Effect of propofol on HMGB1/TLR4 signaling pathway during hepatic ischemia-reperfusion injury in rats / 中华麻醉学杂志

Objective To evaluate the effect of propofol on high-mobility group box 1 protein (HMGB1)/Toll-like receptor 4 (TLR4) signaling pathway during hepatic ischemia-reperfusion (I/R) injury in rats.Methods Thirty-six clean-grade healthy male Sprague-Dawley rats,aged 3 months,weighing 250 -300 g,were divided into 3 groups (n=12 each) using a random number table method:sham operation group (group S),hepatic I/R group (group I/R) and propofol group (group P).Hepatic I/R injury was induced by occluding the portal vein and hepatic artery supplying the left and middle lobes of the liver for 1 h followed by 6-h reperfusion in anesthetized rats.Propofol was infused via the tail vein at a rate of 12 mg ·kg-1 · h-1 starting from 20 min before ischemia until 6 h of reperfusion in group P.The rats were sacrificed at 6 h of reperfusion,and the left lobe of the liver was removed for microscopic examination of the pathological changes which were scored and for determination of the expression of HMGB1,TLR4,tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-6) in liver tissues (by Western blot).Results Compared with group S,pathological scores of liver tissues were significantly increased,and the expression of HMGB1,TLR4,TNF-α and IL-6 was up-regulated in I/R and P groups (P＜0.05).Compared with group I/R,pathological scores of liver tissues were significantly decreased,and the expression of HMGB1,TLR4,TNF-α and IL-6 was down-regulated in group P (P＜ 0.05).Conclusion The mechanism by which propofol reduces liver I/R injury is associated with blocking HMGB-1/TLR4 signaling pathway and inhibiting inflammatory responses in rats.

Surgical Procedures and Perioperative Management for Non-small Cell Lung Cancer Complicated with Left Atrial Tumor Thrombus / 中国肺癌杂志

BACKGROUND@#Non-small cell lung cancer with left atrial tumor thrombus accounts for a small proportion of local advanced lung cancer. Whether surgery could bring benefits, as well as surgical options are still controversial, and have always been hot spots in surgical research. We report a single center experience of surgical treatment to non-small cell lung cancer with left atrial tumor thrombus, aim to figure out more reasonable treatment strategy.@*METHODS@#From August 2006 to July 2017, a total of 11 cases of non-small cell lung cancer with left atrial tumor thrombus underwent surgery in Thoracic Surgery Department of China-Japan Friendship Hospital. Clinical data, treatment options, pathological types and prognosis of these patients were collected to perform a retrospective study.@*RESULTS@#Of the 11 patients (mean age of 57.9), 7 were men and 4 were women. Six of them received neoadjuvant radiotherapy and/or chemotherapy. All patients underwent smooth operation, including 3 cases with cardiopulmonary bypass, 1 case of posterolateral approach under extracorporeal membrane oxygenation, 6 cases of conventional posterolateral approach and 1 case of video-assisted minithoracotomy. Nine patients were evaluated as R0 resection while 2 cases were evaluated as R1 resection. The Surgeries cost an average of 292 min (210 min-380 min), with an average of 436 mL (100 mL-1,600 mL) blood loss. One patient (9.1%) died within 90 days after surgery, and another 4 cases (36.4%) suffered postoperative complications such as arrhythmia, cerebral infarction or hypoxemia. Six cases of squamous cell carcinoma, 4 cases of adenocarcinoma and 1 case of sarcomatoid carcinoma were identified by pathology. Seven cases were staged as pT4N0M0 while 4 cases were staged as pT4N1M0. Nine patients underwent adjuvant chemotherapy, and two patients underwent radiotherapy during follow-up. The overall follow-up time was 2 to 53 months, the 3-year disease-free survival rate was 30.7%, the median disease-free survival time was 31 months, the 3-year overall survival rate was 49.1% and the median overall survival time was 33 months.@*CONCLUSIONS@#For selected patients of non-small cell lung cancer complicated with left atrial tumor thrombus, choose a reasonable surgical approach to resect both the tumor and the thrombus, strengthen the perioperative management and apply neoadjuvant/adjuvant radiotherapy and/or chemotherapy, might obtain satisfying prognosis.

Impact of Chronic Obstructive Pulmonary Disease on Risk of Recurrence in Patients with Resected Non-small Cell Lung Cancer / 中国肺癌杂志

BACKGROUND@#Lung cancer and chronic obstructive pulmonary disease (COPD) are both common diseases in respiratory system and the leading causes of deaths worldwide. The purpose of this study was to determine whether the severity of COPD affects long-term survival in non-small cell lung cancer (NSCLC) patients after surgical resection.@*METHODS@#A retrospective research was performed on 421 consecutive patients who had undergone lobectomy for NSCLC. Classification of COPD severity was based on guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Characteristics among the three subgroups were compared and recurrence-free survivals were analyzed.@*RESULTS@#A total of 172 patients were diagnosed with COPD, 124 as mild (GOLD-1), 46 as moderate(GOLD-2), and 2 as severe (GOLD-3). The frequencies of recurrence were significantly higher in higher COPD grades group (P<0.001). Recurrence-free survival at five years were 78.1%, 70.4%, and 46.4% in Non-COPD, GOLD-1 COPD, and GOLD-2/3 COPD groups, respectively (P<0.001). In univariate analysis, age, gender, smoking history, COPD severity, tumor size, histology and pathological stage were associated with recurrence-free survival. Multivariate analyses showed that older age, male, GOLD-2/3 COPD, and advanced stage were independent risk factors associated with recurrence-free survival.@*CONCLUSIONS@#NSCLC patients with COPD are at higher risk for postoperative recurrence, and moderate/severe COPD is an independent unfavorable prognostic factor. The severity of COPD based on pulmonary function test can be a useful indicator to identify patients at high risk for recurrence. Therefore, it can contribute to adequate selection of the appropriate individualized treatment.

Effects of sevoflurane postconditioning on autophagy during focal cerebral ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To evaluate the effect of sevoflurane postconditioning on autophagy during focal cerebral ischemia-reperfusion (I/R) in rats.Methods Forty-five clean-grade healthy male SpragueDawley rats,weighing 280-350 g,were divided into 3 groups (n=15 each) using a random number table method:sham operation group (S group),cerebral I/R group (I/R group) and sevoflurane postconditioning group (SP group).Focal cerebral I/R injury model was established by Zea-Longa method in chloral hydrate-anesthetized rats.The animals in SP group inhaled 2.4％ sevoflurane for 30 min starting from onset of reperfusion.The expression of autophagy-related proteins LC3 and beclin-1 was detected by Western blot at 2 h of reperfusion.The cerebral cortex was removed for examination of the morphology and number of autophagosomes with an electron microscope.Neurological deficit was assessed and scored at 24 h of reperfusion.Rats were sacrificed at 72 h of reperfusion for determination of the cerebral infarct size.Results Compared with S group,the neurological deficit score was significantly increased,the percentage of cerebral infarct size was increased,LC3Ⅱ/LC3Ⅰ ratio in cerebral cortex was increased,the expression of beclin-1 was up-regulated,and the number of autophagosomes was increased in I/R and SP groups (P＜0.05).Compared with I/R group,the neurological deficit score was significantly decreased,the percentage of cerebral infarct size was decreased,LC3Ⅱ/LC3Ⅰ ratio in cerebral cortex was decreased,the expression of beclin-1 was down-regulated,and the number of autophagosomes was reduced in SP group (P＜0.05).Conclusion Sevoflurane postconditioning mitigates focal cerebral I/R injury through inhibiting autophagy in rats.

Clinical application of Disposcope endoscope in Univent tube intubation and positioning / 临床麻醉学杂志

Objective To observe the clinical application effects of Disposcope endoscope in Univent tube intubation and positioning.Methods Eighty patients underwent scheduled thoracic sur gery (51 males,29 females,aged 18-77 years,ASA Ⅰ-Ⅲ) under one-lung ventilation (OLV) were randomly grouped into two groups:Disposcope endoscope group (group D) and laryngoscope group (group L),40 patients in each group.Group D used Disposcope endoscope for intubation and positio ning while group L used laryngoscope for intubation and auscultation positioning.Patients with difficult intubation,severe ventilation dysfunction and large sputum volume,such as pulmonary hemoptysis and bronchiectasis,were excluded.Intubation and positioning time,airway pressure and arterial carbon dioxide partial pressure (PaCO2) were recorded during double-lung ventilation and OLV,lung collapse effect,and one-time successful intubation ratio,positionging adjustment ratio and the incidence of intubation complications were calculated.Results Intubation and positioning time were significantly longer in group L than in group D [(169.98±52.65)s vs.(102.38±44.45)s](P＜0.05),one-time successful intubation ratio in group L was lower than that in group D (80％ vs.97.5％) (P ＜0.05).The difference of airway pressure and PaCO2 during double-lung ventilation and OLV between the two groups were not statistically significant.The blocker positioning adjust ratio of Univent tube in group L was significantly higher than that in group D (22.5％ vs.7.5％)(P＜0.05).The incidence of bleeding and sore throat after operation in group L were significantly higher than those in group D (27.5％ vs.7.5％,37.5％ vs.15％) (P＜0.05).Conclusion Compare with laryngoscope for intubation and auscultation positioning,Disposcope endoscope used for Univent tube intubation and positioning needs shorter time for intubation and positioning,higher successful one-time intubation ratio,less positioning adjustment.It also reduces the incidence of intubation complications.

The regularity and clinical significance of intrapulmonary lobar and segmental lymph nodes metastasis in patients with cT1N0M0 stage lung adenocarcinoma / 中华胸心血管外科杂志

Objective To investigate the regularity of intrapulnonary lobar and segmental lymph nodes metastasis in patients with cT1N0M0 stage lung adenocarcinoma.To provide a basis for more accurate determination of N stage and indication for pulmonary segmental resection.Methods A prospective study was performed from March 2014 to December 2015.103 cases of cT1 N0M0 stage lung adenocarcinoma received lobectomy and mediastinal lymph node dissection in the thoracic surgery department of China-Japan Friendship Hospital.Intrapulmonary lobar and segmental lymph nodes were dissected and sorted carefully then sent to the pathological department with the corresponding lung specimen and other lymph nodes.Statistical analysis was carried out considering size of the lesion,imaging features,serum CEA levels,pathological subtypes and so on.Results In total 103 cases,pN0 was confirmed in 82 cases,pN1 in 15 cases,pN1 + N2 in 5 cases,and skipping-pN2 in 1 case.14 cases(93.3％) in pN1 group were detected with station 12-14 lymph node metastasis,while only 5 cases (33.3％) were detected with station 12-14 LSNs metastasis.4 cases(66.7％) in pN2 group were detected with station 12-14 lymph node metastasis,while only 1 case(16.7％) with station 13 and station 7 lymph node metastasis.If LSNs were not detected,the false negative rate of N staging could be as high as 6.1％ (5/82),The rate of missed diagnosis of lymph node metastasis might be 30％ (6/20) to N1 stations alone.41.2％ (7/17)cases with metastasis to the adjacent LSNs had been proved with metastasis to the isolated LSNs.The metastasis rate of the isolated LSNs was significantly lower(P =0.049) in pure GGNs compared with those part-solid/solid nodules.Invasive adenocarcinoma had higher metastasis rate of isolated LSNs,compared with preinvasive lesions or minimally invasive adenocarcinomas,with no statistical difference between groups (P =0.055).No significant difference in isolated LSNs metastasis rate was found between groups with different serum CEA levels(P =0.251) or tumor size(P =0.197).Conclusion Dissection of intrapulmonary lobar and segmental lymph nodes might facilitate a more accurate N stage,reduce the false negative rate of lymph node metastasis,and provide basis for more accurate assessment of prognosis and postoperative adjuvant treatment.The sampling area of lymph nodes during segmental resection should include the adjacent LSNs of the target segment.The isolated LSNs metastasis rate of cT1N0M0 stage lung adenocarcinoma with pureGGN as imaging feature is relative low,which might be suitable for segmentectomy when meeting other criteria.

Efficacy of Disposcope endoscope-guided nasotracheal intubation in patients with difficult airway: a comparison with fiberoptic bronchoscope / 中华麻醉学杂志

Objective To evaluate the efficacy of Disposcope endoscope(DE)-guided nasotrache-al intubation in patients with difficult airway by comparing with fiberoptic bronchoscope(FOB). Methods One hundred and twenty American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both se-xes, with body mass index<25 kg∕m2, aged 18-64 yr, with mouth opening<3 cm, of Mallampati classifi-cation Ⅲ or Ⅳ, undergoing maxillofacial surgery requiring nasotracheal intubation were divided into DE group(n=60)and FOB group(n=60)using a random number table.Nasotracheal intubation was per-formed under the guidance of DE or FOB after induction of anesthesia.Glottis exposure was evaluated using Cormack-Lehane grade.Epistaxis during intubation, successful intubation, time and degree of glottis expo-sure, intubation time and development of tachycardia and hypertension and requirement for assisted ventila-tion with face mask during intubation were recorded.The patients were followed up postoperatively, and the development of intubation-related complications was also recorded.Results Compared with group FOB, glottis exposure time and incubation time were significantly shortened(P<0.05), and no significant change was found in Cormack-Lehane grade, rate of successful incubation, rate of successful intubation at first attempt or intubation-related complications in group DE(P>0.05). Hypertension and tachycardia were not found and no patients required assisted ventilation with face mask during intubation in the two groups.Conclusion DE-guided nasotracheal intubation provides similar efficacy to that of FOB with shorter time and is an optimal selection for the patients with difficult airway.

Continuous cardiac output measurement with transesophageal Doppler echocardiography versus Flotrac/Vigileo / 中国基层医药

Objective To compare cardiac output continuously measured by transesophageal echocardiograph (TEE)with Flotrac /Vigileo system.Methods Thirty -six patients,aged 30 -60years,of American Society of Anesthesiologists physical status ⅠorⅡscheduled for laparoscopic hysterectomy (LH )were included in this study.The radial artery puncture on the left connecting the Flotrac /Vigileo system monitoring was established before anesthesia and ultrasonic probe was inserted into the esophagus after anesthesia induction.The depth of the probe was located at the middle esophagus with monitoring of transesophageal echocardiography(tee).At the same time the value of CO after anesthesia,before and after pneumoperitoneum were recorded and the application of SPSS 13.0 software package for statistical analysis was made.Monadic linear correlation and regression analysis were both used in measured CO. Results Each point,the determination of transesophageal echocardiography(tee)between the CO and the determination of the Flotrac /Vigileo CO,had high correlation(r =0.850,P =0.002).The CO at the time of T2 monitored by TEE group and Flotrac /Vigileo group were (3.3 ±0.2)L/min,(3.2 ±0.2)L/min,which were significantly lower than (5.6 ±0.3)L/min,(5.4 ±0.3)L/min(t =2.248,2.178,P =0.032,0.029).But there were no statistically significant differences at other time respectively(tT =0.102,0.199,0.201,0.124,0.198,PT =0.918,0.887,0.894, 0.908,0.898;tF =0.098,0.189,0.214,0.119,0.112,PF =0.953,0.874,0.898,0.913,0.932).Conclusion The correlation of CO monitored by transesophageal echocardiography(tee)and Flotrac /Vigileo was good,which can be safely and efficiently used in intraoperative monitoring of patients.

Mechanism and treatment progress of mechanical ventilator -induced lung injury / 中国基层医药

Mechanical ventilation as an important treatment is widely used in clinical practice,the high inci-dence of ventilation lung injury in the course of operating it has been increasingly concerned.The basic mechanism, mechaical stress and high tidal volume machine stimulate lung cells,makes the inflammation in the cells changes,that is,it is from mechanical lung damage to biological injury.With the international and domestic in -depth researches on VILI,the application of control measures,like some medication treatment,ECMO,liquid ventilation have reduced the incidence of VILI to a certain extent,the occurrence mechanism and progress of treatment of VILI are reviewed briefly.

The prognostic impact of preoperative PET-CT on postoperative recurrence for completely resected stage I non-small cell lung cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the prognostic impact of preoperative (18)F-fluorodeoxyglucose (FDG) PET-CT on postoperative recurrence in patients with completely resected stage I non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>The clinic data of 182 patients with stage I NSCLC who underwent (18)F-FDG PET-CT scan before surgical resection between June 2005 and June 2012 were reviewed retrospectively. There were 121 male and 61 female patients, with an average age of 68 years (range from 34 to 85 years). The pathological stage was I A in 98 patients, I B in 84 patients; the histology were adenocarcinoma in 137 patients, squamous cell carcinoma in 35 patients, and others in 10 patients. Clinicopathological factors including gender, age, smoking history, SUV(max), surgical procedure, pathological features and adjuvant chemotherapy were evaluated to identify the independent factors predicting postoperative recurrences by univariate and multivariate analysis. The survivals were calculated by the Kaplan-Meier method and differences in variables were analyzed by the Log-rank test.</p><p><b>RESULTS</b>The postoperative recurrence rate was 15.9%. The univariate analysis identified that the SUV(max) (t=3.278, P<0.001), p-stage (χ² =5.204, P=0.026), blood vessel invasion (χ² =5.333, P=0.027) and visceral pleural invasion (χ² =7.697, P=0.009) are factors for predicting postoperative recurrence. Only SUV(max) was found to be a significant independent factor according to multivariate analysis (HR=1.068, 95%CI: 1.015 to 1.123, P=0.001). The study population was stratified into three groups by SUV(max), patients with SUV(max) > 5.0 had significantly higher risk of recurrence (23.9%) than those with 2.5 < SUV(max) ≤ 5.0 (15.0%) and SUV(max) ≤ 2.5 (7.3%) (P=0.043); patients with SUV(max) ≤ 2.5 had significantly better 5-year recurrence-free survival rate (90.9%) than those with 2.5 < SUV(max) ≤ 5.0 (82.7%) and SUV(max) ≤ 2.5 (71.0%) (P=0.030). There was a trend toward higher probability of blood vessel invasion (χ² =20.267, P < 0.001), visceral pleural invasion (χ² =6.185, P=0.045) and pathological stage I B (χ² =13.589, P=0.001) with increased SUV(max).</p><p><b>CONCLUSIONS</b>Preoperative SUV(max) of primary tumor is a predictor of postoperative relapse for stage I NSCLC after surgical resection. Therefore, it can contribute to the risk stratification for patients with the same pathological stage and selecting the optimal postoperative follow-up and therapeutic strategy.</p>

Epithelial-myoepithelial carcinoma arising in the nasal cavity: a case report and literature review / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To seek pathological features, diagnosis, treatment, prognosis of Epithelial-myoepithelial carcinoma arising in the nasal cavity.@*METHOD@#One case of Epithelial-myoepithelial carcinoma arising in the nasal cavity was analyzed retrospectively and studied with immunohistochemical Staining and light microscopy, as well as review of the literature.@*RESULT@#The clinical feature of epithelial-myoepithelial carcinoma in the nasal cavity was atypical and diagnosis relied on pathologic features. Epithelial-myoepithelial carcinoma consisted of myoepithelial and epithelial cells. Immunohistochemical staining demonstrated that cytokeratin P, cytokeratin L, S-100 protein, a-smooth muscle actin expressed positively.@*CONCLUSION@#Epithelial-myoepithelial carcinoma in the nasal cavity is a rare neoplasm. Wide surgical excision with a clear margin is the main therapy,and these tumors have the potential for metastasis and recurrence.

Micromorphological observation of bacterial biofilms on ciliated epithelia of chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the micromorphological characteristic of bacterial biofilm on mucosa of chronic rhinosinusitis (CRS).@*METHOD@#Mucosa samples of middle turbinate were obtained from 4 patients of CRS during ESS. The size of each sample was about 4 mm x 4 mm. The samples were fixed in 4% paraformaldehyde for 24 hours, then fixed in 1% osmium tetroxide for 2 hours, graded dehydration with ethanol, dried with carbon dioxide and sputter coated with gold. The ultrastructure of these samples was observed by scanning electron microscope.@*RESULT@#Bacterial biofilms were found on samples in all 4 patients. The biofilms were mainly formed on the surface of cilia. The bacterial flagella and cilia were intertwined. The biofilms could be found in a lot kinds of bacterial infections or mixed infections which were caused by multiple bacteria and fungi.@*CONCLUSION@#Bacterial biofilm could be formed on ciliated epithelia.

Effect of propofol pretreatment on hippocampal monocyte chemotactic protein-1 and CC-chemokine receptor type 2 expression following forebrain ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To investigate the effect of propofol pretreatment on hippocampal monocyte chemotactic protein-1 ( MCP-1 ) and CC-chemokine receptor type 2 (CCR2) expression following forebrain ischemiarepcrfusion (I/R) in rats. Methods Twenty-four male SD rats weighing 250-300 g were randomly divided into 3 groups ( n = 8 each): group Ⅰ control; group Ⅱ I/R and group Ⅲ propofol pretreatment. Cerebral I/R was induced by clamping bilateral common carotid arteries for 10 min combined with hypotension ( MAP was maintained at 35-45 mm Hg) induced by exsanguinations in group Ⅱ and Ⅲ. In group Ⅲ propofol 50 mg/kg was injected into femoral vein immediately before cerebral ischemia. The animals were sacrificed at 6 h of reperfusion. Hippocampal tissue was obtained for detection of MCP-1 mRNA and CCR2 mRNA and their protein expression by RT-PCR and Western blot technique. Results I/R significantly increased the expression of MCP-1 and CCR2 in hippoeampal tissue as compared with control group. Propofol pretreatment significantly attenuated cerebral I/R induced increase in MCP-1 and CCR2 expression. Conclusion Propofol pretreatment can significantly inhibit forebrain I/R-induced hippocampal MCP-1 and CCP2 expression.

Effects of edaravone on lung injury induced by myocardial ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To investigate the effects of edaranvone on lung injury induced by myocardial ischemia-reperfusion (I/R) in rats. Methods Twenty-four male Wistar rats weighing 250-300 g were randomly assigned to one of 4 groups ( n = 6 each): group Ⅰ sham operation (group S); group Ⅱ myocardial I/R and group Ⅲ and Ⅳ different doses of edaravone ( group E1, E2 ). The animals were anesthetized, intubated and mechanically ventilated. In group Ⅱ-Ⅳ myocardial I/R was induced by occlusion of left anterior descending coronary artery for 45 min followed by 3 h reperfusion. In group Ⅲ and Ⅳ edavarone 3 and 10 mg/kg was administered via right femoral vein at 1 min before reperfusion respectively. The animals were sacrificed by exsanguination at the end of 3 h reperfusion. Blood was collected for determination of serum CK-MB activity and total protein content. The left lung was lavaged and the broncho-alveolar lavage fluid (BALF) was colleted for determination of protein content. Pulmonary permeability index (PPI) was calculated. The lung tissue was obtained for determination of BD-2 mRNA and protein and TNF-α expression. Results The serum CK-MB activity, PPI,BD-2 mRNA and protein and TNF-α expression were significantly higher in group I/R, E1 and E2 than in group S,but significantly lower in group E1 and E2 than in group I/R and in group E2 than in group E1. Conclusion Edaravone can reduce myocardial I/R-induced lung injury by scavenging oxygen free radicals and inhibiting inflammatory response of lung tissues in rats.

Surgical therapeutic strategy for non-small cell lung cancer with mediastinal lymph node metastasis (N2) / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>Approximately 30% of patients who are diagnosed with non-small cell lung cancer (NSCLC) are classified as N2 on the basis of metastasis to the mediastinal lymph nodes. The effectiveness of surgery for these patients remains controversial. Although surgeries in recent years are proved to be effective to some extent, yet due to many reasons, 5-year survival rate after surgery varies greatly from patient to patient. Thus it is necessary to select patients who have a high probability of being be cured through an operation, who are suitable to receive surgery and the best surgical methods so as to figure out the conditions under which surgical treatment can be chosen and the factors that may influence prognosis.</p><p><b>METHODS</b>165 out of 173 patients with N2 NSCLC were treated with surgery in our department from January 1999 to May 2003, among whom 130 were male, 43 female and the sex ratio was 3:1, average age 53, ranging from 29 to 79. The database covers the patients' complete medical history including the information of their age, sex, location and size of tumor, date of operation, surgical methods, histologic diagnosis, clinical stage, post-operative TNM stage, neoadjuvant treatment and chemoradiotherapy. The methods of clinical stage verification include chest X-ray, chest CT, PET, mediastinoscopy, bronchoscope (+?), brain CT or MRI, abdominal B ultrasound (or CT), and bone ECT. The pathological classification was based on the international standard for lung cancer (UICC 1997). Survival time was analyzed from the operation date to May 2008 with the aid of SPSS (Statistical Package for the Social Sciences) program. Kaplan-Meier survival analysis, Log-rank test and Cox multiplicity were adopted respectively to obtain patients' survival curve, survival rate and the impact possible factors may have on their survival rate.</p><p><b>RESULTS</b>The median survival time was 22 months, with 3-year survival rate reaching 28.1% and 5-year survival rate reaching 19.0%. Age, sex, different histological classification and postoperative chemoradiotherapy seem to have no correlation with 5-year survival rate. In all N2 subtypes, 5-year survival rate is remarkably higher for unexpected N2 discovered at thoractomy and proven N2 stage before preoperative work-up and receive a mediastinal down-staging after induction therapy (P < 0.01), reaching 30.4% and 27.3% respectively. 5-year survival rate for single station lymph node metastasis were 27.8%, much higher compared with 9.3% for multiple stations (P < 0.001). Induction therapy which downstages proven N2 in 73.3% patients gains them the opportunity of surgery. The 5-year survival rate were 23.6% and 13.0% for patients who had complete resection and those who had incomplete resection (P < 0.001). Patients who underwent lobectomy (23.2%) have higher survival rate, less incidence rate of complication and mortality rate, compared with pneumonectomy (14.8%) (P < 0.01). T4 patients has a 5-year survival rate as low as 11.1%, much less than T1 (31.5%) and T2 (24.3%) patients (P = 0.01). It is noted through Cox analysis that completeness of resection, number of positive lymph node stations and primary T status have significant correlativity with 5-year survival rate.</p><p><b>CONCLUSION</b>It is suggested that surgery (lobectomy preferentially) is the best solution for T1 and T2 with primary tumor have not invaded pleura or the distance to carina of trachea no less than 2 cm, unexpected N2 discovered at thoractomy when a complete resection can be applied, and proven N2 discovered during preoperative work-up and is down-staged after induction therapy. Surgical treatment is the best option, lobectomy should be prioritized in operational methods since ise rate of complication and morality are lower than that of pneumonectomy. Patients' survival time will not benefit from surgery if they are with lymph nodes metastasis of multiple stations (Bulky N2 included) and T4 which can be partially removed. Neoadjuvant chemotherapy increases long-term survival rate of those with N2 proven prior to surgery. However, postoperative radiotherapy decreases local recurrence rate but does not contribute to patients' long-term survival rate.</p>

Tracheal carinal reconstruction and bronchovasculoplasty in central type bronchogenic carcinoma / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>Because radical resection for lung cancer invading the initial borderline of different lobes and carina is difficult, we tried to analyse the variables of successful tracheal carinoplasty and bronchovasculoplasty to discover a proper approach for appropriate early and long-term results.</p><p><b>METHODS</b>Of 1 399 lung resections for primary lung cancer performed in our hospital from April 1985 to December 2006, 133 underwent bronchoplastic surgeries, including 15 carinoplasty cases and 118 sleeve lobectomy (SL) cases, and 118 pneumoectomy (PN) cases were compared at the same time.</p><p><b>RESULTS</b>Complications occurred in 18 cases, with no operative related mortality. For all patients, the 1 year, 3 year, and 5 year survival rates were 79.8%, 56.7% and 31.2%, respectively. The 5 year survival rate by cancer stage was 69.2% for Ib, 40.6% for IIb, 19.6% for IIIa, and 16.6% for IIIa (N2).</p><p><b>CONCLUSION</b>Selection of cases, clearance of lymph nodes, disposal of the bronchus and pulmonary vessel and replacement or restoration of the superior vena cava are the main factors influencing prognosis.</p>

Sequential bilateral lobar transplantation A case report / 中国组织工程研究

BACKGROUND: Lung transplantation can improve quality of life of patients who get terminal pulmonary disease and also it can help to get better survival.Now it has become one of the best therapeutic methods for terminal pulmonary disease.However,limited donors leave the development of lung transplantation in dilemma.The emergence of living lobar transplantation and cadeveric lobar transplantation let this procedure much easier.OBJECTIVE: To evaluate the clinical probability of bilateral lobar transplantation.METHODS: Sequential bilateral lobar transplantation was performed for one 26 years old cystic fibrosis female.Cardiac pulmonary bypass was used during operation.Anti-rejection(Tacrolimus,mycophenolate,etc)and anti-infection was used postoperatively.RESULTS AND CONCLUSION: The recovery course postoperatively was smooth,and the recipient got out of hospital 7weeks later.Bilateral lobar transplantation could offer satisfied short-term pulmonary function.The long term results should be further evaluated.

Expression of thymic stromal lymphopoietin in nasal mucosa of a mouse model with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of thymic stromal lymphopoietin (TSLP) in the nasal mucosa of mouse with allergic rhinitis.@*METHOD@#Twenty wide type BALB/c mouse were divided into 2 groups randomly. Two groups were included, allergic rhinitis group (group A) and control group (group B). The mouse model of allergic rhinitis was established by ovalbumin (OVA) sensitization and challenge. The expressions of TSLP in the nasal mucosa was determined by realtime quantitative PCR and immunohistochemical method.@*RESULT@#The expression of TSLP in the nasal mucosa of group A was significantly higher than that in group B (P<0.01).@*CONCLUSION@#TSLP plays a role in the mouse model of allergic rhinitis.

The expression of mucins gene in the human nasal polyps and allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To detect the mucin gene (MUC2, MUC5AC, MUC5B, MUC18 and MUC19) expression in the nasal polyps, allergic rhinitis (AR) and the normal nasal mucosa in human. To investigate the role and clinical significance of mucin gene in the pathogenesis of nasal polyps and AR patients.@*METHOD@#We obtained samples from 35 cases of nasal polyps, 18 cases of AR inferior turbinate and 18 cases of simple nasal septum deviation inferior turbinate. Specimens were analyzed with RT-PCR and Real-time FQ-RT-PCR.@*RESULT@#The results of RT-PCR and FQ-RT-PCR showed that the expression of MUC5AC, MUC5B in nasal polyps and AR patients was significantly higher than that in normal mucosa (P0.05). The expression of MUC2, MUC18 in nasal polyps and AR was not significantly different from that in normal mucosa (P>0.05). And the results of RT-PCR for MUC19 expression in AR was higher than that in nasal polyps group and normal group (P<0.05 or P<0.01).@*CONCLUSION@#MUC5AC and MUC5B are highly expressed in epithelium of human nasal polyps and AR, and they take part in mucus over-secretion in nasal polyps and AR. The expression of MUC19 in AR was higher than that in nasal polyps group and normal group. It indicates that the secretion of MUC19 in allergic rhinitis was on high level. There was no difference of the expression of MUC2 and MUC18 in nasal polyps group, AR group and in normal group.

The expression of mucins gene in the human nasal polyps and allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

Objective:To detect the mucin gene (MUC2,MUC5AC,MUC5B,MUC18 and MUC19)expression in the nasal polyps, allergic rhinitis (AR)and the normal nasal mucosa in human. To investigate the role and clinical significance of mucin gene in the pathogenesis of nasal polyps and AR patients .Method:We obtained samples from 35 cases of nasal polyps,18 cases of AR inferior turbinate and 18 cases of simple nasal septum deviation inferior turbinate. Specimens were analyzed with RT-PCR and Real-time FQ-RT-PCR.Result:The results of RT-PCR and FQ-RT-PCR showed that the expression of MUC5AC,MUC5B in nasal polyps and AR patients was significantly higher than that in normal mucosa(P0.05). The expression of MUC2, MUC18 in nasal polyps and AR was not significantly different from that in normal mucosa(P>0.05). And the results of RT-PCR for MUC19 expression in AR was higher than that in nasal polyps group and normal group(P<0.05 or P<0.01).Conclusion:MUC5AC and MUC5B are highly expressed in epithelium of human nasal polyps and AR, and they take part in mucus over-secretion in nasal polyps and AR.The expression of MUC19 in AR was higher than that in nasal polyps group and normal group. It indicates that the secretion of MUC19 in allergic rhinitis was on high level. There was no difference of the expression of MUC2 and MUC18 in nasal polyps group, AR group and in normal group.