Selective mediastinal lymph node dissection: Precision surgery in the era of precision medicine / 中国胸心血管外科临床杂志

@#Along with the popularity of low-dose computed tomography lung cancer screening, an increasing number of early-stage lung cancers are detected. Radical lobectomy with systematic nodal dissection (SND) remains the standard-of-care for operable lung cancer patients. However, whether SND should be performed on non-metastatic lymph nodes remains controversy. Unnecessary lymph node dissection can increase the difficulty of surgery while also causing additional surgical damage. In addition, non-metastatic lymph nodes have been recently reported to play a key role in immunotherapy. How to reduce the surgical damage of mediastinal lymph node dissection for early-stage lung cancer patients is pivotal for modern concept of "minimally invasive surgery for lung cancer 3.0". The selective mediastinal lymph node dissection strategy aims to dissect lymph nodes with tumor metastasis while preserving normal mediastinal lymph nodes. Previous studies have shown that combination of specific tumor segment site, radiology and intraoperative frozen pathology characteristics can accurately predict the pattern of mediastinal lymph node metastasis. The personalized selective mediastinal lymph node dissection strategy formed from this has been successfully validated in a recent prospective clinical trial, providing an important basis for early-stage lung cancer patients to receive more personalized selective lymph node dissection with "precision surgery" strategies.

Chinese expert consensus on multidisciplinary minimally invasive diagnosis and treatment of pulmonary nodules / 中国胸心血管外科临床杂志

@#With the widespread application of high-resolution and low-dose computed tomography (CT), especially the increasing number of people participating in lung cancer screening projects or health examinations, the detection of pulmonary nodules is increasing. At present, the relevant guidelines for pulmonary nodules focus on how to follow up and diagnose, but the treatment is vague. And the guidelines of European and American countries are not suitable for East Asia. In order to standardize the diagnosis and treatment of pulmonary nodules and address the issue of disconnection between existing guidelines and clinical practice, the Lung Cancer Medical Education Committee of the Chinese Medicine Education Association has organized domestic multidisciplinary experts, based on literature published by experts from East Asia, and referring to international guidelines or consensus, the "Chinese expert consensus on multi-disciplinary minimally invasive diagnosis and treatment of plmonary nodules" has been formed through repeated consultations and thorough discussions. The main content includes epidemiology, natural course, malignancy probability, follow-up strategies, imaging diagnosis, pathological biopsy, surgical resection, thermal ablation, and postoperative management of pulmonary nodules.

The best surgical treatment strategy for esophageal cancer based on clinical trials / 中华消化外科杂志

Curative esophagectomy and radical lymphadenectomy are the keys to reducing postoperative recurrence and metastasis, improving long-term survival of patient. With the impro-vement of surgical techniques, open, minimally invasive and robotic esophagectomy could be performed safely. For middle and lower esophageal squamous cell carcinoma, radical thoracic-abdominal two-field lymphadenectomy in the upper mediastinum is needed. However, multidisciplinary treatment involving surgery, radiotherapy and chemotherapy is necessary for locally advanced esophageal cancer. Based on the clinical trials for esophageal adenocarcinoma, scholars from European and American believe that compared to surgery alone, neoadjuvant radiotherapy and chemotherapy can improve the survival of patients. According to the results of JCOG1109 research, scholars from Japan suggest that the DCF protocol (docetaxel, cisplatin and 5-fluorouracil) could be the standard as neoadjuvant chemotherapy for esophageal squamous cell carcinoma. Regarding to postoperative adjuvant therapy, immunotherapy can improve survival for those with residual disease after neo-adjuvant chemoradiotherapy. For neoadjuvant therapy, the safety and efficacy of immunotherapy have also been proved. The authors review the clinical trials referring to surgical treatment including surgical approaches, extent of lymphadenectomy and multidisciplinary treatment, aiming to offer indications for the future best surgical treatment strategy for esophageal cancer.

Personalized treatment strategy for ground-glass opacity-featured lung cancer / 中国胸心血管外科临床杂志

@#Along with the popularity of low-dose computed tomography lung cancer screening, an increasing number of lung ground-glass opacity (GGO) lesions are detected. The pathology of GGO could be benign, but persistent GGO indicates early-stage lung cancer. Distinct from traditional lung cancer, GGO-featured lung cancer is more common in the young, nonsmokers and females. GGO-featured lung cancer represents an indolent type of malignancy with a long time to intervene. However, there is still no consensus on the screening, pathology, surgical procedure, and postoperative surveillance of GGO-featured lung cancer. Therefore, we proposed a personalized treatment strategy for GGO-featured lung cancer. The screening for GGO-featured lung cancer should be conducted at young age and low frequency. Adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic, and non-lepidic growth patterns could present as GGO. The following issues should be taken into consideration while determining the treatment of GGO-featured lung cancer: avoiding treating benign disease as malignancies, avoiding treating early-stage disease as advanced-stage disease, avoiding treating indolent malignancy as aggressive malignancy, and choosing appropriate timing to receive surgery without affecting life tracks and career developments. Bronchoscope and bone scan are not necessary for preoperative examinations of GGO-featured lung adenocarcinoma. For selected patients, sublobar resection without mediastinal lymph node dissection might be sufficient. Intraoperative frozen section is an effective method to guide resection strategy. Given the excellent survival of GGO-featured lung cancer, a less intensive postoperative surveillance strategy may be sufficient.

Over- and under-treatment of lung cancer / 中国胸心血管外科临床杂志

@#With the development and improved availability of low-dose computed tomography (LDCT), an increasing number of patients are clinically diagnosed with lung cancer manifesting as ground-glass nodules. Although radical surgery is currently the mainstay of treatment for patients with early-stage lung cancer, traditional anatomic lobectomy and mediastinal lymph node dissection (MLND) are not ideal for every patient. Clinically, it is critical to adopt an appropriate approach to pulmonary lobectomy, determine whether it is necessary to perform MLND, establish standard criteria to define the scope of lymph node dissection, and optimize the decision-making process. Thereby avoiding over- and under-treatment of lung cancer with surgical intervention and achieving optimal results from clinical diagnosis and treatment are important issues before us.

Clinicopathologic analysis of primary pulmonary myxoid sarcoma with EWSR1 translocation / 中国癌症杂志

Background and purpose: Primary pulmonary myxoid sarcoma (PPMS) is a very rare lung tumor that has recently been shown to harbor EWSR1-CREB1 translocation. This study aimed to investigate the clinicopatho-logical characteristics and differential diagnosis of PPMS. Methods: The clinical and pathological features of 6 cases of PPMS with EWSR1 gene rearrangement were reviewed. Immunohistochemistry and fluorescence in situ hybridization (FISH) study were performed. Results: Six patients were enrolled in this study, including 4 male patients and 2 female patients with an age range of 23 to 64 years (median age, 44 years). All tumors involved pulmonary parenchyma, with a predominant endobronchial component in 1 and adjacent to bronchus in 5 patients. Microscopically, the tumor was lobulated and composed of cords of polygonal, spindle cells within myxoid stroma. Tumors were immunoreactive for only Vimentin and weakly focal for epithelial membrane antigen (EMA). All tumors were shown to harbor EWSR1 gene rearrangement by FISH. Follow-up of all patients showed that 1 patient developed a pleura and bone metastasis but was still alive and 5 were disease-free after 4-29 months. Conclusion: PPMS is an extremely rare sarcoma with low-grade malignant potential. This is characterized by distinct histological features and EWSR1 gene rearrangement. It is important that understanding tumor spectrum and genetic feature can contribute to diagnosis and differential diagnosis of PPMS.

Shanghai community-based practice of early lung cancer screening with low-dose spiral computed tomography / 中国癌症杂志

Background and purpose:As one of the most fatal malignant tumors in China, the morbidity and mortality of lung cancer remain high. Early diagnosis and normative treatment is the key to improve the prognosis of lung cancer. The aim of this study was to explore the practice of early lung cancer screening with low-dose spiral computed tomography (CT) based on the current situation in community health service, with integration of superior resources of med-ical institutions at all levels in Shanghai.Methods:From Aug. 2013 to Aug. 2014, we screened high-risk population in selected communities of Minhang District, Shanghai, for early diagnosis of lung cancer with low-dose spiral CT combined with multidisciplinary comprehensive treatment models including minimally invasive surgery, exploring the medical service network covering prevention, diagnosis, treatment, rehabilitation and follow-up.Results:Screening population is 11 332 (male 7 144, female 4 188); Twenty-nine cases with pathological diagnosis of malignant tumor, including 27 cases of pri-mary lung cancer, 1 case of lung metastasis, 1 case of breast cancer. The morbidity of primary lung cancer is 238.26×10-5. There were 22 cases of Stage 0-Ⅰ lung cancer accounting for 81.48% of all diagnosed primary lung cancer.Conclusion:Based on community health service, screening with low-dose spiral CT could improve the early diagnosis rate of lung can-cer with feasibility and validity, which could be applicable in qualified eligible medical center and community in China.

A comprehensive study on histological features of fusion-positive lung adenocarcinomas and their association with psammoma bodies / 中国癌症杂志

Background and purpose:Gene fusions have been identiifed as recurrent oncogenic events in lung adenocarcinoma. Our purpose are to study the histologic features of anaplastic lymphoma kinase (ALK), c-ros oncogene 1 receptor tyrosine kinase (ROS1) andRETproto-oncogene fusion-positive lung adenocarcinomas and to evaluate the correlation between psammoma bodies and fusion-positive lung adenocarcinomas.Methods:In this study, we performed a comprehensive histologic analysis of 44 fusion-positive (including 15RET, 20ALK and 9ROS1) lung adenocarcinomas and 111 fusion-negative [including 20 epidermal growth factor receptor (EGFR), 20 Kirsten rat sarcoma viral oncogene (K-ras), 71 pan-negative] lung adenocarcinomas.Results:ALK,RET andROS1 fusion-positive lung adenocarcinomas were more prevalent in solid or acinar predominant adenocarcinoma. Multivariate analysis showed that tumors harboring a fusion gene had significantly higher prevalence of the presence of signet ring cells (P=0.000), micropapillary component (P=0.044), mucinous cribriform pattern (P=0.000) and extracellular mucin (P=0.010). The incidence of psammoma bodies was higher in the lung adenocarcinomas with a gene fusion than in tumors without gene fusions (P=0.000). Psammoma bodies were more likely to be found in tumors with any micropapillary component and/or mucinous cribriform pattern than in tumors lacking a micropapillary component and/or mucinous cribriform pattern (P=0.000).Conclusion:Our data showed that the presence of psammoma bodies, micropapillary component, mucinous cribriform pattern, extracellular mucin or signet ring cells may be either sensitive or speciifc to predict tumors harboring a fusion gene. These distinct morphologic features may be helpful in selecting cases for further accurate molecular testing.

Electromagnetic navigation bronchoscopy for the diagnosis and treatment of respiratory disease:current and future perspective / 中国癌症杂志

Bronchoscopy is a minimally invasive method for obtaining peripheral pulmonary lesions (PPL). Traditional bronchoscopy-guided transbronchial lung biopsy (TBLB) is performed under X-ray guidance, and diagnostic rate is relatively low. A new, real-time electromagnetic navigation bronchoscopy (ENB) is a minimally invasive diagnostic technique which appeared in recent years. Studies suggest ENB is a feasible and safe method for diagnosis of PPL which shows higher diagnostic yields than traditional TBLB, and its potential application in localization and treatment of PPL. This article reviews the clinical application of the technique.

Discussion on the strategies of common hepatic artery lymph node dissection for thoracic esophageal squamous cell carcinoma / 中华消化外科杂志

Objective To analyze the metastatic rule of common hepatic artery lymph node of thoracic esophageal squamous cell carcinoma,and to investigate the strategies of common hepatic artery lymph node dissection.Methods The clinical data of 682 patients with esophageal squamous cell carcinoma who were admitted to the Cancer Hospital of Fudan University from May 2005 to December 2010 were retrospectively analyzed.The locoregional lymph node metastasis of thoracic esophageal squamous cell carcinoma,relationship between metastatic rates of common hepatic artery lymph node and clinicopathological factors and the postoperative complications were analyzed.The enumeration data were analyzed using the chi-square test.Results A total of 18 277 lymph nodes were dissected (27 lymph nodes per patient).The lymph node metastatic rate was 55.87％ (381/682),and the metastatic lymph node ratio was 7.87％ (1438/18 277).Lymph nodes adjacent to the cardia of stomach,laryngeal nerve,lesser curvature of stomach,cervical esophagus,left gastric artery had a higher metastatic rate,while common hepatic artery lymph node had a lower metastatic rate.All the common hepatic artery lymph node metastasis was accompanied with locoregional metastasis.A total of 1480 common hepatic artery lymph nodes were dissected (2 common hepatic artery lymph nodes per patient).Twenty-four patients had common hepatic artery lymph node metastasis,with the metastatic rate of 3.52％ (24/682) and the lymph node ratio of 2.16％ (32/1480).The common hepatic artery lymph node metastatic rates of upper,middle and lower esophageal squamous cell carcinoma were 2.33％ (1/43),3.76％ (16/425) and 3.27％ (7/217),with no significant difference (x2 =0.295,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients in T1,T2 and T3 stages were 2.35％ (2/85),5.46％ (10/183) and 2.90％ (12/414),with no significant difference (x2 =2.850,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with high,moderate and poor differentiated esophageal squamous cell carcinoma were 0(0/63),3.50％ (16/457) and 4.94％ (8/162),with no significant difference (x2=3.259,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with diameter of tumor under 3 cm,3-5 cm and above 5 cm were 2.59％ (6/232),3.02％ (11/364) and 8.14％ (7/86),with significant difference (x2 =6.267,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in N0,N1,N2,N3 stages were 0(0/301),2.53％ (5/198),5.65％ (7/124) and 20.34％ (12/56),with significant difference (x2 =62.368,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 0(0/62),1.78％ (6/337),5.06％ (13/257) and 19.23％ (5/26),with significant difference (x2=25.959,P ＜0.05).Two hundred and twenty-eight patients had postoperative complications with the complication rate of 33.43％ (228/682).The incidence of anastomotic fistula was the highest,which was 11.58％(79/682).Conclusions The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is the lowest.For patients suffered from esophageal cancer in stage I or the tumor diameter under 5 cm,the dissection of common hepatic lymph node can be ommitted in surgery.

The diagnosis value of CT guidance Hookwire positioning thoracoscopic surgery for solitary pulmonary nodule / 中国癌症杂志

Background and purpose:Lung cancer is currently the greatest threat to human life and health of the malignant tumor, clinical examination revealed a solitary pulmonary nodules (SPN), including a signiifcant portion of early stage lung cancer. The research aimed to discuss the diagnosis value of CT guidance Hookwire positioning thoracoscopic surgery for solitary pulmonary nodule. Methods:From Jul. 2011 to Jun. 2013, 310 SPN patients in the Department of Thoracic Surgery of Fudan University Shanghai Cancer Center were collected. Hookwire positioning pins were retained guided by CT scan into the patients’ body. Video assisted thoracic surgery (VATS) pulmonary wedge resection was adopted. According to the result of intraoperative frozen pathology, further treatment method was decided. Positioning accuracy, complications, VATS lung wedge resection surgery successful rate, transfer rate in the chest and SPN pathological classiifcation and other indicators were calculated with statistical methods. Results:Hookwire positioning successful rate was 100%, meanwhile, 2 patients with hemoptysis received symptomatic treatment.Intraoperative Hookwire fell off in 12 patients (3.87%), VATS wedge resection surgery successful rate was 99%, transit thoracotomy was carried out in 3 patients. SPN postoperative histological pathology results:237 cases with primary lung cancer, 73 cases with benign lesions. Conclusion:The method of CT guided Hookwire thoracoscopic surgery after positioning in treatment of SPN has higher diagnostic accuracy rate, reliable curative effect, fewer complications and great value in clinical promotion.

Endoscopic resection using the new duette multiband mucosectomy kit for esophageal disease / 中国癌症杂志

Background and purpose:Endoscopic treatment is a promising therapeutic option for superifcial lesions throughout the gastrointestinal tract, this study was aimed to evaluate the efficacy of endoscopic resection (ER) using the new Duette multiband mucosectomy kit (DT-6) on treating esophageal disease. Methods:Since Jun. 2011, ER using DT-6 has been performed on 100 patients in a tertiary medical center. Data from those who have been followed up for over 6 months was analyzed. ER and esophagectomy were compared on treating high grade dysplasia (HGD) lesions and early esophageal cancer. Results:From Jun. 2011 to Jan. 2012, a total of 32 patients with esophageal lesions underwent 34 ER using DT-6 (22 male and 10 female, mean age 59.0 years, range 25 to 83 years). There were (3.4±1.0) specimen resected per operation, and the average greatest diameter was (11.8±2.7)mm. Intraoperative blood loss was (5.45±1.47)mL. The median follow-up period was 8.2 months with a 100%half-year-follow-up rate. Except one pneumothorax occurred during one endoscopic submucosal dissection (ESD), no other complications happened. When Comparing ER and esophagectomy on treating HGD and early esophageal cancer, ER showed advantages in terms of operation time, intraoperative blood loss, hospital stay and complications. Conclusion:ER using DT-6 is safe, simple, minimally invasive and effective for esophageal disease. Prospective study and long follow-up are needed to compare endoscopic resection and esophagectomy for HGD and early esophagus cancer.

Totally minimally invasive Ivor-Lewis esophagectomy with manual pursestring and per-thoracic port placement of anvil in patients with thoracic esophageal cancer / 中华胸心血管外科杂志

Objective Totally MIIE with per-oral placement of anvil has been reported elsewhere,but MIIE with manual pursestring and per-thoracic port placement of anvil has been seldomly reported.The feasibility of the latter technique was proved in this study.Methods Patients with mid-lower thoracic esophageal cancer were prospectively treated with totally MIIE at Shanghai Cancer Center of Fudan University from Feberay 28,2013 to August 31,2013.Laproscopic intracorporeal construction of the gastric conduit and needle catheter J-tube were performed in the first stage of MIIE.In the second stage a hand sewn pursestring was made with endostitch system and the anvil of EEA stapler was inserted via the tenth inter costal port prior to the intrathoracic anastamosis.Short-term clinicopathologic outcomes were collected.Results 39 cases were treated with totally MIIE,media age 61 years,ranged 48-69 years,10 females and 29 males.There was 1 conversion to open surgery.The median duration of operation was 245 minutes.The median intraoperative blood loss was 210 ml.All the patients were margin negative and staged from pT1N0M0 to pT3N2M0.The average lymph node yields were 16.5 per patient.The median postoperative hospital stay was 7 days.There was no mortality.Perioperative morbidity occurred in 4 patients (10％).2 patients were complicated with late stage gastric paralysis which began 2 or 3 days after oral feeding and both recovered in 1 month.1 patient was with minor anastamotic leakage which was endoscopically demonstrated on the 14th day postoperatively and the patient recovered in 1 month post leakage.1 patient was complicated with severe pneumonitus and ARDS; the ICU stay of that case was 19 days and the recovered patient was discharged 27 days postoperatively.Conclusion MIIE with regular EEA stapler and intrathoracic anastamosis is feasible in patients with thoracic esophageal cancer.Prospective randomized clinical trials could be conducted to compare the open procedure and totally MIIE with regular EEA stapler.

Initial experience on endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and staging of lung cancer / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>It has been proven that endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was a new minimally invasive method in the diagnosis for mediastinal lymph nodes. The aim of this study is to evaluate the diagnostic and staging yield of EBUS-TBNA for lung cancer.</p><p><b>METHODS</b>Seventy-five patients with tumors and enlarged mediastinal lymph nodes found by CT underwent the diagnosis by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) from April 1, 2009 to Febuary 8, 2010. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were evaluated.</p><p><b>RESULTS</b>Seventy-five patients with 177 lymph node groups (2.4 groups in average) were studied. Histopathological samples were found in 49.33% patients and in 28.81% groups. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA for diagnostic were 98.43%, 100.00%, 100.00%, 91.67% and 98.66%, respectively, in per patient analysis and were 95.10%, 100%, 100.00%, 82.93%, and 96.05%, respectively, in per group analysis, higher than CT examination (P < 0.05) expect for sensitivity (P = 0.435). Staging changed in 19 (26.03%) patients after EBUS-TBNA.</p><p><b>CONCLUSION</b>EBUS-TBNA proved to be a safe procedure with a high yield for the diagnosis of lung cancer.</p>

The effects of up-regulation of nuclear Clusterin gene on the biological behaviors of A549 cells / 肿瘤

Objective:To observe the up-regulation of nuclear Clusterin (nCLU)gene on the biological behaviors of human non-small cell lung cancer cell line A549 .Methods:Sense eukaryotic expression vector of nCLU was constructed by cloning the cDNA of nCLU into pIREShyg3 vector. A549 cells were transfected with pIRES-nCLU and pIREShyg3 vectors by lipofectAMINE~(TM) 2000 mediation, respectively. Stable transfected cells were selected by hygromycin B screening. CCK-8 assay was performed to evaluate the effect of nCLU over-expression on cell proliferation in vitro. The expression level of nGLU protein was examined by Western blotting. Cell cycle distribution was detected by FCM with PI staining. The alteration of migration and metastasis potential of A549 cells before and after nCLU gene transfection were assayed by cell chemotactic migration and invasion test. Results:The proliferation speed of the transfected A549 cell clones stably over-expressing nCLU was slowed down. FCM analyses revealed that the percentage of cells in G_0/G_1 phase dramatically increased from (33.54±2.10)% to (63.31±4.30)%. The cell chemotactic migration and invasion potentials were markedly reduced after nCLU gene transfection (P<0.05). Conclusion:Up-regulation of nCLU can greatly inhibited the proliferation and decreased the migration and invasion capabilities of A549 cells.

CT-guided localization with a Hook-wire system for nodular pulmonary lesions before video-assisted thoracoscopic resection / 中华放射学杂志

Objective To evaluate the feasibility,safety and clinical value of CT-guided localization with a Hook-wire system for nodular pulmonary lesions before video-assisted thoracoscopic resection (VATS). Methods The records of all patients undergoing VATS resection for solitary pulmonary nodules preoperatively localized by CT-guided a Hook-wire system were assessed with respect to failure to localize the lesion by the Hook-wire system, conversion thoracotomy rate, duration of operation, postoperative complications, and histology of nodular pulmonary lesions. Results Sixty-eight patients with seventy four nodules underwent VATS resections. Preoperative CT-guided Hook-wire localization succeeded in all patients ( 100. 0% ). Conversion thoracotomy was necessary in 2 patients. The average operative time was ( 15 ±6)min. Asymptomatic complication rate was 70.6% (48/68), asymptomatic pneumothorax rate, asymptomatic hemorrhage rate and simultaneous pneumothorax and bleeding rate were 45.6% (31/68),25.0% ( 17/68 ) and 4. 4% ( 3/68 ), respectively. The mean hospitalization was ( 15 ± 6 ) days.Histological assessment revealed primary lung cancer (NSCLC) in 30, metastasis in 18, and nonmalignant disease in 26 nodules. Conclusions Video-assisted thoracoscopic resection of nodular pulmonary lesions previously localized by a CT-guided Hook-wire system is related to a low conversion thoracotomy rate, short operation time, and high safety. It for differential diagnosis and treatment.

The status of diagnosis and treatment on invasive fungal pulmonary infections / 中华临床感染病杂志

Objective To review the status of diagnosis and treatment for invasive fungal pulmonary infections(IFPI)in Lishui Central Hospital.Methods The clinical data of 79 patients with IFPI were retrospectively analyzed.Results The diagnostic status could be classified ills follows:6 eases had confirmed diagnosis,30 had clinical diagnosis,35 had suspected diagnosis and 8 misdiagnosed.The treatments were all effeetive in 6 COnfirmed cases;in 30 clinically diagnosed cases,6 were eriective.21 were inefiective and 3 died;in 35 suspected cases.3 were effective.25 were iHefieetive and 7 cflses did not receive antifungal treatment.Aspergillus and Cryptococcus pulmonary infections were predominant in confirmed cases.and the antifungal treatment lasted for 3 to 6 months.Conclusion Diagnosis and treatment for IFPI need to be improved.

Lung cancer in young patients aged from 15 to 44 years:incidence trend, current status and survival analysis from 2002 to 2005 / 肿瘤

Objective:To analyze the incidence trend, current status and survival period of young patients with lung cancer aged from 15 to 44 years in Shanghai between 2002 to 2005. Methods:All the data were collected from the database of registration and ma-nagement system of diagnosed cancer cases in Shanghai city organized by Shanghai Municipal Center for Disease Control & Prevention. The incidence trend was analyzed by using APC(annual percent change)model. The survival period and median survival time were calculated by using SPSS 12.0 software and life table method. The univariate and multivariate analyses were analyzed by using Kaplan-Meier and COX regression model, respectively.Results:A total of 972 young patients with lung cancer who aged from 15 to 44 years were diagnosed in Shanghai between 2002 and 2005, accounting for 3.09% of the whole percentage of adenocarcinoma in young patients was higher than that in whole lung cancer population at the same period, while the TNM stage was not significantly different between male and female young patients. Multivariate analysis demonstrated that gender, pathological classification and TNM stage were independent prognostic factors for young patients with lung cancer. Conclusion:The lung cancer had different characteristics in young patients compared with that in whole lung cancer population in Shanghai city. It was necessary to further investigate the biologic behavior of lung cancer in young patients.

Initial experience on endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA) in the dignosis for mediastinal lymph nodes / 中国癌症杂志

Background and purpose: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new minimally invasive method in the dignosis for mediastinal lymph nodes. This study was to evaluate the diagnostic yield of EBUS-TBNA for mediastinal lymph nodes. Methods: Twenty patients with mediastinal lymph nodes found by CT underwent the dignosis by EBUS-TBNA form April 1st 2009 to July 16th 2009. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were evaluated. Results: Twenty patients with 37 lymph node groups were studied. Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EBUS-TBNA for diagnostic were 84.62%, 100%, 100%, 77.78% and 90.00%, respectively. The diagnostic accuracy for cancer was 100%. The operation time was 11.9min per group in average with no serious complication. The median length of hospital stay was 1 (range from 1 to 17 days) day after operation. There were significant differences in the average operation time between the first three patients and the others (36.25 min vs. 7.76 min; z=3.247, P=0.001). Conclusion: Endobronchial ultrasound-guided transbronchial needle aspiration proved to be a safe procedure with a high yield for the diagnosis of mediastinal lymph nodes.

Laparoscopic and Thoracoscopic Ivor Lewis Esophagectomy / 中国微创外科杂志

Objective To explore the feasibility and short-term efficacy of combined use of laparoscopic and thoracoscopic Ivor Lewis esophagectomy for the treatment of esophageal carcinoma.Methods A case of esophageal carcinoma was treated in our hospital in December 2007.Five trocars were used via laparoscopy to free the stomach and create a tube-like stomach.Afterwards,thoracoscopy was carried out via 4 trocars to remove the lesion and open the diaphragm,and then the tube-like stomach was pulled into the chest cavity and anastomosed to the chest wall.Results The operation time was 330 min,and the intraoperative blood loss was 200 ml.The lesion was removed completely with negative cutting edges.Postoperative pathological examination showed squamous cell carcinoma(stage T2N0M0).Follow-up was available for 3 months,during which no recurrence was found.Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy is feasible and safe for the treatment of esophageal carcinoma.