Experience of robot-assisted lung segmentectomy through anterior approach / 中国胸心血管外科临床杂志

@#Objective    To evaluate the feasibility and clinical value of robot-assisted lung segmentectomy through anterior approach. Methods    We retrospectively analyzed the clinical data of 77 patients who underwent robotic lung segmentectomy through anterior approach in our hospital between June 2018 to October 2019. There were 22 males and 55 females, aged 53 (30-71) years. Patients' symptoms, general conditions, preoperative imaging data, distribution of resected lung segments, operation time, bleeding volume, number of lymph node dissected, postoperative duration of chest tube insertion, drainage volume, postoperative hospital stay, postoperative complications, perioperative death and other indicators were analyzed. Results    All operations were successfully completed. There was no conversion to thoracotomy, serious complications or perioperative death. The postoperative pathology revealed early lung cancer in 48 patients, and benign tumors in 29 patients. The mean clinical parameters were following: the robot Docking time 1-30 (M=4) min, the operation time 30-170 (M=76) min, the blood loss 20-400 (M=30) mL, the drainage tube time 2-15 (M=4) days, the drainage fluid volume 200-3 980 (M=780) mL and the postoperative hospital time 3-19 (M=7) days. Conclusion    Robotic lung segmentectomy through anterior approach is a safe and convenient operation method for pulmonary nodules.

TLR7 mediates increased vulnerability to ischemic acute kidney injury in diabetes

SUMMARY OBJECTIVE Diabetes is a risk factor for acute kidney injury (AKI). However, its mechanism of pathogenesis has not been elucidated. The aim of the study was to investigate the role of inflammation and the toll-like receptor 7 (TLR7) in ischemic AKI for diabetes. METHODS A high glucose hypoxia-reoxygenation model of human renal tubular epithelial (HK-2) cells was used to generate AKI induced by ischemia-reperfusion in diabetes. The activity of cells was measured by CCK-8 assay and LDH activity. Inflammatory cytokines were assessed by ELISA. TLR7, MyD88, and NF-κB expressions were examined by western blotting. Apoptosis was evaluated by flow cytometry. RESULTS The high glucose group and low glucose group were subjected to hypoxia-reoxygenation. The low glucose group developed only mild cell damage, apoptosis, and inflammatory response. In contrast, an equivalent hypoxia-reoxygenation injury provoked severe cell damage, apoptosis, and inflammatory response in the high glucose group. Expression of TLR7 and its related proteins were measured in the high glucose group before and after hypoxia-reoxygenation. The high glucose group exhibited more significant increases in TLR7 expression following hypoxia-reoxygenation than the low glucose group. In addition, the expression of TLR7 and its related proteins after hypoxia-reoxygenation were higher in the high glucose group than in the low glucose group. Inhibition of TLR7 provides significant protection against ischemic injury in diabetes. CONCLUSION Our results suggest that diabetes increases the vulnerability to ischemia-induced renal injury. This increased vulnerability originates from a heightened inflammatory response involving the TLR7 signal transduction pathway.

RESUMO OBJETIVO O diabetes é um fator de risco para a lesão renal aguda (LRA). No entanto, seu mecanismo de patogênese não foi elucidado. O objetivo do estudo foi investigar o papel da inflamação e do receptor Toll-like 7 (TLR7) na LRA isquêmica no diabetes. MÉTODOS Um modelo de hipóxia-reoxigenação de células epiteliais tubulares renais humanas (HK-2) na presença de concentrações altas de glicose foi utilizado para gerar LRA induzida por isquemia-reperfusão em diabetes. A atividade das células foi medida pelo ensaio Cell Counting Kit-8 (CCK-8) e pela atividade da lactato desidrogenase (LDH). As citocinas inflamatórias foram avaliadas por ensaio imunoenzimático (Elisa). A expressão de TLR7, do fator de diferenciação mieloide 88 (MyD88) e do fator de transcrição nuclear-κB (NF-κB) foi examinada por Western blotting. A apoptose foi avaliada por citometria de fluxo. RESULTADOS Os grupos glicose alta e glicose baixa foram submetidos à hipóxia-reoxigenação. O grupo de baixa glicose desenvolveu apenas danos celulares ligeiros, apoptose e uma resposta inflamatória. Em contraste, no grupo de alta glicose, uma lesão equivalente de hipóxia-reoxigenação provocou danos celulares graves, apoptose e uma resposta inflamatória. A expressão de TLR7 e suas proteínas relacionadas foi medida no grupo de alta glicose antes e após a hipóxia-reoxigenação. O grupo de alta glicose exibiu maiores aumentos na expressão de TLR7 após hipóxia-reoxigenação do que o grupo de baixa glicose. Além disso, a expressão de TLR7 e suas proteínas relacionadas após a hipóxia-reoxigenação foi maior no grupo com alto nível de glicose do que no grupo com baixo nível de glicose. A inibição do TLR7 fornece proteção significativa contra a lesão isquêmica no diabetes. CONCLUSÃO Nossos resultados sugerem que o diabetes aumenta a vulnerabilidade à lesão renal induzida por isquemia. Essa vulnerabilidade acrescida tem por origem uma resposta inflamatória aumentada envolvendo a via de transdução de sinal do TLR7.

Status quo of enhanced recovery after surgery in different regional thoracic surgery in the mainland of China / 中国胸心血管外科临床杂志

@#Objective To analyze the current status and difficulties of ERAS applicated in thoracic surgery in different regional hospitals. Methods A total of 773 valid questionnaires were collected during the First West China Forum on Chest ERAS and analyzed by geographical distribution. The content of the questionnaire was divided into two parts, including the respondents’ institute and personal information, as well as 10 questions about ERAS. Results There were 83.57%, 83.82%, 89.58%, 93.75%, 94.74% and 92.86% of surgeons and nurses in Sichuan province, municipalities, the eastern, western, southern and northern respectively who believed that ERAS in all surgeries should be used. There were 61.84%, 60.29%, 65.97%, 81.25%, 73.68% and 75.00% of surgeons and nurses who thought that the concept of ERAS was more in the theory than in the practice; 77.99%, 80.88%, 74.31%, 78.13%, 83.33%and 69.64% of respondents agreed that average hospital stay, patients’ experience and social satisfaction should be the evaluation standard of ERAS practice while 58.50%, 63.24%, 54.86%, 62.50%, 70.18% and 58.93% of respondents believed that immature procedure, lack of consensus and specifications and insecurity for doctors were the reasons for poor compliance of ERAS; 63.23%, 67.65%, 59.72%, 68.75%, 72.81% and 67.86% of respondents thought that the best team of ERAS should be based on the combination of subject integration, surgery orientation and surgeon-nurse teamwork; 43.73%, 44.12%, 43.75%, 46.88%, 59.65% and 41.07% of respondents thought that multidisciplinary cooperation, multi-modality conducted and surgical programming should be the best way for ERAS implementation; 72.98%, 69.12%, 62.50%, 65.63%, 80.70% and 55.36% of responders agreed that the ERAS forum or conference should include the norms and consensus, analysis and implementation of projects and the status and progress of ERAS. Conclusion There are more consistent views on the clinical application of ERAS in all regions. The subject integration, surgeon-nurse teamwork and multidisciplinary, multi-modality cooperation are the best team and best way for ERAS program implementation.

Research progress of fraction of exhaled nitric oxide in common pulmonary diseases / 中国胸心血管外科临床杂志

@#Detection of the fraction of exhaled nitric oxide (FeNO) is a safe, simple and easy method to assess airway inflammation noninvasively. Thus, FeNO detection has been paid more attention to diagnosis and guide treatment of pulmonary diseases. The common feature of pneumonia, asthma, chronic obstructive pulmonary disease and chronic cough is the existence of varying degrees of airway inflammation. In this review, FeNO production and its potential pathologic and physiologic role in various pulmonary diseases were discussed.

Advance in microRNAs and epidermal growth factor receptor mutation on metastasis of non-small cell lung cancer / 中国胸心血管外科临床杂志

@#MicroRNA (miRNA) is a noncoding RNA and protein involved in regulating gene expression in the transcription level. Epidermal growth factor receptor (EGFR) is a protein tyrosine kinase receptor and its mutations have been confirmed in non-small cell lung cancer (NSCLC) by a large number of studies in recent years. EGFR tyrosine kinase inhibitor (EGFR-TKI) is widely used for treatment of NSCLC patients with EGFR mutation. In recent years, miRNA is more and more important in tumor metastasis. The role of EGFR mutations in NSCLC has become a hot spot as well. New researches report that the relationship between miRNA and EGFR mutations plays an important role in NSCLC metastasis. Therefore, we write this review to discuss the mechanisms of miRNA and EGFR mutations in metastasis of NSCLC.

Risk of Vertebral Fracture in Patients Diagnosed with a Depressive Disorder: A Nationwide Population-Based Cohort Study

OBJECTIVE: Previous studies have reported that depression may play a crucial role in the occurrence of vertebral fractures. However, a clear correlation between depressive disorders and osteoporotic fractures has not been established. We explored the association between depressive disorders and subsequent new-onset vertebral fractures. Additionally, we aimed to identify the potential risk factors for vertebral fracture in patients with a depressive disorder. METHODS: We studied patients listed in the Taiwan National Health Insurance Research Database who were diagnosed with a depressive disorder by a psychiatrist. The comparison cohort consisted of age- and sex-matched patients without a depressive disorder. The incidence rate and hazard ratios of subsequent vertebral fracture were evaluated. We used Cox regression analysis to evaluate the risk of vertebral fracture among patients with a depressive disorder. RESULTS: The total number of patients with and without a depressive disorder was 44,812. The incidence risk ratio (IRR) between these 2 cohorts indicated that depressive disorder patients had a higher risk of developing a subsequent vertebral fracture (IRR=1.41, 95% confidence interval [CI]=1.26-1.57, p<0.001). In the multivariate analysis, the depressive disorder cohort showed a higher risk of vertebral fracture than the comparison cohort (adjusted hazard ratio=1.24, 95% CI=1.11-1.38, p<0.001). Being older than 50 years, having a lower monthly income, and having hypertension, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease, autoimmune disease, or osteoporosis were considered predictive factors for vertebral fracture in patients with depressive disorders. CONCLUSIONS: Depressive disorders may increase the risk of a subsequent new-onset vertebral fracture.

Effect of silk fibroin on degradation and in vivo biocompatibility of poly (L-lactic-co-ε-caprolactone) electronspun nanofibrous scaffolds / 第二军医大学学报

Objective To investigate the effect of silk fibroin (SF) on degradation and biocompatibility of poly (L-lactic acid-co-e-caprolactone) (P[LLA-CL]) in vivo. Methods The scaffolds of P(LLA-CL) (w/w=1:1) blended with 25% of SF (SF/P[LLA-CL]) and P(LLA-CL) were prepared by electrospinning. Both kinds of scaffolds were subcutaneously implanted in 45 6-month-old rats for up to 6 months to evaluate their degradation and biocompatibility characteristics. Results Pathological sections showed P(LLA-CL) scaffold become swollen and began to separate into different layers after 3 months, and then become broken after 6 months; while SF/P (LLA-CL) scaffold largely maintained its structure after 6 months. Immunohistochemical staining showed a large number of macrophages on the surface and in P(LLA-CL) scaffolds 1 month after implantation, and they could still be found 3 months after implantation, accompanied by foreign body giant cells; while no obvious macrophages or foreign body giant cells were found in SF/P(LLA-CL) scaffolds at different time points. Examination of inflammatory gene expression showed that TNF-α and IL-10 expression in P(LLA-CL) scaffolds was significantly higher than that in SF/P(LLA-CL) scaffolds 1 week after implantation (P<0. 05), the same was also true for TNF-α, IL-1β and IL-10 expression 1 month after implantation (P<0. 05), for TNF-α and IL-10 expression 2 months after implantation (P<0. 05), for TGF-β expression 3 months after implantation (P<0. 05%, and for IL-1β and TGF-β expression 6 months after implantation (P<0. 05%). Conclusion SF incorporation can delay degradation, reduce inflammation, and improve the biocompatibility of P(LLA-CL) scaffolds, which may provide reference for scaffold design in tissue engineering.

Setting property and compressive strength of nHA/α-CSH combined bone grafts / 医用生物力学

Objective To develop a new type of combined bone grafts mainly including nanometer hydroxyapatite (n-HA) and α-calcium sulphate hemihydrate (α-CSH), and investigate its setting property and compressive strength. Methods The setting time and compressive strength of nHA/α-CSH combined bone grafts with different liquid-to-solid (L/S) ratio or calcium sulphate dehydrate (CSD) amount were measured and observed by the X-ray diffraction (XRD) and the scanning electron microscope (SEM). Results The setting time of combined bone grafts was increased along with the increase of L/S ratio or nHA amount, and reduced with the increase of CSD amount. The setting time of the compound with 20% of nHA, 80% of α-CSH was (169±36) min, while that of the compound with 5% of nHA, 20% of CSD, 75% of α-CSH was (6±1.1) min. The compressive strength of combined bone grafts reduced along with the increase of nHA amount. The average compressive strength of pure α-CSH was (12.3±2.4) MPa, while that of the compound with 20% of nHA, 80% of CSH was (4.8±0.6) MPa. The XRD results showed that no other materials were produced except that α-CSH was transformed to CSD during the setting process. The SEM results indicated that nHA was filled in the crystal structure of the CSD, presenting two-phase structure. Conclusions The setting time and compressive strength of nHA/α-CSH combined bone grafts can be adjusted by the different proportion of nHA, CSD amount and L/S ratio, which provides an appropriate condition for clinical application.