Risk factors for major adverse events of video-assisted thoracic surgery lobectomy for lung cancer.

AIMS: The purpose of this study was to identify the risk factors for major adverse events of VATS (Video-Assisted Thoracic Surgery) lobectomy for primary lung cancer. METHODS: 1806 Patients (1032 males, 57.1%) planned to undergo VATS lobectomy for stage IA-IIIA lung cancer from July 2007 to June 2012. The Thoracic Morbidity and Mortality Classification TM&M system was used to evaluate the presence and severity of complications. Postoperative complications were observed during a 30-day follow up. Univariate and multivariate analysis were used to analyze the independent risk factors for major adverse events. RESULTS: Successful rate of VATS lobectomy was 97.6% (1763/1806). Major complications occurred in 129 patients (7.3%), with a mortality of 0.3% (5/1763). Pulmonary complications contribute up to 90.7% of the major complications and 80% of mortality. Logistic regression indicated that comorbidities, elder age ≥70y, operative time ≥240min and hybrid VATS were predictors for major adverse events (P<0.05). Hybrid and converted VATS lobectomy result in higher major adverse events compared with complete VATS, 15.1%, 20.9% and 7.4% respectively (P=0.013). CONCLUSIONS: The overall complication rate and mortality of VATS lobectomy are low, while major complications sometimes occur. Pulmonary complications are the most common major complications and cause of mortality. Age ≥70y, comorbidities, operative time ≥240min and Hybrid VATS are predictors of major adverse events.

Microbispora hainanensis sp. nov., isolated from rhizosphere soil of Excoecaria agallocha in a mangrove.

Strain 211020(T) was isolated from rhizosphere soil of Excoecaria agallocha in a mangrove in Hainan, China. The strain produced longitudinal pair spores branching from aerial hyphae. 16S rRNA gene sequence analysis showed that the isolate belonged to the genus Microbispora, exhibiting the highest 16S rRNA gene sequence similarity (98.75 %) to Microbispora corallina JCM 10267(T) with a low DNA-DNA relatedness value (13 ± 0.6 %). The isolate contained meso-diaminopimelic acid as the diagnostic diamino acid but madurose was not detected. The predominant menaquinones were MK-9(H(4)), MK-9(H(2)) and MK-9(H(0)), and the major fatty acids were iso-C(16 : 0), iso-C(15 : 0) and C(17 : 0). The phospholipid profile of strain 211020(T) comprised phosphatidylinositol mannoside, phosphatidylethanolamine, diphosphatidylglycerol and phospholipids of unknown structure containing glucosamine. The DNA G+C content was 70.8 mol%. On the basis of phenotypic and genotypic data, strain 211020(T) can be distinguished as a novel species of the genus Microbispora, for which the name Microbispora hainanensis sp. nov., is proposed. The type strain is 211020(T) ( = CGMCC 4.5595(T) = DSM 45428(T)).

Micromonospora rhizosphaerae sp. nov., isolated from mangrove rhizosphere soil.

Strain 211018(T) was isolated from mangrove Excocaria agallocha rhizosphere soil. 16S rRNA gene sequence analysis showed the highest similarity to the type strains of Micromonospora olivasterospora DSM 43868(T) (98.6 %) and Micromonospora pattaloongensis TJ2-2(T) (98.4 %). gyrB gene sequence analysis also indicated that strain 211018(T) should be assigned to the genus Micromonospora. The characteristic whole-cell sugars are xylose, mannose and arabinose. The predominant menaquinone is MK-9(H(4)) and the major fatty acids are iso-C(15 : 0) (27.5 %), 10-methyl C(17 : 0) (14.2 %), C(17 : 1)ω8c (12.8 %), iso-C(16 : 0) (12.6 %), anteiso-C(15 : 0) (6.1 %), iso-C(17 : 0) (4.1 %) and anteiso-C(17 : 0) (4.0 %). The phospholipid profile comprises phosphatidylethanolamine, phosphatidylglycerol, phosphatidylinositol and phosphatidylinositol mannosides. The DNA G+C content is 70.8 mol%. The chemotaxonomic data of the strain coincided with those of the genus Micromonospora. Furthermore, a combination of DNA-DNA hybridization results and some physiological and biochemical properties indicated that the novel strain could be readily distinguished from the closest phylogenetic relatives. On the basis of these phenotypic and genotypic data, strain 211018(T) represents a novel species of the genus Micromonospora, for which the name Micromonospora rhizosphaerae sp. nov. is proposed. The type strain is 211018(T) (=CGMCC 4.5599(T) =DSM 45431(T)).

Streptomyces sanyensis sp. nov., isolated from mangrove sediment.

A novel strain, 219820(T), whose metabolites were found to be active against tumour cells, was isolated and characterized. The isolate belonged to the genus Streptomyces and had white to grey aerial mycelium and long chains of smooth spores in the aerial mycelium. A phylogenetic tree based on 16S rRNA gene sequences showed that strain 219820(T) had highest similarity to members of the genus Streptomyces and was most closely, albeit loosely, associated with Streptomyces crystallinus NBRC 15401(T) (98.624 % similarity), Streptomyces melanogenes NBRC 12890(T) (98.565 %) and Streptomyces noboritoensis NBRC 13065(T) (98.564 %). However, DNA-DNA relatedness and phenotypic data readily distinguished strain 219820(T) from these phylogenetically related type strains. It is evident from the combination of genotypic and phenotypic data that strain 219820(T) represents a novel species of the genus Streptomyces, for which the name Streptomyces sanyensis sp. nov. is proposed; the type strain is 219820(T) ( = CGMCC 4.5626(T)  = DSM 42014(T)).

Asanoa hainanensis sp. nov., isolated from rhizosphere soil of Acrostichum speciosum in a mangrove, and emended description of the genus Asanoa.

A Gram-reaction-positive, non-motile actinobacterium, designated strain 210121(T), was isolated from rhizosphere soil of the mangrove fern Acrostichum speciosum. 16S rRNA gene sequence analysis showed that the isolate belonged to the genus Asanoa. DNA-DNA relatedness values between strain 210121(T) and the type strains of the three recognized species of the genus Asanoa were below the 70 % threshold recommended for distinguishing bacterial genomic species. The novel isolate contained glutamic acid, glycine, alanine and meso-A(2)pm as cell-wall amino acids, indicating peptidoglycan type A1γ. The characteristic whole-cell sugars were xylose, ribose, glucose and mannose. The predominant menaquinones were MK-9(H(4)), MK-9(H(6)) and MK-9(H(8)). The major fatty acids were iso-C(16 : 0) (30.9 %), C(17 : 0) (23.0 %), anteiso-C(15 : 0) (14.9 %) and iso-C(15 : 0) (12.3 %). The phospholipid profile comprised phosphatidylethanolamine, phosphatidylinositol mannosides and phospholipids of unknown structure containing glucosamine. The G+C content of the DNA was 70.3 mol%. On the basis of the phenotypic and genotypic data, strain 210121(T) ( = CGMCC 4.5593(T)  = DSM 45427(T)) represents a novel species of the genus Asanoa, for which the name Asanoa hainanensis sp. nov., is proposed. An emended description of the genus Asanoa is also proposed.

Nonomuraea wenchangensis sp. nov., isolated from mangrove rhizosphere soil.

Strain 210417(T), which forms highly branched substrate and aerial mycelia, is a Gram-positive, aerobic and non-motile actinomycete isolated from mangrove rhizosphere soil. 16S rRNA gene sequence analysis showed that the strain should be classified in the genus Nonomuraea, being most closely related to the type strains of Nonomuraea coxensis (99.6 %) and Nonomuraea bangladeshensis (99.3 %). Chemotaxonomic properties [madurose as the major sugar in the cell wall; meso-diaminopimelic acid and N-acetylmuramic acid in the peptidoglycan; MK-9(H(4)) as the major menaquinone; iso-C(16 : 0) (24.1 %) as major fatty acid; and phospholipid pattern type IV] are consistent with the assignment of strain 210417(T) to the genus Nonomuraea. Strain 210417(T) could be differentiated from the closely related species N. coxensis and N. bangladeshensis by morphological, physiological, biochemical and chemotaxonomic properties, 16S rRNA gene sequence analysis and DNA-DNA hybridization results. It is therefore proposed that strain 210417(T) represents a novel species of the genus Nonomuraea, for which the name Nonomuraea wenchangensis sp. nov. is given; the type strain is 210417(T) ( = CGMCC 4.5598(T)  = DSM 45477(T)).

A preliminary study of neck-stomach syndrome.

AIM: To determine the expression of c-Fos, caspase-3 and interleukin-1beta (IL-1beta) in the cervical cord and stomach of rats with cervical spondylosis, to analyze their relationship, and to offer an explanation of one possible cause for functional dyspepsia (FD) and irritable bowel syndrome (IBS) caused by cervical spondylosis. METHODS: The cervical spondylosis model in rats was established by destroying the stability of cervical posterior column. The cord segments C4-6 and gastric antrum were collected 3 mo and 5 mo after the operation. Rats with the sham operation were used as controls. The expressions of c-Fos, caspase-3 and IL-1beta in the cervical cord and gastric antrum were determined by immunohistochemistry and/or Western blot. RESULTS: Immunohistochemical staining showed a few c-Fos, caspase-3 and IL-1beta-positive cells in the cervical cord and antrum in the control. There was a significant increase in c-Fos, caspase-3 and IL-1beta expression in model groups compared to the control groups at 3 mo and 5 mo after operation. More importantly, there was a significant (P < 0.05) increase in c-Fos, caspase-3 and IL-1beta expression in the model group rats at 3 mo compared to those at 5 mo after the operation (c-Fos: 11.20 +/- 2.26 vs 27.68 +/- 4.36 in the cervical cord, 11.3 +/- 2.3 vs 29.3 +/- 4.6 in the gastric antrum; caspase-3: 33.83 +/- 3.71 vs 36.32 +/- 4.01 in the cervical cord, 13.23 +/- 3.21 vs 26.32 +/- 4.01 in the gastric antrum; IL-1beta: 42.06 +/- 2.95 vs 45.91 +/- 3.98 in the cervical cord, 26.56 +/- 2.65 vs 32.01 +/- 2.98 in the gastric antrum). Western blot analysis showed time-dependent changes of caspase-3 and IL-1beta protein in the cervical cord and gastric antrum of rats with cervical spondylosis; there was no significant expression of caspase-3 and IL-1beta protein in the control group at 3 mo and 5 mo after the sham operation, whereas there was a significant difference in caspase-3 and IL-1beta protein levels between the model group rats followed up for 3 mo and those for 5 mo (P < 0.05). CONCLUSION: There is a significant association of c-Fos, caspase-3 and IL-1beta expressions in the gastric antrum with that in the spinal cord in rats with cervical spondylosis, suggesting that the gastrointestinal function may be affected by cervical spondylosis.

[One-stage radical eradication and wedged vertebral osteotomy through a purely posterior procedure in treating thoracic and lumbar spine tuberculosis associated with kyphosis or scoliokyphosis demormity].

OBJECTIVE: To investigate the feasibility, clinical indications and significance of one-stage radical eradication, wedged vertebral osteotomy and instrumentation in the treatment of tuberculosis of thoracic and lumbar spine associated with kyphosis or scoliokyphosis through a purely posterior procedure. METHODS: Sixteen cases with tuberculosis of thoracic and lumbar spine associated with kyphosis or scoliokyphosis were treated by one-stage radical eradication, wedged vertebral osteotomy and instrumentation fixation through posterior procedure. All patients included 12 males and 4 females, and the average age was 37.1 years (from 17 to 53 years). The preoperative average Cobb angle of kyphosis was 78.3 degrees (range from 54 degrees to 138 degrees ). There were 2 cases associated with scoliosis (the Cobb angle of scoliosis was 31 degrees and 24 degrees), and 1 case with lateral transition. Spinal cord compression were found in 7 cases. According to the Frankel's classification, 2 cases belonged to C degree, and 5 cases to D degree. There were 2 cases with caudal equina or nerve root lesions. RESULTS: The average blood loss during the operation was 1100 ml (range from 450 to 2200 ml), and the average operation time was 265 min (range from 215 to 325 min). The postoperative results were satisfactory, 14 cases were excellent and 2 cases were good. Obvious improvement was obtained in 9 cases with neurological dysfunction. The postoperative average Cobb' angle was 28.5 degrees (range from 0 degrees to 67 degrees), and the corrective rate was 63.6%. The followed-up was ranged from 14 to 52 months with an average of 26.3 months. There were no major complications related to the fixations, loss of correction and the fusion were achieved in all patients. CONCLUSIONS: One-stage radical eradication, wedged vertebral osteotomy and instrumentation is a feasible and an effective procedure in the treatment of spinal tuberculosis associated with kyphosis or scoliokyphosis. Compared with combined anterior and posterior procedure, the surgical technique may decrease injuries and has better result.