Limited thoracoplasty and free musculocutaneous flap transposition for postpneumonectomy empyema: A case report.

BACKGROUND: Empyema is a severe complication following pneumonectomy that is associated with high morbidity and mortality rates. Although there are a wide variety of treatment options, successful management remains challenging when this condition is combined with a large cavity in very thin patients who had previously undergone a posterolateral thoracotomy. CASE SUMMARY: We reported the case of a thin, 63-year-old man with a progressive pulmonary cyst who underwent left pneumonectomy via posterolateral thoracotomy 23 years ago. After an initially uneventful postoperative course, he was readmitted with empyema and a large cavity 21 years after surgery. He was successfully treated with limited thoracoplasty, followed by free vastus lateralis musculocutaneous flap transposition. CONCLUSION: This case highlights that the treatment mode of limited thoracoplasty and free vastus lateralis musculocutaneous flap transposition is safe and effective for the management of postpneumonectomy empyema with a large cavity in thin patients who had previously undergone a posterolateral thoracotomy.

Thoracoscopic diagnosis of traumatic pericardial rupture with cardiac hernia: A case report.

BACKGROUND: Pericardial rupture caused by blunt chest trauma is rare in clinical practice. Because of its atypical clinical symptoms, and because surgeons are often unfamiliar with the clinical and radiological manifestations of the injury, preoperative diagnosis is difficult; it is easily misdiagnosed and causes serious consequences. CASE SUMMARY: A 60-year-old man, previously healthy, was transported to the emergency room after falling from a great height. Upon arrival, his vital signs were stable. Electrocardiography and echocardiography were performed, and there was no sign of cardiac injury or ischemia. Chest and abdomen computerized tomography revealed pneumopericardium, hemopneumothorax, lung contusion, multiple rib fractures on the right side (Figure 1), and right scapula and clavicle fractures. He was admitted to the inpatient department for further observation after tube thoracostomy. The next day, the patient suddenly experienced rapid arrhythmia (the ventricular rate reached 150-180 beats/min) when turning onto his right side, accompanied by a blood pressure drop to 70/45 mm Hg and a chief complaint of palpitation. Thoracoscopy was performed urgently, and a large vertical tear (8 cm × 6 cm) was found in the pericardium. The defect was successfully repaired using a heart Dacron patch. His postoperative condition was uneventful without any fluctuations in vital signs, and he was transferred to the orthopedics department for further surgery on postoperative day 8. CONCLUSION: Although the possibility of pericardial rupture combined with cardiac hernia is extremely low, it is one of the causes of cardiogenic shock following blunt trauma. Therefore, clinicians need to be more familiar with its characteristic manifestations and maintain a high degree of vigilance against such injuries to avoid disastrous consequences.

[Electroacupuncture Intervention Combined with Anesthetics for Analgesia and Post-surgical Gastrointestinal Recovery in Pneumectomy Patients].

OBJECTIVE: To observe the effect of electroacupuncture (EA) stimulation of bilateral Taichong (LR 3), Yan-glingquan (GB 34), Waiguan (TE 5) and Chize (LU 5) on pain and post-surgical gastrointestinal reactions in patients undergoing pneumectomy. METHODS: Sixty patients with pneumectomy were randomly divided into EA group (30 cases) and control group (30 cases). For patients of the EA group, EA stimulation (2 Hz, 3 - 5 mA) was applied to bilateral LR 3, GB 34, TE 5 and LU 5 once every 12 h in the following two days after the surgery. For patients of the control group, the filiform needles were just adhered to the abovementioned acupoints without electrical stimulation. In addition, patients of both groups were treated first with lower dose of anesthetics including Fentanyl (250 µg) + Flurbiprofen axetil (25 mg) + normal saline (i. v., 2 mL/h), and Sauteralgyl (muscular injection if necessary). The visual analogue scale (VAS) was used for measuring the patients' pain reaction at 24(th) h and 48(th) h after surgery. The contents of plasma ß-endorphine (EP) and leu-enkephalin were assayed by ELISA, the times of vomiting and nausea, and the time of postoperative exhaust and defecation were recorded. RESULTS: Compared with the control group, the VAS score at 48 h after surgery, and the dosage of the supplemented Sauteralgyl were evidently lower, and the time of both exhaust and defecation after surgery was significantly earlier, and the degree of nausea after surgery was obviously milder in patients of the EA group (P<0.05, P<0.01). Compared with 0 h post-operation, the ß-endorphin and leu-enkephalin levels were significantly increased in the EA group (P<0.01). No significant difference was found between the control and EA groups in the vomiting rating (P>0.05). CONCLUSION: EA intervention combined with anesthetics is effective in reducing the dosage of the supplemented Sauteralgyl and the degree of postoperative nausea, and in improving postoperative gastrointestinal functional recovery in patients undergoing pneumectomy.

Antihyperlipidaemic and antioxidant effect of the total flavonoids in Selaginella tamariscina (Beauv.) Spring in diabetic mice.

OBJECTIVES: To investigate the antidiabetic, antihyperlipidaemic and antioxidant activity of total flavonoids in Selaginella tamariscina (Beauv.) Spring (TFST) in a mouse model of diabetes. METHODS: Normal mice, mice fed with a high-fat emulsion diet and streptozotocin (STZ)-induced diabetic mice were treated with TFST for 6 weeks. Serum glucose, insulin and lipid, hepatic steatosis, production of the protein visfatin and antioxidant indices were evaluated. KEY FINDINGS: TFST significantly decreased the concentration of fasting blood glucose, total cholesterol, triglycerides and low-density-lipoprotein cholesterol, while it increased the levels of insulin and high-density-lipoprotein cholesterol in diabetic mice. TFST also improved the results of the oral glucose tolerance test to a certain degree. Furthermore, both the free fatty acid levels in the liver and hepatic steatosis were ameliorated by TFST treatment. These changes may be be associated with decreased production of visfatin. Administration of TFST also significantly decreased the levels of malondialdehyde, nitric oxide and inducible nitric oxide synthase and increased the content of glutathione and the activity of superoxide dismutase, catalase, glutathione peroxidase and glutathione-S-transferase in the liver. No change in blood glucose levels were observed in the normal mice treated with TFST. CONCLUSIONS: TFST showed an excellent effect in reducing the high blood glucose level but had no effect on normal blood glucose level. The antidiabetic activity of TFST could be explained by its antioxidant and antihyperlipidaemic activity, which finally elevated the insulin sensitivity of liver.

Anti-diabetic activity and potential mechanism of total flavonoids of Selaginella tamariscina (Beauv.) Spring in rats induced by high fat diet and low dose STZ.

AIM OF THE STUDY: To evaluate the anti-diabetic effects of the total flavonoids of Selaginella tamariscina (Beauv.) Spring (TFST), and to explore the pertinent mechanism. MATERIALS AND METHODS: High fat diet and STZ (35 mg/kg) induced diabetic rats were administered with TFST at graded oral doses (100, 200 and 400mg/kg/day, ig.) for 8 weeks. A range of parameters, including blood glucose and lipid, serum insulin and glucagon, glucose tolerance, were tested to evaluate its anti-diabetic effects. The determination of protein expression of peroxisome proliferator activated receptor γ (PPAR-γ) in adipose tissue and insulin receptor substrate 1 (IRS-1) in hepatic and skeletal muscle tissues was used to study the mechanism of TFST. Moreover, the preliminary study of TFST on the antioxidant activity was performed. RESULTS: The TFST possessed anti-diabetic activities as shown by the decreased serum levels of fast blood glucose (FBG), glycosylated hemoglobulin A1C (HbA1c), triglyceride (TG), total cholesterol (TC), free fatty acid (FFA), low density lipoprotein-cholesterol (LDL-C) and glucagon, as well as increased serum levels of high density lipoprotein-cholesterol (HDL-C), insulin and C-peptide. TFST also improved the oral glucose tolerance test (OGTT) to a certain degree. Furthermore, TFST increased the protein expression of PPAR-γ in adipose tissue, and increased the protein expressions of IRS-1 in hepatic and skeletal muscle tissues. These benefits were associated with increased superoxide dismutase (SOD) and decreased malondialdehyde (MDA) in serum. CONCLUSIONS: TFST exert beneficial effects on hyperglycosemia and hyperlipoidemia in diabetic rats possibly through regulating the levers of PPAR-γ in adipose tissue and IRS-1 in hepatic and skeletal muscle tissues.

Highly effective and recyclable dendritic ligands for the enantioselective aryl transfer reactions to aldehydes.

[reaction: see text] A series of chiral pyrrolidinylmethanol-based dendritic ligands were synthesized for application in enantioselective aryl transfer reactions to aldehydes with the (ArBO)3/ZnEt2 system in up to 98% ee.