Objective To evaluate the feasibility and safety of complete video-assisted thoracoscopic surgery （VATS）anatomic segmentectomy. Methods Clinical data of 26 patients with lung diseases who underwent complete VATS anatomic segmentectomy in the First Affiliated Hospital of Nanjing Medical University from November 2010 to July 2011 were retrospectively analyzed. There were 8 male and 18 female patients with their age of 13-81 （53.2±3.1） years. There were 23 patients with pulmonary nodules including 13 patients who underwent direct surgical resection and 10 patients with ground-glass opacity nodules （3 patients received preoperative localization and the other 7 patients received direct surgical resection）. All the 3 patients with non-nodule pulmonary diseases （bronchiectasis, pulmonary bulla and pulmonary cyst respectively） underwent direct surgical resection. Results All the 26 patients received complete VATS anatomic segme- ntectomy successfully. The operation time was 150-250 （193.7±7.3） min，and intraoperative blood loss was 10-200 （65.7±12.7） ml. Patients with lung cancer received 4-7 （5.1±0.3） stations of lymph node dissection and the number of lymph node dissection was 4-16 （12.3±0.5） for each patient. There was no in-hospital death or postoperative complication. Postoperative thoracic drainage time was 3-7 （3.9±0.4） days. All the patients were discharge uneventfully. Lung cancer patients were followed up for 3-6 months without recurrence or metastasis. Conclusion Complete VATS anatomic segmentectomy is a safe and feasible surgical procedure.
ObjectiveTo investigate the feasibility of the 3rd-6th intercostal nerve transfer to the suprascapular nerve for reconstruction of shoulder abduction. MethodsFifteen thoracic walls (30 sides) were collected from human cadavers. The 3rd-6th intercostal nerve length which can be dissected between the midaxillary line and midclavicular line, and the transfer distance between the midaxillary line and midpoint of the clavicular bone (prepared point for neurotization) were measured. ResultsIn 30 sides of specimens, the 3rd and 4th intercostal nerves could be obtained between the midaxillary line and midclavicular line, the available length of which was significantly greater than the transfer distance (P lt; 0.01). Six sides of the 5th intercostal nerve and 16 sides of 6th intercostal nerve were covered by the costal cartilage before reaching the midclavicular line. The available length of the 5th intercostal nerve was similar to the transfer distance (P gt; 0.01), while the available length of the 6th intercostal nerve was significantly less than transfer distance (P lt; 0.01). The suprascapular nerve could be dissociated and turned to the clavicular bone of more than 2 cm. The whole length of the available 5th intercostal nerve length and the turning length (2 cm) of suprascapular nerve was significantly greater than the transfer distance (P lt; 0.01), but for the 6th intercostal nerve, the whole length was still less than transfer distance (P lt; 0.01). ConclusionIt could be an alternative method to use the 3rd, 4th, and 5th intercostal nerve transfer to the suprascapular nerve for reconstruction of shoulder abduction. And for the 6th intercostal nerve, longer dissociated length may be required for direct coaptation or using a graft for nerve repair.
【Abstract】 Objective To investigate the feasibil ity of applying enzymatic method to prepare decellularizedporcine aorta and to evaluate its biomechanical properties, immunogenicity and cell compatibil ity. Methods 0.1% trypsin- 0.01% EDTA was appl ied to extract cells from porcine aorta under 37 continuously vibrating condition and its histology and microstructure were observed. The thickness, stress-strain curve, ultimate tension stress (UTS) and strain of failure (SOF) were compared before and after decellularization for 48, 96 and 120 hours under uniaxial tensile tests, respectively. The histological change was observed at 1, 3 and 6 weeks after the decellularized tissue was implanted subcutaneously in 3 dogs. According to the HE stains and a semi-quantitative Wakitani grading method, gross changes, category and amounts of infiltrated cells and neo-capillaries were compared between pre- and post-decellularization of porcine aortae. Endothel ial cells from canine external jugular vein were seeded onto the decellularized patches to observe the cell compatibil ity. Results Microscopy and electron microscopies examination identified that cell components was completely removed from the fresh porcine aorta and Masson’ strichrome showed that the structure of matrix (fibrins) was maintained intact at 96 hours using the decellularization method. There were no significant differences in the thickness, UTS and SOF between before and after decellularization (P gt; 0.05). However, The UTS values showed a decrease tendency and SOF showed an increase tendency. The stress-strain curve also verified a decrease tendency in mechanical intensity and an increase one in ductil ity after decellularization. After implanting the acellularized matrix subcutaneously in canine, moderately lymphocyte infiltration was seen at the 1st week and the infiltration was replaced by fibroblasts accompanied by neocapillary formation at the 6th week. A semi-quantity histological evaluation showed that there were differences in gross observation, category and the numbers of the infiltrated cells between decellularized and non-decellularized tissues（P lt; 0.05). A cell monolayer was identified by HE staining and scanning electron microscopywhen the endothel ial cells were seeded onto the inner luminal surface of the scaffold, al igned at the same direction on the whole. Conclusion The decellularized porcine aortic scaffold, prepared by trypsin-EDTA extraction under continuously vibrating condition, could meet the requirements of tissue-engineering graft in biomechanical properties, immunogenicity and cell compatibil ity.
Objective To investigate the different influence of the expression levels of the epidermal growth factor (EGF) and the keratinocyte growth factor (KGF) after the unilateral phrenectomy in piglets. Methods Thirty-six piglets were divided into 3 groups according to their ages during the operation (10 d,30 d,50 d). In each group, 6 piglets underwent the left cervical phrenectomy and 6 piglets were used as the shamoperation controls. The expression levels of EGF and KGF were determined by the real time quantitative RT-PCR at 2 weeks after operation.Results The melting curves of RTPCR showed that there was a single peark at the temperature of 80.0, 84.5 and 89.0℃ of EGF,KGF and GAPDH, respectively. In the experimental group, the expression levels of EGF were 3.53±0.36 and 1.73±0.29, and the expression levels of KGF were 4.71±0.42 and 2.77±0.29 in thepiglets undergiong the operation at their ages of 10 d and 30 d.Compared with the control group,the expression levels of EGF (4.60±0.41，2.18±0.24) and KGF(6.05±0.42，3.58±0.31) showed that there was a significant decrease postoperatively in the piglets undergoing the operation at their ages of 10 d and 30 d（P＜0.05）. However, there was no significant change in the piglets undergoing the operation at their ages of 50 d（P＞0.05）. The expression levels of EGF and KGF were significantly decreased with the lung development of the piglets（P＜0.05）. Conclusion The unilateral phrenectomy performed in the piglets younger than 30 d may cause abnormity of the EGF and KGF expression levels. The piglets older than 50 d may not cause a significant influence.
Objective To evaluate the reliability and the advantageof canal laminoplasty with laminoplasty over laminectomy for treatment of lumbar spinal stenosis.Methods From June 2000 to September 2004, the titanium miniplate fixation technique was applied to re-implantation of the vertebral lamina in the lumbar spine. The vertebral lamina was made with a specially made osteotome and a special technique in 18 patients with lumbar spinal stenosis. Results The patients were followed up for 1 yr and 8 mon on average (range, 3 mon4 yr and 3 mon) and were observed to have a bony fusion of the re-implanted lamina 3-9 months postoperatively. There was no nonunion, displacement of the re-implanted lamina, overgrowth of the anterior bone edge of osteotomy, recompression of the nerves or instability of the lumbar spine. Conclusion The result demonstrates that canal laminoplasty with the titanium miniplate re-implantation of the vertebral lamina in lumbar spine can restore the normal anatomy, keep stability of the spine, and avoid adhesion and scar in the canal.
Objective To explore clinical characteristics and risk factors for mortality of community-acquired pneumonia due to Enterobacteriaceae (EnCAP) . Methods This was a single-center, retrospective study. Baseline demographic, clinic, radiologic characteristcs, treatment and outcomes were compared between patients hospilized with EnCAP and community-acquired pneumonia due to Streptoccocus pneumoniae (SpCAP) during January 1, 2010 to December 31, 2015. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with 30-day mortality for EnCAP. Results In comparison with SpCAP, cerebrovascular disease, chronic hepatopathy, chronic renal disease, aspiration risk, confusion, pleural effusion and higher PSI risk class/CURB-65 score, lower leukocyte, hemoglobin, albumin, longer length of stay in hospital were associated with EnCAP. Multivariate logistic regression analysis demonstrated sepsis shock (OR 1.700, P=0.018, 95%CI 0.781 to 38.326), hemoglobin (OR 0.087, P=0.011, 95%CI 0.857 to 0.981) and appropriate empirical antimicrobial therapy (OR 0.108, P=0.002, 95%CI 0.011 to 0.151) were risk factor for 30-day mortality of EnCAP. Conclusions The clinical characteristics of EnCAP are different with SpCAP. Clinic physicians should pay much attention to the risk factors for 30-day mortality of EnCAP.
ObjectivesTo explore a reliable and simple predictive tool for 30-day mortality of influenza A community-acquired pneumonia (CAP).MethodsA multicenter retrospective study was conducted on 178 patients hospitalized with influenza A CAP, including 144 alive patients and 34 dead patients. Receiver operating characteristic (ROC) curves were performed to verify the accuracy of severity scores as 30-day mortality predictors in the study patients.ResultsThe 30-day mortality of influenza A CAP was 19.1%. The actual mortality of PSI risk class Ⅰ-Ⅱ and CURB-65 score 0-1 were 14.5% and 15.7%, respectively, which were much higher than the predicted mortality. Logistic regression confirmed blood urea nitrogen >7 mmol/L (U), albumin <35 g/L (A) and peripheral blood lymphocyte count <0.7×10 9/L (L) were independent risk factors for 30-day mortality of influenza A CAP. The area under the ROC curve (AUC) of UAL (blood urea nitrogen >7 mmol/L+ albumin <35 g/L+ peripheral blood lymphocyte count <0.7×10 9/L) was 0.891, which was higher than CURB-65 score (AUC=0.777, P=0.008 3), CRB-65 score (AUC=0.590, P<0.000 1), and PSI risk class (AUC=0.568,P=0.000 1).ConclusionUAL is a reliable and simple predictive tool for 30-day mortality of influenza A CAP.
Objective To review the advances in diagnosis and treatment of acute scaphoid fractures. Methods The characteristic, classification, diagnosis, and treatment of acute scaphoid fractures were reviewed and summarized. Results As one of the common fracture in hand, scaphoid fractures are generally classified as either undisplaced and stable or displaced and unstable. CT and MRI has best diagnostic specificity and sensitivity respectively. Most undisplaced and stable fractures can be treated successfully by plaster immobilization, whereas the displaced and unstable fractures have great prognosis after open reduction and internal fixation. Conclusion Acute scaphoid fractures should be diagnosed and treated at an early stage, and choose the appropriate treatment according to the location and stability of the fracture.
ObjectiveTo examine the high-risk factors and prognosis of patients with superior interlobar lymph nodes (11s nodes) metastasis in non-small cell lung cancer (NSCLC) located in the right middle or lower lobe.MethodsThe clinical data of 157 patients with NSCLC in the right middle or lower lobe from January 2015 to July 2020 in our hospital were retrospectively analyzed, including 98 males and 59 females aged 23-86 (60.01±10.58) years. The patients underwent lobectomy and systemic lymph node dissection along with dissection of 11s nodes. They were divided into a 11s (+) group and a 11s (–) group according to whether the 11s nodes were involved.ResultsThere were 31 patients with invasion in the 11s nodes, and the overall incidence of metastasis was 19.75%, including 13.64% with middle lobe tumors and 20.74% with lower lobe tumors. The 2R+4R nodes involvement was the influencing factor associated with 11s nodes metastasis (P=0.026). The 7th nodes and the inferior mediastinal lymph nodes involvement were high-risk factors affecting the prognosis of patients (P<0.05). The 11s nodes metastasis had nothing to do with the location of the tumor, and it was not an independent factor affecting disease-free survival.ConclusionThe 11s nodes may be a transit for 2R+4R nodes metastasis in the right middle or lower lobe lung cancer, and the 11s nodes should be cleared in the surgical treatment for NSCLC in either the middle or lower lobe of the right lung. The influencing factors for disease-free survival after surgery for lung cancer in the right middle or lower lobe are the metastasis of the subcarinal lymph nodes and the inferior mediastinal lymph nodes.
Whether anatomical segmentectomy can replace lobectomy in the treatment of early-stage lung cancer remains controversial. A large number of studies have been conducted for decades to explore whether pulmonary segmentectomy can treat early-stage lung cancer, which is actually to explore the indications of intentional segmentectomy. With the development of scientific researches, it is found that many characteristics affect the malignancy of lung cancer, and the different grades of each characteristic affect the prognosis of patients. It is worth exploring whether different surgical approaches can be used for early-stage lung cancer with different characteristics and different grades. This article reviews the literature and studies to discuss the advances in indications of segmentectomy for early-stage lung in terms of tumor size, consolidation-to-tumor ratio, pathological classification and tumor location, respectively. The objective of this review is to help thoracic surgeons to objectively and scientifically select the surgical method according to the clinical characteristics of early-stage lung cancer.