ABSTRACT
In recent years， the incidence of pulmonary nodules has kept rising. To give full play to the advantages of traditional Chinese medicine （TCM） in the treatment of pulmonary nodules and identify the breakthrough points of integrating TCM with Western medicine， the China Association of Chinese Medicine organized medical experts in TCM and western medicine to carry out in-depth discussion regarding this disease. The discussion encompassed the modern medical advances， TCM theories of etiology and pathogenesis， the role and advantages of TCM in the whole course management of pulmonary nodules， contents and methods of research on pulmonary nodules， and science popularization work， aiming to provide a reference for clinical practice and scientific research. After discussion， the experts concluded that the occurrence of pulmonary nodules was rooted in the deficiency of the lung and spleen and triggered by phlegm dampness， blood stasis， and Qi stagnation. TCM can treat pulmonary nodules by controlling and reducing nodules， improving physical constitution， ameliorating multi-system nodular diseases， reducing anxiety and avoiding excessive diagnosis and treatment， and serving as an alternative for patients who are unwilling or unfit for surgical treatment. At present， the optimal diagnosis and treatment strategy for pulmonary nodules has not been formed， which needs to be further studied from multiple perspectives such as clinical epidemiology， biology， and evidence-based medicine. The primary task of current research is to find out the advantages， effective prescriptions， and target populations and determine the effective outcomes of TCM in the treatment of pulmonary nodules. At the same time， basic research should be carried out to explore the etiology and biological behaviors of pulmonary nodules. The expert consensus on the diagnosis and treatment of pulmonary nodules with integrated TCM and Western medicine needs to be continuously revised to guide clinicians to conduct standardized， scientific， and accurate effective diagnosis and treatment.
ABSTRACT
Objective:To study the effect of ulinastatin combined with early enteral nutrition on severe acute pancreatitis and its effect on nuclear factor-κB(NF-κB) and Toll-like receptor 4 (TLR4).Methods:Ninety severe acute pancreatitis patients who were treated in Central Hospital of Lijin County from January 2016 to January 2020 were selected and were divided into U+EEN group (ulinastatin combined with early enteral nutrition therapy) and EEN group (early enteral nutrition therapy) by random number table method, with 45 patients in each group. Curative effect, complications, nutritional indicators, immunoglobulins and inflammatory factors were detected and compared with analysis of variance. Western blot was used to detect the expression of NF-κB and TLR4 in pancreatic tissue in two groups.Results:The hospitalization time, ICU admission time, intestinal ventilation time, hospitalization costs and organ failure rate, pancreatic cysts, diabetes, chronic pancreatitis, incidence of sepsis in U + EEN group were lower than those in EEN group: (2.1 ± 0.4) months vs. (2.4 ± 0.6) months, (16.9 ± 2.1) d vs. (21.7 ± 2.8) d, (23.7 ± 3.8) d vs. (27.4 ± 4.1) d, (11.4 ± 1.5) thousand Yuan vs. (14.1 ± 2.1) thousand Yuan and 8.9%(4/45) vs. 20.0%(9/45), 13.3%(6/45) vs. 28.9%(13/45), 11.1%(5/45) vs. 24.4%(11/45), 8.9%(4/45) vs. 26.7%(12/45), 6.7%(3/45) vs. 22.2%(10/45), and the differences were statistically significant ( P<0.05). The levels of prealbumin (PA), albumin (ALB) and total protein (TP) after treatment in U + EEN group were higher than those in EEN group: (107.4 ± 6.5) mg/L vs. (102.8 ± 4.7) mg/L, (46.1 ± 3.5) g/L vs. (43.4 ± 2.8) g/L, (55.9 ± 3.4) g/L vs. (53.7 ± 3.1) g/L, and the differences were statistically significant ( P<0.05). The levels of IgG, IgA, IgM after treatment in U+EEN group were higher than those in EEN group: (10.5 ± 1.6) g/L vs. (9.5 ± 1.3) g/L, (8.9 ± 1.4) mg/L vs. (8.3 ± 1.2) mg/L, (60.5 ± 3.6) mg/L vs. (55.9 ± 3.4) mg/L, the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 in U+EEN group were lower than those in EEN group: (25.1 ± 2.9) mg/L vs. (30.6 ± 4.1) mg/L, (20.1 ± 1.9) mg/L vs. (24.6 ± 1.5) mg/L, (17.8 ± 1.9) mg/L vs. (20.1 ± 2.3) mg/L, and the differences were statistically significant ( P<0.05). The expressions of NF-κB and TLR4 protein in pancreatic tissue of patients in U + EEN group were significantly lower than those in EEN group (0.3 ± 0.2 vs. 0.5 ± 0.2, 0.2 ± 0.1 vs. 0.5 ± 0.1, P<0.05). Conclusions:Ulinastatin combined with early enteral nutrition can significantly improve the nutritional status and immune function and improve the prognosis of patients with severe acute pancreatitis, which may be related to ulinastatin′s reduction effect of NF-κB and TLR4′s expressions.
ABSTRACT
Objective@#To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection.@*Methods@#171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64.1±7.7) years. 54.4% had a history of smoking. The diameter of the tumors was(3.3±1.9) cm; Central-type tumor were 59 cases(34.5%), peripheral 112 cases(65.5%), upper lobe 95 cases(55.6%) and lower lobe 76 cases(44.4%). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors.@*Results@#The metastasis rate of station 4L was 21.6%. Tumor size, locations(central type/upper lobe), operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univariate analysis. Tumor size(OR=1.611, P=0.032) and location of upper lobe(OR=2.823, P=0.008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2.5cm. The metastatic rate of 4L was 32.6% when tumor size larger than 2.5 cm and 7.9% when tumor size smaller than 2.5cm.Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7.@*Conclusion@#Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2.5 cm or located at upper lobe.
ABSTRACT
Objective To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection. Methods 171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64. 1 ± 7. 7) years. 54. 4％ had a historyofsmoking. Thediameterofthetumorswas(3.3±1.9)cm;Central-typetumorwere59cases(34.5％),peripheral 112 cases(65. 5％), upper lobe 95 cases(55. 6％) and lower lobe 76 cases(44. 4％). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors. Results The metastasis rate of station 4L was 21. 6％. Tumor size, locations(central type/upper lobe),operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univari-ate analysis. Tumor size(OR=1. 611,P=0. 032) and location of upper lobe(OR=2. 823,P=0. 008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2. 5cm. The metastatic rate of 4L was 32. 6％ when tumor size larger than 2. 5 cm and 7. 9％ when tumor size smaller than 2. 5cm. Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7. Conclusion Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2. 5 cm or located at upper lobe.
ABSTRACT
<p><b>BACKGROUND</b>To investigate pathologically the characteristics of proximal bronchial invasion of lung cancer, and to provide the theoretic basis for the selection of a proper operation mode.</p><p><b>METHODS</b>A total of 398 patients with lung carcinoma underwent radical pulmonectomy and systematic lymphadenectomy. The proximal bronchi and the hilar and mediastinal lymph nodes of their operatively resected specimens were selected for pathological study.</p><p><b>RESULTS</b>(1)The direct invasion of cancerous cells through mucous, submucous or multiple layers was the most frequent way during lung cancer spread, rating 9.3%, 21.8% and 68.9% respectively. 96.4% of the cancerous invasion occurred at the proximal bronchial wall less than 1.5 cm apart from the cancer margin. The extension of invasion correlated with the histopathologic type of cancer, mode of invasion and TNM classification. (2)The cancer infiltration by the nodes metastasizing into the bronchus wall (bronchial external tunica or cartilage) was also an important way for the cancer to spread, especially in adenocarcinoma. The poor differentiated adenocarcinoma has significantly higher metastatic rate and infiltration rate than the well differentiated ( P < 0.01, P < 0.01). There were 22 such cases, including 3 of lobar bronchus wall invaded by N1 metastasis and 19 of main bronchus wall by N2 metastasis.</p><p><b>CONCLUSIONS</b>For radical removal of tumor, the key point for selecting a rational operation mode is to keep a distance of 1.5 cm or more between the excision margin of the bronchus and the tumor, to pay attention to the bronchial wall invasion caused by the metastatic lymph nodes, even in peripheral adenocarcinoma, and to dissect extensively and completely the lymph nodes of the hilar and upper and lower mediastinum at the homolateral thoracic cavity.</p>
