Surgical treatment is an important treatment for spontaneous pneumothorax, which can remove the gas in the pleural cavity, relieve symptoms, promote lung recruitment, moreover, prevent future recurrence. The surgical modalities included video-assisted thoracoscopic surgery (VATS) and non VATS treatment. Nowadays, the treatment of spontaneous pneumothorax has entered a minimally invasive era. With the development of minimally invasive techniques in recent years, as the representative of minimally invasive surgery, the surgeon techniques of VATS has developed to diversity, including three-port VATS, two-port VATS, uniportal VATS, subxiphoid uniportal VATS, 3D VATS, robotic-assisted VAT and cervical uniportal VATS. Each technique has its own advantages and limitations, and individual choices should be made.
ObjectiveTo investigate the short-term effectiveness of proximal fixation of one vertebra above to the upper end vertebra and the upper end vertebra in the treatment of Lenke type 1 adolescent idiopathic scoliosis (AIS) patients with preoperative right higher shoulder.MethodsThe clinical data of 37 Lenke type 1 AIS patients treated with posterior correction between January 2010 and December 2015 were retrospectively analysed. According to proximal fixation vertebra, the patients were divided into 2 groups: group A (n=17), proximal fixation of one vertebra above to the upper end vertebra; group B (n=20), proximal fixation of the upper end vertebra. There was no significant difference in gender, age, Risser stage, radiographic shoulder height (RSH), flexibility of proximal thoracic curve, flexibility of main thoracic curve, flexibility of thoracolumbar/lumbar curve between 2 groups (P>0.05). The main thoracic curve Cobb angle, proximal thoracic curve Cobb angle, thoracolumbar/lumbar curve Cobb angle, apical vertebral translation (AVT), clavicle angle (CA), RSH, coronal trunk shift, sagittal trunk shift, thoracic kyphosis (TK), and lumbar lordosis (LL) were measured by X-ray film before operation, and at 1 month, 1 year, and 2 years after operation. The correction indexes of main thoracic curve were evaluated, including the correction degree and correction rate of main thoracic curve and AVT correction at 1 month after operation, the loss degree and the loss rate of the correction of main thoracic curve at 2 years after operation.ResultsThe operation time and intraoperation blood loss in group A were significantly greater than those in group B (P<0.05). All the patients were followed up, and the follow-up time was 2-4 years (mean, 2.8 years) in group A and 2-3.5 years (mean, 2.6 years) in group B. No serious complication such as nerve damage occurred during perioperative period and follow-up period. No complication such as failure of fusion, loosening and rupture of internal fixator, adjacent segment degeneration, and proximal junctional kyphosis occurred. There was no significant difference between 2 groups in the correction degree and correction rate of main thoracic curve and AVT correction at 1 month after operation, the loss degree and the loss rate of the correction of main thoracic curve at 2 years after operation (P>0.05). Comparison within the two groups: except for LL had no significant difference between pre- and post-operation (P>0.05), the other indicators were significantly improved after operation (P<0.05) in the two groups. There were significant differences in RSH, CA, proximal thoracic curve Cobb angle, and thoracolumbar/lumbar curve Cobb angle at each time point after operation (P<0.05), and there were spontaneous correction during follow-up; however, there was no significant difference in main thoracic curve Cobb angle, AVT, TK, LL, trunk shift at each time point after operation (P>0.05), and there was no significant loss during follow-up. Comparison between the two groups: there was no significant difference in all the radiographic indexes at pre- and post-operation (P>0.05).ConclusionFor Lenke type 1 AIS patients with preoperative right high shoulder, proximal fixation vertebra be fixed to the upper end vertebral can obtain satisfactory short-term orthopedic effectiveness and reduce blood loss and operation time.
ObjectiveTo design a method for observing pulmonary microcirculation in vivo in a native tissue environment, due to the high incidence of lung diseases and the advantages of animal experiments in vivo.MethodsTen BALB/c male mice were randomly divided into group A and group B, with five mice in each group. A self-made apparatus was used to control the movement towards local lung tissues in order to get a stabilized observation plane, and then a 5-minute video was shot with laser confocal scanning microscope. During the filming, the mice in group A were injected with fluorescein isothiocyanate-dextran via the tail vein, and the mice in group B were injected with green fluorescent protein-platelets (extracted from the blood of tie2-cre&rosa26-tomato-EGFP transgenic black C57 male mice). The data of group A was used to observe the lungs perfusion and the damage to tissue by this method, and the data of group B was used to observe the movement of platelets.ResultsImage of lung structure obtained by this method was clear and stable. Mean areas of alveolus in an instant and at the 30th, 60th, 120th, 180th, and 300th second were (1 603±181), (1 588±183), (1 528±363), (1 506±353), (1 437±369), (1 549±307) μm2, respectively, and there were no significant differences between each time point (P>0.05). The video was smooth, the rapid movement of platelets was recorded and the particles were clear and without tailing; after the observation, hematoxylin-eosin staining showed no obvious damage to the lung tissue.ConclusionThe method can be used for the observation and research of the lung microcirculatory system in the living state of the mouse, and provides a methodological basis for studies of other lung diseases in vivo.
Evidence produced by clinical trial is the main basis for health care decision-making at all levels. In recent years, some problems been revealed in the national data audit of new drug clinical trials have sounded the alarm for the quality of clinical research in China. In addition to strengthening the implementation of clinical trial process management and supervision, we call attention to the coherence and consistency of trial design and implementation, including the promotion of clinical trial design in the agenda of improving the quality of the trials and putting forward reasonable suggestions. We hope that our work could make research ideas clear from the source of a clinical trial, with a view to avoid violating protocol behavior and provide standardized recommendations for improving the quality of clinical trials in China.
ObjectiveTo optimize the culture method of human primary pancreatic ductal adenocarcinoma (PDAC) cells and cancer associated fibroblasts (CAFs) and investigate the effect of CAFs on the growth of primary PDAC cells in vitro and tumor formation in patient-derived xenograft (PDX) model.MethodsThe PDAC specimens were collected and primarily cultured. In order to observe the effect of CAFs on the growth of primary PDAC cells in vitro, the CAFs were co-cultured with primary PDAC cells consistently and the alone cultured primary PDAC cells served as the control. Then, these cells were injected into the shoulder blades of NOG mice in order to develop the PDX model.ResultsWhen the primary PDAC cells separated from the CAFs, the proliferation capacity of the primary PDAC decreased rapidly in the passage culture in vitro, and the most cells were terminated within 5 generations. By contrast, when the CAFs co-cultured with the primary PDAC cells, the proliferation capacity of primary PDAC cells were preserved, which could be stably transferred to at least 10 generations. The tumors of NOG mice were detected during 2–3 weeks after injecting the mixed cells (primary PDAC plus CAFs), while had no tumor formation after injecting CAFs alone. The rate of tumor was 92.9% (13 cases) in the primary PDAC plus CAFs group, which was higher than that of the CAFs alone group (64.3%, 9 cases), but there was no statistical difference because of the small sample size. The volume of tumor in the primary PDAC plus CAFs group at 2, 4, 6, and 8 weeks after the tumor cells injection was significantly larger than that in the CAFs alone group at the corresponding time point, the differences were statistically significant (P<0.01).ConclusionsThe CAFs could promote the growth of primary PDAC cells in vitro. This new method of co-culture CAFs with primary PDAC could improve the success rate of primary PDAC cells culture and improve the success rate of PDX model in NOG mice.
ObjectiveTo summarize the expression and role of CD146 in mesenchymal stem cells (MSCs).MethodsThe literature related to CD146 at home and abroad were extensively consulted, and the CD146 expression in MSCs and its function were summarized and analyzed.ResultsCD146 is a transmembrane protein that mediates the adhesion of cells to cells and extracellular matrix, and is expressed on the surface of various MSCs. More and more studies have shown that CD146+ MSCs have superior cell properties such as greater proliferation, differentiation, migration, and immune regulation abilities than CD146- or unsorted MSCs, and the application of CD146+ MSCs in the treatment of specific diseases has also achieved better results. CD146 is also involved in mediating a variety of cellular signaling pathways, but whether it plays the same role in MSCs remains to be demonstrated by further experiments.ConclusionThe utilization of CD146+ MSCs for tissue regeneration will be conducive to improving the therapeutic effect of MSCs.
ObjectivesTo evaluate the methodological and reporting quality of clinical guidelines and consensus for esophageal cancer.MethodsDatabases including PubMed, EMbase, Web of Science, CBM, WanFang Data and CNKI were electronically searched and major guideline websites such as GIN, NICE, NGC and Yimaitong were also searched to collect guidelines and consensus for esophageal cancer from inception to August 2018. Two reviewers independently screened the literatures and extracted data according to the inclusion and exclusion criteria and then evaluated the quality of the included guidelines using the AGREE II and RIGHT instruments.ResultsA total of 26 esophageal cancer guidelines and consensus were included. The mean scores for each domain of AGREE II was 49.63% for scope and purpose, 25.16% for stakeholder involvement, 23.42% for rigor of development, 49.25% for clarity of presentation, 16.91% for applicability, and 21.07% for editorial independence. The item with the highest reporting rate among the RIGHT evaluation items was 5 (84.62%), followed by 1a (80.77%), 1c (65.38%), 13a (65.38%), and 4 (61.54%), and the remaining items were all reported below 50%. Results of subgroup analysis showed that the guidelines and consensus developed based on the evidence-based medicine method had higher average scores in the six domains of AGREE II and the RIGHT score than the guidelines and consensus developed based on expert opinions or reviews. The foreign guidelines and consensus had higher average scores in the three domains of AGREE II (formulation rigor, clarity, editorial independence) and the RIGHT score than the domestic guidelines.ConclusionsThe methodological and reporting quality of the guidelines and consensus on esophageal cancer is low, with the guidelines and consensus in China even lower, requiring further improvement. It is suggested that the guideline developers should refer to the standards such as AGREE II and RIGHT to develop high-quality guidelines and promote their application, so as to better guide the standardized diagnosis and treatment of esophageal cancer.
Clinical research reports are the main form of clinical evidence. Based on the requirements of clinical research reports and the characteristics of clinical research on traditional Chinese medicine, it is an important basic systematic project to construct a standardized system of clinical curative effects study report on Chinese medicine. This article elaborates existing problems, focus of attention and construction process in order to help promote the improvement of clinical curative effects research report on Chinese medicine, provide more high-quality evidences for clinical decision-making and promote the development of Chinese medicine.