Pneumonectomy is known as an effective treatment of lung cancer, lung tuberculosis, and damaged lung. But the incidences of complications and mortality are significantly higher in patients undergoing pneumonectomy than those undergoing lobectomy. The complication rate within 30 days after pneumonectomy is 11%-49% and the mortality is 3%-25%. Mortality of right pneumonectomy is triple that of left pneumonectomy. Postpneumonectomy complications include cardiopulmonary failure, bronchopleural fistula and postpneumonectomy syndrome. Besides the symptomatic treatment, which includes flushing drainage, plugging and operation, observation and prompt diagnosis are necessary for prevention. This review is focused on the prevention and treatment of complications after pneumonectomy.
ObjectiveTo explore the effectiveness of Ovol2 gene for epithelial-mesenchymal transition (EMT) to offer some theory evidences for the targeted therapy in lung adenocarcinoma. MethodsA549 cells were treated with control and Ovol2 overexpressioned by lentivirus infection. Real-time PCR were performed to test the mRNA level of genes correlated to EMT. Western Blot was performed for protein level of the following makers:E-cadherin, N-cadherin, vimentin, ect. Moreover, we tested the migration and invasion ability of A549 cells by transwell and wound healing experiment. ResultsAfter treated with Ovol2 overexpressed, the expression level of E-cadherin raised, while the expression level of N-cadherin, vimentin and Twist1 declined in both mRNA and protein expression level. The results of wound healing and transwell experiment indicated that the migration and invasion ability of A549 cells weakened. ConclusionOverexpression of Ovol2 gene can suppress the distant metastasis ability and invasion ability of A549 cells by inhibiting the EMT.
ObjectiveTo investigate MUC1 over-expression on chemotherapy of 5-fluorouracil and cisplatin for esophageal cancer cells. MethodsMUC1 over-expression and stable silencing of MUC1 expression esophageal cancer cell lines were constructed. Xenograft model of esophageal cancer was established in nude mice. Cisplatin (8 mg/kg, day 1 and day 7)and 5-fluorouracil (20 mg/kg, day 1 to 6)were injected intraperitoneally. Tumor volume and body weight of nude mice were measured. Tumor growth curve and body weight curve were drawn, and tumor inhibitory rate was calculated. ResultsBoth cisplatin and 5-fluorouracil suppressed tumor growth of MUC1 over-expression esophageal cancer nude mice. Body weight and tumor volume of nude mice of cisplatin and 5-fluorouracil groups were significantly smaller than those of the control group (P < 0.05), and the inhibitory effects of cisplatin were significantly greater than those of 5-fluorouracil (P < 0.05). There was no significant inhibitory effect in stable silencing of MUC1 expression esophageal cancer nude mice. ConclusionBoth cisplatin and paclitaxel can suppress the growth of MUC1 over-expression esophageal cancer, and cisplatin has greater inhibitory effects than 5-fluorouracil in tumor volume and body weight of nude mice.
ObjectiveTo assess the feasibility of 3D digital lung software used in preoperative planning of patients with multiple pulmonary nodules and poor pulmonary function. MethodsFive patients with multiple pulmonary nodules in the left lung, meanwhile with a history of single lung lobectomy in the right lung were included in our hospital between June and December 2015. There were 4 males and 1 female at an average age of 50.4±2.6 years. A 320-slice volumetric CT scanner was used to the CT angiography (CTA) of the pulmonary artery. The data of CT images were imported into the 3D digital lung software that was researched and developed by Xiamen QiangBen Science and Technology Company. The 3D reconstruction of digital virtual lung was completed by this software based on those data. At the same time the soft-ware completed the automatic segmentation of the lung based on the pulmonary artery system and the 3D reconstruction of the pulmonary nodules. The 3D digital lung software calculated the volume proportion of the intended removal (segm-ental lesions) to the whole lung, estimated the effect of surgery on forced expired volume in one second (FEV1), and the patient's tolerance ability to surgery. After the preoperative planning, the patients received multiple pulmonary segmental/subsegmental resection under the general anesthesia by video-assisted thoracoscopic surgery (VATS). ResultsThe 3d reconstruction of the pulmonary arteries reached 5 levels in 5 patients. And the software automatically identified out the lung segment/subsegment to show the lung nodules of lung segment/subsegment. The preselection lung volume of 5 patients accounted for 14.00%-27.00% of total lung volume. The software estimated FEV1 as 1.16-1.46 L which can tolerate the operation. The 5 patients were successfully performed surgery of multiple pulmonary segmental/subsegmental resection under the general anesthesia by VATS. The software located lung nodules from the resection of pulmonary segments during operation immediately. Then we sent them to the rapid pathological examination for diagnosis. After operation, the patients recovered well, and had no respiratory insufficiency. Hospitalization day was 4 days. ConclusionThe 3D digital pulmonary software can not only automatically identify the pulmonary segments, precisely position the pulmonary nodule, show the relationship among the target pulmonary segments artery, vein, bronchus and the surroun-ding artery, vein, and bronchus, but also calculate the volume of the pulmonary segments, estimate the impact of the pulmonary segmentectomy on the FEV1. It is useful for precise evaluation of the tolerant capacity of multiple pulmonary nodules in patients with unstaged multiple pulmonary segments.
Objective To explore the early clinical effect of 3D printing external fixed guide combined with video-assisted thoracic surgery (VATS) in the treatment of flail chest, and to provide evidence for the promotion of this technology. Methods Patients with flail chest treated in our hospital from January 2010 to January 2023 were retrospectively selected as the study objects. The trial group was treated with 3D printed external fixation guide combined with VATS, and the control group was treated with open reduction internal fixation. Operation time, intraoperative blood loss, closed thoracic drainage time, thoracic volume recovery, visual analogue scale (VAS) score 1 month after surgery and complications were compared between the two groups. Results A total of 40 patients were included, 20 in each group. In the experimental group, there were 13 males and 7 females, with an average age of 45.7±3.8 years. In the control group, there were 14 males and 6 females, with an average age of 47.3±4.1 years. There was no statistical difference in gender, age, number of rib fractures or VAS between the two groups (P>0.05). The surgery was successful in both groups, the wounds healed in stage Ⅰ, and the pain symptoms were significantly reduced. No postoperative complications occurred in the trial group, while chronic pain occurred in 1 patient, fracture malunion occurred in 1 patient and incision infection occurred in 1 patient in the control group, with a complication rate of 15.0%. Operation time, intraoperative blood loss and closed thoracic drainage time in trial group were lower than those in control group (P<0.05). There was no statistical difference in the recovery of thoracic volume and VAS at 1 month after operation (P>0.05). Conclusion 3D printing external fixation guide combined with VATS in the treatment of flail chest has satisfactory early curative effect, which has the advantages of minimally invasive, high efficiency, rapid recovery and reducing postoperative complications. This method can effectively reconstruct the shape of the chest, restore the volume of the chest.
ObjectiveTo systematically review the efficacy and safety of ibuprofen for premature infants with patent ductus arteriosus. MethodsDatabases including PubMed, Ovid-EMbase, The Cochrane Library (Issue 11, 2014), CNKI, WanFang Data and VIP were searched to collect randomized controlled trials (RCTs) and quasi-RCTs about ibuprofen for premature infants with patent ductus arteriosus from inception to December 2014. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. ResultsA total of 37 RCTs, involving 2 370 patients were included. The results of meta-analysis showed that, compared with the placebo/blank group, ibuprofen could increase the closure rate of PDA (LBWI:RR=1.93, 95%CI 1.25 to 2.99，P=0.003; VLBW:RR=1.23, 95%CI 1.02 to 1.48, P=0.03; ELBWI:RR=2.86, 95%CI 1.51 to 5.41, P=0.001) and decrease the incidence of sepsis (VLBW:RR=0.21, 95%CI 0.07 to 0.64，P=0.006); Compared with the indometacin groups, ibuprofen could decrease the incidence of the increase of serum creatinine (LBWI:RR=0.11, 95%CI 0.04 to 0.37, P=0.000 2), NEC (LBWI, RR=0.52, 95%CI 0.29 to 0.95, P=0.03) and oliguria (LBWI: RR=0.30, 95%CI 0.16 to 0.56, P=0.000 2; VLBW:RR=1.40, 95%CI 1.03 to 1.92, P=0.03); Compared with the intravenous ibuprofen, Oral ibuprofen could increase the closure rate of PDA (VLBW: RR=1.35, 95%CI 1.12 to 1.62, P=0.002; ELBWI, RR=1.42, 95%CI 1.07 to 1.87, P=0.01). ConclusionCurrent evidence shows that there is not indeterminate between ibuprofen and paracetamol groups. Compared with other general drugs, ibuprofen has an advantage over curing PDA and obviously reduces side effects. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.