Right upper lobe segmentectomy and subsegmentectomy guided by classification pattern of peripheral segmental veins.

Background: Studies have analyzed the simplified branching pattern of peripheral segmental veins and developed a standardized approach for intersegmental vein identification in the right upper lobe (RUL). However, the identification approach of intersubsegmental veins has not been reported. This study aimed to supplement the identification approach of intersubsegmental veins and the classification pattern of peripheral segmental veins by using three-dimensional computed tomography bronchography and angiography (3D-CTBA). Materials and methods: A total of 600 patients with ground glass opacity (GGO) who had undergone 3D-CTBA preoperatively at Hebei General Hospital between September 2020 and September 2022 were used for the retrospective study. We reviewed the anatomical variations of RUL veins in these patients using 3D-CTBA images. Results: According to the anatomical position, the peripheral segmental veins structures of RUL were classified into five categories: "Iab type of anterior with central vein" (256/600, 42.7%), "Ib type of anterior with central vein" (166/600, 27.7%), "Central vein type" (38/600, 6.3%), "Anterior vein type" (81/600, 13.5%), "Right top pulmonary vein type" (57/600, 9.5%). The approach for intersegmental vein and intersubsegmental veins identification was divided into five types: anterior approach, posterobronchial approach, central vein approach, V2t approach, and intermediate bronchus posterior surface approach. Conclusions: The classification pattern of peripheral segmental veins should find wide application. Further, approaches identifying intersegmental veins and intersubsegmental veins may help thoracic surgeons perform safe and accurate RUL segmentectomy.

Analysis of variations in the bronchovascular pattern of the lingular segment to explore the correlations between the lingular segment artery and left superior division veins.

Background: With the development of anatomical segmentectomy, the thoracic surgeons must master the anatomical variations of the pulmonary bronchi and vessels. However, there are only a few reports showing anatomic variations of the lingular segment (LS) using three-dimensional computed tomography bronchography and angiography (3D-CTBA). Thus, the present study aimed to analyze the bronchovascular patterns of the LS and explore the correlation between the lingular segment artery (LSA) and left superior division veins (LSDV). Materials and methods: The 3D-CTBA data of the left upper lobe (LUL) were collected from patients who had undergone lobectomy or segmentectomy at Hebei General Hospital between October 2020 and October 2022. We reviewed the clinical characteristics and variations in bronchi and pulmonary vessels and grouped them according to different classifications. Results: Among all 540 cases of 3D-CTBA, the branching patterns of LSA included 369 (68.3%) cases with the interlobar origin, 126 (23.3%) cases with the interlobar and mediastinal origin, and 45 (8.3%) cases with the mediastinal origin. The branching pattern of LSDV could be classified into three forms: Semi-central vein type (345/540, 63.9%), Non-central vein type (76/540, 14.1%), and Central vein type (119/540, 22.0%). There were 51 cases (9.4%) with Non-central vein type, 50 cases (9.3%) with Central vein type, 268 cases (49.6%) with Semi-central vein type in the interlobar type, and 7 cases (1.3%) with Non-central vein type, 9 cases (1.7%) with Central vein type, 29 cases (5.4%) with Semi-central vein type in the mediastinal type. Moreover, the Non-central vein type, the Central vein type, and the Semi-central vein type accounted for 18 (3.3%), 60 (11.1%), and 48 (8.9%) in the interlobar and mediastinal type. Combinations of the branching patterns of the LSA and LSDV were significantly dependent (p < 0.005). The combinations of the interlobar and mediastinal type with the Central vein type, and the interlobar type and the mediastinal type with the Semi-central vein type were frequently observed. Conclusions: This study found the relationship between the LSA and LSDV and clarified the bifurcation patterns of the bronchovascular in the LS. Our data can be used by thoracic surgeons to perform safe and precise LS segmentectomy.

The detailed classification of the interlobar artery and the artery crossing intersegmental planes in the right upper lobe.

Background: With the prevalence of three-dimensional computed tomography bronchography and angiography (3D-CTBA) and the development of anatomical segmentectomy, several studies have analyzed the branching patterns of peripheral segmental arteries in the right upper lobe (RUL). Nevertheless, the detailed classification of the branching patterns of the interlobar artery and the artery crossing intersegmental planes remains unknown. Thus, we conducted a retrospective study to analyze the variations of the interlobar artery and the artery crossing intersegmental planes in the RUL using 3D-CTBA. Materials and methods: A total of 600 patients with ground-glass opacity (GGO) who had undergone 3D-CTBA preoperatively at Hebei General Hospital between September 2020 and September 2022 were used for the retrospective study. We reviewed the anatomical variations of the RUL arteries in these patients using 3D-CTBA images. Results: The branching patterns of the RUL artery were classified into the following four categories: trunk superior (Tr. sup), Tr. sup + interlobar artery, Tr. sup + trunk inferior (Tr. inf), and Tr. sup + Tr. inf + interlobar artery. The branching patterns of the interlobar artery were subclassified into four subtypes: posterior ascending artery (A. pos), anterior ascending artery (A. ant), A. pos + A. ant, and ascending artery (A. asc). The artery crossing intersegmental planes contains two types: type A, anterior subsegmental artery crossing intersegmental planes (AX1b); type B, recurrent artery crossing intersegmental planes (AX. rec). Conclusion: The variation types of blood vessels in the RUL are complex. This study explored the detailed classification of the interlobar artery and the artery crossing intersegmental planes. It can help thoracic surgeons understand the anatomy variations, accurately locate lesions before surgery, and effectively plan surgeries.

What is the correlation between the defective and splitting posterior segmental bronchus and recurrent artery crossing intersegmental planes in the right upper lobe?

Background: With the prevalence of three-dimensional computed tomography bronchography and angiography (3D-CTBA) and the development of anatomical segmentectomy, studies have confirmed the increased incidence of anomalous veins in patients with tracheobronchial abnormalities. Nevertheless, the characteristic anatomical correlation between bronchus and artery variation remains unknown. Thus, we conducted a retrospective study to investigate recurrent artery crossing intersegmental planes and their associated pulmonary anatomical features by analyzing the incidence and types of the right upper lobe (RUL) bronchus and the artery composition of the posterior segment. Materials and Methods: A total of 600 patients with ground-glass opacity who had undergone 3D-CTBA preoperatively at Hebei General Hospital between September 2020 and September 2022 were included. We reviewed the anatomical variations of the RUL bronchus and artery in these patients using 3D-CTBA images. Results: Among all 600 cases, the defective and splitting B2 contained four types of the RUL bronchial structure: B1 + BX2a, B2b, B3 (11/600, 1.8%); B1, B2a, BX2b + B3 (3/600, 0.5%); B1 + BX2a, B3 + BX2b (18/600, 3%); B1, B2a, B2b, B3 type (29/600, 4.8%). The incidence of recurrent artery crossing intersegmental planes was 12.7% (70/600). The incidence of recurrent artery crossing intersegmental planes with and without the defective and splitting B2 was 26.2% (16/61) and 10.0% (54/539), respectively (p < 0.005). Conclusions: In patients with defective and splitting B2, the incidence of recurrent artery crossing intersegmental planes was increased. Our study provides certain references that surgeons can use to plan and perform RUL segmentectomy.

Effect of Yupingfeng granules on the skin barrier in atopic dermatitis mice models.

OBJECTIVE: To investigate effect of Yupingfeng granules, prepared with Chinese Medicines, on the wound healing and on the expression of aquaporin 3 (AQP3) and the skin barrier in the animal models of atopic dermatitis (AD). METHODS: Acute skin lesions of AD models were prepared using 2,4-dinitrochlorobenzo (DNCB) in mice and animals were treated with either Yupingfeng granules or placebo for two weeks. Skin wound healing outcome was assessed by measuring skin thickness, weight (quality) of the skin, and trans-epidermal water loss (TEWL). Expression of AQP3 mRNA and protein was assessed by reverse transcriotion polymerase chain reaction (RT-PCR) and immunoblotting, respectively. RESULTS: Yupingfeng granule treatment resulted in significant acceleration of wound healing with 63.64% efficiency, which was significantly higher than that of placebo granule treatment (31.82%, P < 0.01 by Wilcoxon Rank-sum test). Skin thickness, weight of the wounded skin, and TEWL were significantly higher in the AD models compared to that of normal animals. Treatment with Yupingfeng granules resulted in significant decrease in skin thickness [(937 ± 31) vs (360 ± 21) urn, P < 0.01], weight of the wounded skin [(42 ± 4) vs (24 ± 5) mg, P < 0.01], and TEWL [(30 ± 4) vs (13 ± 4) g•h-1•m-2, P < 0.01]. Yupingfeng granules also significantly down-regulated mRNA and protein expression of AQP3 in the animal models. CONCLUSION: Our findings suggested that Yupingfeng granules could be used in AD treatment.

Effect of new Pulian Ointment () in treating psoriasis of blood-heat syndrome: A randomized controlled trial.

OBJECTIVE: To objectively assess the clinical efficacy and safety of a new Pulian Ointment (, NPLO) in treating psoriasis of blood-heat syndrome of Chinese medicine. METHODS: A total of 108 patients with psoriasis of blood-heat syndrome were equally assigned, using a randomizing digital table, to the test group treated externally with NPLO and the control group treated with placebo; the medication was done using a singleblinded method twice a day. Meanwhile, all patients received by oral intake a conventional Chinese decoction for clearing heat and cooling blood; the therapeutic course was 4 weeks for both groups. The therapeutic efficacy, changes in the Psoriasis Area and Severity Index (PASI) score and various aspects of the lesion, including scaly eruption, erythema, infiltration, size, score of itching as well as adverse reactions were observed. RESULTS: The trial was completed in 100 patients, 51 in the test group and 49 in the control group. The remarkably effective rate was 45.10% and the total effective rate was 84.31% in the test group, which were significantly higher than those in the control group, 12.24% and 51.02%, respectively, showing a significant difference between groups (P<0.01). The test group also showed better effects in the improvement of the PASI score of the lesions and scores on erythema, infiltration, size of lesion as well as itching. No adverse event was found in either group. CONCLUSION: NPLO is a Chinese remedy for the external treatment of psoriasis of the blood-heat syndrome with a reliable therapeutic efficacy and good safety.