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@#Objective To compare the safety and efficacy of the da Vinci robot and thoracoscopic subxiphoid approach for the treatment of anterior mediastinal tumors. Methods The clinical data of patients who underwent anterior mediastinal tumor resection through the subxiphoid approach admitted to the same medical group in the Department of Thoracic Surgery of the First Hospital of Lanzhou University between June 2020 and April 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a robot-assisted thoracoscopic surgery (RATS) group and a video-assisted thoracoscopic surgery (VATS) group. The perioperative data and the incidence of postoperative complications were compared between the two groups. Results A total of 79 patients were enrolled. There were 41 patients in the RATS group, including 13 males and 28 females, with an average age of 45.61±14.99 years. There were 38 patients in the VATS group, including 14 males and 24 females, with an average age of 47.84±15.05 years. All patients completed the surgery successfully. Hospitalization cost and operative time were higher or longer in the RATS group than those in the VATS group, and the difference was statistically significant (P<0.05). Intraoperative bleeding, postoperative hospital stay, postoperative water and food intake time, postoperative off-bed activity time, white blood cell count, neutrophil percentage and visual analogue scale (VAS) score on the first postoperative day, white blood cell count and neutrophil percentage on the third postoperative day, duration of analgesic pump use, the number of voluntary compressions of the analgesic pump, and mediastinal drainage volume were all superior to those in the VATS group (P<0.05). The differences in VAS scores on the third postoperative day, duration of drainage tube retention and postoperative complication rates were not statistically different between the two groups (P>0.05). Conclusion RATS subxiphoid anterior mediastinum tumor resection is a safe and feasible surgical method with less injury and higher safety, which is conducive to rapid postoperative recovery and has wide clinical application prospects.
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@#Lung cancer is a malignant tumor with the highest mortality worldwide, and its early diagnosis and evaluation have a crucial impact on the comprehensive treatment of patients. Early preoperative diagnosis of lung cancer depends on a variety of imaging and tumor marker indicators, but it cannot be accurately assessed due to its high false positive rate. Liquid biopsy biomarkers can detect circulating tumor cells and DNA in peripheral blood by non-invasive methods and are gradually becoming a powerful diagnostic tool in the field of precision medicine for tumors. This article reviews the research progress of liquid biopsy biomarkers and their combination with clinical imaging features in the early diagnosis of lung cancer.
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@#Objective To investigate the application of enhanced recovery after surgery (ERAS) in da Vinci robotic McKeown surgery for esophageal cancer. Methods Clinical data of patients admitted to the First Hospital of Lanzhou University and undergoing da Vinci robotic McKeown surgery for esophageal cancer from 2017 to 2021 were retrospectively analyzed. According to the treatment, they were divided into two groups, a conventional group and an ERAS group. Patients in the conventional group were treated with the conventional perioperative treatment mode of thoracic surgery, and patients in the ERAS group were treated with accelerated rehabilitation surgical treatment mode. Relevant hospitalization indicators and postoperative complication rates were compared between the two groups. Results Finally 128 patients were collected, including 106 males and 22 females, with an average age of 61.91 years. There were 71 patients in the conventional group and 57 patients in the ERAS group. The postoperative pain index in the ERAS group was significantly lower than that in the conventional group (P<0.05), and the duration of postoperative analgesic pump used in the ERAS group was shorter than that in the conventional group (2.39±0.49 d vs. 3.13±0.63 d, P<0.001). There was no statistical difference in the incidence of postoperative related complications (gastroesophageal reflux, anastomotic stenosis, anastomotic fistula, arrhythmia, recurrent laryngeal nerve injury, chylothorax, anastomosis stomatitis or incisional infection) between the two groups (P>0.05), but the incidence of postoperative lung infection in the ERAS group was statistically lower (12.28% vs. 26.76%, P=0.043), and the volume of postoperative pleural effusion was statistically less compared with the conventional group (P<0.05). In the ERAS group, the surgery time (294.35±15.19 min vs. 322.79±59.09 min, P<0.001), postoperative exhaust time (1.44±0.39 d vs. 1.94±0.43 d, P<0.001), postoperative removal time of nasolasal tube (6.79±0.73 d vs. 8.21±0.86 d, P<0.001), hospital stay (19.88±3.36 d vs. 21.34±3.59 d, P=0.020), hospitalization costs (105 575.28±8 960.75 yuan vs. 137 894.64±19 518.60 yuan, P<0.001) were all lower or shorter than those of the conventional group. Postoperative activity was longer in the ERAS group than that in the conventional group (P<0.05), but there was no statistical difference in preoperative anesthesia time between the two groups (P=0.841). Conclusion The application of ERAS in da Vinci robotic McKeown surgery for esophageal cancer can effectively alleviate the physiological and psychological burden of patients, reduce the occurrence of postoperative related complications, effectively shorten the total hospital stay, save hospitalization costs, and reduce the economic burden of patients and society. Therefore, it can be promoted and applied in the clinic.
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@#Objective To establish a machine learning model based on computed tomography (CT) radiomics for preoperatively predicting invasive degree of lung ground-glass nodules (GGNs). Methods We retrospectively analyzed the clinical data of GGNs patients whose solid component less than 3 cm in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from March 2021 to July 2021 and the First Hospital of Lanzhou University from January 2019 to May 2022. The lesions were divided into pre-invasiveness and invasiveness according to postoperative pathological results, and the patients were randomly divided into a training set and a test set in a ratio of 7∶3. Radiomic features (1 317) were extracted from CT images of each patient, the max-relevance and min-redundancy (mRMR) was used to screen the top 100 features with the most relevant categories, least absolute shrinkage and selection operator (LASSO) was used to select radiomic features, and the support vector machine (SVM) classifier was used to establish the prediction model. We calculated the area under the curve (AUC), sensitivity, specificity, accuracy, negative predictive value, positive predictive value to evaluate the performance of the model, drawing calibration and decision curves of the prediction model to evaluate the accuracy and clinical benefit of the model, analyzed the performance in the training set and subgroups with different nodule diameters, and compared the prediction performance of this model with Mayo and Brock models. Two primary thoracic surgeons were required to evaluate the invasiveness of GGNs to investigate the clinical utility of the mode. Results A total of 400 patients were divided into the training set (n=280) and the test set (n=120) according to the admission criteria. There were 267 females and 133 males with an ……
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Objective:To evaluate the clinical radiological features combined with circulating tumor cells in the diagnosis of benign and malignant pulmonary solid nodules.Methods:Clinical data of 437 patients from Shanghai Pulmonary Hospital(SPH cohort) from January to April 2021 and 82 patients from Lanzhou University First Hospital (LZH cohort) from August 2019 to May 2022 were retrospectively included. Patients in Shanghai pulmonary hospital were randomly divided into training set and internal validation set in a ratio of 4∶1 by random number table method and patients in Lanzhou University First Hospital were as external validation set. Independent risk factors were selected by regression analysis of training set constructed a Nomogram prediction model. The performance of the Nomogram prediction model was estimated by applying receiver operating curve( ROC) analysis, tested in different nodules size and intermediate risk IPSNs and tested by calibration curve. Results:Independent risk factors selected by regression analysis for solid pulmonary nodules were age, the level of CTC, pleural Indentation, lobulation, spiculation. The Nomogram prediction mode provided an area under ROC( AUC) of 0.888, 0.833 in internal validation set and external validation set, outperforming radiological features model(0.835, P=0.007; 0.804, P=0.043) Mayo clinical model(0.781, P=0.019; 0.726, P=0.033) and CTCs(0.699, P=0.002; 0.648, P=0.012) in both two validation sets, C-index of 0.888, 0.871 and corrected C-index of 0.853, 0.842 in both two validation sets . The AUC of the prediction model with internal validation set was 0.905 and 0.871 for nodule diameter of 5-20 mm and intermediate risk probability. Conclusion:The prediction model in this study has better diagnostic value and practicability, and is more effective in clinical diagnosis of diseases.
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Objective:To investigate the clinical application of ultrafine thoracic drainage tube(Abel, 8FR, 20 cm) after pulmonary uniportal video-assisted thoracoscopic surgery lung tumors.Methods:A total of 2 031 patients who doing lung tumor surgery in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from May 2015 to July 2020 were retrospectively enrolled. According to the types of thoracic drainage tubes, they were divided into the ultrafine drainage tube group(1 026 cases) and the conventional drainage tube group(1 005 cases). The groups were compared in terms of postoperative thoracic drainage at 24 h, 48 h and 72 h, postoperative hospital stay, drainage time, postoperative pain index at three days, postoperative analgesia times and postoperative complications.Results:There was no significant difference between two groups in terms of the postoperative thoracic drainage at 24h, 48h, 72h and drainage time( P>0.05). Notably, there were significant differences between two groups in terms of the postoperative hospital stay, postoperative pain index at three days, postoperative analgesia times and postoperative complications( P<0.05). Conclusion:The use of ultrafine thoracic drainage tube after lung tumor surgery is safe and reliable, can better postoperative drainage, achieve the purpose of relieving pain, speeding up postoperative rehabilitation, and convenient nursing, worthy of clinical promotion and application.
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@#Objective To systematically evaluate the efficacy of neoadjuvant chemoradiotherapy or chemotherapy followed by surgery versus definitive chemoradiation in stage ⅢA-N2 non-small cell lung cancer (NSCLC). Methods We searched PubMed, EMbase, Web of Science and The Cochrane Library to collect clinical studies on the efficacy comparison between neoadjuvant chemoradiotherapy or chemotherapy followed by surgery and definitive chemoradiation in stage ⅢA-N2 NSCLC from inception to September 2022. The meta-analysis was performed by using RevMan 5.3 software. Results A total of 9 studies (3 randomized controlled trials and 6 retrospective cohort studies) with 12 801 patients were included. The results of meta-analysis showed that there was no statistical difference in the progression-free survival rate between the inductive treatment followed by surgery (including lobectomy and pneumonectomy) and definitive chemoradiation (HR=0.99, 95%CI 0.86-1.15, P=0.91). Compared with definitive chemoradiation, the overall survival (OS) rate in the inductive treatment followed by surgery (including lobectomy and pneumonectomy) was lower (HR=1.24, 95%CI 1.09-1.42, P=0.001), while the OS rate in the inductive treatment followed by lobectomy was higher (HR=0.55, 95%CI 0.51-0.61, P<0.000 01). And the local recurrence rate in the inductive treatment followed by surgery was reduced (OR=0.44, 95%CI 0.36-0.55, P<0.000 01). Conclusion Neoadjuvant chemoradiotherapy or chemotherapy followed by lobectomy is superior to definitive chemoradiation in OS and it has a lower local recurrence rate, so lobectomy should be one of the multidisciplinary treatments for selected ⅢA-N2 NSCLC patients.
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@#Objective To evaluate the clinical radiological features combined with circulating tumor cells (CTCs) in the diagnosis of invasiveness evaluation of subsolid nodules in lung cancers. Methods Clinical data of 296 patients from the First Hospital of Lanzhou University between February 2019 and February 2021 were retrospectively included. There were 130 males and 166 females with a median age of 62.00 years. Patients were randomly divided into a training set and an internal validation set with a ratio of 3 : 1 by random number table method. The patients were divided into two groups: a preinvasive lesion group (atypical adenomatoid hyperplasia and adenocarcinoma in situ) and an invasive lesion group (microinvasive adenocarcinoma and invasive adenocarcinoma). Independent risk factors were selected by regression analysis of training set and a Nomogram prediction model was constructed. The accuracy and consistency of the model were verified by the receiver operating characteristic curve and calibration curve respectively. Subgroup analysis was conducted on nodules with different diameters to further verify the performance of the model. Specific performance metrics, including sensitivity, specificity, positive predictive value, negative predictive value and accuracy at the threshold were calculated. Results Independent risk factors selected by regression analysis for subsolid nodules were age, CTCs level, nodular nature, lobulation and spiculation. The Nomogram prediction mode provided an area under the curve (AUC) of 0.914 (0.872, 0.956), outperforming clinical radiological features model AUC [0.856 (0.794, 0.917), P=0.003] and CTCs AUC [0.750 (0.675, 0.825), P=0.001] in training set. C-index was 0.914, 0.894 and corrected C-index was 0.902, 0.843 in training set and internal validation set, respectively. The AUC of the prediction model in training set was 0.902 (0.848, 0.955), 0.913 (0.860, 0.966) and 0.873 (0.730, 1.000) for nodule diameter of 5-20 mm, 10-20 mm and 21-30 mm, respectively. Conclusion The prediction model in this study has better diagnostic value, and is more effective in clinical diagnosis of diseases.
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@#Objective To explore the safety, feasibility and superiority of tubeless video-assisted thoracoscopy in the treatment of primary palmar hyperhidrosis (PPH). Methods The clinical data of 46 patients with palmar hyperhidrosis treated by thoracoscopy in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from March 2017 to September 2020 were retrospectively analyzed. Among them, 22 received tubeless video-assisted thoracoscopic surgery, and were divided into a tubeless group, including 10 males and 12 females with an average age of 24.3±6.4 years; 24 received conventional thoracoscopic surgery, and were divided into a control group, including 13 males and 11 females with an average age of 23.5±4.8 years. The operation status, anesthesia effect and postoperative complications of the two groups were compared. Results Forty-six patients successfully completed the operation with the assistance of thoracoscopy. There was no intraoperative transfer to thoracotomy, or intraoperative transfer to tracheal intubation in the tubeless group. Anesthetic recovery time (14.4±1.6 min vs. 20.1±1.8 min, P=0.000), time to get out of bed on the first postoperative day (3.1±0.6 h vs. 1.6±0.4 h, P=0.000), visual analogue score for postoperative pain (1.4±0.6 points vs. 3.4±1.1 points, P=0.000), postoperative hospital stay (1.7±0.5 d vs. 2.8±0.6 d, P=0.000), postoperative satisfaction rate of patients (95.5% vs. 66.7%, P=0.037) in the tubeless group were shorter or better than those in the control group. There was no statistical difference in age, gender, smoking history, palmar hyperhidrosis classification, palms or other associated parts, the total time of bilateral surgery, intraoperative blood loss, postoperative complications, or compensatory hyperhidrosis (mild) between the two groups (P>0.05). Conclusion Compared with traditional thoracoscopic surgery for PPH, tubeless video-assisted thoracoscopic surgery for PPH has the advantages of safety, reliability, light pain and quick recovery, in line with the concept of accelerated rehabilitation surgery.
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@#Objective To explore the clinical effect of tubeless 3 mm ultra-fine thoracoscope combined with needle electrocoagulation hook thoracic sympathicotomy in the treatment of primary palmar hyperhidrosis. Methods The clinical data of 77 patients with primary palmar hyperhidrosis who underwent surgery in the First Hospital of Lanzhou University from September 2017 to July 2021 were retrospectively analyzed, including 50 males and 27 females, with an average age of 23.60±5.60 years. A total of 36 patients were treated with tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy (an observation group), and 41 patients were treated with conventional thoracoscopic thoracic sympathicotomy (a control group). The baseline data, perioperative data and the results of 12 hours after operation were compared between the two groups. Results All the 77 patients completed the operation successfully, no conversion to thoracotomy, no intraoperative bleeding, and no conversion to endotracheal intubation in the observation group. In the observation group, the time of anesthesia before operation [19.00 (17.00, 23.75) min vs. 25.00 (21.00, 27.00) min, P=0.001] and postoperative hospital stay [2.00 (1.00, 2.00) d vs. 2.00 (1.00, 3.00) d, P=0.012] were shorter than those in the control group. The operation time [22.50 (21.00, 25.75) min vs. 26.00 (23.50, 28.50) min, P=0.001], intraoperative blood loss [5.00 (2.25, 5.00) mL vs. 6.00 (5.00, 10.00) mL, P=0.003], postoperative pain index [2.00 (1.00, 2.00) vs. 3.00 (2.00, 3.00), P=0.001], hospitalization cost (14 246.58±879.28 yuan vs. 15 085.90±827.15 yuan, P<0.001) and postoperative inflammation index: white blood cell count [(12.96±2.32)×109/L vs. (14.47±2.05)×109/L, P=0.003], percentage of neutrophils (76.31%±5.40% vs. 79.97%±7.12%, P=0.014) were significantly lower or less than those in the control group. There was no significant difference in the incidence of major postoperative complications or adverse consequences between the two groups (P>0.05). In the evaluation of 12 hours after operation, the time of getting out of bed [2.00 (1.00, 2.00) h vs. 2.00 (2.00, 3.00) h, P=0.017], the time of drinking water after operation [1.50 (1.00, 2.00) h vs. 2.00 (1.00, 3.00) h, P=0.005], and the heart rate (80.25±14.42 bpm vs. 91.07±15.08 bpm, P=0.002), the incidence of dizziness, nausea and other uncomfortable symptoms (5.6% vs. 25.0%, P=0.040) at 12 hours after operation were shorter or lower than those in the control group. There was no significant difference in blood oxygen saturation (non-inhaled oxygen state) 12 hours after the operation between the two groups [97.00% (95.25%, 98.00%) vs. 97.00% (96.00%, 98.00%), P=0.763]. Conclusion Compared with conventional thoracoscopic thoracic sympathicotomy, tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy can significantly shorten the operation time, reduce postoperative pain and promote postoperative recovery, in line with the concept of accelerated rehabilitation surgery and minimally invasive surgery, and is worth popularizing in clinical practice.
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Objective To screen the secretory factor-related, mechanoresponsive microRNAs (miRNA) of osteocytes. Methods Cyclic mechanical tensile strain (ε=2.5,f=0.5 Hz) was applied to osteocytes and osteoblasts cultured in vitro respectively, and the differentially expressed miRNAs only in the osteocytes were screened out by using miRNA chip. Through bioinformatics technology, in these differentially expressed miRNAs, the target genes of secretory factors including insulin-like growth factor-1(IGF-1), nitric oxide synthesase (NOS), fibroblast growth factor 23 (FGF23) and sclerostin (SOST) were further screened out. Then the selected miRNAs were compared with the biochip detected, differentially expressed miRNAs in femur bone of the mice which were trained on treadmill, and four of these miRNAs were randomly selected for quantitative PCR verification. Results For the 77 differentially expressed miRNAs only in the mechanically strained osteocytes in vitro, 22 miRNAs whose target genes were the 4 secreted factors (IGF-1, NOS, FGF23 and SOST), were screened out. Moreover, a total of 11 miRNAs in the 22 miRNAs were differentially expressed in femur bone of the treadmill trained mice with the same trend as those in osteocytes in vitro, and the randomly selected miR-361-3p, miR-3082-5p, miR-6348 and miR-706 were confirmed to be differentially expressed with the same trend in femur bone and osteocytes. Conclusions These mechanoresponsive miRNAs differentially expressed only in osteocytes, such as miR-361-3p, miR-3082-5p, miR-6348 and miR-706, probably influence osteoblastic differentiation or bone metabolism through regulating the secretory factors.
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Osteocytes are the main mechanical sensory and transductive cells of bone tissues. They connect with each other through many synaptic structures to form a huge regulatory network of bone steady-state cells, which are connected with osteoblasts, osteoclasts and other bone matrix surface cells. Osteocytes regulate bone metabolism and maintain bone regeneration by affecting osteoblast bone formation and osteoclast bone resorption through paracrine pathway. Aiming at the effects of some signal molecules or protein factors secreted or released by osteocytes after mechanical stimulation on the growth and differentiation of osteoblasts and osteoclasts, this paper reviews recent advances in how mechanically stimulated osteocytes communicate with osteoblasts and osteoclasts, so as to provide new ideas for the study of osteocytes biomechanics.
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Objective To investigate the relation between the imaging microfeatures of AI-assisted diagnosis system and the prognosis of lung adenocarcinomas presented as ground-glass nodules (GGN). Methods We retrospectively analyzed CT data of 162 patients with lung adenocarcinomas presented as GGN. According to different imaging characteristics, the patients were divided into pure ground glass nodules (PGGN) group and mixed ground glass nodules (MGGN) group. The AI-assisted diagnosis system was used to extract their imaging microfeatures, and their relation with the prognosis of the patients was analyzed. Results The five-year OS and RFS were 89.7% and 88.5% in PGGN group, and 81.0% and 79.0% in MGGN group (χ2=6.289/7.255, P < 0.05). Multivariate Cox regression showed that imaging microfeatures such as microvascular cluster (P < 0.001), standard nodule volume (P=0.013) and nodule length (P < 0.001) were independent risk factors for OS, meanwhile, imaging microfeatures such as microvascular cluster (P < 0.001), standard nodule volume (P=0.017), nodule length (P=0.005), nodule central density (P=0.038) and lymph node metastasis (P < 0.001) were independent risk factors for RFS. Conclusion The AI-assisted diagnosis system can effectively predict the prognosis of lung adenocarcinomas presented as GGN, and it also has a certain reference value for the clinical precision diagnosis and treatment of GGN and the prevention and treatment of early lung cancer.
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Objective To investigate the effect of microgravity on MC3T3-E1 osteoblast differentiation. Methods The differential miRNA and mRNA expression profiling of MC3T3-E1 cells during exposure to microgravity were established by RNA transcriptome sequencing technology (RNA-seq). The RNA sequencing results were validated using quantitative real-time polymerase chain reaction (q-PCR). Bioinformatic analyses were applied for further study of these differentially expressed miRNAs and mRNAs. Results Compared with control (CON) group, A total of 1 912 coding transcripts and 160 miRNAs were detected along with osteogenic differentiation in simulated microgravity (SMG) group. Bioinformatic analysis revealed 10 core regulatory genes including 7 mRNAs and 3 miRNAs. Based on the analysis and verification, one miRNA, miR-9_6666-5p, was identified, which might play an important role in osteogenic differentiation process under microgravity. Conclusions The process of osteoblast differentiation was repressed under microgravity which might be related to the changed expression profile of miRNA/mRNA. The research findings can contribute to the better understanding of the molecular mechanisms of mRNA and miRNAs in osteogenic differentiation and bone formation under the microgravity condition.
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Objective:To evaluate the clinical efficacy of traditional tubular mechanical anastomosis versus nested anastomosis assisted by tubular stapler in McKeown resection of esophageal cancer.Methods:A total of 182 patients who underwent McKeown resection for esophageal cancer between January 2016 and August 2017 were recruited, including 85 patients in the traditional tubular mechanical anastomosis group and 97 patients in the nested anastomosis assisted by tubular stapler group. The incidence of anastomotic fistula and anastomotic stenosis was observed in 6 months after the operation.Results:Compared with the traditional mechanical anastomosis, the incidence of anastomotic fistula in nested anastomosis assisted by tubular stape[0(0/97)vs. 4.7%(4/85)], lung infection[3.1%(3/97) vs. 11.8%(10/85)], gastroesophageal reflux[7.2%(7/97)vs. 17.6%(15/85)], anastomotic stenosis[3.1%(3/97) vs. 10.6%(9/85)], the neck incision infection rate[1.0%(1/97)vs. 7.1%(6/85), the operative anastomosis time[(14.69±2.65) min vs.(20.25±4.31)min], the difference was statistically significant( P<0.05). There was no significant difference in arrhythmia, recurrent laryngeal nerve injury, chylothorax and anastomosis between the two groups. Conclusion:The incidence of complications such as anastomotic fistula, anastomotic stricture, gastroesophageal reflux, and pulmonary infection can be significantly reduced by nested anastomosis assisted by tubular stapler, which is an ideal choice for cervical anastomosis in McKeown resection of esophageal cancer.
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Objective To study the effect of Ilizarov technique on thumb shortening and bone defect after trauma.Methods The clinical data of 20 patients with thumb shortening or bone defect treated by Ilizarov technique from April 2010 to January 2018 were retrospectively analyzed.There were 19 males and 1 female including 15 left fingers and 5 right fingers.The age ranged from 20 to 56 years,with an average of 33.1 years.The osteotomy plane included 9 cases at distal part of the metacarpal,6 cases proximal phalanx base,1 case interphalangeal joint and 1 case distal part of proximal phalanx.Two cases were osteomyelitis after proximal and distal phalanges trauma,which resulted in interphalangeal joint defects after lesion clearance,and the length of the joint defect was 0.5 cm and 0.7 cm respectively.One case was emergency finger shortening fusion,which resulted in metacarpophalangeal joint defect due to nonunion of fusion site,and the length of the joint defect was 0.5 cm.Causes of injury included mechanical strangulation (12 cases),crush injury (6 cases) and traffic injury (2 cases).Semi-ring external fixator was used to extend the extension.There were 15 cases of metacarpal bone osteotomy and 5 cases of proximal phalanx osteotomy,prolonged from the 5th day after surgery.The osteotomy was prolonged by 0.5 mm every day,once every 6 hours.Results The follow-up time ranged from 184 to 446 days with an average of 244.6 days.The average extension period was 62.2 days (26-118 days),and the average extension length was 3.1 cm (1.3-5.9 cm).The healing index was 43.7-84.1 d/cm and the average healing index was 64.8 d/cm.The external fixed extender was used for 114-376 days with an average of 206.3 days.The distraction index was 20.1 c/cm (range,19.5-21.4 d/cm) and the maturity index was 46.5 d/cm (range,39.4-110.1 d/cm) and the external fixation index was 66.5 d/cm (range,60-130.8 d/cm).The finger pointing function and sensory function of thumb were restored after operation.According to the trial criteria of thumb and finger reconstruction function evaluation in the upper limb part evaluation criteria of Hand Surgery Society of Chinese Medical Association,11 cases were excellent,9 cases good,and the excellent and good rate was 100％(20/20).The two-point discrimination was 4-9 mm.The patients were satisfied with the function and appearance.Conclusion Ilizarov technique is a good method to treat thumb shortening and bone defect after trauma.
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In this study, we aim to investigat the effect of microgravity on osteoblast differentiation in osteoblast-like cells (MC3T3-E1). In addition, we explored the response mechanism of nuclear factor-kappa B (NF-κB) signaling pathway to "zero- " in MC3T3-E1 cells under the simulated microgravity conditions. MC3T3-E1 were cultured in conventional (CON) and simulated microgravity (SMG), respectively. Then, the expression of the related osteoblastic genes and the specific molecules in NF-κB signaling pathway were measured. The results showed that the mRNA and protein levels of alkaline phosphatase (ALP), osteocalcin (OCN) and type Ⅰ collagen (CoL-Ⅰ) were dramatically decreased under the simulated microgravity. Meanwhile, the NF-κB inhibitor α (IκB-α) protein level was decreased and the expressions of phosphorylation of IκB-α (p-IκB-α), p65 and phosphorylation of p65 (p-p65) were significantly up-regulated in SMG group. In addition, the IL-6 content in SMG group was increased compared to CON. These results indicated that simulated microgravity could activate the NF-κB pathway to regulate MC3T3-E1 cells differentiation.
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Animales , Ratones , Células 3T3 , Diferenciación Celular , FN-kappa B , Fisiología , Osteoblastos , Transducción de Señal , Simulación de IngravidezRESUMEN
Objective To investigate the effect of high body mass index (BMI) on perioperative complications under thoracoscope radical resection of lung cancer and its clinical efficacy.Methods A total of 235 patients who received pulmonary radical resection under thoracoscope between January 2012 and December 2017 in Department of Thoracic Surgery of the First Hospital of Lanzhou University were retrospectively analyzed.The patients were divided into normal BMI group (BMI≥ 18.5 kg/m2 and BMI ＜24.0 kg/m2,n =147) and high BMI group (BMI≥24.0 kg/m2,n =88) according to BMI in China.The incidence of postoperative complications and clinical efficacy were compared by using x2 test and t test.Logistic regression was used to identify that if high BMI was the independent risk factor of postoperative pulmonary infection in patients with lung cancer.Results The incidence of the complications in high BMI group was higher than that in normal BMI group,including pulmonary infection [17.0％ (15/88) vs.6.1％(9/147),x2 =7.162,P ＜ 0.05],pulmonary atelectasis [11.4％ (10/88) vs.3.4％ (5/147),x2 =5.840,P ＜ 0.05],respiratory failure [5.7％ (5/88) vs.0.1％ (1/147),x2 =5.535,P ＜ 0.05] and poor wound healing [10.2％ (9/88)vs.3.4％ (5/147),x2 =4.578,P ＜ 0.05].Postoperative recovery time [(7.1±1.4) d vs.(6.7±0.8) d,t =2.706,P ＜ 0.05],chest drainage tube removal time [(3.8±1.6) d vs.(3.4±0.7) d,t =3.089,P ＜ 0.05] in high BMI group were longer than those in normal BMI group.Multiple-factor analysis showed that the independent risk factors were diabetes,high blood pressure,high BMI,long operation time,old age,smoking history (all P ＜0.05).Conclusions The incidence of pulmonary infection,pulmonary atelectasis and poor wound healing for the patients with high BMI is increased.Besides,postoperative recovery time and chest drainage tube removal time are prolonged.High BMI is an independent risk factor of pulmonary infection.
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Objective To explore the feasibility of postoperative nutrition of cervical gastric fistula after radical resection of thoracic esophageal carcinoma.Methods 288 patients with esophageal carcinoma from January 2015 to December 2017 of thoracic surgery in the first hospital of Lanzhou University were analyzed,in which 133 patients underwent cervical gastric fistula,88 patients retained the nasal and enteral nutrition tube,and 67 patients underwent jejunum fistula.The postoperative complications were observed and analyzed.Results The cervical gastric fistula was significantly superior to the enteral nutrition catheter and jejunum fistula in the patients with pulmonary infection,stoma infection,oropharyngeal comfort and so on after thoracic and laparoscopic resection of esophageal carcinoma.Conclusion The high cervical gastric fistula is a safe and feasible nutritional support method for the patients with thoracic and laparoscopic resection of the posterior sternum and the radical resection of esophageal carcinoma.
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Objective To evaluate the relationship between the Trefoil factor 3 (TFF3) serum,concentration and gastrointestinal failure(GIF) and discuss eaely diagnosis,treatment and prognosis in patients with GIF after esophageal cancer surgery.Methods To test the TFF3 levels of the serum during the postoperation of esophageal cancer by ELISA.Results Serum TFF3 concentrations measured prior to the occurrence of GIF were significantly higher than in control group (P ＜ 0.01).serum TFF3 concentration was significantly related to gastrointestinal tract function score(r =-0.712).Cox proportional hazards model analysis showed that the serum TFF3 concentrations at the time of occurrence of gastrointestinal failure,and 48 hours later,could be used as prognostic factors in critically ill pediatric patients with GIF(r =1.443 and 1.872,respectively).Conclusion TFF3 may play an important role in predicting GIF in pediatric critical illness and has a protective function in the mucosal repair process.