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BACKGROUND@#Postoperative complications are an important cause of death after lung resection. At present, the adoption of video assisted thoracoscopic surgery (VATS) for lung cancer in China is increasing every year, but the prediction model of postoperative complications of VATS for lung cancer is still lack of evidence based on large sample database. In this study, Thoracic Mortality and Morbidity (TM&M) classification system was used to comprehensively describe the postoperative complications of VATS major lung resection in our center, and the prediction model of complications was established and verified. The model can provide basis for the prevention and intervention of postoperative complications in such patients, and accelerate the recovery of patients.@*METHODS@#The clinical data of patients underwent VATS major lung resection in our center from January 2007 to December 2018 were collected retrospectively. Only patients with stage I-III lung cancer were included. The postoperative complications were registered strictly by TM&M classification system. The patients were divided into two groups according to the operation period: the early phase group (From 2007 to 2012) and the late phase group (From 2013 to 2018). The baseline data of the two groups were matched by propensity score matching. After matching, binary logistic regression analysis was used to establish the prediction model of complications, and bootstrap internal sampling was used for internal verification.@*RESULTS@#A total of 2,881 patients with lung cancer were included in the study, with an average age of (61.0±10.1) years, including 180 major complications (6.2%). Binary Logistic regression analysis of 1,268 matched patients showed: age (OR=1.04, 95%CI: 1.02-1.06, P<0.001), other period (OR=0.62, 95%CI: 0.49-0.79, P<0.001), pathological type (OR=1.73, 95%CI: 1.24-2.41, P=0.001), blood loss (OR=1.001, 95%CI: 1.000-1.003, P=0.03), dissected lymph nodes (OR=1.022, 95%CI: 1.00-1.04, P=0.005) were independent risk factors for postoperative complications. The ROC curve indicates that the model has good discrimination (C-index=0.699), and the C-index is 0.680 verified by bootstrap internal sampling for 1,000 times. The calibration curve shows a good calibration of the prediction model.@*CONCLUSIONS@#TM&M system can comprehensively and accurately report the postoperative complications of thoracoscopic lung cancer surgery. Age, operative period, pathological type, intraoperative bleeding and dissected lymph nodes were independent risk factors for postoperative complications of VATS major lung resection for lung cancer. The established complication prediction model has good discrimination and calibration.
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Aged , Humans , Middle Aged , Lung , Lung Neoplasms/surgery , Morbidity , Nomograms , Pneumonectomy , Postoperative Complications/etiology , Retrospective Studies , Thoracic Surgery, Video-AssistedABSTRACT
OBJECTIVE:To systematically review the efficacy of Ginseng polysaccharideinjection combined with radiotherapy or chemotherapy in the treatment of malignancies,and provide evidence-based reference for clinical treatment. METHODS:Re-trieved from CNKI,CBM,VIP,Wanfang Database PubMed,EMBase,Web of Science,randomized controlled trials (RCT) about Ginseng polysaccharideinjection combined with radiotherapy or chemotherapy(test group)versus radiotherapy or chemothera-py alone(control group) in the treatment of malignancies were collected. Meta-analysis was performed by using RevMan5.3 soft-ware after data extract and quality evaluation by Cochrane 5.1.0. RESULTS:Totally 7 RCTs were enrolled,involving 567 patients. Results of Meta-analysis showed,the effective rate [OR=1.99,95%CI(1.27,3.14),P=0.003] and improvement rate of life quality [OR=2.95,95%CI(1.75,4.97),P<0.001] in test group were significantly higher than control group,cell abnormal rate [OR=0.26,95%CI(0.16,0.41),P<0.001] was lower than control group,the differences were statistically significant. There were no obvi-ous adverse reaction in 2 groups. CONCLUSIONS:Ginseng polysaccharideinjection combined with radiotherapy or chemotherapy is effective in the treatment of malignancies.
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Objective To explore the protection and mechanism of hydrogen sulfide (H2S) preconditioning against injury induced by cisplatin in human marrow mesenchymal stem cells (HMMSCs).Methods HMMSCs were treated by cisplatin at 0,5,10,20,40,60,80 mg/L concentrations for 24 h respectively and were exposed to cisplatin at 20 mg/L concentrations for 0,6,12,24,36,48 h respectively.HMMSCs were pretreated with NaHS at 0,0.4,0.6,0.8,1.0 mmol/L respectively for 30 min before exposed to cisplatin at 20 mg/L concentrations for 24 h.HMMSCs were treated by U0126 or combined with human epidermal growth factor (HEGF) together for 30 min before they were preconditioned with NaHS for 30 min.The cell survival rate,cell apoptosis rate,the expression of p-ERK1/2 and t-ERK1/2 were recorded.Results The cell survival rate decreased to 71.72％±2.72％,59.41％±5.44％,50.37％±4.55％,38.97％±2.92％,30.11％±4.64％ and 21.71％±5.35％ respectively after cells were treated with cisplatin at 5,10,20,40,60,80 mg/L concentrations respectively,and the differences were statistically significant compared with 0 mg/L group.The cell viability fell to 70.30％±6.20％,61.63％±2.70％,51.29％±3.13％,38.72％±3.66％ and 27.57％±2.32％ after HMMSCs were treated with cisplatin at 20 mg/L for 6,12,24,36,48 h respectively,and the differences were statistically significant compared with 0 h group.The cell viability increased to 65.99％±2.67％,72.93％±5.44％,75.10％±4.71％ and 76.56％± 5.25％ when HMMSCs got pretreatment of NaHS,and the differences had statistical significance compared with cisplatin group.The cell apoptotic rate decreased from 35.29％±2.77％ to 18.62％±0.97％ when HMMSCs were pretreated with NaHS at 0.6 mmo/L.Treatment of HMMSCs with cisplatin at 20 mg/L for 24 h reduced p-ERK1/2 expression.The pretreatment of NaHS could inhibit the inhibitory action to the expression of p-ERK1/2 induced by cisplatin.Pretreatment with U0126 or HEGF inhibited or promoted the protection and the upregulated expression ofp-ERK1/2 caused by NaHS pretreatment.Conclusion The preconditioning of H2S can protect cell damage caused by cisplatin via activating the ERK1/2 pathway of HMMSCs.