Several suggestions on the classification management process and countermeasures of pulmonary surgery during the COVID-19 / 中华胸心血管外科杂志

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.

Diarrhea pathogens in rotavirus-negative infants in Hangzhou / 中华检验医学杂志

Objective To investigate the distribution of diarrhea pathogens in infants without rotavirus-detection in Hangzhou. Methods 605 stool samples of children with rotavirus-negative diarrhea were collected from Hangzhou First People's Hospital of Zhejiang University, Children's Hospital of Zhejiang University and Hangzhou Children's Hospital from March 2017 to June 2018. The routine test results were analyzed retrospectively and Bristol score was used for the characteristics of stool samples. DNA and/or RNA were extracted from fecal samples with DNA and RNA extraction kit. The extracted DNA and RNA-reversed cDNA were used as templates. 7 common pathogens DNA and/or RNA were amplified by polymerase chain reaction (PCR). The amplified products were detected by agarose gel electrophoresis. The positive rates of pathogens were analyzed by chi-square test. Results Among 605 children, 375 were male (28±11) months and 230 were female (29±10) months. Bristol score of stool samples was mainly in type 6 (496, 82％), followed by type 7 (85, 14％) and type 5 (24, 4％). Among 605 results 97 cases were occult blood positive (positive rate 16％) and 170 cases were white blood cell positive (positive rate 28％).452 of 605 stool samples were positive for pathogen target genes. The positive rate was 74.7％. 319 cases detected single pathogen gene fragments. 127 cases detected two pathogen genes and 6 cases detected three pathogen gene fragments. The positive rate of Clostridium difficile toxin B (48.9％, 296/605)was the highest than the others, followed by Salmonella (20.0％, 121/605) and Norovirus (10.9％, 66/605). The positive rate of Clostridium difficile toxin A was 1.0％ (6/605). The positive rates of pathogens in male and female children were 86.7％(325 / 375) and 86.5％ (199 / 230) respectively, with (χ2 =0.002, P=0.959). Conclusions Salmonella and Norovirus were the main pathogens in children with diarrhea who were negative for rotavirus detection in Hangzhou. The high positive rate of Clostridium difficile toxin B may be related to the colonization of Clostridium difficile in the gastrointestinal tract of infants rather than the pathogen of diarrhea because of the low positive rate of Clostridium difficile toxin A. There was no gender difference in the detection rate of diarrhea pathogens.

The clinical application of central venous catheter for thoracic closed drainage after esophagectomy / 中华胸心血管外科杂志

Objective To explore the safety and effectiveness of central venous catheter for thoracic drainage after esoph-agectomy.Methods We prospectively analyzed 95 patients who underwent esophagectomy for esophageal carcinoma in our de-partment from August 2016 to August 2017.Forty-six patients with central venous catheter drainage were observation group, and 49 patients with traditional chest-tube closed drainage were control group.Compared the differences of drainage amount, pain score, postoperative patient quality of life score, duration of drainage and chest tube incision healing between the two groups.Results There were no significant differences in daily drainage volume and patency of drainage tube between the two groups(P>0.05).Compared with the control group, the duration of thoracic drainage in the observation group was significant shorter, the pain intensity score was significant lower , and the emotional function of postoperative patient quality of life was sig-nificant better(P<0.01).There were more patients suffered uncomfortable symptoms, such as nausea, vomiting, pain, in-somnia in the control group(P<0.05).Conclusion The application of central venous catheter in thoracic drainage can de-crease the postoperative pain and improve the postoperative quality of life for esophageal carcinoma patients after esophagecto-my.It is safe and feasible for thoracic drainage after esophagectomy .

Surgical resection of stage Ⅲ and Ⅳa invasive thymoma after inductive chemoradiotherapy / 中华内分泌外科杂志

Objective To discuss the diagnosis and inductive chemoradiotherapy of stage Ⅲ and stage Ⅳa invasive thymoma.Methods Clinical data of 13 cases with incomplete resected invasive thymoma were analyzed retrospectively,among which 8 cases were in stage Ⅲ and 5 cases in stage Ⅳa.All the 13 cases had invasion of major vessels,pericardial and lung tissues,or had metastasis of pleura and pericardium.Each patient got pathological diagnosis by fine needle aspiration,video-assisted thoracoscopic biopsy or anterior mediastinal biopsy.After 3 cycles of NP or CAP inductive chemotherapy and synchronous radiotherapy,tumors shrank and got palliative or complete surgical resection.The Follow up ranged from 2.8 to 9 years.Results All the 13 cases were malignant thymoma,including 4 cases of type B2,6 cases of type B3 and 5 cases of type C.7 patients got radical resection and 2 got palliative resection.9 patients survived more than 3 years after operation,7 patients survived more than 5 years,one patient even lived 8 years,and the other 4 patients without getting surgery died in 4 years.Conclusion Inductive chemoradiotherapy could shrink stage Ⅲ and stage Ⅳa invasive thymoma,reduce clinical stage,improve the resection rate,and prolong survival.

Comparison of thoracoscopic esophagectomy and traditional esophagectomy in radical mediastinal lymphadenectomy for esophageal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare thoracoscopic esophagectomy with traditional esophagectomy in radical mediastinal lymphadenectomy for esophageal cancer, and to explore the feasibility and safety of thoracoscopic mediastinal lymphadenectomy for esophagectomy.</p><p><b>METHODS</b>Clinical data associated with perioperation and mediastinal lymph nodes clearance of 304 patients undergoing radical operation of esophageal cancer via left neck-right chest-upper abdomen in our department from June 2009 to June 2011 were analyzed retrospectively. Among 304 cases, 199 received traditional open radical resection and 105 thoracoscopic esophagectomy. The intrathoracic mediastinal lymph node metastasis rate, extent of metastasis, time of operation, blood loss and complications between two groups were compared.</p><p><b>RESULTS</b>All the 304 cases completed their operations successfully. A total of 3724 mediastinal lymph nodes were removed, mean 12.3±7.0 per case, including 1065 in thoracoscopic group, mean 10.1±5.5 per case, and 2659 in open group, mean 13.3±7.5 per case, whose difference was significant. But further analysis according to the postoperative pathologic staging showed no significant difference of above lymph nodes removed between two groups. Mediastinal lymph node metastasis was found in 126 patients with a rate of 41.4%, which was 35.6% and 44.7% in thoracoscopic and open groups respectively without significant difference(P>0.05). The left laryngeal recurrent nerve lymph node metastasis rate in open group and thoracoscopic group was 16.1% and 6.7% respectively, and the difference was significant(P<0.05). Differences of lymph node metastasis rate in other regions were not significant between the two groups. There were 365 positive lymph nodes, and the lymph node metastasis degree was 9.8%. which was 8.2% and 10.5% in thoracoscopic group and open group respectively(P<0.05), besides metastasis degree of open group was much higher in right laryngeal recurrent nerve and subcarinal lymph node region. The overall complication rate was 36.8%, which was 28.6% in thoracoscopic group and 41.2% in open group respectively with significant difference(P<0.05). There were no significant differences in operative time and blood loss between the two groups(both P>0.05).</p><p><b>CONCLUSION</b>Radical mediastinal lymphadenectomy with thoracoscopic esophagectomy is technically safe and feasible for early to moderate stage esophageal cancer with similar lymph nodes removed and lower complication morbidity. In the early period of carrying out thoracoscopic radical mediastinal lymphadenectomy, laryngeal recurrent nerve and subcarinal lymph node region should be identified to prevent incidental injury.</p>

Effects of retroperfusion on the levels of serum soluble inetr cellular adhesion molecule-1,soluble P-selectin and cardiac troponin Ⅰin patients of cardiac operation under direct vision / 中国医师进修杂志

Objective To investigate the effects of retrograde cardioplegia on serum soluble inter cellular adhesion molecule (sICAM)-1,soluble P-selectin (sPs) and cardiac troponin Ⅰ(cTnI) in the process of heart valve replacement operation.Methods Fifty-six cases undergoing heart valve replacement with cardiopulmonary bypass (CPB) were divided into antegrade cardioplegia (AC) group and retrograde cardioplegia (RC) group.Serum levels of sICAM-1,sPs and cTnI were measured using enzyme-linked immunosorbent assayd (ELISA) at six times.Results After the CPB,the levels of sICAM-1,sPs and cTnI ascended quickly,at the time of 8-hour after operation achieved the peak value.The peak value of RC group were lower than those of AC group[sICAM-1 (817.9±133.2)μg/L vs(901.1±132.0)μg/L,sPs(83.46±16.24)μg/L vs(107.82±19.68) μg/L,cTnI(10.50±2.03) μg/L vs (14.45±2.26)μg/L],and the dedined degree of RC group were faster than those of AC group.Conclusion Retroperfusion has a better myocardial protection to the patients suffering heart valve replacement operation through active suppressed expression of sICAM-1,sPs and cTnI palliated inflammatory reaction.

Surgical treatment for lung cancer in the elderly / 中国肺癌杂志

<p><b>BACKGROUND</b>The prevalence of lung cancer in the elder increases gradually recently, and lung cancer has become the main cause of cancer-related death. The aim of this study is to analyse the operative indication, complication, perioperative management and surgical measures, results and specificity for lung cancer in the elderly patients.</p><p><b>METHODS</b>One hundred and thirty-seven elderly patients with lung can-cer, aged from 70 to 83 years old with mean age of 74 were analysed. Of the 137 cases, 13 patients were in the stage I, 76 in stage II, 48 in stage III. Surgical procedures included pneumonectomy for 4 patients, lobectomy for 122 patients, segmentectomy and wedge resection for 7 patients, sleeve lobectomy for 19 patients, bronchoplastic procedure and pulmonary artery reconstruction for 2 patients. Video-assisted thoracic surgery was performed in 13 cases for segmentectomy and wedge excision</p><p><b>RESULTS</b>There was no operative death. The resection rate was 97.1%, and postoperative complication rate was 29.9%. The follow-up rate was 88.3% . The 1-, 2-, 3-year survival rate was 62%, 35%, 28% respectively.</p><p><b>CONCLUSIONS</b>Elderly patients with lung cancer can obtain good therapeutic results and prognosis undergoing surgical therapy, but the operative indications will be limited. Exquisite surgical technique and application of respirator after operation may expand the operative indications.</p>

A preliminary study of antineoplastic effects of Anticancer Ketonon on lung cancer in mice / 中国肺癌杂志

<p><b>BACKGROUND</b>It has been proved that Tanshinone has obvious anticancer effect, but its mechanisms of anticancer are still unknown. Anticancer Ketonon is complex antitumor drug which Tanshinone is combined with other anticancer elements. This study aims to explore the antineoplastic effects of Anticancer Ketonon on Lewis lung cancer and the mechanisms in mice.</p><p><b>METHODS</b>The mice were divided into three groups: Ketonon group, 5-fluorouracil (5-Fu) group and control group. The former two groups were treated with responsive drugs after subcutaneous inoculation of Lewis lung cancer. The last group was only treated with normal saline after inoculation. Apoptosis index and cell cycle were measured by flow cytometry.</p><p><b>RESULTS</b>Two experiments were carried out in male and female mice respectively. The tumor inhibitory rates of Anticancer Ketonon were 38.9% and 32.2% respectively, those of 5-FU were 59.6% and 53.9%. Compared with those of control groups, the tumor weights in Ketonon group and 5-Fu group were statistically decreased (P < 0.05). Metastasis rates of the lung in the three groups were not statistically different (P > 0.05). The apoptosis index of Ketonon group was significantly higher than that of control group (P < 0.05), but the cell cycle was not statistically changed compared with that of control group (P > 0.05).</p><p><b>CONCLUSIONS</b>Anticancer Ketonon has antineoplastic effect on Lewis lung cancer in mice and the mechanism may be associated with inducing apoptosis of tumor cells.</p>

Study on the growth-inhibiting effect of anticancer ketonon on lung cancer cell line and its mechanism / 中国肺癌杂志

<p><b>BACKGROUND</b>To observe the growth-inhibiting effect of anticancer ketonon on A549 cell line and PLA-801D cell line and to explore its mechanism based on the antineoplastic effects of Tanshinon.</p><p><b>METHODS</b>A549 and PLA-801D cell lines were treated with anticancer ketonon by techniques of cell culture in vitro . The growth curves and dose-effect curves were drawn up. The ability of clone formation was determined. It was observed and analysed by light microscopy and flow cytometry.</p><p><b>RESULTS</b>The growth of A549 and PLA 801D cell lines was evidently inhibited. Ability of clone formation was inhibited. The apoptosis index of cells was increased after treated with anticancer ketonon and the cell cycle was blocked at G0/G1 phase.</p><p><b>CONCLUSIONS</b>Anticancer ketonon can significantly inhibit the growth of human lung cancer cells probably through inducing the apoptosis of cancer cells.</p>

The growth-inhibiting effect and its molecular mechanism of Tanshinone on human lung cancer cell line in vitro / 中国肺癌杂志

<p><b>BACKGROUND</b>To study the growth-inhibiting effect and its molecular mechanism of Tanshinone on human lung carcinoma cell line.</p><p><b>METHODS</b>Human lung adenocarcinoma cell line (SPC-A-1) was treated in vitro with 0.5μg/ml Tanshinone IIA for five days, and the cells treated with all trans retinoic acid (RA) and DDP as control. Changes in cell morphology, proliferation dynamics, cell cycle distribution and tumor-related gene expression were detected.</p><p><b>RESULTS</b>The cell growth and rate of clone formation of SPC-A-1 cells were markedly inhibited in Tanshinone group than RA group. Flow cytometry demonstrated that S phase cells decreased and G₀/G₁ phase cells increased in Tanshinone group. Expression of p53, p21 was up-regulated obviously but CDKN₂ was down-regulated markedly by Tanshinone IIA.</p><p><b>CONCLUSIONS</b>Tanshinone IIA can inhibit cell growth and clone formation in human lung cancer cell line (SPC-A-1) and its possible molecular mechanism may be inhibiting DNA synthesis by up-regulating p53, p21 and down-regulating CDKN₂.</p>

Apoptosis-inducing effect of Tanshinone and its molecular mechanism on human lung cancer cells / 中国肺癌杂志

<p><b>BACKGROUND</b>To study the apoptosis-inducing effect of Tanshinone and its molecular mechanism on human lung cancer cells.</p><p><b>METHODS</b>Human lung cancer cell line (SPC-A-1) was treated in vitro with 0.5 mg/L Tanshinone IIA for five days, and the cells treated with all trans retinoic acid (RA) or DDP as controls. Changes in cell morphology, apoptotic index and apoptosis related gene expression were detected by electron microscope, FCM and DNA-end-labeling.</p><p><b>RESULTS</b>Many apoptotic cells were observed by light and electron microscopes. FCM examination showed that apoptotic index in Tanshinone group was much higher than that of DDP and control groups, but no difference was found statistically compared with RA group. The expression of p53, Fas and Bax genes in Tanshinone group was up-regulated markedly, but Bcl-2 was obviously down-regulated.</p><p><b>CONCLUSIONS</b>Tanshinone IIA can induce apoptosis in human lung cancer cell line (SPC-A-1) . Up-regulating expression of p53, Bax, Fas and down-regulating Bcl-2 expression might be its molecular mechanisms.</p>