Prognosis of Concurrent Versus Sequential Chemo-Radiotherapy Induction Followed by Surgical Resection in Patients with Advanced Thymic Epithelial Tumors: A Retrospective Study.

BACKGROUND: This study aimed to evaluate the prognosis of concurrent chemo-radiotherapy (CCRT) versus sequential chemo-radiotherapy (SCRT) induction followed by surgical resection in patients with advanced thymic epithelial tumors (TETs). METHODS: This retrospective study included patients with advanced TETs who underwent CCRT or SCRT induction followed by surgical resection at the Second General Hospital of Guangdong Province between January 2008 and December 2019. The primary outcomes were induction response rate and surgical complete resection rate. The secondary outcomes were surgery combined resection, post-induction T staging, postoperative TNM staging, postoperative pathological tumor regression grade, progression-free survival (PFS) and overall survival (OS), and adverse events (AEs). RESULTS: A total of 31 patients were included, 15 of whom received CCRT and the other 16 SCRT. The induction response rates were 80.0 and 62.5%, respectively, the post-induction step-down rates were 46.7 and 31.3%, respectively, and the post-induction R0 resection rates were 80.0 and 68.8%, respectively, without significant differences between CCRT and SCRT groups (all P > 0.05). The 5-year OS rate was 64.2 and 51.6%, respectively, and PFS was 42.3 and 21.4%, respectively, without significant differences between CCRT and SCRT groups (both P > 0.05). AEs in the hematologic system were significantly higher with CCRT compared with SCRT (P = 0.009). CONCLUSIONS: Patients with advanced TETs might have a good prognosis with both CCRT and SCRT induction therapy, while SCRT induction may result in a lower probability of AEs in the hematologic system.

Experience of the Wang procedure in treating pectus excavatum in two hundred fifty-six paediatric patients.

INTRODUCTION: To analyze and summarize the orthopaedic effect and application experience of the Wang procedure in the treatment of pectus excavatum in paediatric patients. METHODS: The clinical data of 256 children ranging from 0.83~14 years (4.89±2.83 years) who underwent the Wang procedure for pectus excavatum from January 2017 to September 2020 in our hospital were analyzed retrospectively. A 1~2-cm incision was made in front of the xiphoid, and a tunnel was constructed on the deep surface of the thoracic cage. Steel wires were inserted through the bilateral costal arch and the lower sternum, and a steel bar was placed in the tunnel. The wires were pulled taut and fixed to the bar, and the incision was sutured. RESULTS: All the procedures were performed using one steel bar. The range of the procedure duration, the intra-operative bleeding volume, and the hospitalization stays of the patients were 18 to 45 (24.02±4.89) minutes, one to ten (2.16±1.68) mL, and three to nine days (5.71±1.35 days) respectively. Post-operative pneumothorax occurred in three cases without other complications. All the cases received follow-up for one to 45 months after discharge, during which six cases experienced poor wound healing, removed steel plate in 82 cases, and three cases of pectus excavatum recurrence. CONCLUSIONS: The Wang procedure is a good option for treating pectus excavatum, secondary pectus excavatum, or recurrent pectus excavatum in paediatric patients.

Bilateral correction of asphyxiating thoracic dystrophy.

Several operations for asphyxiating thoracic dystrophy (ATD) have been used previously, but they all have disadvantages. We report a 25-year-old male ATD patient who had significant depressions on both sides of thorax. We designed a special operation for him, which had not only eliminated the depression, but also increased the volume of the thorax. The results show that this operation is a reasonable choice for this kinds of patient.

Novel median thoracic expansion for asphyxiating thoracic dystrophy.

There are several surgical techniques for asphyxiating Thoracic Dystrophy (ATD), and various techniques have various indications, but no one has studied this problem in the past. We designed a new procedure for the type of ATD with narrow and cylindrical thorax, and clinical results show that this method is reasonable for this type of patient.

Minimally invasive operation of severe complex thoracic deformity with Wenlin procedure and Wung procedure.

Severe complex thoracic deformity has both protrusion and depression on the chest wall. General minimally invasive operation cannot complete the treatment. We recently treated a 15-year-old boy with Wenlin procedure and Wung procedure, and achieved satisfactory results.

Wenlin procedure combined with Wung procedure for treatment of severe pectus carinatum.

Pectus carinatum can be treated with a single minimally invasive surgery, but the severe cases will appear secondary depression after treatment, which needs to be corrected additionally. We used the combined Wenlin procedure and Wung procedure to treat a patient with severe pectus carinatum and achieved satisfactory results.

Reoperation 10 years after Nuss procedure failed: Wung procedure combined with Wenlin procedure.

After the failure of Nuss procedure for pectus excavatum, the risk of reoperation is high, and it is difficult and challenging. Recently, we performed the reoperation for a patient who had failed Nuss procedure 10 years ago. During the operation, Wung procedure and Wenlin procedure were combined to be used and satisfactory results were obtained.

Wenlin procedure for treatment of compound thoracic deformity after cardiac surgery.

Cardiac surgery is usually completed through the median sternotomy. If the sternum is not fixed firmly after the operation, it may lead to secondary thoracic deformities. The most common deformity after operation is pectus carinatum, and the relatively less common deformity is pectus excavatum, but the compound thoracic deformity has not been reported. We met a 3-year-old boy who underwent surgery for congenital ventricular septal defect at the age of 1. He developed a severe compound thoracic deformity after surgery. We used Wenlin procedure to correct his deformity and obtained satisfactory results. This article reports the operation of this patient.

Wang procedure for secondary thoracic deformity after simultaneous operation of sternal cleft with congenital heart disease.

Sternal cleft is a rare thoracic deformity, often associated with congenital heart disease, which requires simultaneous treatment. There are many methods for treatment of sternal cleft, the early effect may be satisfactory, but the late effect is rarely reported. We performed a simultaneous operation on a patient with sternal cleft and ventricular septal defect, but the patient developed secondary depression deformity after the operation. We used Wang procedure to correct it and got satisfactory results.

Reoperation after the failure of Wang procedure on pectus excavatum: Wung procedure + Wenlin procedure.

Wang procedure for pectus excavatum is a simple and safe surgery. However, improper operation may lead to failure of the surgery. We received a 7-year-old male patient with pectus excavatum who failed Wang procedure. We used the combination of Wung procedure and Wenlin procedure to correct the deformity and achieved satisfactory results.

Wenlin procedure for chest wall reconstruction after tumor resection.

After the resection of the chest wall tumor, there will be obvious defects in the chest wall, which needs to be reconstructed. In the past, reconstruction surgery mainly focused on the selection of materials rather than the surgical methods. Recently, We used Wenlin procedure to reconstruct the chest wall defect after tumor resection in a 65-year-old patient, and achieved satisfactory results.

Chest wall reconstruction with digitally designed materials for straight back syndrome with tracheal stenosis: a case report.

Severe symptoms of straight back syndrome (SBS) occur through compression of the mediastinal structures. The treatment is to relieve compression, but surgical relief has not been reported. A 29-year-old woman was admitted to hospital because of dyspnea for 2 years. Physical examination showed the physiological curvature of the spine had disappeared and imaging examination confirmed that the spine was straight, the distance between the spine and the anterior chest wall was shortened, and the lower part of the trachea was obviously compressed with a severe stenosis. The chest wall was simulated by 3D technology, and a model was obtained by 3D printing. The surgical resection was simulated on the model, and the required replacement material was digitally designed and processed. The upper half of the sternum, the first and second costal cartilages, and the thymus were excised. After the chest wall defect was repaired with the digital material, the ascending aorta was suspended on the reconstruction to relieve the tracheal compression. The operation was completed in 135 min without any complications. All symptoms disappeared after operation. Postoperative imaging examination showed complete resolution of the tracheal stenosis. The patient was discharged 10 days after operation. Surgical reconstruction of the anterior chest wall is a good method for treating tracheal stenosis in SBS, and digitally produced material is ideal for the reconstruction.

Povidone-iodine chemical pleurodesis in treating spontaneous chylothorax in pediatric patients.

BACKGROUND: Chylothorax is a rare disease with a high mortality rate in pediatric patients like newborns and infants. As one of the minimally invasive treatments, chemical pleural pleurodesis has been gradually used in treating pediatric chylothorax patients in recent years. This study explored the feasibility, safety and effect of povidone-iodine chemical pleurodesis (CP) for spontaneous chylothorax in young pediatric patients. METHODS: From January 2009 to December 2019 the clinical data of 22 children treated for spontaneous chylothorax at Guangdong Second Provincial General Hospital were retrospectively analyzed. The data included the patients' medical history, clinical manifestations, pleural effusion examinations, treatment methods, and effects and complications. On the basis of conventional conservative treatment and closed thoracic drainage, all the children were treated by CP with povidone-iodine until the pleural effusion was absorbed and the thoracic tube was removed. After discharge from the hospital, each patient was followed up for 1-10 years. RESULTS: Of the 22 children (16 males and 6 females), 3 cases were diagnosed with pleural effusion at prenatal examination, 5 cases had acute respiratory distress at birth, and 6 case had experienced pneumonia repeatedly since birth. All of the children had different degrees of cyanosis and dyspnea. Pleural effusion was diagnosed in all patients by chest X-ray and chest ultrasound after admission (12 cases on the left side, 5 cases on the right side, and 5 cases on both sides). The results of all chyle tests during pleural effusion examination were positive. The mean leukocyte count was (9,278.8±9,504.6)×106 /L, the lymphocyte ratio was (83.9±6.1)%, and the mean triglyceride content was (7.18±6.10) mmol/L. All patients were treated with thoracic drainage, diet control, nutritional support, and povidone-iodine CP, among 6 of them with pneumonia on admission received antibiotics. The mean length of stay (LOS) was (36.0±18.2) days. The patients received thoracic drainage for (23.0±15.6) days and pleurodesis (3.0±2.0) times. No serious side effects occurred after pleurodesis, although some patients experienced mild chest pain and low fever. All the patients successfully achieved a clinical cure. CONCLUSIONS: Povidone-iodine CP is a safe, effective, and minimally invasive treatment, with high success rate and few complications in young pediatric patients with spontaneous chylothorax.

Chemical pleurodesis and somatostatin in treating spontaneous chylothorax in pediatric patients: a retrospective analysis and review of the literature.

BACKGROUND: Chylothorax is a rare disease, defined as an abnormal accumulation of chylous lymphatic effusion in thoracic cavity, with a high mortality rate in pediatric patients. At present, there are few studies on the treatment of pediatric chylothorax, and conservative treatments like somatostatin (SST) and pleurodesis are performed empirically. SST has been used for treating pediatric chylothorax over 20 years, and povidone-iodine chemical pleurodesis (PICP) is adopted in recent years with a high cure rate, but both the effect are still uncertain. The safety and efficacy of SST and PICP in treating pediatric chylothorax was compared in this study. METHODS: From January 2009 to May 2020, 27 pediatric chylothorax patients who accepted life support, SST and PICP treatment were retrospectively reviewed in this study. Their medical history, clinical manifestations, pleural effusion examinations, treatment methods, effects, and complications were screened. PICP and SST was performed in 19 and 8 children, respectively. Each patient was followed up after discharge from the hospital. RESULTS: After admission, chest X-ray and ultrasound diagnosed pleural effusion in 27 patients (18 males and 9 females), including 13 and 6 cases on the left and right side, and 8 cases on both sides. In the pleural effusion, the mean leukocyte count was (9,826±9,482)×106/L, the mean lymphocyte ratio was (84.82±6.58)%, the mean triglyceride content was 7.11±6.63 mmol/L. In PICP and SST group, the mean length of stay was 38.42±19.42 and 35.13±12.72 d (P=0.664), the mean time of thoracic drainage was 24.58±16.34 and 19.63±8.88 d (P=0.440), the mean time of parenteral nutrition was 27.16±18.29 and 25.25±13.52 d (P=0.793), respectively. PICP was performed for 3.16±2.27 times, and SST was used for 14.75±9.08 d with the dosage of 0.5 to 10 µg/kg/hour. After the treatment, all patients in PICP group had mild chest pain and low-grade fever, and 12 cases were observed with transient decrease of oxygen saturation. Eight patients in SST group had nausea and vomit, and 1 child had diarrhea simultaneously. Both were cured by symptomatic treatment, thoracic drainage and discontinuing using SST. Three children were diagnosed with refractory chylothorax and cured by PICP after SST. Pleural effusion in 27 patients was finally absorbed. All of them achieved a clinical cure successfully, and there was no recurrence during discharge follow-up. CONCLUSIONS: PICP has a high success rate and few adverse reactions in treating spontaneous chylothorax in pediatric patients, expected to be a new treatment option for pediatric chylothorax after SST.

[Experience with Wang procedure for treatment of pectus excavatum in young children].

OBJECTIVE: To review the experience with Wang procedure for treatment of pectus excavatum in young children. METHODS: The clinical data of 21 children with a mean age of 3.3 ± 1.1 years (ranging from 1.5-6 years) undergoing Wang procedure for pectus excavatum were analyzed. A longitudinal incision (1 to 2 cm) was made in the front of the xiphoid, and two tunnels were created using steel bars beneath the muscles on two sides of the chest wall. The fibrous tissue between the diaphragm and the sternum was dissociated, and the steel wires were sutured through the deformed chest wall. After the steel bar was placed in the tunnels, the wires were pulled and fixed in the middle of the bar, and the incision was sutured. RESULTS: All the operations were performed using 3 wires and 1 steel bar. The operation time was 25 to 51 (38.1 ± 9.6) min with an intraoperative bleeding volume of 5 to 10 (7.1±1.5) mL. The time of hospitalization of the patients ranged from 6 to 10 days (mean 8.1±1.3 days). In all the patients, the incision healed smoothly without serious pain or obvious complications. All the patients were followed up for 1 to 13 months after the operation. During the follow- up, no recess recurred and no such complications as bar displacement or transposition occurred. According to the evaluation criteria after pectus excavatum operation, 13 cases had a total score of 9, and 8 had a total score of 8. The overall effect was satisfactory, and there were no cases rated as basically satisfactory or unsatisfactory. CONCLUSIONS: Wang procedure is a good option for treatment of pectus excavatum in young children.

MiR-145 acts as a metastasis suppressor by targeting metadherin in lung cancer.

MiR-145 has been reported to be downregulated in multiple tumors. It acts as a tumor suppressor in lung cancer. In this study, we investigated the potential effects of miR-145 on invasion and metastasis and the molecular mechanism in non-small cell lung cancer. MiR-145 was downregulated in the NSCLC specimens and significantly correlated with advanced clinical stage and lymph node metastasis. In addition, AEG-1/MTDH was a direct target of miR-145, and the expression of AEG-1/MTDH was inversely correlated with miR-145 expression in NSCLC tissues. Ectopic expression of miR-145 suppressed cell invasion and metastasis in NSCLC cells. AEG-1/MTDH overexpression partially reversed the suppressive effect of miR-145. These findings provide novel insights with potential therapeutic applications for the treatment of NSCLC.