Low-pressure Pneumoperitoneum With Abdominal Wall Lifting Versus Standard Pressure Pneumoperitoneum in Laparoscopic Fundoplication for Gastroesophageal Reflux Disease: A Propensity Score-matched Analysis.

OBJECTIVE: The objective of this study was to compare the treatment results of low-pressure pneumoperitoneum with abdominal wall lifting (AWL+LP, 6 mm Hg) versus standard pressure pneumoperitoneum (SP, 12 mm Hg) during laparoscopic fundoplication for gastroesophageal reflux disease (GERD), using propensity score matching (PSM). MATERIALS AND METHODS: A retrospective analysis was made of 362 patients, 123 in the AWL+LP group and 239 in the SP group, who underwent laparoscopic fundoplication for GERD from January 2010 to December 2017. Perioperative and prognostic outcomes were compared after PSM with 1:1 match. RESULTS: After PSM, 107 matched pairs were obtained. Compared with the SP group at 30 and 60 minutes after pneumoperitoneal initiation, the AWL+LP group showed significantly lower end-tidal carbon dioxide value (P<0.001, <0.001, respectively), lower partial pressure of carbon dioxide value (P<0.001, 0.016, respectively) and significantly higher pH value (P<0.001, <0.001, respectively). However, postoperative shoulder pain, abdominal pain, and arrhythmia in the AWL+LP group were less than those in SP group (P=0.01, 0.017, 0.005, respectively). There was no significant difference in operative time (106.54±27.80 vs. 107.38±24.78 min), blood loss [15 mL (interquartile range: 12.5 to 20 mL) vs.15 mL (interquartile range: 10 to 20 mL)], length of stay (4 vs. 4 d), the wound ecchymosis [2 (1.87%) vs. 3 (2.80%)] and rates of recurrence [8 (7.48%) vs. 5 (4.67%)] between AWL+LP group and SP group. CONCLUSION: AWL+LP resulted in comparable perioperative and prognostic outcomes with less impact on changes in cardiorespiratory function compared with SP approaches of laparoscopic fundoplication for GERD.

Placing covered self-expanding metal stents by suspension laryngoscope in benign tracheal stenosis.

BACKGROUND: Tracheobronchial stent placement for malignant airway strictures has been proved to improve respiratory function, but experience for benign tracheobronchial stenoses is limited. The purpose of our study is to investigate the efficacy of covered expandable metallic stents, inserted through a suspension laryngoscope, treating tracheal stenosis following intubation or tracheostomy. METHODS: From 2010 to 2018, 67 adult patients with the benign tracheal stenosis, underwent stent placement, using a suspension laryngoscope. According to the date of stent placement and stent caliber, these patients have been subdivided into two groups: Group 1 (from 2010 to 2013, stent caliber ranging from 16 to 20 mm) and Group 2 (from 2014 to 2018, stent caliber ranging from 18 to 22 mm). Complications, related reinterventions, and long-term prognosis were retrospectively evaluated. RESULTS: Primary successful stent placement was achieved and symptoms were improved in all patients. Complications occurred in 27 (40.3%) cases. Among these, there were 14 (20.9%) cases with stent migration, 10 (14.93%) with granulation tissue formation and 3 (4.48%) with pneumonia. Stent migration in Group 1 was nearly 30% higher than that in Group 2 (P = 0.002). Five of the 8 patients who had placement of 16 mm stents had stent migration, more often than with 20 mm stents (P = 0.002). Ten patients' trachea had slight narrowing but without any symptoms. Six patients still had granulation tissue but without any growth at least two-year follow-up (2 patients whose stents were removed more than 1 year after placement). Even without tracheal narrowing and granulation tissue, 5 patients felt persistent shortness of breath. 92.5% of the patients reported to be satisfied with significant improvement in symptoms. CONCLUSIONS: Patients with tracheal obstruction secondary to intubation or tracheostomy can benefit from tracheal stents. Placing 16 mm stents might lead to stent migration more easily than 20 mm stents. Tracheal stents placed by a suspension laryngoscope provide a reasonable alternative to open surgery for patients with benign tracheal stenosis or obstruction.

Surgical feasibility and long-term outcome of superior vena cava replacement for advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy.

BACKGROUND: The aim of this study was to investigate the long-term outcome of superior vena cava (SVC) replacement after chemotherapy or chemoradiotherapy for advanced thymoma. METHODS: The medical information of patients with advanced thymoma who underwent thymoma resection and SVC replacement in Beijing Tongren Hospital from 2002 to 2017 were reviewed. We compared surgical outcomes, postoperative complications and long-term prognosis in the chemoradiotherapy + surgery group (CRT + surgery group, 19 cases) and the surgery group (26 cases). RESULTS: The operation time (486.05 ± 148.01 vs. 370.77 ± 124.32 min; p = 0.007) and intraoperative blood loss (1400 ml [IQR 1125-2105 ml] vs. 855 ml [IQR 555-1682.5 ml], p = 0.036), poor wound healing (three cases [15.79%] vs. zero cases [0.0%], p = 0.036) in the CRT + surgery group were significantly higher than those of the surgery group. There was no significant difference between the CRT + surgery group and the surgery group in postoperative chest tube drainage time, hospitalization time, postoperative arrhythmia and incidence of pneumonia. Kaplan Meier analysis showed that the recurrence-free survival (RFS) curves of the CRT + surgery group patients were better than those of the surgery group (p = 0.031). However, overall survival (OS) between the two groups was not significantly different (p = 0.069). CONCLUSIONS: Thymoma resection and SVC replacement is feasible for patients undergoing preoperative induction chemotherapy or chemoradiotherapy for advanced thymoma. Although patients in the CRT + surgery group had a longer operation time and increased intraoperative bleeding, the RFS rate seemed to be better than that in the surgery group.

Evaluating the effectiveness of chemotherapy for thymic epithelial tumors using the CD-DST method.

BACKGROUND: Thymic epithelial tumors (TET) are frequently eligible for curative-intent surgical resection. For locally advanced TETs, chemotherapy has been used to both reduce the tumor burden and achieve prolonged disease control. However, effective therapy for this disease largely remains to be determined. Here, we report the chemosensitivity of 100 patients with TETs determined by the collagen gel droplet embedded culture-drug sensitivity test (CD-DST). METHODS: A total of 100 patients with TETs underwent surgical resection. The efficacy of antitumor agents on TET cells was tested by CD-DST. RESULTS: Thymic epithelial tumors were pathologically confirmed after surgery: two cases were type A thymoma, 17 were type AB, 12 were type B1, 44 were type B2, 12 were type B3, and there were 13 cases with thymic carcinoma. A total of 36% patients with TETs were sensitive to different types of chemotherapeutic agents. There was no significant differences in age, histological type, clinical staging, or association with autoimmune diseases between sensitive and nonsensitive cases. Type B1 and B2 thymoma were relatively more sensitive to chemotherapeutic agents (6/12 and 18/44, respectively), while sensitivity of type B3 cases to chemotherapeutic agents was much lower (only 2/12). Cases with type A thymoma were not sensitive to any antitumor drugs. Among 11 chemotherapeutic agents tested in our study, the sensitivity of TETs to EPI was the highest (16%). No patients with thymoma were sensitive to Alimta (Pemetrexed). CONCLUSIONS: Our work illuminates the effectiveness of chemotherapy for TETs and provides important clues for choosing antitumor drugs with relatively high drug sensitivity to TETs in advance.

[Comparison of cutaneous temperature at 12 Jing-well points regions of bilateral yin- and yang-meridians in healthy volunteers].

OBJECTIVE: To observe differences of cutaneous temperature of the 12 Jing-well points regions of the yin-meridians and yang-meridians, and on the upper and lower limbs so as to provide a reference for clinical diagnosis. METHODS: A total of 26 healthy young volunteers (15 men and 11 women, 23 to 31 years in age) participated in the present study. The skin temperature of the 12 Jing-well points [Shaoshang (LU 11), Sahngyang (LI 1), Yinbai (SP 1), Lidui(ST45), Shaochong (HT9), Shaoze (SI 1), Yongquan (KI 1), Zhiyin (BL 67), Zhongchong (PC 9), Guanchong(SJ 1), Dadun (LR 1) and Qiaoyin (GB 44)] at night (19:00-21:00) was detected under a room temperature of (20 +/- 2) degrees C and humidity of 65%-75% by using an infrared thermometer. RESULTS: Comparison between the single Jing-well point of the yin-meridians and that of the yang-meridians showed that only the cutaneous temperature of Zhiyin (BL 67) was significantly lower than that of Yongquan (KI 1, P < 0.05). No significant differences were found between Shaoshang (LU 11) and Shangyang (LI 1), Yinbai (SP 1) and Lidui (ST 45), Shao-chong (HT 9) and Shaoze (SI 1), Zhongchong (PC 9) and Guanchong (SJ 1), and between Dadun (LR 1) and Qiaoyin (GB 44) in the skin temperature (P > 0.05). Comparison between the 6 Jing-well points of the 6 yin-meridians group and those of the 6 yang-meridians group showed that the average skin temperature of the latter was significantly lower than that of the former (P < 0.01). The average skin temperature was significantly lower at the 3 Jing-well points of the 3 yin-meridians of foot than that at the 3 Jing-well points of the 3 yin-meridians of hand (P < 0.01). Such is the case at the 3 Jing-well points of the 3 yang-meridians of foot in comparison with the 3 yang-meridians of hand (P < 0.01). The average skin temperature of the 6 Jing-well points of the right yang-meridians was significantly higher than that of the 6 Jing-well points of the left yang-meridians (P < 0.01). No significant differences were found between the left yin-meridians and right yin-meridians in skin temperature (P > 0.05). CONCLUSION: The average skin temperature values of the Jing-well points are evidently higher at the 6 yin-meridians than at the 6 yang-meridians, obviously higher on the upper limbs than on the lower limbs, and apparently higher on the right meridians than on the left meridians in healthy volunteers.