Objective To explore the modality of multi-disciplinary team (MDT) applied in surgical treatment of the colorectal cancer. Methods The literatures about the applied status and opinion of the modality applied in the surgical treatment of colorectal cancer in recent years were collected and reviewed. Results The modality of MDT in surgical treatment of the colorectal cancer is still in the primary stage. Conclusion There are lots of problem of this modality such as construction and collaborative needed more research.
Objective To explore the concept, contents and existing problems of the fast-track programmes in colorectal surgery. Methods The literatures about the applied status and opinion of the modality applied in the surgical treatment of the colorectal cancer and fundament investigation in recent years were collected and reviewed. Results The fast-track programmes enhance recovery of the patients who underwent the colorectal resection with the combination of multimodal techniques and approaches. Conclusion The fast-track programmes in colorectal surgery is the typical modality of the multi-disciplinary treatment, this modality can decrease the complications and reduce the hospital stay with preserve the well physiological fundament of the patients.
Objective To explore the content and scientific evidence of every element of the fast-track programmes in colorectal surgery. Methods The literatures about the applied status and opinion of the modality applied in the surgical treatment of the colorectal cancer and fundament investigation in recent years were collected and reviewed. Results The feasibility of the every fast-track’s element was based on the clinical and fundamental investigaton. Conclusion The advantage of the fast-track programmes in colorectal surgery is confirmed.
Lung cancer is the most common malignant tumor in the world and the leading cause of cancer-related death. Due to the lack of effective early diagnosis methods, the prognosis of lung cancer is poor, but compared with advanced lung cancer, the survival rate of early lung cancer is greatly improved. Therefore, early diagnosis of lung cancer is crucial. As a major epigenetic modification, DNA methylation plays an important role in the development of lung cancer. A large number of studies have shown that detection of tumor suppressor gene methylation is an ideal early diagnosis method for lung cancer. With the continuous improvement of detection technology, methylation detection of multiple genes can be achieved. And it is found that multi-gene methylation combined detection of tissue samples obtained by minimally invasive operation such as puncture of diseased tissue and puncture of lymph node tissue, as well as the noninvasive samples such as peripheral blood, bronchoalveolar lavage fluid and sputum have higher detection rate and higher sensitivity and specificity than single gene methylation. It is an ideal method for early diagnosis of lung cancer.
ObjectiveTo investigate the CT features and clinicopathological features of thin-walled cystic lung cancer with the largest diameter less than or equal to 3 cm.MethodsThe CT features and clinicopathological data of 26 thin-walled cystic lung cancer patients diagnosed by chest CT and surgical or puncture pathology were retrospectively analyzed. There were 16 males and 10 females, with an average age of 62 years.ResultsThe lesions were distributed in different pulmonary lobes, all of which were peripheral. The maximum diameter of lesion was 21.4 mm on average, and the maximum diameter of cyst was 12.9 mm on average. Among them, there were 19 patients of lobulation sign, 18 patients of spicule sign, 16 patients of pleural indentation, 9 patients of vascular convergence sign, 7 patients of bronchus sign, 21 patients of irregular inner wall, 26 patients of uneven thickening of cystic wall, 18 patients of intra-cystic separation, and 10 patients of vessels through the cystic cavity. The pathological types were all adenocarcinoma and 24 patients were invasive adenocarcinoma.ConclusionAll patients were peripheral adenocarcinoma. CT not only shows the common typical signs of lung cancer, but also has the characteristic fertures of irregular inner wall, intra-cystic separation and vessels through the cystic cavity.
ObjectiveTo investigate the CT signs and clinicopathological features of peripheral cavitary lung adenocarcinoma with the largest diameter less than or equal to 3 cm.Methods From January 2015 to December 2017, the CT signs and clinicopathological fertures of 51 patients with ≤3 cm peripheral cavitary lung adenocarcinoma diagnosed by chest CT and surgical pathology were retrospectively analyzed. Furthermore, CT signs and clinicopathological features of thick-walled cavitary lung adenocarcinoma and thin-walled cavitary lung adenocarcinoma were compared. There were 29 males and 22 females at age of 62 (56, 67) years.ResultsThere were 27 thick-walled cavitary lung adenocarcinoma and 24 thin-walled cavitary lung adenocarcinoma. Thick-walled cavitary adenocarcinoma had greater SUVmax [6.5 (3.7, 9.7) vs. 2.2 (1.4, 3.8), P=0.019], larger cavity wall thickness (11.8±4.6 mm vs. 7.6±3.7 mm, P=0.001), larger tumor tissue size [2.1 (1.7, 2.8) cm vs. 1.6 (1.2, 2.0) cm, P=0.006], and more solid nodules (17 patients vs. 8 patients, P=0.035). Thin-walled cavitary adenocarcinoma had more smoking history (12 patients vs. 6 patients, P=0.038), larger cavity size [12.3 (9.2, 16.6) mm vs. 4.4 (2.8, 7.1) mm, P=0.000], and larger proportion of cavities [0.30 (0.19, 0.37) vs. 0.03 (0.01, 0.09), P=0.000]. On CT signs, there were more features of irregular inner wall (19 patients vs. 6 patients, P=0.000), intra-cystic separation (16 patients vs. 6 patients, P=0.001) and vessels through the cystic cavity (10 patients vs. 1 patient, P=0.001) in thin-walled caviraty lung adenocarcinoma.ConclusionPeripheral cavitary lung adenocarcinoma of ≤3 cm on chest CT has characteristic manifestations in clinical, imaging and pathology, and there is a statistical difference between thick-walled cavitary lung adenocarcinoma and thin-walled cavitary lung adenocarcinoma.
Objective To investigate the current prevalence of cerebral stroke and hypertension in Ganzi Tibetan state, so as to control stroke and hypertension in future. Methods A representative people sample of Kangding, Dege, Ganzi, Litang and Batang county was selected through randomized cluster sampling. Data of demographic characteristics, hypertension and stroke status were collected by face-to-face interview. Results 5 049 people were included, of which 48.6% were male, and 51.4% were female. The prevalence rate of hypertension and stroke were 23.4% and 1 894/100 000 respectively. The population with hypertension had high prevalence of stroke. The prevalence increased along with the age. Conclusions The prevalence of hypertension and stroke is high in Ganzi Tibetan state. The causes may be ascribed to special geography surroundings and life style. It is very important to pay more attention to prevent and control of hypertension and stroke in this area.
Objective To investigate effects of fast track surgery (FTS) combined with laparoscopy on perioperative inflammatory mediators, immune indices, and clinical short-term recovery effect in patient with colorectal cancer. Methods A prospective randomized controlled trial was conducted. The patients underwent laparoscopic colorectal cancer surgery at the Department of Gastrointestinal Surgery, The Third People’s Hospital of Chengdu from July 2014 to March 2017 were included in this study. The patients were randomly divided into FTS group and traditional group by the random digital table. The FTS mode and the traditional method were adopted during the perioperative period in the FTS group and the traditional group respectively. The inflammatory mediators such asC reactive protein (CRP) and interleukin 6 (IL-6) and cellular immune indexes such as CD4, CD8 and CD4/CD8 on the preoperative 1 d, postoperative 1 d, 3 d and 7 d, as well as the index of clinical short-term rehabilitation were compared between these 2 groups. Results ① Eighty-four patients were included in this study, there were 43 patients in the FTS group and 41 patients in the traditional group. There were no significant differences in the baseline characteristics and the surgical-related indicators between the two groups (P>0.050). ② There were no significant difference in the levels of CRP and IL-6 between the two groups at different time points (P>0.050). The change trend of CRP and IL-6 levels in FTS group and traditional group before and after operation were the same, the CRP and IL-6 levels at the first day after operation were significantly higher than those on 1 d before operation (P<0.001), but on the 7th day after operation decreased significantly. ③ There were no significant difference of CD4, CD 8 and CD4/CD8 levels between the two groups at different time points (P>0.050). The CD4 decreased significantly in 2 groups at the first day after operation (P<0.050), it began to rise on the 3rd day after operation and was close to the preoperative level on the 7th day after operation, but the increase in the traditional group was smaller. The changes of CD8 level at different time points before and after operation were not significant in two groups (P>0.050). The changes of CD4/CD8 ratio at different time points before and after operation were not significant in two groups (P>0.050), only the first day after operation of FTS group was significantly lower than that in preoperative 1 d (P<0.001), and on the third day after operation, it increased significantly and was close to the level of 1 day before operation. ④ The time of the first postoperative anal exhaustion or defecation in the FTS group was significantly shorter than that in the traditional group (P<0.001). The overall incidence of postoperative complications and the incidence of hypoproteinemia in the FTS group were significantly lower than those in the traditional group (P<0.050). Conclusion Compared with traditional perioperative management in combination with laparoscopic surgery, FTS combined with laparoscopic surgery has no effects on postoperative inflammatory mediators and immune parameters in patient with colorectal cancer, and it could reduce complications, reduce traumatic stress, and accelerate postoperative recovery for patient with colorectal cancer.
ObjectiveTo investigate the mediastinal lymph node metastasis of cT1a-cN0M0 lung adenocarcinoma, so as to provide a theoretical basis for intraoperative lymph node dissection in patients with early stage lung adenocarcinoma.MethodsClinicopathological features of lung adenocarcinoma patients who received operation in our hospital from 2017 to 2018 were collected. A total of 667 patients including 241 male and 426 female patients at age of 59 (16, 87) years were included. There were 234 patients with pure ground glass nodules, 98 patients with ground glass-predominant tumor, 199 patients with consolidation-predominant tumor and 136 patinets with solid tumor in the study. Postoperative N1 lymph node metastasis occurred in 30 patients and N2 lymph node metastasis occurred in 52 patients.ResultsThe result of univariate analysis showed that male (P=0.014), higher carcino-embryonic antigen levels (P<0.001), larger nodal diameter (P<0.001), larger consolidation tumor ratio (P<0.001), smaller tumor disappearance ratio (P<0.001), solid nodules (P<0.001), cavitary sign (P=0.005), lobulation sign (P=0.002), spicule sign (P=0.003), pleural indentation sign (P=0.001), bronchus sign (P=0.025) were risk factors for mediastinal lymph node metastasis. In terms of pathology, the N2 positive group had larger size of pathological tissue (P<0.001), more N1 lymph node metastasis (P<0.001), higher pathology T stage (P<0.001), more spread through air space (P=0.001), more pleural invasion (P<0.001), and more lymphovascular invasion (P<0.001). Multivariate analysis showed that lymphovascular invasion (OR=6.9, 95%CI 2.3-20.7, P=0.001), larger consolidation tumor ratio (OR=109.6, 95%CI 3.8-3 124.3, P=0.006), cavitary sign (OR=3.1, 95%CI 1.1-8.3, P=0.028) and N1 lymph node metastasis (OR=15.7, 95%CI 6.7-36.4, P<0.001) were independent risk factors for mediastinal lymph node metastasis.ConclusionFor lung adenocarcinoma, mediastinal lymph node metastasis will not occur in ground glass nodule and ground glass-predominant tumor patients. The probability of mediastinal lymph node metastasis increases with the increase of solid components and presence of cavitary sign. Therefore, different types of lymph node resection can be considered for patients with different imaging findings.
ObjectiveTo investigate the predictive value of preoperative radiological features on spread through air spaces (STAS) in stage cⅠA lung adenocarcinoma with predominant ground-glass opacity, and to provide a basis for the selection of surgical methods for these patients.MethodsThe clinical data of 768 patients with stage cⅠA lung adenocarcinoma undergoing operation in our hospital from 2017 to 2018 were reviewed, and 333 early stage lung adenocarcinoma patients with predominant ground-glass opacity were selected. There were 92 males and 241 females, with an average age of 57.0±10.0 years. Statistical analysis was performed using SPSS 22.0.ResultsSTAS-positive patients were mostly invasive adenocarcinoma (P=0.037), and had more micropapillary component (P<0.001) and more epidermal growth factor receptor (EGFR) gene mutations (P=0.020). There were no statistically significant differences between the STAS-positive and STAS-negative patients in other clinicopathological features. Univariate analysis showed that the maximum diameter of tumor in lung window (P=0.029), roundness (P=0.035), maximum diameter of solid tumor component in lung window (P<0.001), consolidation/tumor ratio (CTR, P<0.001), maximum area of the tumor in mediastinum window (P=0.001), tumor disappearance ratio (TDR, P<0.001), average CT value (P=0.001) and lobulation sign (P=0.038) were risk factors for STAS positive. Multivariate logistic regression analysis showed that the CTR was an independent predictor of STAS (OR=1.05, 95%CI 1.02 to 1.07, P<0.001), and the area under the receiver operating characteristic (ROC) curve was 0.71 (95%CI 0.58 to 0.85, P=0.002). When the cutoff value was 19%, the sensitivity of predicting STAS was 66.7%, and the specificity was 75.2%.ConclusionCTR is a good radiological feature to predict the occurrence of STAS in early lung adenocarcinoma with predominant ground-glass opacity. For the stagecⅠA lung adenocarcinoma with predominant ground-glass opacity and CTR ≥19%, the possibility of STAS positive is greater, and sublobar resection needs to be carefully considered.