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Objective To explore the value of perfusion CT quantitative analysis for predicting tumor regression grade (TRG) after chemoradiotherapy in patients with rectal cancer.Methods From June 2016 to June 2018,94 rectal cancer patients diagnosed and treated in Cangzhou Central Hospital of Hebei Province were selected and were divided into reaction group (TRG 3-4) and non-reaction group (TRG 0-2) according to the results of surgical specimens.Perfusion CT was performed in both groups before treatment,and chemoradiotherapy and surgery were used.Baseline data and perfusion CT results including blood flow,blood volume,mean transit time (MTT),permeability surface (PS) were compared between the two groups,and receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of perfusion CT indexes for chemoradiotherapy responsiveness.Results In this study,a total of 23 cases (24.47％) were responsive to chemoradiotherapy,and 71 cases (75.53％) were not responsive to chemoradiotherapy.Blood flow in reaction group [(38.60 ±7.13) ml · 100 g-1 · min-1] was significantly lower than that in non-reaction group [(67.39 ± 11.33) ml · 100 g-1 · min-1,t =3.273,P =0.001].MTT in reaction group was significantly longer than that in non-reaction group [(11.12 ±2.19) s vs.(6.88 ± 1.32) s,t =4.500,P ＜0.001].There was no significant difference in blood volume [(4.62 ±0.73) ml/100 g vs.(5.01 ± 1.04) ml/100 g] and PS [(13.72±3.82) ml · 100 g-1 · min-1 vs.(11.40 ±2.59) ml · 100 g-1 · min-1] between the two groups (t =0.818,P =0.415;t =0.409,P =0.683).The best cut-off points of blood flow and MTT for predicting chemoradiotherapy responsiveness were 50.89 ml · 100 g-1 · min-1 and 8.99 s,the area under the curve (AUC) was 0.825 and 0.922,and the AUC of combined prediction of chemoradiotherapy responsiveness was 0.982,which was significantly better than that of single prediction (Z =2.868,P =0.004;Z =2.051,P =0.004).The accuracy (91.49％) and specificity (90.14％) of combined prediction of chemoradiotherapy responsiveness were significantly better than those of single prediction (blood flow:accuracy 75.53％,specificity 73.24％;MTT:accuracy 79.79％,specificity 78.87％),and the differences were statistically significant (x2 =8.800,P =0.012;x2 =6.766,P =0.034).Conclusion Blood flow and MTT in perfusion CT have great predictive value for chemoradiotherapy responsiveness in patients with rectal cancer.
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Objective To establish a porcine allogeneic left lung orthotopic transplantation model to closely simu-late human lung transplantation.Methods Twelve Huanjiang mini-pigs were used as donors and 12 Bama mini-pigs as recipients.The left lung orthotopic transplantation was completed by the left fourth intercostal thoracotomy.At 1 h, 2 h, 4 h, 6 h, 12 h after transplantation, the left and right pulmonary artery pressure were measured, the left and right pulmonary vein blood gas was analyzed, and samples of the left and right lung tissues were taken to determine the water content and for pathological examination.Results All animals survived, and the transplanted pulmonary vein blood PaO2/FiO2 and PAP were rised along with the prolonged postoperative time, compared with those of the recipient normal lung showing a signifi-cant difference (P<0.05).With the pass of time, there were increasing edema, inflammatory cell infiltration, RBC ooze, thickening of alveolar wall in the transplanted lung tissue, and some alveolar lumen occlusion and lung tissue consolidation. The water content of the transplanted lung tissue was increased significantly compared with that in the recipient lung tissue ( P<0.05 ) .Conclusions The established method in this study provides an ideal animal model for research on lung transplantation ischemia-reperfusion injury and immune rejection mechanism.
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The most important cause of late mortality after lung transplantation is obliterative bronchiolitis ( OB) . It is clear that a good animal model is indispensable to further unravel and clarify the pathogenesis of bronchiolitis obliterans syndrome ( BOS) .Many animal models have been developed to study BOS, however, so far, none of these models truly mimics the human condition.In recent years mouse models of orthotopic lung transplantation have been established, which provide potential possibilities for further studies of OB/BOS after lung transplantation.The aim of this article was to review the pros and cons of those animal models, and discuss the possible approaches to establish animal models of chronic rejec-tion after lung transplantation.
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Objective To investigate the value of three-dimensional CT volume rendering in predicting ARDS following pulmonary contusion and identifying high-risk patients.Methods Seventy-one cases of pulmonary contusion (AIS ＞ 2 points) confirmed by chest CT during an emergency admission between July 2010 and June 2011 were enrolled.Using computer-generated three-dimensional reconstruction,contusion volume was measured and expressed as a percentage of total lung volume.The admission data,such as blood gas analysis results,systolic arterial pressure,hematocrit,AIS,ISS,and injury distribution,were prospectively collected.Independent predictive factors of ARDS following pulmonary contusion was identified using logistic regression analysis and further estimation on accuracy and value of the predictors were performed.Influence of contusion volume percentage on clinical outcomes was detected.Results Of all,mean contusion volume percentage was (22.07 ± 14.50)％ (range,5.60％-61.00％),which was not strongly correlated to the admission PaO2/FiO2 ratio (R2 =0.059).ARDS and infection were diagnosed in 31 cases and 25 cases respectively.PaO2/FiO2 ratio and contusion volume percentage were independent predictive factors of ARDS after pulmonary contusion.The best cut-off of contusion percentage in predicting ARDS development was 21.5％ with a specificity of 80.0％,sensitivity of 71.0％,positive predictive value of 73.3％,and negative predictive value of 78.1％.Conclusion Three-dimensional CT volume rendering technique allows quantification of pulmonary contusion and identification of patients at high risk of ARDS,to whom further treatment may be directed.
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This study compares early and late outcomes for treatment by video-assisted thoracic surgery [VATS] versus treatment by thoracotomy for clinical N0, but post-operatively unexpected, pathologic N2 disease [cN0-pN2]. Clinical records of patients with unexpected N2 non-small cell lung cancer [NSCLC] who underwent VATS were retrospectively reviewed, and their early and late outcomes were compared to those of patients undergoing conventional thoracotomy during the same period. VATS lobectomy took a longer time than thoracotomy [P < 0.001], but removal of thoracic drainage and patient discharge were earlier for patients in the VATS group [P < 0.001]. There was no difference in lymph node dissection, mortality and morbidity between the two groups [P > 0.05]. The median follow-up time for 287 patients [89.7%] was 37.0 months [range: 7.0-69.0]. The VATS group had a longer survival time than for the thoracotomy group [median 49.0 months vs. 31.7 months, P < 0.001]. The increased survival time of the VATS group was due to patients with a single station of N2 metastasis [P = 0.001], rather than to patients with multiple stations of N2 metastasis [P = 0.225]. It is both feasible and safe to perform VATS lobectomy on patients with unexpected N2 NSCLC. VATS provides better survival rates for those patients with just one station of metastatic mediastinal lymph nodes
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Humans , Female , Male , Lung Neoplasms/surgery , Thoracic Surgery, Video-Assisted , Lung Neoplasms/pathology , Treatment OutcomeABSTRACT
Objective To do research on Multi-points EGFR gene mutation and heterogeneity in lung adenocarcinoma and its influence on the prognosis,to analyze EGFR gene mutation and its heterogeneity influence on patients'overall prognosis.Methods The clinical features of patients with lung adenocarcinoma at stage Ⅲa from January 2006 to January 2007 at our institution were retrospectively reviewed.The primary lung tumors and corresponding metastatic lymph nodes tissue specimens were obtained by surgery.The adenocarcinoma primary nodes and corresponding metastatic lymph nodes EGFR mutation were detected by amplification refractory mutation system (ARMS).Univariate analysis and multivariate analysis by Cox proportional-hazard model were used to analyze the impact of EGFR mutation and its heterogeneity as influential factor on patients 'prognosis.Results 76 patients with the adenocarcinoma primary nodes and corresponding metastatic lymph nodes were detected by epidermal growth factor receptor (EGFR) mutation.40 patients with EGFR mutation were detected (40/76,52.63％).There were 9 specimens out of 40 who had lung primary nodes and corresponding metastatic lymph nodes EGFR gene heterogeneity (9/40,22.5％).Log-Rank univariate analysis showed that there was no significant difference in overall survival period between EGFR mutation patients and wild-type patients(x2 =0.382,P =0.537),but there was significant difference in illnessfree progression period(x2 =4.147,P =0.042).Gene heterogeneity factor does not affect on the overall survival period and illness-free progression period of the patients with EGFR gene mutation (x2 =1.774,P =0.183 ;x2 =1.249,P =0.264).Multivariate analysis by Cox proportional-hazard model showed that EGFR gene mutation is not the independent risk factor that has 赵 impact on the prognosis of patients with lung adenocarcinoma.Conclusion Assessment of EGFR gene mutations in a single-point specimen can not reflect the whole EGFR gene mutation status,which may probably cause difference between targeted drugs'predicted effect and its actual usage effect.