Chinese expert consensus on diagnosis, treatment and prevention of venous thrombus embolism associated with chest trauma (2022 version) / 中华创伤杂志

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

Clinical analysis of 31 lung metastases patients by percutaneous thermal ablation in a single center / 中国胸心血管外科临床杂志

@#Objective    To explore the factors that affect the accuracy of percutaneous thermal ablation of lung metastases and coping strategies. Methods    We retrospectively analyzed the clinical data of 31 patients who met the conditions for thermal ablation of lung metastases in Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine between October 2019 and December 2020. There were 19 males and 12 females with a mean age of 40-81 (62.8±10.3) years. A total of 33 metastases tumors were thermally ablated, 12 were radiofrequency ablation and 19 were microwave ablation. Results    Of the 33 metastatic tumors, 5 targets showed significant puncture deviation, 4 of them completed the ablation after adjustment and 1 failed. The result of the univariate logistic regression showed the distance within the lung parenchyma (P=0.043) and the maximum diameter of the tumor (P=0.025) were independent risk factors for the accuracy of percutaneous thermal ablation. In terms of correlation, there was a positive correlation between the accuracy of percutaneous thermal ablation and the distance within the lung parenchyma (P=0.033), and a negative correlation between the maximum diameter of metastases tumor (P=0.004) and hemoptysis (P=0.015). Complete ablation rate was 87.8% (29/33). Conclusion    When we perform CT-guided percutaneous thermal ablation of lung metastases, we must fully prepare the deviation plan for the small diameter tumor, the long travel distance in the lung parenchyma, and hemoptysis during puncture. Complete ablation can be achieved by fully identifying the anatomical features of the tumor and its surrounding structures, shortening the travel distance in the lung parenchyma and increasing the ablation range.

Surgical design and novel modified Nuss procedure for pectus excavatum / 中国胸心血管外科临床杂志

@#Objective    To explore the surgical design and efficacy of novel modified Nuss procedure for pectus excavatum (PE). Methods    We retrospectively analyzed the clinical data of 903 patients with PE who were treated by the new kind of steel bar and the novel modified Nuss procedure. There were 716 males and 187 females at mean age of 2-45 (12.1±6.8) years. Preoperative chest CT scans Haller index (HI) was 3.1-15.2 (4.6±1.3), with 38 patients of mild PE (HI<3.2), 302 patients of moderate PE (HI 3.2-3.5), 521 patients of severe PE (HI 3.6-6.0), and 42 patients of extremely severe PE (HI>6.0). The operative time, operative blood loss, hospital stay time as well as postoperative complications were reviewed and analyzed. Results    All of the 903 patients successfully completed the surgery. The mean operative time was 20-45 (25.2±2.6) min for primary PE and that for special type of PE (including recurring PE, PE patients after heart disease operation and those corrected by 2 bars) was 48-150 (63.5±28.1) min. Blood loss was less than 10 mL for primary PE and 15-50 (23.5±5.5) mL for special type of PE. Postoperative hospital stay was 3-15 (4.5±1.6) d. A total of 845 patients (93.6%) required 1 steel bar insertion, 58 patients (6.4%) required 2 steel bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 805 patients, good in 84 patients, fair in 14 patients and poor in 0. The good quality rate was 98.4%. Conclusion    Novel modified Nuss procedure can simplify and optimize the surgical design with good short and mid-term effects.

A new steel bar used in minimally invasive surgery for pectus carinatum / 中华胸心血管外科杂志

Objective To introduce the application experience of a new steel bar used in minimally invasive surgery for pectus carinatum.Methods From January to October 2018, Cardiothoracic Surgery Department of Shanghai Xinhua Hospital performed a minimally invasive surgery for 25 cases of patients with pectus carinatum used a new type of steel bar.All 25 pa-tients were male, aged 10 -17 years, with an average age of(13.80 ±1.66)years.The application experience of the new bar in pectus carinatum minimally invasive surgery was summarized .Results All operations were successfully completed .The op-eration time was 35-100 min, averaged(73.44 ±17.49)min, postoperative hospital stay was 3 -6 days, averaged(3.68 ± 0.85)days.Postoperative complications included 5 cases of pneumothorax(the lung compression was about 2％ -10％, not necessary for surgical intervention).One case occured wound healing delay 1 month after operation, and healed after no surger-cal treatment.The other patients recovered smoothly.Conclusion The new steel bar is convenient to use, greatly reduces the difficulty of the pectus carinatum surgery procedure , also reduced surgical trauma and complications , has a good application prospect.

Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules / 中国胸心血管外科临床杂志

@#Objective To share the experience of single-stage bilateral pulmonary resections by video-assisted thoracic surgery (VATS) for multiple nodules. Methods Clinical records of patients undergoing one-stage bilateral resections of multiple pulmonary nodules between January 2015 and December 2016 in our institution were retrospectively reviewed and analyzed. There were 9 males and 15 females, aged from 33 to 69 (55.0±8.0) years. Two patients underwent bilateral lobectomy. Lobar-sublobar (L/SL) resection and bilateral sublobar resection (SL-SL) were conducted in 9 patients and 13 patients respectively. Results All operations completed successfully. Operation time was 135–330 (231.4±59.1) min, duration of use of chest drains was 2–17 (5.4±3.1) days. Overall duration of hospitalization after surgery was 5–37 (8.6±6.3) days. There was no perioperative death. Postoperative course was uneventful in 17 (70.8%) patients. The postoperative complications included one patient of incision infection and one patient of pulmonary infection. Persistent air leak for >3 days duration and unilateral pleural drainage for more than 200 ml/d were observed in 3 patients and 2 patients respectively. Conclusion Single-stage bilateral surgery in selected patients with synchronous bilateral multiple nodules is feasible and associated with satisfactory outcomes.

1020 cases of pectus excavatum treated by a novel modified nuss procedure without turning over the steel plate / 中华胸心血管外科杂志

Objective Based on the disadvantages of NUSS procedure, we design a new type of funnel chest orthodontic steel bars for clinical application to simplify surgery operation , reduce the surgical trauma, improve operation effect, enhance the safety of operation, and relieve the suffering of the patients, etc.Methods From June 2010 to July 2015, 1020 patients used the new type of funnel chest orthodontic metal plates, including 706 cases of males and 314 cases of females, aged 3-40(aver-age age 11.38 ±5.31).Haller index of 3.36 to 15.45(average index 4.97 ±1.58).668 symmetrical funnel chest cases, 281 cases of asymmetry and 71 recurrent funnel chest cases are involved.Surgical steel bars, having 15 specifications, are arc-shaped, the lengths of which are from 12cm to 26cm.The two ends of steel bars have fixed piece, one end of the bar was fused with a stabilizer and the other end connected to an introducer or a stabilizer and use screws to fix two ends .Steel plates, as the design product, are finalized in the factory.Therefore we need not make intraoperative reprocess.Front tip of introducer and the back-end can be connected to the metal plate.Patients were placed supine position under general anesthesia.Two inci-sions, with length about 2cm and deep to the rib periosteum were made along axillary midline line on the both sides .In the di-rection of high blunt slightly medial free for subcutaneous tunnel to the highest point .Fixed wires were worn around the ribs on both sides.A thoracoscope to guide the bar was inserted from the highest point on the right side of the rear of the medial by sternum low into the chest from the left corresponds to the highest point of the medial , remove the introducer to connect another stator, use screws to fix the connection, with a fixed stator and steel plate stabilized.At the end of the surgery, the stabilizer on either side was secured with sutures.Results The median first operation time was 23 -45(32.31 ±3.57)min, second op-eration time was about 34-147(68.27 ±30.25)min..The bleeding volume(first operation) was 0-2(0.40 ±0.36)ml, the bleeding of second operation time was 1-630(144.00 ±57.00)ml.The hospital stay was 3-9(4.22 ±0.61)days after the operation.All the cases were followed up for 34-48(34.4 ±6.1)months.Steel plate was fixed at the bottom of the sternum in 957 of them,with slight shifting in 58 patients.There was another 5 cases who need re-operation because of the obvious shift-ing.Conclusion The new type of funnel chest orthodontic steel bars simplify surgery operation, reduce the surgical trauma, improve operation effect, relieve the suffering of the patients and enhance the safety of operation.

Bone marrow mesenchymal stem cells with reduced glutathione against mouse lung injury / 中国组织工程研究

BACKGROUND:A large number of experiments have shown that bone marrow mesenchymal stem cels (BMSCs) have good effects on the treatment of lung disease or improvement of lung injury, and its therapeutic effect is mainly oriented to reduce the inflammatory response. OBJECTIVE: To study the effects of BMSCs combined with reduced glutathione in murine models of bleomycin-induced lung injury. METHODS:BMSCs were isolated from a male NOD/SCID mouse and cel morphology and phenotype were observed. Sixty-four female NOD/SCID mice were randomly divided into a control group, a model group, a BMSCs group and a BMSCs+reduced glutathione group (combined group). The control group received intratracheal injection of normal saline, the model group received intratracheal injection of bleomycin, and the BMSC group received BMSCs injectionvia the tail vein at 2 hours after intratracheal injection of bleomycin, and combined group received BMSCs+reduced glutathione injection via the tail vein at 2 hours after intratracheal injection of bleomycin. Al mice were kiled after 7 days, and levels of tumor necrosis factor-α, interleukin-β, malondialdehyde in lung tissue were detected and lung tissue specimens were obtained for pathological examination. RESULTS AND CONCLUSION:BMSCs were fibroblast-like cels, Positive for CD10, CD13 and CD44, but negative for CD34 and CD45. Compared with the control group, the levels of tumor necrosis factor-α, interleukin-β and malondialdehyde were increased in the model group, while decreased significantly in the BMSCs group and combined group (P < 0.05), especialy in the combined group (P < 0.05). Pathological examination showed that more serious lung injury was observed in the model group and BMSCs group than the combined group. These findings indicate that BMSCs combined with reduced glutathione can more effectively protect against bleomycin-induced lung injury.

Intercostal artery: study to assess its suitability as a coronary bypass grafting vessel / 中华胸心血管外科杂志

Objective To assess potential suitability of the intercostal artery as a conduit in coronary bypass graft.Methods Collected 36 cases of chinese adult thoracic aorta CTA original cross-sectional images,the images were retrospectively reconstructed under volume rendering technology (VR),multi-planar reconstruction (MPR),curved planar reformation (CPR) and maximum intensity projection(MIP).Observed and measured the data of the 8th,9th and 10th bilateral intercostal arteries and internal thoracic arteries.Results Toshiba 320-slice volume scanning CT can clearly display the intercostal arteries.The average length and diameter at corresponding point of the left and right 8-10th intercostal artery is similar,all the length is longer than 180 mm,and the diameter at axillary line is all bigger than 2.1 mm,the mean length of right intercostal arteries is slightly longer than the left intercostal arteries,the diameter at each corresponding point of left and right intercostal artery is similar,and equivalent to approximately 85％-90％ of internal thoracic artery.Conclusion Intercostal artery can be used as an ideal alternative vessel in coronary artery bypass grafting.

Clinical study on the treatment of primary premature ejaculation with paroxetine hydrochloride and tamsalosin / 重庆医学

Objective To evaluate the therapeutic effects and adverse events on treatment of primary premature ejaculation (PE) with paroxetine hydrochloride and/or tamsalosin .Methods 225 cases of healthy men ,a history of lifelong PE and an intravaginal e‐jaculation latency time(IELT) < 120 sec were included in this study .The patients were divided into three groups(with 75 cases in each group) .Group A were given paroxetine hydrochloride 20 mg/d for 8 weeks ;group B were given tamsalosin 0 .2 mg/d for 8 weeks ;group C were given paroxetine hydrochloride and tamsalosin for 8 weeks .The effects and adverse events were evaluated by the overall change and fold increase in average IELT and the mean change in all four measures of the premature ejaculation profile (PEP) .Results The reliable data from 198 patients were achieved .The mean IELT after treatment were significantly improved in all groups than that of before treatment (P<0 .05) .The mean IELT in group C was increased for 8 .15 min after treatment .The in‐creased folds of mean IELT in group C (8 .02 folds) was significantly higher than that in group B (1 .98 folds)and group A (6 .92 folds)(P<0 .01) .The mean PEP scores that include measures of perceived control over ejaculation ,satisfaction with sexual inter‐course ,ejaculation‐related personal distress ,ejaculation‐related interpersonal difficulty were significantly improved in all groups after treatment .The mean PEP scores in group C had more significant improvements than that in group A and B .The prevalence of ad‐verse events in group A ,B ,C were 10 cases(13 .3% ) ,2 cases(2 .6% ) and 9 cases(12 .0% ) ,respectively .Conclusion Paroxetine hydrochloride combined with tamsalosin lead to better therapeutic effects and could be a priority selection for the treatment of pri‐mary PE .