Application of transesophageal echocardiography in the monitor of allogeneic lung transplantation / 中华超声影像学杂志

Objective To investigate the application value of transesophageal echocardiography(TEE) in allogeneic lung transplantation. Methods The study enrolled 37 patients receiving allogeneic lung transplantation because of end stage lung disease,including sequential bilateral lung transplantation 20 cases and unilateral lung transplantation 17 cases,the latter included 4 cases with extracorporeal membrane oxygenation (ECM O).Echocardiographic parameters before surgery,including right ventricular transverse diameter (RVTD),left ventricular transverse diameter (LVTD),right atrial transverse diameter (RATD), left atrial transverse diameter (LATD),main pulmonary artery (DMPA),left ventricular ejection fraction (LVEF),pulmonary arterial systolic pressure (SPAP),and TEE parameters during surgery,including pulmonary artery anastomosis diameters (DRPAand/or DLPA) and blood flow velocity (VRPAand/or VLPA), pulmonary vein anastomosis blood flow velocity (V RPVand/or VLPV),were measured. Results ①Preoperative transthoracic echocardiographic showed a slight increase of right heart in patients with allogeneic lung transplantation,different degrees of increase in SPAP,a normal or slightly increase of D MPA and a normal LVEF,according to the ASE guidelines. ②Compared with pre-operation,the diameters of left and right pulmonary artery decreased ( P < 0.001) and the blood flow velocity of arteries and veins increased ( P <0.001). ③Patients with ECMO support had a higher SPAP before operation ( P <0.05) and a lower LVEF ( P <0.05),but within a normal range.The blood flow velocity of pulmonary artery and vein had no difference between two groups ( P > 0.05). Conclusions During allogeneic lung transplantation,TEE plays an important role in the monitor of pulmonary arteriovenous anastomosis. It could remind the surgeon whether anastomosis is narrow timely,and determine the patient′s hemodynamic status and cardiac load to guide the surgical process.

Changes of thoracic drainage volume and their relationship with prognosis after lung transplantation / 中华器官移植杂志

Objective To observe the changes of thoracic drainage volume after lung transplantation,and to explore the influencing factors and their relationship with the prognosis of lung transplantation.Methods This retrospective analysis included 46 consecutive lung transplantations in our hospital between 2005 and 2016.The volume of postoperative chest drainage was recorded and analyzed.Single factor analysis of the factors that may affect the drainage was done.The patients were divided into different groups according to different prognosis at different time points after operation,and drainage volume was compared among groups.All analyses were performed with SPPS,version 19.0.Results There were no operative deaths.The median thoracic drainage time was 9.3 days,the median total thoracic drainage volume was 4318 mL,and the average daily drainage volume was 487 mL.During the perioperative period,the use of cardiopulmonary bypass or extracorporeal membrane oxygenation increased significantly the volume of unilateral pleural drainage (P＜0.05).The average daily drainage volume and the average daily unilateral pleural drainage volume in the postoperative dead patients were significantly greater than those of survivals at 1 st month,3rd month and 1 st year after lung transplantation (P＜0.05).At 3rd month after transplantation,the total amount of postoperative thoracic drainage was significantly greater than that of survivals (P＜ 0.05).The average daily unilateral pleural drainage volume in dead patients after surgery was significantly greater than that of the survival patients 3 years after operation (P＜0.05).Conclusion Intraoperative hemostasis in patients with lung transplantation should receive considerable attention,cardiopulmonary bypass and extracorporeal membrane oxygenation should be used cautiously during perioperative period,and greater postoperative chest drainage predicated poor short-term prognosis.

Application value of the mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer / 中华消化外科杂志

Objective To verify the accuracy of the mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer and explore predictive value of the mathematical model in the postoperative complications.Methods The retrospective case-control study was conducted.The clinicopatholo gical data of 192 patients with esophageal cancer who underwent esophagectomy in the Beijing Chaoyang Hospital of Capital Medical University between October 2013 and October 2016 were collected.Among 192 patients,160 didn't have postoperative complications and 32 had postoperative complications (7 with postoperative anastomotic leakage,9 with pulmonary infection and 16 with dysfunction of gastralintestinal tract).Patients selected the appropriate surgical procedures according to individual conditions,and then volume of gastrointestinal decompression was recorded daily.According to the regression equation of influencing factors of volume of postoperative gastrointestinal decompression:average daily drainage volume within 5 days (mL)=262.287 + 132.873 × tubular stomach-72.160 × smoking history-27.904 × pathological type of tumor-36.368 × age,predictive value of postoperative gastrointestinal decompression was calculated and compared with real volume of gastrointestinal decompression.Observation indicators:(1) comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients without complications;(2) comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients with complications.Measurement data with normal distribution were represented as (x)±s and comparison was analyzed using the pairedsamples t test.Measurement data with skewed distribution were described as M (range),and comparison was analyzed using the Wilcoxon signed rank tests.Results (1) Comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients without complications:predictive value and real volume of postoperative gastrointestinal decompression in 160 patients without complications were respectively 187 mL (range,58-392 mL) and 207 mL (range,20-570 mL),with no statistically significant difference (Z=-1.106,P＞0.05).(2) Comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients with complications:7 patients had postoperative anastomotic leakage,including 1 with cervical anastomotic leakage and 6 with chest anastomotic leakage.The predictive value and real volume of postoperative gastrointestinal decompression in 7 patients with anastomotic leakage were respectively (215±58)mL and (338± 106)mL,with a statistically significant difference (t=-3.139,P＜0.05).The predictive value and real volume of postoperative gastrointestinal decompression in 9 patients with postoperative pulmonary infection were respectively (176±61) mL and (239± 111) mL,with no statistically significant difference (t =-1.805,P＞0.05).The predictive value and real volume of postoperative gastrointestinal decompression in 16 patients with dysfunction of gastralintestinal tract were respectively (236 ± 60) mL and (357 ± 107) mL,with a statistically significant difference (t =-4.716,P＜ 0.05).Conclusions The mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer is correct and feasible.There is a predictive value for patients with postoperative anastomotic leakage and dysfunction of gastralintestinal tract.

Expression and correlation of CTGF, TGF-β1, β-Gal in the primary pulmonary bulla / 中华胸心血管外科杂志

Objective To detect the express of the pulmonary fibrosis factor CTGF,TGF-β1 and the senescence correlated β-Gal in the primary pulmonary bulla,and investigate the correlation of the pulmonary fibrosis factor,cell senescence and the development of the primary pulmonary bulla.Methods The expression of CTGF,TGF-β1 and β-Gal protein in the tissue of normal lung tissues and lung bullae were tested.The cell image extracted with the digital camera system was entered into the Image-pro Plus 6.0 morphology Image analysis system and analyzed with Semi-quantitative way.Results The expression level of TGF-β1 and CTGF in primary pulmonary bulla organization was obviously higher than that of normal lung tissue.There was a statistically significant difference(P ＜ 0.05).CTGF and TGF-β1 expression level had a significant correlation (r =0.965,P ＜ 0.01).β-Gal expression level of primary pulmonary bullae had no obvious difference with normal lung tissue.Conclusion CTGF and TGF-β1 may play an important role in the formation of primary pulmonary bulla.Both play a synergistic role in the formation of primary pulmonary bulla.Cell senescence is not relevanted with the formation of primary pulmonary bulla.

Changes of thoracic drainage volume and their relationship with prognosis after lung transplantation / 中华器官移植杂志

Objective To observe the changes of thoracic drainage volume after lung transplantation,and to explore the influencing factors and their relationship with the prognosis of lung transplantation.Methods This retrospective analysis included 46 consecutive lung transplantations in our hospital between 2005 and 2016.The volume of postoperative chest drainage was recorded and analyzed.Single factor analysis of the factors that may affect the drainage was done.The patients were divided into different groups according to different prognosis at different time points after operation,and drainage volume was compared among groups.All analyses were performed with SPPS,version 19.0.Results There were no operative deaths.The median thoracic drainage time was 9.3 days,the median total thoracic drainage volume was 4318 mL,and the average daily drainage volume was 487 mL.During the perioperative period,the use of cardiopulmonary bypass or extracorporeal membrane oxygenation increased significantly the volume of unilateral pleural drainage (P＜0.05).The average daily drainage volume and the average daily unilateral pleural drainage volume in the postoperative dead patients were significantly greater than those of survivals at 1 st month,3rd month and 1 st year after lung transplantation (P＜0.05).At 3rd month after transplantation,the total amount of postoperative thoracic drainage was significantly greater than that of survivals (P＜ 0.05).The average daily unilateral pleural drainage volume in dead patients after surgery was significantly greater than that of the survival patients 3 years after operation (P＜0.05).Conclusion Intraoperative hemostasis in patients with lung transplantation should receive considerable attention,cardiopulmonary bypass and extracorporeal membrane oxygenation should be used cautiously during perioperative period,and greater postoperative chest drainage predicated poor short-term prognosis.

The diagnosis and surgical treatment of esophageal rupture / 中华胸心血管外科杂志

Objective Summarize the experience of diagnosis and treatment of esophageal rupture.Methods Twelve cases of esophageal rupture were treated with surgical intervention and clinical data were analyzed retrospectively.Diagnosis was confirmed in all patients by chest X-cays,Closed thoracic drainage,upper gastrointestinal contrast,chest CT scan and gastroscopy.In this series,there were 6 cases of spontaneous esophageal rupture,2 cases of iatrogenic esophageal rupture,4 cases of foreign body in esophagus rupture.For surgical treatment of 8 cases,including emergency esophageal stitching issue and diaphragmatic muscle or greater omentum to cover 6 cases;Esophageal ligation and resection of rupture area on both closes of the near and far,phase ii gastroesophageal anastomosis of esophagus resection in 2 cases,including 1 case of esophagus repair failure after turning the operation).Esophageal resection of gastroesophageal anastomosis in 1 case (for into the outer court misdiagnosed patients);4 cases were conservative.Results Initial diagnosis of spontaneous esophageal rupture and iatrogenic esophageal rupture 7 patients were cured,17 to 53 days of hospital stay,Follow-up for 3 months to 5 years,no esophageal related complications.Exception 1 patient died of postoperative infection(misdiaguosed for a long time).4 cases of esophageal foreign bodies to rupture were cured and these cases' fissure were less than 5 mm by chest CT scan and gastroscope diagnosis.Conclusion Complete collection of medical history,chest X-cays,Closed thoracic drainage,upper gastrointestinal contrast,chest CT scan and gastroscopy may clear diagnosis.Choose the proper method according to the patients as early as possible by general closed gap is the key to the treatment,at the same time be adequate drainage,control of infection and nutrition support treatment.

Clinical value of preoperative serum carcinoembryonic antigen detection in the prediction of esophageal cancer lymph node metastasis / 中华消化外科杂志

Objective To investigate the clinical value of preoperative serum carcinoembryonic antigen (CEA) detection in the prediction of esophageal cancer lymph node metastasis.Methods The clinical data of 111 patients with esophageal cancer who were admitted to the Chaoyang Hospital of Capital Medical University between December 2010 and January 2014 were retrospectively analyzed.Patients received preoperative serum CEA examination and enhanced CT of the chest.The surgical procedures were selected according to the condition of patients, including radical resection of esophageal cancer via left thoracic approach, transabdominal right thoracic approach (open and laparoscopic surgeries), cervico-thoracic-abdominal triple incision (open and laparoscopic surgeries) and transabdominal incision.The international standard was used for tumor location and TNM stage of esophageal cancer.The count data and comparison of ordinal data in the univariate analysis were analyzed using the chi-square test, Fisher exact probability and rank-sum test, respectively.The multivariate analysis was done using the stepwise logistic regression.The ROC curve was used for evaluating diagnostic value of serum CEA examination and enhanced CT of the chest.All the 111 patients were divided into 4 groups according to the interquartile range results of the CEA examination, and the lymph node metastasis rates of 4 groups were compared by the chi-square test.Results All the 111 patients underwent successful radical resection of esophageal cancer after preoperative serum CEA detection and enhanced CT of the chest, including 40 via left thoracic approach, 56 via transabdominal right thoracic approach, 8 via cervico-thoracic-abdominal triple incision and 7 via transabdominal incision.There were 3 patients with upper thoracic esophageal cancer, 52 with middle thoracic esophageal cancer, 36 with lower thoracic esophageal cancer and 20 with cancer of gastro-esophageal junction.The postoperative pathological type included 84 squamous cell carcinomas, 23 adenocarcinomas and 4 other carcinomas.There were 44 patients with negative lymph node metastases and 67 with positive lymph node metastases.The positive rate of elevated serum CEA in the 111 patients was 36.04％ (40/111).Tumor location, pathological type and N stage of tumor were clinical pathological factors affecting the positive rate of serum CEA of patients (Z =6.815, 6.608, 16.928, P ＜0.05).N stage of tumor was an independent risk factor affecting the positive rate of serum CEA of patients by multivariate analysis [OR =2.206, 95％ confidence interval (CI) :1.370-3.552, P ＜ 0.05].The T stage of tumor and serum CEA level were risk factors affecting lymph node metastasis of esophageal cancer by univariate analysis (Z =18.971, x2=10.081, P ＜0.05), and those were also independent risk factors affecting lymph node metastasis of esophageal cancer by multivariate analysis (OR =3.558, 3.936, 95％ CI: 1.798-7.041, 1.480-10.469, P ＜0.05).The lymph node metastasis rates of esophageal cancer were 46.43％, 48.28％ , 55.56％ and 92.59％ when CEA level≤ 1.75 μg/L, 1.75 μg/L ＜ CEA level ≤ 2.68 μg/L, 2.68 μg/L ＜ CEA level ≤4.21 μg/L and CEA level ＞ 4.21 μg/L by the stratified analysis, respectively, with a significant difference among the 4 groups (x2=16.026, P ＜ 0.05).The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.687 (95％ CI: 0.590-0.785) and 0.689 (95％ CI: 0.591-0.788) by ROC curve, which were significantly different from the area under the guides (P ＜0.05).The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.785 (95％ CI: 0.697-0.873, P ＜ 0.05).Conclusions Serum CEA detection not only has certain predictive value for lymph node metastasis of esophageal cancer, but has a higher predictive value combined with enhanced CT of the chest.There is a risk of lymph node metastasis for patients with deep tumor invasion and elevated CEA level, and the range of lymph node dissection should be expanded.

Analysis of hospitalization expenses of the different esophagectomy / 中华胸心血管外科杂志

Objective To explore economic valuation of the minimally invasive esophagectomy.Methods The cases undergone esophagectomy were studied retrospectively.Monofactorial analysis was done to evaluate the impact of various factors on the overall hospitalization costs.The correlated factors then were used as independent variables to carry out the multiple linear regression aimed at the hospitalization costs.Results The results of monofactorial analysis showed that the accompanying diseases,days during hospitalization,modes of esophagectomy,postoperative complications were correlated factors of the overall hospitalization costs.According to the multiple linear regression,it were sorted based on descending order duing to its effect of largenning the hospitalization costs:postoperative complications (β =0.439,P =0.000),days during hospitalization (β =0.397,P =0.000),accompanying diseases(β =0.257,P =0.000),modes of esophagectomy(β =0.132,P =0.000).The expenses caused immediately by the operations were statistically more of the minimally invasive surgery than that of the open procedures whatever the numerous or proportion of the overall costs (P =0.000).Conclusion Combined thoracoscopic and laparoscopic esophagectomy was more expensive than open operation.Nevertheless,impact of the other factors,such as postoperative complications,were more significant than that of the different procedure.h was a strategy to minimally invasive osophagectomy that hospitalization costs could be reduced by means of controlling complications and diminishing hospitalization days.

The clinical experience of 28 cases with lung transplantation / 中华胸心血管外科杂志

ObjectiveTo discuss the clinical experience and influence factors of airway complications after lung transplantation for end-stage lung diseases through reviewed 28 lung transplantation cases in our center.MethodsFrom August 2005 to December 2010,28 patients with end-stage lung diseases received lung transplantations consecutively in our center,in which 13 patients were bilateral-lung transplantation(BLT) and 15 patients were single-lung transplantation(SLT).The donor lungs were perfused with LPD solution antegrade and retrograde followed.During operation,the pulmonary artery pressure and flow rate were tested real time through the transesophageal echocardiography and Swans catheter.Postoperative care of patients was in respiratory intensive care unit,and immunosuppressive drugs were adjusted according to blood drug concentration.ResultsThere were no airway complications including anastomotic fistula or stenosis found in all patients.The mortality was 7.2％ in the early postoperative period ( 1-30 days).Cumulative survival rate was 94.1％ ％ at 1 year,76.2％ at 2 years,and 71.4％ at 3 years respectively.Four patients (14.3％) died in the postoperative 90 days.Three patients were reanastomosed pulmonary artery in operation because of stenosis detected by transesophageal echocardiography.After operation,three patients were reoperated,in which two were bleeding and one was pulmonary bulla and pneumothorax.All patients were followed from 1 year to 6.1 years after operation.The quality of life was improved significantly.ConclusionThe well improved technique of lung transplantation is helpful to reduce the operation related complications,decrease the early mortality post operation and play the important role in the effects of quality of life and long term survival rate.The intraoperative transesophageal echocardiography examination could detect the anomalous situation of vascular anastomosis.At the same time the patients should get benefits from the routine and close follow-up.

Evaluate of transesophageal echocardiography during lung transplantation / 中华胸心血管外科杂志

Objective To investigate the clinical value of transesophageal echocardiography during the lung transplanta tion. Methods From August 2005 to August 2009, 19 patients with advanced lung diseases received lung transplantation.The average age was(48.35±13.04) years. The echocardiographic probe was placed in patient's esophagus before surgery.The left and right pulmonary venous openings, artery blood flow velocity, right ventricular wall motion, left and right ventricular volume, right ventricular ejection fraction were recorded at different time intervals during lung transplantation, especially at the break and after completion of bronchus, pulmonary veins, and pulmonary artery anastomosis. Results The procedure included sequential-type lung transplantation in 6 cases and single lung transplantation in 13. The blood flow disappeared when blocking pulmonary artery and vein and right ventricular volume increased slightly. The right ventricular volume restored after completion of trachea, pulmonary veins, pulmonary artery anastomosis. TEE detected that the blood flow velocity of pulmonary veins, pulmonay artery anastomosis increased slightly. In 1 case the opening of the right pulmonsry artery blood flow velocity increased significantly and blood flow velocity decresed and blood oxygen partial pressure resumed after re-anastomosis of pulmonary artery. Conclusion TEE play an important role in monitoring pulmonary artery and vein anastomosis diameter and blood flow velocity and right ventricular function and predicting complications during lung transplantation.

A study on creating a promotion index system of medical quality in Grade Ⅲ hospitals in Beijing / 中华医院管理杂志

To explore how to create and optimize a promotion index system of medical quality evaluation, this article focuses on the hospital visiting process from patients, using analyzing collected those index system from couples of Grade Ⅲ hospitals in Beijing, and combining the results of literal study, field study and specialist consult, according to the different situation of general hospitals and specially hospitals, with the spirit of "maintaining the patients benefits, safeguarding the patients safety,and enhancing the medical quality", introduces the framework of the promotion index system, the rules to select the indicator, and so on, and discusses several problerns related to creating the index system.

Detection of pulmonary vascular by transesophageal echocardiography during lung transplantation / 中华超声影像学杂志

Objective To detect the new views for pulmonary vascular by transesophageal echocardiography(TEE) during lung transplantation.Methods Seventeen cases with respiratory failure underwent lung transplantation.A series of scans were detected by TEE during preoperative anesthesia, preand pro-pulmonary vascular occlusion and pro-donor lung, and bronchus, pulmonary veins, pulmonary artery anastomoses.Left and right lung veins open and left and right pulmonary artery branch were key to observed.Pulmonary artery trunk and branch diameter, velocity of blood flow were measured.Results All left and right pulmonary artery,pulmonary vein images were given by TEE.TEE detected the normal blood flow velocity of pulmonary artery branches during pre-operation,average of 65 cm/s.After clipping the side of the pulmonary artery, the lateral pulmonary blood flow disappeared.TEE detected pulmonary veins,pulmonary artery anastomoses pro-operation.Except for 1 case of anastomotic pulmonary vein flow velocity increased,all the pulmonary vein and pulmonary artery branch anastomoses flow velocity increased slightly faster than those before transplantation (mean pulmonary artery branch of 160 cm/s, the average pulmonary vein 149 cm/s).Conclusions TEE can monitor diameter and flow velocity of pulmonary artery branch and pulmonary vein during lung transplantation,and can detect the rightventricular function.The views of left and right branch pulmonary artery and pulmonary vein branches play an important role during lung transplantation.

Extraction of the 7 Loci of the donor murine MHC gene and construction of plasmids / 中华器官移植杂志

Objective To extract the loci of murine MHC gene and construct plasmids.Methods The RNA of mice was extracted and reversely transcribed into cDNA.By using nested PCR,the products were connected with T vector,cloned,and sequenced.Subsequently,the genes were digested by endonucleases,connected with expression vector,and sequenced again to choose the correct clones.Results After the nested PCR,the products were approved by sequencing.After being connected with the vectors,they were approved again by sequencing and the correct clones were chosen.Conclusion All of the loci of the MHC gene can be obtained by nested PCR.The plasmids from the correct clone can be used in the further experiments of transferring the gene to mitigate the transplantation rejection.

Expression and clinical significance of c-met and HnRNP A2/B1 gene in non-small cell lung cancer / 肿瘤研究与临床

Objective To investigate the mRNA expression level of the hepatocyte growth factor receptor, c-met, and heterogeneous nuclear ribonucleoprotein, HnRNPA2/B1, in non-small cell lung cancer (NSCLC) patients and their relationships with invasion and metastasis of NSCLC. Methods The mRNA expressions of the c-met and HnRNP A2/B1 in postoperative samples of 46 patients with NSCLC and tissue samples of 30 patients with lung innocence disease as normal controls were detected by RT-PCR, and the efficacies of each marker and combining both of markers in the diagnosis of NSCLC were analyzed by Chi square test. Results The positive rates and relative expression quantity of c-met [65.2 % and (0.903±0.04)]and HnRNP A2/B1 [60.9 % and (0.162±0.04)] in NSCLC were significantly higher than those in control group [26.7 %, (0.205±0.06) and 20.0 %, (0.096±0.02), respectively] (P ＜0.05), and the positive rate of combining both was higher than that of single marker for NSCLC diagnosis(P ＜0.05) . The overexpression of two markers was also significantly correlated with the N stage and clinical stage, but not with age, gender and pathologic types. Conclusion The high expression of c-met and HnRNP A2/B1 in NSCLC may be of significance for the clinical stage. Combining test of two markers provides more sensitivity for NSCLC diagnosis. The expression change of two markers may involve in the carcinogenesis and development of NSCLC.

Establishment of a permanent mechanism for medical service support in large-scale activities as pioneered by the Olympic Games / 中华医院管理杂志

Bejing Chaoyang Hospital provided medical service support as a designated hospital for the Beijing 2008 Olympic Games. In the course, the hospital is benefited in terms of its management system building, guarantee of medical service quality, effective connection within the service system,real-time improvement of medical service quality, comprehensive information management and development of the emergency treatment system. These experiences are being converted into part of the permanent mechanism, rendering profound influence on medical service support for large-scale activities in the future.