A new independent subtype CD4+ T cell which massively secreted interleukin-17 (IL-17) was found at the beginning of the 21st century, and thus it was named as T helper cell 17 (Th17 cell). With the progress of the research in recent years, Th17 cells were found to be widely involved in a variety of the human diseases such as autoimmune diseases, infections and tumors through secretion of IL-17. The relationship between Th17 cells, IL-17 and the occurrence, development and prognosis of lung cancer was reviewed.
Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of abdominal apoplexy, arousing clinic doctors’ attention to this disease. Methods Two hundred and thirty-two domestic cases with abdominal apoplexy were analyzed retrospectively and related literatures in and abroad were reviewed. Results Abdominal apoplexy occured mainly patients aged 45 to 70 years in China and 50 to 59 years abroad. It was more common in women than in men, and male to female ratio was 1 to 1.4 in China and 1 to 2.5 abroad. There were various etiological factors to this disease. It was usually abrupt, with complicated clinical manifestation. The main symptoms were abdominal pain and hemorrhagic shock with nauseat, vomiting and diarrhea. Preoperative diagnosis rate of abdominal apoplexy was very low, literatures showed only 1.7% in China and 2.3% abroad. There was no particular evaluation approach. Abdominal cavity puncture, combined with CT, ultrasound, MRI and selective abdominal angiography helped to raise diagnosis rate. Overall postoperative mortality was 7.3%. In 7.8% cases, no bleeding site could be found during laparotomy, and the mortality rate was 41.2%. Conclusion Abdominal apoplexy is rarely seen in clinic with low preoperative diagnosis rate and poor prognosis. The first choice management is exploratory laparotomy, and the key is to ligate ruptured vessels.
Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare type of lung cancer with special characteristics of epidemiology, clinical diagnosis, treatment and prognosis. It has close relationship with Epstein-Barr virus (EBV) infection and has prominent regional feature. Most patients are young and non-smoking. There is no specificity of clinical manifestation. Most patients are asymptomatic at the time of diagnosis. As for treatment, the standard treatment for early stage disease is complete resection. Platinum-based doublet chemotherapy has been applied in locally advanced disease as the first line therapy. Due to its rarity, the treatment of advanced PPLELC is still lack of evidence of large sample randomized controlled trial. Whether target therapy or immunotherapy is effective is worth further study. This article reviews the research progress of PPLELC, to give a particular sight for clinicians and provides a better understanding of this rare tumor for researchers.
Congenital chest deformity is caused by abnormal development of spine or ribs, resulting in sternal depression or protrusion. Pectus carinatum and pectus excavatum are the most common diseases in clinic, which can either be accompanied by other syndromes or exist alone. The genetic factors of congenital thoracic deformity can be related to single gene mutation, polygene mutation and chromosome aberration. Common clinical congenital thoracic deformity with syndromes, such as Marfan syndrome and Noonan syndrome, often have relatively fixed and clear pathogenic genes. The genetic pathogenesis of non-syndromic and independent congenital thoracic malformations is usually diverse, and treatments for syndromic and non-syndromic congenital thoracic deformity are different. Therefore, it is necessary for us to differentiate syndromic and non-syndromic congenital thoracic deformities in basic research, clinical diagnosis and treatment.
Objective To investigate the methods and effectiveness of multi ple surgical treatment for complex aortic arch and descending aorta disease, including cardiopulmonary bypass operation, hybrid operation, and total endovascular aneurysm repair (EVAR). Methods Between October 2006 and September 2011, 48 patients with complex aortic arch anddescending aorta disease were treated. There were 31 males and 17 females, aged from 28 to 81 years (mean, 52.4 years). The disease duration ranged from 1 to 90 days (mean, 10.2 days). There were 30 cases of type B aortic dissection involving the aortic arch, 11 cases of thoracic aortic aneurysm, 3 cases of thoracic pseudoaneurysme, 3 cases of penetrating aortic ulcer, and 1 case of aortoesophageal fistula. Cardiopulmonary bypass operation, hybrid operation, and total EVAR were performed in 15, 12, and 21 cases, respectively. Results In the patients undergoing cardiopulmonary bypass operation, the following complications occurred: 1 case of bleeding, 1 case of coma, 3 cases of psychiatric disorders, 4 cases of pneumonia, 2 cases of acute renal insufficiency, and 2 cases of multi-organ dysfunction; finally 3 patients died. In the patients undergoing hybrid operation, cerebral infarction and renal function failure occurred in 1 case. In the patients undergoing total EVAR, no complication occurred. A total of 41 patients were followed up 2 to 60 months (mean, 28.6 months). Sl ight left subclavian steal syndrome occurred in 3 cases, but self rel ieved. Other patients recovered to normal l ife. Conclusion In the surgical treatments of complex aortic arch and descending aorta disease, cardiopulmonary bypass operation will be gradually replaced by EVAR because of the surgical trauma and risk, hybrid operation is an important technique, and total EVAR will be the future progress.
Because of the characteristics such as accurate, efficient and individuation, 3D printing is being widely applied to manufacturing industry, and being gradually expanded into the medical field. Diseases of chest wall is a common type in thoracic surgery, and surgery is a proper treatment to this kind of disease. For the past few years, 3D printing is being gradually applied in surgery of chest wall diseases. The article mainly makes a statement of two parts that including the possibility to apply 3D printing including chest wall reconstruction and chest wall orthopedic, and to analyze the possibility and application prospect of applying 3D printing to the chest wall disease.
ObjectiveTo detect expressions of Lgr5 and E-cadherin (E-cad) proteins in gastric cancer tissues and analyze their relationships with the clinicopathologic characteristics and prognosis of patients with gastric cancer.MethodsThe expressions of Lgr5 and E-cad proteins in the 69 patients with gastric cancer and adjacent normal gastric mucosa tissues were measured by the immunohistochemical SABC method, and the relationships between the Lgr5 or E-cad protein expression in the gastric cancer tissues and the clinicopathologic characteristics and the survival of patients with gastric cancer were analyzed.ResultsThe expressions of Lgr5 and E-cad proteins were positive in 60 cases (87.0%) and 30 cases (43.5%) of gastric cancer tissues, respectively, and in 5 cases (16.7%) and 30 cases (100%) of adjacent normal gastric mucosa tissues. There was a significant difference in the positive rate of Lgr5 or E-cad protein expression in the different tissues, respectively (Lgr5 protein: χ2=45.814, P<0.001; E-cad protein: χ2=11.249, P=0.001). The positive rates of Lgr5 and E-cad protein expressions in the gastric cancer were related to the degree of differentiation and the depth of invasion. Meanwhile the positive rate of Lgr5 protein expression in the gastric cancer tissue was also related to the lymph node metastasis and Helicobacter pylori infection, while the positive rate of E-cad protein expression was not related to these (P>0.05). The 5-year total survival time had no significant difference in the patients between with positive and with negative expressions of Lgr5 protein (χ2=1.819, P=0.117), which had a significant difference in the patients between with positive and with negative expressions of E-cad protein (χ2=5.814, P=0.016). The positive expression of Lgr5 was negatively correlated with that of E-cad (rs=−0.355, P=0.003).ConclusionsLgr5 protein may get involved in the mechanism of tumor invasion, lymph nodal metastasis, and low differentiation, while no relationship between the Lgr5 protein and prognosis has been confirmed. E-cad protein may get involved in the mechanism of tumor invasion and affect the prognosis of patients.
[Abstract]In recent years, with the improvement of people's awareness of physical examination and the more accurate detection equipment, the detection rate of pulmonary nodules is getting higher and higher. Surgical resection is the first choice for the treatment of malignant pulmonary nodules, but multiple pulmonary nodules, nodules in complex areas and those with surgical contraindications are not suitable for surgery. As an effective, less invasive and low-cost treatment, ablation has developed rapidly in the treatment of multiple pulmonary nodules. This paper reviews the progress of several common ablation treatments in the treatment of multiple pulmonary nodules.
Objective To investigate the current development status of chest wall surgery at all levels of hospitals in Sichuan Province, as well as to provide evidence for the promotion of chest wall surgery. Methods We conducted a questionnaire study to investigate chest wall surgery at all levels of hospitals in Sichuan Province and to collect suggestions for chest wall surgery development from thoracic surgeons attending the meeting of the Sichuan International Medical Exchange & Promotion Association from September 2021 to January 2022. Results A total of 128 questionnaires were issued, with 97 (75.8%) of them being valid. According to the survey results, hospitals with grade A secondary or higher in Sichuan Province performed chest wall surgery. Chest wall surgery accounted for 14.3% of thoracic surgery, with 70.4% being chest wall trauma surgeries, 11.6% being chest wall tumor surgeries, 10.5% being chest wall infection surgeries, and 7.5% being chest wall deformity surgeries. Chest wall surgery accounted for 9.3% of thoracic surgery in the grade A tertiary hospitals, primarily for chest wall trauma and tumor; 23.1% in grade B tertiary hospitals, primarily for chest wall trauma and tumor; and 50.7% in grade A secondary hospitals, primarily for chest wall trauma and infection. Totally 96.9% of hospitals supported the establishment of a subspecialty in chest wall surgery. Suggestions for advancing chest wall surgery included: enhancing communication and cooperation (e.g. holding academic conferences, training courses), the establishment of the chest wall surgery association or consortium, and the formulation of regulations and guidelines or consensus, etc. Conclusion Chest wall surgery has been performed at all levels of hospitals in Sichuan Province. The relevant guidelines can be made based on the related academic associations, thus boosting the development of chest wall surgery in the future.
Objective To summarize the cl inical experience of vascular bypass grafting combined with endovascularaortic repair (EVAR) for aortic dilatation disease. Methods Between January 2008 and August 2011, 12 patients with aorticdilatation disease were treated with vascular bypass grafting combined with EVAR. Of 12 patients, 11 were male and 1 wasfemale, aged 47-81 years (mean, 65.9 years). All cases were diagnosed through computed tomography angiography (CTA),including 1 case of Stanford type A dissection, 5 cases of Stanford type B dissection, 4 cases of aortic arch aneurysm, and 2 casesof abdominal aortic aneurysm. Eight patients received neck artery bypass grafting before EVAR, and 4 patients underwentfemoral artery bypass grafting after EVAR. Results After operation, pulmonary infection occurred in 3 patients, renalinsufficiency in 2 patients, cerebral infarction in 1 case, decreased hemoglobin and platelets in 7 cases, and poor healing of groinwound in 1 case. Eleven patients were followed up 3-42 months, with an average of 18.6 months. In 1 case undergoing EVARof the thoracic and abdominal aorta, EVAR was performed again because new aneurysms formed at 6 months after operation,and the patient achieved good recovery after 3 months. CTA showed reduced false lumen, thrombosis formation, no endoleak,no deformation or displacement of stent, and anastomotic patency of artificial blood vessels in the other patients at 3, 6, and12 months after operation. Conclusion Vascular bypass grafting combined with EVAR can expand the indications forendovascular repair. It not only provides sufficient anchoring area, but also ensures the blood supply to vital organs, simplifiesthe surgical procedure, and reduces the difficulty of endovascular treatment.