Cardiopulmonary exercise testing screening and pre-operative pulmonary rehabilitation reduce postoperative complications and improve fast-track recovery after lung cancer surgery: A study for 342 cases.

BACKGROUND: An evaluation of cardiopulmonary exercise testing (CPET) screening and pre-operative pulmonary rehabilitation in reducing postoperative complications and improving fast-track recovery in high-risk patients who undergo resection for lung cancer. METHODS: Of 342 potential lung cancer cases, 142 high-risk patients were finally divided into two groups: group R (n = 71) underwent an intensive pre-operative pulmonary rehabilitation program (PRP), followed by lobectomy; group S (n = 71) underwent only lobectomy with conventional management. Postoperative complications, average days in hospital, postoperative days in hospital, and cost were analyzed. RESULTS: The 142 high-risk patients were screened by smoking history and CPET. Sixty-eight patients had bronchial hyperresponsiveness (BHR) and 47 patients had peak expiratory flow <250 L/minute by CPET. The rate of postoperative total complications in group R (16.90%) was significantly lower than in group S (83.31%) (P = 0.00), as was the rate of postoperative pulmonary complications PPC: group R (12.81%) versus S (13.55%) (P = 0.009); the PPC in the left lung (17.9%) was higher than in the right lung (2.3%) (P = 0.00). The average days in hospital in group S was significantly higher than in group R (P = 0.03). There was no difference between groups in average hospital cost (P = 0.304). CONCLUSION: Pre-operative screening using CPET is conducive to identifying high-risk patients for lung resection. Pre-operative pulmonary rehabilitation is helpful to reduce postoperative complications and improve fast-track recovery.

[Cardio-pulmonary exercise capacity in patients with lung cancers: a comparison study between video-assisted thoracoscopic lobectomy and thoracotomy lobectomy].

OBJECTIVE: To determine the effect of video-assisted thoracoscopic lobectomy on the pulmonary rehabilitation of patients with lung cancers. METHODS: Between September 2010 and December 2011, 138 patients. with lung cancers were treated with lobectomy: 68 using video-assisted thoracoscopic surgery (VATS) and 70 using thoracotomy. The preoperative and postoperative (7 d and 30 d) pulmonary functions and Cardio-pulmonary Exercise Capacities as well as postoperative (7 d and 30 d) DE Morton Index of the two groups of patients were assessed. The two groups of patients had similar in clinical characteristics. RESULTS: (1) Patients in the VATS group had greater FEV1 (1.64 +/- 0.21) L and PEF [(310.58 +/- 30.13) L/min] on the 7 d after operations than those with thoracotomy [FEV1 (1.34 +/- 0.11) L and PEF (270.18 +/- 25.67) L/min], P < 0.05. (2) Patients in the VATS group had lower fatigue index (0.27 +/- 0.08) and dyspnea index (0.28 +/- 0.17) on the 7 d after operations than those with thoracotomy (0.44 +/- 0.10 fatigue index and 0.39 +/- 0.09 dyspnea index), P < 0.05. (3) Patients in the VATS group had longer 6-min walking distance on the 7 d [(490.57 +/- 118.33) m] and 30 d [(524.32 +/- 140.87) m] after operations than those with thoracotomy [(395.07 +/- 100.19) m at 7 d and (471.10 +/- 118.57) m at 30 d], P < 0.05. (4) Patients in the VATS group had higher DE Morton index (74.58 +/- 16.23) on the 7 d after operations than those with thoracotomy (55.87 +/- 14.79), P < 0.05. CONCLUSION: VATS lobectomy for curative lung cancer resection appears to provide a superior functional health recovery compared with thoracotomy.

[Pulmonary hilum Castleman's disease: a report of 4 cases and review of literature].

OBJECTIVE: To investigate the clinical characteristics of pulmonary hilum Castleman's disease. METHODS: The clinical characteristics of 4 patients diagnosed with pulmonary hilum Castleman's disease in our department were analysed and compared with findings in relevant literature. RESULTS: Gender and age were not associated with Castleman's disease. The disease was often identified in physical examinations with atypical clinical symptoms. Chest CT was the most common and valuable diagnostic method revealing soft tissue mass near the pulmonary hilum. Gross-total resection of the tumor and (or) lobectomy through a combined posterior trans-thoracic approach were commonly performed, with good prognosis. CONCLUSION: Hilum Castleman's disease can be effectively diagnosed and treated.

Clinical study of domestic ZQL-type retrievable vena cava filter.

BACKGROUND: Pulmonary thromboembolism (PTE) is a serious disease often leading to disability and death. Percutaneous placement of an inferior vena cava (IVC) filter is an effective method to prevent fatal PTE caused by lower extremity deep venous thrombosis (LEDVT). We developed the ZQL-type retrievable vena cava filter. The aim of this study was to evaluate the safety and effectiveness of the ZQL-type filter for prevention of fatal PTE. METHODS: A total of 144 patients with indications for placement of an IVC filter received insertion of filters via a femoral (n = 37) or jugular (n = 107) vein approach. Abdominal X-ray and color Doppler ultrasonography of IVC were regularly performed to visualize the position and condition of the IVC filter following filter placement. If thrombi in the lower extremity deep veins were removed within 2 weeks, the filter retrieval procedure was performed after an abdominal radiograph, an inferior vena cavogram and a pulmonary angiography. Otherwise, the filter should be kept permanently in place with regular follow-up inspections. RESULTS: One hundred and forty-four filters were implanted at the target sites with a success rate of 98.61% for one-time placement and 100% for two-time placement. Of the 137 patients followed up (follow-up rate, 95.14%), 43 patients had filters retrieved during a period of between 7 and 14 days (median, 12 days) following filter placement. The remaining 94 patients were followed for 7 days to 39 months (median follow-up period, 17 months). No filter migration or tilt, filter fracture or IVC perforation was observed. No obstruction of IVC occurred. No symptomatic PTE developed during the follow-up period. CONCLUSION: The ZQL-type retrievable vena cava filter is a safe and effective device to prevent PTE. This filter possesses a distinctive stent-shape, stable design, high capture efficacy, and is easy to insert and retrieve and thus is suitable for clinical application.

[Cloning deletion of mouse medullary CD4SP thymocyte subgroups induced by superantigen staphylococcal enterotoxin B].

OBJECTIVE: To investigate the clonal deletion of medullary CD4SP thymocyte subgroups induced by superantigen SEB, and to understand the stage specificity of thymic negative selection based on the developmental pathway of medullary CD4SP thymocytes we established previously. METHODS: SEB was intravenously injected into C57BL/6 mice, and then the expression of surface molecules and apoptosis of thymocytes were detected by FACS. The reduction of each subgroup of medullary CD4SP thymocytes was analyzed by FACS assay and cell counting. RESULTS: The percentage of apoptotic CD4SP thymocytes significantly increased after the intravenous injection of SEB. The cell number of CD4SP decreased about 43.8%. Among TCR Vbeta8(+)CD4SP thymocytes, the percentage of 6C10(+)CD69(+)Qa-2(-)thymocytes(SP1) was reduced by two thirds and the percentage of Qa-2(+) thymocytes(SP4) was comparatively increased, while the cell numbers of SP1 to SP3 decreased over 80% and that of SP4 decreased about 50%. CONCLUSION: Thymic negative selection occurs during the stage of SP and goes through the whole developmental progress from SP1 to SP4.The thymocytes in the stage of SP1 to SP3 are more sensitive to apoptosis than those in the stage of SP4.

Characterization of the in vivo dynamics of medullary CD4+CD8- thymocyte development.

Our previous studies have defined a differentiation program followed by the newly generated single-positive (SP) thymocytes before their emigration to the periphery. In the present study, we further characterize the development of CD4SP cells in the thymic medulla using mainly intrathymic adoptive transfer assays. By analyzing the differentiation kinetics of the donor cells, which were shown to home correctly to the medullary region following adoptive transfer, we established the precursor-progeny relationship among the four subsets of CD4SP thymocytes (SP1-SP4) and demonstrated that the progression from SP1 to SP4 was unidirectional and largely synchronized. Notably, while the phenotypic maturation from SP1 to SP4 was achieved in 2-3 days, a small fraction of donor cells could be retained in the thymus for a longer period, during which they further matured in function. BrdU incorporation indicated that cell expansion occurred at multiple stages except SP1. Nevertheless, CFSE labeling revealed that only a limited number of cells actually divided during their stay in the medulla. As to the thymic emigration, there was a clear bias toward cells with increasing maturity, but no distinction was found between dividing and nondividing thymocytes. Collectively, these data not only provide solid evidence for a highly ordered differentiation program for CD4SP thymocytes, but they also illustrate several important features associated with the developmental process.

Emergency endovascular repair of iliac artery rupture caused by post-stenting angioplasty with an endograft.

Iliac artery rupture is a rare complication of post-stenting angioplasty and can lead to massive life-threatening haemorrhage. Conventional surgery can not repair the damaged vessel easily and may cause substantial blood loss and high operative morbidity and mortality. We report our experience with a self-expanding covered endoprosthesis for endovascular repair of the rupture of an iliac artery caused by stenting angioplasty.

Mesenchymal hamartoma of liver: magnetic resonance imaging and histopathologic correlation.

AIM: To describe the imaging features of hepatic mesenchymal hamartoma with emphasis on magnetic resonance imaging (MRI) compared to histopathologic results. METHODS: Spin-echo sequence(SE),fast spin-echo sequence(FSE) were performed in 12 children (7 males,5 females) with mesenchymal hamartoma of the liver (MHL), aged 1.2 months to 12 years;( mean age, 6.3 years) axial, saggital, coronary plain imaging with an Elscint 2.0T MR equipment. Their main symptoms were abdominal mass (5 cases), enlarged liver (8 cases), abdominal pain (1 case) and anemia (2 cases), and negative alphafetoprotein. Dynamic enhancement examination was added in 2 cases. RESULTS: Six cases had single mass type of MHL, in which 3 cases had solid masses showing slight low-signal-intensity in T1WI, and irregular high-signal-intensity in T2WI, 1 case had a cystic-solid mixed mass showing several border-clear cysts in a solid mass, 2 cases had cystic masses with multi-septa. Five cases had diffuse and multifocal lesions type of MHL with its signal intensity being similar to that of the solid mass. One case had a combined diffuse and single cystic mass. In the early dynamic enhancement examination, the lesions were slightly circum-enhanced , and the center was enhanced in the later scan images. Inner hepatic vessels were compressed in 5 cases, vena cava and abdominal aortae were compressed in 3 cases. Pathological findings included fiber hyperplasia, hyaline degeneration, biliary duct hyperplasia, lobule-like array. CONCLUSION: MR imaging is a better way to differentiate and diagnose MHL. MHL may be recognized by its characteristic occurrence in infancy and MR imaging features.