.05). On the 1st day after surgery, IL-6 of the thoracoscope group was higher than that of the robot group, while CD3+, CD4+ and CD8+ were lower than those of the robot group, with statistically significant differences (P<0.05). Conclusion    Compared with thoracoscopic lobectomy, robotic lobectomy has less trauma, less inflammatory response, faster recovery, less inhibitory effect on lymphocyte subsets, and has clinical advantages.

Robotic versus thoracoscopic lung segmentectomy: a case control study / 中华胸心血管外科杂志

Objective:To summarize the experience of robotic and thoracoscopic segmentectomy in Daping Hospital, Army Medical University, and comparison analysis the clinical application value for early-stage lung cancer.Methods:A retrospective cohort study was conducted to continuously enroll 190 patients, 100 who received robotic(33 males and 67 females, median age of 51 years)and 90 who received VATS(34 males and 56 females, median age of 54 years), who underwent segmentectomy between June 2018 and October 2019. Perioperative outcomes(the operation time, intraoperative blood loss, postoperative thoracic drainage volume and time, pain score, complications, postoperative hospital stay and survival and mortality) were compared.Results:All the patients successfully completed the surgery and recovered from hospital, with no perioperative death.The baseline characteristics(sex, age, clinical symptoms, smoking status, underlying disease, tumor size, pathological type) and type of segmentectomy were comparable. There was significant difference in operative time[120(interquartile range, IQR 60-225)min vs. 155( IQR 75-330)min, P<0.001], blood loss[30( IQR 20-400) ml vs. 100( IQR 20-1 600) ml, P<0.001] between the robotic and VATS groups, respectively. But there was no significant difference in postoperative thoracic drainagevolume[4( IQR 1-15) days vs. 4( IQR 2-29) days, P=0.547], postoperative thoracic time[755( IQR 200-3 980)ml vs. 815( IQR 280-3 920)ml, P=0.902], pain score[2.33( IQR 0.88-4.75) points vs. 3.13( IQR 0.95-5.29)points, P=0.199], complications[7.4%(14/190) vs. 6.3%(12/190), P=0.303], postoperative hospital stay[7( IQR 3-19) days vs. 6( IQR 4-21) days, P=0.405] , number of lymph nodes[(4.83±3.18) vs.(6.15±4.1), P=0.255] between the robotic and VATS groups, respectively. The follow-up time was 6.5( IQR 1-26) months in the two groups, without recurrence, metastasis or death. Conclusion:Robotic lung segmentectomy is safe and feasible. This approach might lead to a better in operative time and blood loss. The short-term efficacy is similar with thoracoscopy, and the long-term efficacy needs further follow-up time.

Suggestions for thoracic surgery clinical practice in non-epidemic area of coronavirus infected disease-19 / 中华外科杂志

In this paper, the mechanism of destroying human alveolar epithelial cells and pulmonary tissue by 2019 novel coronavirus (2019-nCoV) was discussed firstly. There may be multiple mechanisms including killing directly the target cells and hyperinflammatory responses. Secondly, the clinical features, CT imaging, short-term and long-term pulmonary function damage of the 2019 novel coronavirus pneumonia (COVID-19) was analyzed. Finally, some suggestions for thoracic surgery clinical practice in non-epidemic area during and after the epidemic of COVID-19 was provided, to help all the thoracic surgery patients receive active and effective treatment.

Clinical application of three-dimensional computed tomography bronchography and angiography in robotic lung segmentectomy / 中国胸心血管外科临床杂志

@#Objective    To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in robotic lung segmentectomy. Methods    A non-randomized control study was performed and continuously enrolled 122 patients who underwent robotic lung segmentectomy in our hospital from January 2019 to January 2020. 3D-CTBA was performed before operations in 53 patients [a 3D-CTBA group, including 18 males, 35 females, with a median age of 52 (26-69) years] and not performed in the other 69 patients [a traditional group, including 23 males, 46 females, with a median age of 48 (30-76) years]. The clinical data of the patients were compared between the two groups. Results    All the patients were successfully completed the surgery and recovered from hospital, with no perioperative death. The baseline characteristics of the patients were not significantly different between the two groups (P>0.05). No significant difference was found in the operative time [120 (70-185) min vs. 120 (45-225) min, P=0.801], blood loss [50 (20-300) mL vs. 30 (20-400) mL, P=0.778], complications rate (17.0% vs. 11.6%, P=0.162), postoperative hospital stay [7 (4-19) d vs. 7 (3-20) d, P=0.388] between the two groups. In the 3D-CTBA group, 5 (9.4%) patients did not find nodules after segmentectomy, and only 1 (1.9%) of them needed lobectomy, but in the traditional group, 8 (11.6%) patients did not find nodules and had to carry out lobectomy, the difference was statistically significant (P<0.05). The follow-up time was 10 (1-26) months, and during this period, there was no recurrence, metastasis or death in the two groups. Conclusion    3D-CTBA is helpful for accurate localization of nodules and reasonable surgical planning before operations, and reducing wrong resections in segmentectomy, without increasing the operation time, blood loss and complications. It is safe and effective in anatomical lung segmentectomy.

Clinical analysis of robot-assisted lobectomy through anterior approach in 180 patients / 中国胸心血管外科临床杂志

@#Objective    To evaluate the feasibility and clinical value of robot-assisted lobectomy through anterior approach. Methods    We retrospectively analyzed the clinical data of 180 patients who underwent robot-assisted lobectomy through anterior approach in our hospital between April 2017 and February 2018. There were 97 males and 83 females, aged 59.5 (32.0-83.0) years. The clinical effects were analyzed. Results    One patient was transferred to thoracotomy due to tumor invasion of adjacent blood vessels and injury to the blood vessels, and there was no perioperative death. There were 8.5 (1.0-35.0) dissected lymph nodes for each patient. The median operation time was 120 (50-360) min, including robot Docking time 5 (1-23) min and robot operation time 65 (7-270) min. The median blood loss was 50 (5-1 500) mL, 132 (73.3%) patients had malignant tumors and median drainage time was 5 (2-30) d. The mean postoperative pain score was 3.4±0.7 points and the postoperative hospital time was 8 (2-32) d. At the median follow-up of 24 months, 11 patients developed recurrence and metastasis, and 3 died. Conclusion    Robot-assisted lobectomy through anterior approach is a safe and convenient operation method, which is worthy of clinical application.

Chinese expert consensus on robot-assisted pulmonary resections / 中国胸心血管外科临床杂志

@# Robotic surgery system has been widely used in various types of pulmonary resections. With the unremitting efforts of Chinese thoracic surgeons, the quantity and quality of robotic pulmonary resections in China have reached a remarkable level. With the development and rapid promotion of this technology, the popularity of robotic surgery is also increasing. In order to standardize the clinical practice, guarantee the quality of treatment and promote the development of robotic pulmonary resections, the Committee of Thoracic Surgery, Doctor Society of Medical Robotics, Chinese Medical Doctor Association organized relevant domestic experts to formulate the consensus of Chinese clinical experts on robot-assisted lung cancer surgery.

The application of detecting BCAR1 (+)-circulating tumor cells in postoperative monitoring of early stage lung adenocarcinoma / 中华胸心血管外科杂志

Objective To explore the clinical significance regarding monitoring circulating tumor cells in early stage lung adenocarcinoma.Methods From November 2015 to January 2018,48 patients with stage Ⅰ lung adenocarcinoma were included in the study.BCAR1 expression in CTCs in peripheral blood were detected by using CanPatrolTM and RNA in situ hybridization detection.Results Among the 48 cases,CTCs and BCAR1 (+)-CTCs were detected in 41 cases(85.4％) and 30 cases(62.5％),respectively.Number of BCAR1 (+)-CTCs seemed to be significantly positively related to that of CTCs.BCAR1 (+)-CTCs were more likely to appear in the M-CTCS and E&M-CTCS.BCAR1 (+)-CTCs remarkably increased in three relapsed cases.Furthermore,there were 19 stable cases who had postoperative CTCs data:(1) in 12 patients,either CTCs or BCAR1 (+)-CTCs were significantly reduced or remained stable;(2) in 7 cases,CTCs increased,but BCAR1 (+)-CTCs remained stable in 2 cases,reduced in 1 case,and the other 4 cases underwent close follow-up.Conclusion Evaluation of BCAR1 (+)-CTCs possibly can be contributive to prediction of early lung adenocarcinoma recurrence or metastasis.

Application of Electromagnetic Navigation Bronchoscopic Biopsy Combined with Massage Staining in Diagnosis and Treatment of Peripheral Pulmonary Lesion / 中国肺癌杂志

BACKGROUND@#Electromagnetic navigation bronchoscopy (ENB) has become the latest minimally invasive diagnostic and therapeutic technique due to its characteristics, e.g., non-invasion, accuracy, real-time positioning. In this study, we investigated the application of ENB biopsy combined with Massage staining in the diagnosis and treatment of peripheral pulmonary lesions (PPL).@*METHODS@#The clinical data of 15 PPL patients undergoing ENB biopsy plus Massage staining between August 2017 and January 2018 were retrospectively reviewed. Among them, there were 12 male and 3 female, and the mean age was (51.3±2.1) years old.@*RESULTS@#The diameter of PPLs ranged from 6 mm to 36 mm (mean: 14.0 mm). The successful biopsy rate was 66.7%. All patients successfully underwent Massage staining. The distance between the centers of staining and lesion was (1.0±0.4) cm, and the diameter of staining was (2.8±0.6) cm. The mean operation time was (26.7±5.3 ) min, and the mean blood loss during surgery was (3.3±1.5) mL. There was no pneumothorax, hemothorax and pulmonary vascular injury during the procedure.@*CONCLUSIONS@#The ENB biopsy plus Massage staining technique caused very few complications, and provided high precision, which warrants further application.

Effect of A High Intensive Preoperative Rehabilitation on the Perioperative Complications in Patients with Chronic Obstructive Pulmonary Disease Eligible for Lung Cancer Surgery / 中国肺癌杂志

BACKGROUND@#Chronic obstructive pulmonary disease (COPD) will reduce the cardiopulmonary function and increase perioperative risk. The aim of this study is to investigate the effect of preoperative short-term high intensity lung rehabilitation training on lung function and postoperative complications in patients with COPD who are eligible for lung cancer surgery.@*METHODS@#We analysis of 101 patients with COPD and a diagnosis of lung cancer, with 43 patients in pulmonary rehabilitation group and 58 patients in conventional group. The pulmonary function, postoperative pulmonary complications (PPCs) and length of stay (LOS) will be compared between the two groups, the lung function will be compared before and after the rehabilitation at the same time.@*RESULTS@#There were no significant difference between the two groups in general information, lung function before surgery, postoperative pulmonary infection [8 (18.6%) vs 17 (29.3%)], atelectasis [1 (2.3%) vs 1 (1.7%)], respiratory failure [1 (2.3%) vs 2 (3.4%)] and postoperative LOS [(8.93±3.78) d vs (9.62±3.98) d, P>0.05]. In the rehabilitation group, the FEV1 [(2.06±0.45) L vs (2.15±0.45) L, P<0.001] and PEF [(4.32±0.90) L/s vs (5.15±1.05) L/s, P<0.001) were higher, and PCO2 [(42.42±2.79) mmHg vs (41.58±2.98) mmHg, P=0.009] was lower after rehabilitation, significantly. The increase value of FEV1 in moderate to severe COPD group was higher than that of the mild COPD group after the rehabilitation [(0.16±0.05) L, 8.6% vs (0.06±0.05) L, 2.8%, P<0.001).@*CONCLUSIONS@#The short-term highly-intensity lung rehabilitation can improve lung function in lung cancer patients with COPD, and the improvement of pulmonary function in moderate to severe COPD patients is more obviously.

The early experience of robot-assisted thymectomy / 中国医师杂志

Objective To summarize the early experience of thymectomy by robot-assisted thoracoscopic surgery (RATS) with the da Vinci S Surgical System.Methods A total of 16 patients was underwent thymectomy from October 2016 to May 2017 by RATS.Among them,there were 10 cases of thymic hyperplasia,5 cases of thymoma and 1 case of thymic small cell carcinoma,including 11 cases of myasthenia gravis (MG).The Osserman types were as follows:type Ⅰ (5),type ⅡA (3),type ⅡB (2),and type Ⅲ (1).Clinical data were collected and analyzed.Results The operations were successfully accomplished by RATS in all the 16 patients without any conversion to open surgery and major complication.The docking time was 2-45 (11.69 ± 11.03) min.The operation time was 47-152 (84.06 ± 25.67) min.The blood loss was 0-150 (57.50 ± 37.32) ml.The diameter of thymus or tumor was 4-19.5 cm and (8.22 ± 3.64) cm.Fourteen cases were removed tracheal intubation in the operation day,and the other 2 cases taked off in 6th and 8th days.One case occurred myasthenia gravis crisis after surgery.All patients were followed up for 2-7 months after discharge without MG recurrence.Conclusions The da Vinci S Surgical System can be safely,accurately and stably used for thymectomy.

Current opinion of diagnosis and treatment of myasthenic crisis / 中华胸心血管外科杂志

Myasthenic crisis (MC) is a severe comorbidity or complication which may be critical to the patients during the treatment or onset of myasthenia gravis.We conduct the review and comment regarding prevention and treatment of MC.

Strategies to shorten the duration of mechanical ventilation in patients with post-thymectomy myasthenic crisis / 中华胸心血管外科杂志

Objective To identify the clinical and demographical features that may impact the duration of mechanical ventilation(DMV) in the patients with post-thymectomy myasthenic crisis(PTMC).Methods Reviewed the patients who had PTMC from June 2008 to November 2015.Cox proportional hazard regression analysis was used to identify potential prognostic factors that may impact DMV and long-term survival,respectively.One-way ANOVA analysis was used to compare the four groups with continuous variates.Statistical powers were calculated by using XLSTAT.Results In total,seventy patients with PTMC were enrolled.Alcoholic abuse,high MGFA classification and Clavien-Dindo classification were the critical factors that remarkably delayed early extubation.Postoperative lung infection(PLI) as sole complication did not prolong DMV as compared to those without any complication,however,PLI with other more severe complications requiring at least pharmacological treatment seemed to remarkably prolong DMV,as compared to those without any complication.Conclusion Preoperative abstinence,proper treatment of MG and postoperative complications can decrease the incidence of PTMC,shorten the use of ventilator time and improve the prognosis of patients.

Surgical treatment of ocular myasthenia gravis: a clinical analysis of 129 cases / 中华胸心血管外科杂志

Objective Summing up and analyzing outcome and influencing factors following thymectomy in patients with ocular myasthenia gravis tries to provide clinical evidence for an option of the treatment modalities.Methods From May 2007 to November 2014,thymectomy was performed in 129 patients with ocular myasthenia gravis consisting of 110 patients by Video-assisted thoracoscopic surgery(VATS) and 19 by partial sternotomy.Follow-up information was obtained by outpatient visit and telephone contact.The outcome evaluation after thymectomy was classified into full remission,partial remission,unchanged and deteriorated.Statistical analysis was done using x2 test and Cox regression model.Results There was no perioperative death.Seven(5.4％) postoperative complications occurred and cured after treatment.Follow-up was complete in 123 patients(95.3％) and the mean duration of follow-up was 49(range 21-99) months.Surgical outcome revealed full remission in 40 patients,partial remission in 68,unchanged in 9 and deteriorated in 6 patients.Response(full remission and partial remission) rate was 87.8％ and no benefit(unchanged and deteriorated) rate was 12.2％.Four of 6 patients in deteriorated condition progressed into generalized myasthenia gravis(3.3％).The significant difference was noted in 24 months or less of preoperative clinical duration (P =0.004) and thymic hyperplasia (P =0.001) in postoperative pathology among the full remission,partial remission and no benefit group.On the other hand,there was no statistical difference in sex,age,symptoms,comorbidities,preoperative taking acetylcholinase inhibitor,corticosteroid,surgical approach,and associated thymona among the three groups.Multivariate Cox regression analysis also demonstrated that a preoperative duration of symptoms 24 months or less and postoperative histology being thymic hyperplasia favourably influenced the outcome.Conclusion The role of thymectomy in patients with ocular myasthenia gravis can relieve symptoms effectively and avert or decrease the potential development of generalized symptoms.Thymectomy,which has a low postoperative mortality and morbidity,may be a first-line option of the therapeutic armamentarium to treat ocular myasthenia gravis.Thymectomy via VATS has clinical advantages of minimal trauma,less pain,fast recovery,and the comparable clinical results over via the traditional sternotomy.Therefore,this procedure deserves to be advocated for ocular myasthenia gravis.

Study of esophageal motility in the cases with myasthenia gravis / 中华胸心血管外科杂志

Objective To study the features of esophageal motility in the cases with myasthenia gravis(MG).Methods 15 healthy controls and 45 patients with MG were tested by using a low-compliance four-lumen hydraulic infusion system,respectively.Focused on the following parameters:PP,UESP,UEP,MEP and MERP.Results There were significant differences of the parameters in between MG cases and healthy controls PP (73.24 ± 31.40) mmHg (1 mmHg =0.133 kPa) vs.(103.78±29.47) mmHg,P=0.002;UESP(41.75 ±21.04) mmHg vs.(60.59 ±17.97) mmHg,P=0.003;UEP (56.63 ±30.26) mmHg vs.(78.98 ±30.14) mmHg,P =0.016;MEP(53.96 ±23.25) mmHg vs.(75.11 ±23.75) mmHg(P =0.004).However,MERP of MG cases or healthy controls seemed to be similar[(-7.76 ± 5.94) mmHg vs.(-7.58 ± 5.76) mmHg,P =0.91).Additionally,the above-mentioned parameters in the cases with generalized myasthenia gravis or dysphagia were significantly different compared with other subtypes or healthy controls (P ＜ 0.01).However,there were no significant differences of the parameters in between ocular MG and healthy controls,or in between MG with and without thymoma.Conclusion The upper and middle part of esophageal motility dysfunction is very common in MG cases,especially in those with dysphagia or generalized MG,characterizing by the declined pressure.Manometry in MG cases can help us classify the subtypes of MG and verify their esophageal motility functions.

Diagnosis and surgical treatment of pulmonary sequestration in adults / 局解手术学杂志

Objective To explore the diagnosis and surgical treatment of pulmonary sequestration in adults. Methods Clinical data of 21 cases of pulmonary sequestration whose diagnosis was confirmed by surgical biopsy in our department from March 2009 to February 2016 were retrospectively analyzed. Divided the patients into the thoracotomy group (n=9) and the thoracoscope group (n=12) according to dif-ferent surgical methods, and compared the diagnosis and surgery of the two groups. Results Among the patients, 8 cases were diagnosed as pulmonary sequestration and the remaining 13 cases were misdiagnosed,with the misdiagnosis rate of 61. 9%. Intraoperative exploration dem-onstrated that the abnormal blood vessels were originated from thoracic aorta (n=14,66. 7%),abdominal aorta (n=4,19%),phrenic artery (n=3,14. 3%) and aortic arch (n=1,4. 8%), and there were 20 cases (95. 2%) of intralobar sequestration and 1 case (4. 8%) of ex-tralobar sequestration. Patients underwent thoracotomy and patients underwent video-assisted thoracoscopic surgery were of no significant differences in operative time (P=0. 104),blood loss (P=0. 209),chest tube duration (P=0. 511),drainage volume (P=0. 135) and postoperative hospital stay (P=0. 450). All the patients recovered well after surgery. Conclusion As pulmonary sequestration lacks specific clinical manifestations,missed diagnosis and misdiagnosis are very common in patients. Chest enhanced CT and CT angiography are effective diagnostic methods at present. Both thoracotomy and VATS can achieve good therapeutic effects.

Value of 18F-FDG PET/CT for diagnosis of lymphatic metastasis in patients with non-small cell lung cancer / 局解手术学杂志

Objective To assess the value of fuorine-18-fluom deoxy glucose positron emission tomography /computer tomography (18F-FDG PET/CT) in diagnosis of lymph node metastasis in the cases with non-small cell lung cancer ( NSCLC) .Methods From March 2012 to March 2015,167 patients underwent 18F-FDG PET/CT and contrast enhanced CT inspection within 10 days prior to the surgery and were pathologically diagnosed as non-small cell lung cancer(NSCLC) after surgery.With regard to estimation of the lymphatic metastasis,we com-pared the sensitivity,specificity,accuracy,positive and negative predictive value ,and Youden index between the PET/CT and contrast en-hanced CT.Results There were 731 lymph node stations from the 167 patients.Referred to the final pathological results ,PET/CT has screened 143 lymph node stations in true positive set ,26 lymph node stations in false positive set ,61 lymph node stations in false negative set , and 501 lymph node stations in true negative set .Furthermore,the sensitivity,specificity,the positive and negative forecast values ,and Youden index of PET/CT and CT was 70.10%vs.54.19%(P<0.05),95.07%vs.92.23%(P<0.05),88.10%vs.81.67%(P<0.05),84.62%vs.72.85%(P<0.05),89.15%vs.81.67%(P<0.05) and 0.65 vs.0.46 (P<0.05),respectively.Conclusion It is more effective to to precisely validate lymphatic metastasis of NSCLC by using PET /CT than using contrast enhanced CT inspection .Additionally,PET/CT can provide more information for the preoperative diagnosis , staging and the follow-up treatment of lung cancer .

Correlation between overexpression of PC4 in lung adenocarcinoma with lymph node metastasis / 重庆医学

Objective To investigate the promotion effect of human transcriptional positive cofactor 4 (PC4) overexpression on lymphatic metastasis in lung adenocarcinoma .Methods 96 samples of lung adenocarcinoma tissue were collected .The immuno‐histochemistry(IHC) and real‐time quantitative polymerase chain reaction (qRT‐PCR) were adopted for detecting the expression levels of PC4 protein and mRNA .The correlation of PC4 expression with lymphatic metastasis and TNM stage was analyzed .Re‐sults The expression of PC4 protein was positively correlated mRNA in lung adenocarcinoma (r=0 .63 ,P<0 .01);the expression of PC4 protein was positively correlated with lymph node metastasis (χ2 =8 .29 ,P<0 .01) and TNM stage (χ2 =4 .71 ,P<0 .05);the expression of PC4 mRNA was also positively correlated with lymph node metastasis (χ2 = 8 .40 ,P< 0 .01) and TNM stage (χ2 =5 .10 ,P<0 .05) .Conclusion PC4 overexpression is found to be closely associated with the lymph node metastasis and TNM stage .PC4 may facilitate the lymph node metastasis of lung adenocarcinoma .