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@#Objective To introduce a new method for identifying intersegmental planes during thoracoscopic segmentectomy using pulmonary circulation single-blocking in the target segment. Methods To retrospectively analyze the clinical data of 83 patients who underwent thoracoscopic pulmonary segmentectomy from January 2019 to March 2020 using the pulmonary circulation single-blocking method. There were 33 males and 50 females, with a median age of 54 (46-65) years, and they were divided into a single vein group (SVG, n=31) and a single artery group (SAG, n=52), and the clinical data of two groups were compared. Results The intersegmental planes were identified successfully in both groups and there were no statistically significant differences between the two groups in terms of intersegmental plane management (P=0.823), operating time (P=0.786), intraoperative blood loss (P=0.775), chest drainage time (P=0.659), postoperative hospital stay (P=0.824) or the incidence of postoperative complications (P=1.000). Conclusion The use of pulmonary circulation single-blocking for intersegmental plane identification during thoracoscopic segmentectomy is safe and feasible, and the intersegmental plane can be satisfactorily identified by the single-blocking of arteries or veins.
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@#Objective To examine the high-risk factors and prognosis of patients with superior interlobar lymph nodes (11s nodes) metastasis in non-small cell lung cancer (NSCLC) located in the right middle or lower lobe. Methods The clinical data of 157 patients with NSCLC in the right middle or lower lobe from January 2015 to July 2020 in our hospital were retrospectively analyzed, including 98 males and 59 females aged 23-86 (60.01±10.58) years. The patients underwent lobectomy and systemic lymph node dissection along with dissection of 11s nodes. They were divided into a 11s (+) group and a 11s (–) group according to whether the 11s nodes were involved. Results There were 31 patients with invasion in the 11s nodes, and the overall incidence of metastasis was 19.75%, including 13.64% with middle lobe tumors and 20.74%with lower lobe tumors. The 2R+4R nodes involvement was the influencing factor associated with 11s nodes metastasis (P=0.026). The 7th nodes and the inferior mediastinal lymph nodes involvement were high-risk factors affecting the prognosis of patients (P<0.05). The 11s nodes metastasis had nothing to do with the location of the tumor, and it was not an independent factor affecting disease-free survival. Conclusion The 11s nodes may be a transit for 2R+4R nodes metastasis in the right middle or lower lobe lung cancer, and the 11s nodes should be cleared in the surgical treatment for NSCLC in either the middle or lower lobe of the right lung. The influencing factors for disease-free survival after surgery for lung cancer in the right middle or lower lobe are the metastasis of the subcarinal lymph nodes and the inferior mediastinal lymph nodes.
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BACKGROUND@#Pulmonary epithelial-myoepithelial carcinoma is a very rare type of salivary gland lung tumor. No standard treatment plan yet. This article intends to analyze the clinical characteristics of pulmonary epithelial-myoepithelial carcinoma and discuss the diagnosis and treatment of pulmonary epithelial-myoepithelial carcinoma.@*METHODS@#The clinical data of a patient with pulmonary epithelial-myoepithelial carcinoma were analyzed and other relevant clinical literatures were reviewed.@*RESULTS@#Epithelial cells immunohistochemically expressed cytokeratin and myoepithelial cells immunohistochemically expressed SMA and S-100. The next-generation sequencing was mainly HRAS gene mutation and the express of PD-L1 protein was negative.@*CONCLUSIONS@#Most of the patients with Pulmonary epithelial-myoepithelial carcinoma have a good prognosis. Diagnosis mainly depends on microscopic examination and immunohistochemistry. The treatment of pulmonary epithelial-myoepithelial carcinoma is mainly surgical resection. The effect of radiotherapy and chemotherapy is not clear.
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With the popularity of computed tomography (CT) scan in recent years, early stage lung cancer has been discovered in large numbers of patients and pulmonary segmentectomy has been widely used clinically. Identification of the intersegmental plane is one of the key steps in pulmonary segmentectomy, and current methods for identifying the intersegmental plane are numerous and have their own advantages and disadvantages. We will review relevant methods to help the clinical practice. .
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With the popularity of computed tomography (CT) scan in recent years, early stage lung cancer has been discovered in large numbers of patients and pulmonary segmentectomy has been widely used clinically. Identification of the intersegmental plane is one of the key steps in pulmonary segmentectomy, and current methods for identifying the intersegmental plane are numerous and have their own advantages and disadvantages. We will review relevant methods to help the clinical practice. .
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@#Objective To explore the clinical pattern of intrapulmonary lymph node metastasis and the significance of No.13 and No.14 lymph nodes biopsy in patients with non-small cell lung cancer (NSCLC). Methods The clinical data of 234 patients with primary peripheral NSCLC who underwent systemic dissection of intrathoracic lymph nodes and intrapulmonary lymph nodes in the First Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were retrospectively analyzed. There were 159 males and 75 females, aged 36-89 (61.35±8.57) years. Statistical analysis was performed accordingly on hilar (No.10), interlobar (No.11), lobar (No.12) and segmental (No.13 and 14) sites of the samples of N1 lymph nodes after surgery. Results A total of 3 019 lymph nodes of No.10-14 were dissected in 234 patients (12.9 per patient). The 263 lymph nodes were positive with a rate of 8.71% (263/3 019) and lymph node metastasisa occured in 99 patients with a rate of 42.31% (99/234), among whom there were 40 patients of N1 metastasis, 48 of N1+N2 metastasis and 11 of N2 skipping metastasis. Routine pathological examination demonstrated No.13 and No.14 lymph nodes metastasis in 16 patients with a rate of 6.84% (16/234). In 886 dissected lymph nodes of No.13 and No.14, 86 lymph nodes showed metastasis with a rate of 9.71% (86/886). Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 56.32% of them were confirmed with lymph node metastasis by postoperative histopathology; while 34.01% of the patients with normal size lymph nodes had lymph node metastasis. Conclusion In the surgical treatment of NSCLC, it is necessary to detect the metastasis of No. 13 and 14 lymph nodes and non-tumor parabronchial lymph nodes, which is helpful to obtain accurate postoperative TNM staging and is of great significance for guiding postoperative treatment. Preoperative CT is not a reliable method to judge lymph node metastasis, particularly for intrapulmonary lymph node metastasis.
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In recent years, with the popularization of low-dose computed tomography (LDCT) and high-resolution CT (HRCT), the discovery rate of early-staged non-small cell lung cancer has been on the rise, and more thoracic surgeons have explored more reasonable resection scope. Clinical studies have demonstrated that there is a lower rate of local tumor recurrence in patients with negative lung margins compared with positive ones. Therefore, it is of great clinical significance to ensure the negative margin during sublobar resection for early-staged lung cancer. This paper will focus on this area. .
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Humans , Carcinoma, Non-Small-Cell Lung , Pathology , General Surgery , Lung , Pathology , General Surgery , Lung Neoplasms , Pathology , General Surgery , Neoplasm Staging , RecurrenceABSTRACT
Objective To establish the lung cancer cell strain with low ATG5 expression and to detect the effect of celastrol on lung cancer cell apoptosis after downregulation of autophagy.Methods H1299 was infected by lentivirus-mediated ATG5 shRNA.RT-qPCR and Western blot assays were applied to confirm the effect of ATG5 knock down.Autophagy was measured by Western blot and RFP-LC3 transfection.Cell apoptosis of ATG5 normal expression group and of ATG5 low expression group of H1299 cells was detected by FACS.Finally, Western blot was used to detect the expression of apoptosis-related proteins Bcl-2, Bax and cleaved caspase-3.Results The expression of ATG mRNA and protein significantly decreased after ATG5 knockdown in H1299 cells (P<0.05).The autophagy marker of LC3-Ⅱ level was downregulated and P62 expression was upregulated after inhibition of ATG5, and the RFP-LC3 puncta reduced significantly after ATG5 knockdown (P<0.05).Compared with control group,the apoptosis rate in ATG5 downregulation group increased significantly after celastrol treatment (P<0.01).Pro-apoptotic proteins of Bax and cleaved caspase-3 levels were upregulated and anti-apoptotic protein of Bcl-2 level decreased after ATG5 inhibition (P<0.05).ConclusionsThe effect of celastrol-induced apoptosis of lung cancer cells was enhanced after downregulation of autophagy, demonstrating inhibition autophay may be a new target of lung cancer treatment.
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Objective Arrhythmias are one of the main causes of postoperative morbidity after thoracic surgery.The aim of this study was to evaluate whether video-assisted thoracoscopic surgery decreases the risk of postoperative arrhythmias compared with traditional open lung lobectomy.Methods 138 consecutive patients were enrolled from January 2011 to February 2012,after five age and risk factors matched,68 patients undergoing video-assisted thoracic surgery and 70 patients undergoing traditional open lung lobectomy were eligible for analysis.The rhythm was documented preoperatively and postoperatively with standard electrocardiogram (ECG) recording and ECG monitoring.All patients followed 3 months after hospital admission.Results There was a 17.6％ incidence (12/68) of postoperative new-onset arrhythmias undergoing video-assisted thoracic surgery and 18.6％ of patients (13/70) undergoing thoracotomy,but the difference was not statistically significant.In both groups,atrial fibrillation was the most common arrhythmia (60％).There was no significant difference in the other morbidity (P ＞0.05) and mortality rate(P =0.57,1.5％ vs 2.9％) between the two groups.Conclusion New-onset arrhythmias,most frequently atrial fibrillation,are common after lung lobectomy.Regardless of surgical approach,postoperative arrhythmias after lobectomy occurred with equal frequency.New insights in the pathophysiology of postoperative thoracic arrhythmias and advances in prevention and therapy are need future study.
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Objective To analyze the cost-effectiveness of integrated pharmaceutical care (IPC) in community-based patients with chronic obstructive pulmonary disease (COPD).Methods The COPD patients were divided randomly into intervention group (group A,n =79) and control group (group B,n =71).Group A received the IPC intervention measures,including serial lectures of pharmaceutical knowledge,home supervision and web-based communications for while group B group had none.Results As compared with group B,group A obviously improved on the knowledge of pharmaceutical treatment effect and side effect (95.1％,67.4％ vs.63.1％,21.9％,x2 =12.445,P=0.000 vs.x2 =55.557,P=0.000).There were notable differences between two groups [ ( 1.77 ± 1.23 ) vs.( 2.42 ± 1.66 ) s,t =2.583,P=0.011],pulmonary rales [ (0.01 vs.0.01)s,Z =2.370,P=0.018],6-min walk distance (6 MWD) [ (457 ± 67 ) vs.(425 ± 72) m,t =2.760,P =0.007 ],vital capacity ( VC ) [ ( 1.60 ± 0.25 ) vs.( 1.49 ± 0.23 ) L,t =2.718,P =0.007 ) ] andquality-of-life items ( 48 ± 10 vs.52 ± 11,t =2.624,P =0.010) after intervention.Analyze of cost-effectiveness show that groupA was superior to group B [ total effect total cost(TE/TC =764.6/4936,15.49％ )vs.(TE/TC =1509.4/4708),32.06％,x2 =6.183,P ＜ 0.01 ].Conclusion IPC can improve the disease condition and achieve excellent cost-effectiveness for community-based COPD patients.
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Drug reservation wag investigated in 2077 community residents.We found that most drugs were obtained from the hospitals(83.78%),kept at a relatively lower place(69.23%),packed in box(75.25%),and did not meet the storage requirement(72.60%).Half of the overdue drugs(median time,12 months)were used for internal treatment.This study suggests that there might be unsafe drug storage in communities.
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<p><b>BACKGROUND</b>To analyze clinicopathological correlation of detection of lung cancer micrometastasis in regional lymph nodes (LNs) by reverse transcriptase-polymerase chain reaction (RT-PCR).</p><p><b>METHODS</b>Regional LNs (n=261) were obtained from 40 patients with lung cancer who underwent lobectomy. Each LN was bisected. Half of each LN was subjected to histological examination (HE) and the other half was subjected to RT-PCR amplification of CK19 mRNA.</p><p><b>RESULTS</b>In 18 of 40 patients, the metastasis in regional LNs was found by both HE and RT-PCR. Of 22 N0 diseases diagnosed by HE, 6 (27%) were found to express CK19 mRNA in regional LNs. According to the results of regional LNs metastasis in 40 patients by CK19 RT-PCR, the presence of the CK19 product in LNs was related to tumor size (Chi-square=5.76, P < 0.025), the presence of tumor vascular invasion (Chi-square=3.88, P < 0.05), cell differentiation of the tumor (Chi-square=7.08, P < 0.01) and P-TNM stages (Chi-square=7.42, P < 0.01). In the histologically node-negative patients, lymph node micrometastasis was significantly related to tumor size (P=0.038, exact test) and P-TNM stage (P=0.01, exact test). However, the results of routine histological examination did not show the above clinicopathological correlation (P > 0.05).</p><p><b>CONCLUSIONS</b>The RT-PCR method is superior to routine histological examination in detecting metastasis in LNs. The micrometastasis in LNs can be detected accurately by RT-PCR. It is helpful for screening the patients in whom the early subclinical metastasis exists and disclosing the intrinsic rule of malignancy metastasis.</p>