Abstract： Objective To compare the influence of different doses of low molecular weight heparin on blood coagulation system of patients who have received thoracic surgery. Methods Eightytwo patients (with lung cancer, esophageal cancer, thymoma, pleural endotheliomas or other diseases) who were treated in Tongji Hospital of Huazhong University of Science and Technology from January 2009 to March 2010 were divided into three groups, based on the time of hospitalization. In the control group, there were 24 patients including 10 females and 14 males with an average age of 43.5±21.3 years. No low molecular weight heparin was given after operation. There were 32 patients in group I, including 14 females and 18 males, with an average age of 45.2±18.6 years. An amount of 0.2 ml (2 125 U) low molecular weight heparin was subcutaneously injected daily during the first 7 days after operation. In group Ⅱ, there were 26 patients including 11 females and 15 males with an average age of 43.8±20.1 years. An amount of 0.4 ml (4 250 U)low molecular weight heparin was subcutaneously injected daily during the first 7 days after operation. The differences of preoperative and postoperative coagulation factors including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D dimer (D-D), platelet count (PLT) and anti-Ⅹa activity were observed. Results The preoperative average values of PT, APTT, Fib, D-D, PLT of all the three groups were in the normal range and showed no significant difference (Pgt;0.05). For all three groups, after operation, PT prolonged, APTT shortened, the amount of Fib, D-D increased, PLT reduced on the 3rd day and then increased on the 7th day and anti-Ⅹa activity increased, all of which showed a significant difference from preoperative values (Plt;0.05). The amount of Fib in group Ⅱ was significantly lower than that in group Ⅰ after operation (the 5th day after operation: 4.7±2.5 g/L vs. 7.0±3.3 g/L, Plt;0.05); the amount of D-D in group Ⅱ was significantly lower than that in the control group (the 5th day after operation: 891.3±891.3 μg/L vs. 1 583.2±984.7 μg/L, Plt;0.05) and group Ⅰ (the 5th day after operation: 891.3±891.3 μg/L vs. 1 452.6±1 052.9 μg/L,Plt;0.05); and the anti-Ⅹa activity of group Ⅱ was significantly higher than that in group Ⅰ (the 5th day after operation: 0.54±0.05 U/ml vs. 0.29±0.04 U/ml, Plt;0.05). Conclusion In a certain weight range, fixeddose (4 250 U) of low molecular weight heparin is able to improve postoperative hypercoagulable state and avoid the occurrence of venous thromboembolism without increasing risk of complications like bleeding.
ObjectiveTo investigate the effectiveness of sublobar resection and lobectomy via uniportal video-assisted thoracoscopic surgery (U-VATS) for lung metastases from colorectal cancer.MethodsRetrospective research was conducted on 42 colorectal cancer patients with lung metastases who underwent U-VATS sublobar resection and lobectomy at the Tongji Hospital, Huazhong University of Science and Technology between April 2016 and May 2019, including 24 males and 18 females with an average age of 58.0±9.9 years. Among them 17 patients received U-VATS sublobar resection and 25 patients received lobectomy. The operation time, intraoperative blood loss, postoperative pulmonary infection, drainage tube indwelling time, drainage volume on the first day after surgery, postoperative hospital stay were analyzed between the two groups, and the relationship between the prognosis and clinical characteristics of the two groups was compared.ResultsSublobar resection patients had less lung metastases (P=0.043) and shorter operation time (P=0.023) compared with the lobectomy patients. There was no significant difference between the lobectomy and sublobar resection groups in intraoperative blood loss (P=0.169), rate of postoperative infection (P=0.982), postoperative drainage duration (P=0.265), drainage volume on the first day after surgery (P=0.402) and postoperative hospital stay (P=0.612). The progression-free survival of the two groups was 25.19 months and 23.63 months (P=0.721), and their overall survival was 29.09 months and 30.64 months (P=0.554).ConclusionConsidering guantity and locations of lung metastases, U-VATS sublobar resection can achieve a similar prognosis to lobectomy for lung metastases from colorectal cancer. Further efficacy of this surgical strategy remains to be proved by longer follow-up.
Objective To investigate the effect of modular disscection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for lung cancer radical resection and assess its safety and feasibility. Methods Data of 311 patients (171 males and 140 females, a mean age of 59.4±5.1 years) with non-small cell lung cancer (NSCLC) who received modular dissection of mediastinal lymphadenectomy in uniportal-VATS or three portal VATS (3P-VATS group) during March to December 2015 were retrospectively analyzed. There were 208 patients (110 males and 98 females, a mean age of 59.2±5.3 years) in the uniportal-VATS group and 103 patients (61 males and 42 femals, a mean age of 59.7±5.1 years) in the 3P-VATS group. The effects of lymph nodes (LNs) dissection and postoperative clinical data were compared between the two groups, especially for N2 LNs dissection. Results There were no perioperative death in two groups. The overall number of dissected stations and LNs in the uniportal-VATS group (7.3±1.0, 17.5±3.0) were similar with those in the 3P-VATS group (7.2±1.0, 17.7±2.7, P=0.208, P=0.596). The dissected stations (uniportal-VATS: 4.3±0.7, 3P-VATS: 4.3±0.6) and number (uniportal-VATS: 8.6±1.1, 3P-VATS: 8.5±1.1) of N2 LNs were both similar between the two groups (P=0.850, P=0.587). The chest tube duration and postoperative hospital stay of uniportal-VATS group (4.4±1.3 d and 9.2±0.9 d) were much shorter than those of 3P-VATS group (5.0±1.3 d and 9.8±2.0 d, both P<0.001). No significant difference was found in morbidity rate between the two groups (P>0.05). Conclusion Modular dissection of mediastinal lymphadenectomy could meet the requirment of radical resection and it is a safe and valid method which could be used during uniportal-VATS for radical resection of lung cancer.
Objective To investigate the feasibility and clinical outcomes of minimally invasive sternal depression by autologous force for the correction of pectus carinatum. Methods Between October 2011 and September 2015, 22 pectus carinatum patients underwent minimally invasive surgical correction of pectus carinatum in Tongji Hospital. Clinical data of 22 patients were retrospectively analyzed. There were 19 males and 3 females with a mean age of 12.00±2.87 years, ranging from 6 to 15 years. Among them, 17 patients were symmetric malformation, and the others were asymmetric. Preoperative chest CT scan was performed on 14 patients. Haller index was 1.65-2.23 (1.97±0.15). All the patients underwent the minimally invasive surgical correction of pectus carinatum with a NUSS bar via sternal depression by autologous force. Results All the operations were completed successfully. The mean operation time was 55-120 (83.73±16.62) min and blood loss volume was 10-50 (28.18±11.63) ml. The mean postoperative hospital stay was 3-6 (4.23±1.17) d. Postoperative complications included wound infection in 2 patients, minor pneumothorax in 3 patients, who were cured by conservative treatment. One patient suffering postoperative hydropneumothorax received drainage. All the patients were followed up for 6-48 months after discharge and very satisfied with the chest appearance following surgery. No patient complained of persistent pain. There was no displacement of the bar or the stabilizers. Nine patients underwent the removal of the NUSS bar without pectus carinatum recurrence. Conclusion Minimally invasive sternal depression by autologous force simplifies the procedure of correction of pectus carinatum with reliable and satisfactory outcomes.
ObjectiveTo investigate CT image features of ground glass opacity (GGO)-like 2019 novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) and early-stage lung carcinoma for control and therapy of this acute severe respiratory disease.MethodsWe retrospectively analyzed the clinical data of 71 GGO-like COVID-19 patients who received therapy in Tongji Hospital of Huazhong University of Science and Technology between January 17th and February 13th, 2020. These 71 GGO-like COVID-19 patients were as a COVID-19 group. And 80 GGO-like early-stage lung carcinoma patients who underwent resection were as a lung carcinoma group. Clinical features such as sex, age, symptoms including fever, cough, fatigue, myalgia and dyspnea, detailed exposure history, confirmatory test (SARS-CoV-2 quantitative RT-PCR) and pathologic diagnosis were analyzed.ResultsSignificantly different symptoms and exposure history between the two groups were detected (P<0.001). More lesions (61 patients at percentage of 85.92%, P<0.001), relative peripheral locations (69 patients at percentage of 97.18%, P<0.001) and larger opacities (65 patients at percentage of 91.55%, P<0.001) were found in chest radiographs of GGO-like COVID-19 compared with GGO-like early-stage lung carcinoma. Similar features appeared in early-stage of COVID-19 and lung carcinoma, while pneumonia developed into more extensive and basal predominant lung consolidation. Coexistence of GGO-like COVID-19 and early-stage lung carcinoma might occur.ConclusionConsidering these similar and unique features of GGO-like COVID-19 and early-stage lung carcinoma, it is necessary to understand short time re-examination of chest radiographs and other diagnostic methods of these two diseases. We believe that the findings reported here are important for diagnosis and control of COVID-19 in China.
ObjectiveTo investigate the efficacy of transcranial combined with peripheral repetitive magnetic stimulation on motor dysfunction after stroke.MethodsA total of 40 patients after stroke who were hospitalized in the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University between January and December 2019 were selected. The patients were divided into the trial group and the control group by random number table method, with 20 cases in each group. Both groups received conventional rehabilitation and medicine treatment, on that basis, the trial group received repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS), while the control group received rTMS combined with fake rPMS, both lasted for 2 weeks. Before treatment and 2, 4, 12 weeks after the initiation of treatment, the Fugl-Meyer Assessment (FMA) [including FMA-Upper Limb (FMA-UL), FMA-Lower Limb (FMA-LL)], National Institute of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI) were used to evaluate the efficacy of rTMS combined with rPMS.ResultsFive patients fell off, and 35 patients were finally included, including 18 in the trial group and 17 in the control group. No adverse reaction occurred during the study. Before treatment, there was no significant difference in FMA, FMA-UL, FMA-LL, NIHSS or MBI scores between the two groups (P>0.05). After treatment, the FMA score of the trial group changed from 36.44±28.59 to 75.56±19.94, and that of the control group changed from 39.05±29.85 to 54.64±23.25; the between-group difference was statistically significant at the end of the 4th and 12th weeks (P<0.05). The FMA-UL score of the trial group changed from 21.39±22.14 to 46.94±15.84, and that of the control group changed from 20.82±20.47 to 31.29±16.98; the between-group difference was statistically significant at the end of the 4th and 12th weeks (P<0.05). The FMA-LL score of the trial group changed from 15.06±9.10 to 28.61±5.69, and that of the control group changed from 18.23±10.33 to 23.35±8.20; the between-group difference was statistically significant at the end of the 12th week (P>0.05). The NIHSS score of the trial group changed from 6.83±4.54 to 2.78±2.05, and that of the control group changed from 6.35±3.67 to 3.94±2.56; the MBI score of the trial group changed from 53.33±17.90 to 83.06±12.50, and that of the control group changed from 60.88±25.45 to 78.82±15.67; there was no statistically significant difference in NIHSS or MBI between the two groups at any timepoint (P>0.05). Except for the FMA-LL of the control group, the other outcome indicators in each group were significantly different after treatment compared with those before treatment (P<0.05).ConclusionsBoth rTMS and rTMS combined with rPMS can improve the limb motor function and activities of daily living of stroke patients. The treatment mode of rTMS combined with rPMS has better effect on motor dysfunction after stroke, which is of great significance for improving the overall rehabilitation effect.
Near-infrared fluorescence imaging technology, which possesses superior advantages including real-time and fast imaging, high spatial and temporal resolution, and deep tissue penetration, shows great potential for tumor imaging in vivo and therapy. Ⅰ-Ⅲ-Ⅵ quantum dots exhibit high brightness, broad excitation, easily tunable emission wavelength and superior stability, and do not contain highly toxic heavy metal elements such as cadmium or lead. These advantages make Ⅰ-Ⅲ-Ⅵ quantum dots attract widespread attention in biomedical field. This review summarizes the recent advances in the controlled synthesis of Ⅰ-Ⅲ-Ⅵ quantum dots and their applications in tumor imaging in vivo and therapy. Firstly, the organic-phase and aqueous-phase synthesis of Ⅰ-Ⅲ-Ⅵ quantum dots as well as the strategies for regulating the near-infrared photoluminescence are briefly introduced; secondly, representative biomedical applications of near-infrared-emitting cadmium-free quantum dots including early diagnosis of tumor, lymphatic imaging, drug delivery, photothermal and photodynamic therapy are emphatically discussed; lastly, perspectives on the future directions of developing quantum dots for biomedical application and the faced challenges are discussed. This paper may provide guidance and reference for further research and clinical translation of cadmium-free quantum dots in tumor diagnosis and treatment.
ObjectiveBy summarizing the clinical characteristics of perioperative patients with cross infection of novel coronavirus in thoracic surgery ward, to guide the prevention and treatment of nosocomial infection during the anti-epidemic period.MethodsThe clinical data of 451 patients with chest diseases in the Department of Thoracic Surgery of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 1st to 24th, 2020 were analyzed and followed up. There were 245 surgical patients and 206 non-surgical patients.ResultsIn the department, 7 patients (7/451, 1.55%) were infected with the novel coronavirus and all of them were surgical patients, whose preoperative imaging data did not reveal the imaging changes of novel coronavirus. There were 5 males and 2 females, aged 56 to 68 years. The patients with old age, smoking, surgery, coronary heart disease, chronic liver disease and tumor history were more susceptible to infection. From the spatial distribution of patient beds, it was found that the distance among infected patients was greater than 1 m, and no cross infection was found in the other patients of the same ward. During follow-up, two family members of noninfected patients were found to be infected one week after discharge. However, there was no overlap of spatiotemporal distribution between the family members and the infected patients during the hospitalization period.ConclusionThe novel coronavirus pneumonia rate in the department of thoracic surgery is low, which may be opportunistic infection. At the same time, a good control and prevention of epidemic disease can reduce the occurrence of cross infection in the department of thoracic surgery.
ObjectiveTo explore the safety and feasibility of the application of video-assisted thoracic surgery (VATS) anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis.MethodsFrom June 2014 to June 2018, 19 patients with bilateral localized bronchiectasis underwent single-stage bilateral thoracic surgery with VATS anatomic segmentectomy, including 11 males and 8 females aged 38.0±12.5 years. The clinical efficacy of the surgery was evaluated.ResultsAll surgeries were successfully completed, of which 17 were bilateral VATS, 2 were unilateral VATS with the other lateral converted to thoracotomy. The average number of bilateral resected segments was 4-8 (5.9±1.2). Mean operation time was 330.0±40.0 min and mean blood loss was 150.0±60.0 mL. Mean ventilator-assisted breathing time was 6.0±1.8 h, mean duration of chest-tube placement was 4.0±1.0 d and mean hospital stay time was 14.0±1.5 d. Three patients suffered pulmonary infection and 1 patient received tracheotomy. No perioperative death occurred. Arterial oxygen pressures on postoperative day (POD) 1 (F=340.18, P<0.05) and POD 3 (F=131.26, P<0.05) were significantly lower than that before operation, arterial carbon dioxide pressures on POD 1 (F=46.62, P<0.05) and POD 3 (F=48.21, P<0.05) were significantly higher than that before operation, and pulse oximeter saturation on POD 1 was significantly lower than that before operation (F=210.82, P<0.05). The patients were followed up for one to five years without recurrence.ConclusionApplication of VATS anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis is safe and feasible with strictly selected patients. Postoperative airway management is very important. The surgery is worthy of wide clinical practice.