Risk factors for nausea and vomiting after total hip arthroplasty in elderly patients / 中华麻醉学杂志

This study was a single-center large-sample case-control study.Data of 1 106 elderly patients who underwent unilateral total hip arthroplasty from June 2013 to May 2019 were collected, including items such as patient′s baseline characteristics, comorbidities, perioperative medication, intraoperative blood pressure, and postoperative outcomes.Patients were divided into postoperative nausea and vomiting(PONV)group and non-PONV group according to whether nausea and vomiting occurred within 24 h after operation.Logistic regression analysis was used to determine the risk factors for PONV.The incidence of PONV was 11.03%.Female, intraoperative use of dezocine, and intraoperative hypotension(duration>3 min or cumulative time>6 min)are independent risk factors for PONV, while femoral neck fractures and intraoperative use of dexamethasone are protective factors.

Mechanisms of Akt3 gene knockout on neuropathic pain in mice with sciatic nerve ligation / 中华行为医学与脑科学杂志

Objective:To explore the mechanism of Akt3 gene knockout on neuropathic pain induced by sciatic nerve ligation.Methods:Twelve Akt3 knockout mice with SPF grade C57BL/6 mice as background were randomly divided into Akt3 gene knockout + Sham group (Akt3 -/-+ Sham, n=6)and Akt3 gene knockout + CCI group(Akt3 -/-+ CCI, n=6). Twelve wild type C57BL/6 mice were randomly divided into wild + Sham group (WT + Sham, n=6) and wild + CCI group (WT + CCI, n=6) by random number table. Chronic sciatic nerve ligation was used to make neuropathic pain model in CCI group, and sham group was subjected to sham operation. The paw withdrawal mechanical threshold (PWMT) was measured 1 day before operation and 7 days after CCI. Three mice were randomly killed in Sham group 7 days after modeling, and 3 mice in CCI group were killed at 7 days and 14 days respectively.The L3-5 spinal cord segment was taken. Akt3, phosphorylated Akt (p-Akt), GSK3β and phosphorylated NR2B (p-NR2B) were detected by Western blot. SPSS 21.0 software was used for statistical analysis. Results:Group time interaction effects of PWMT, the expression of protein Akt3, p-Akt, GSK3β, p-NR2B in spinal cord were significantly different ( F=16.667, 269.899, 26.651, 572.998, 37.836, P<0.01). Compared with the Akt3 -/-+ Sham group, the PWMT in Akt3 -/-+ CCI group was significantly lower((0.34±0.20)g, (1.18±0.11)g, P<0.01), and the expression of p-Akt((0.90±0.08), (0.51±0.06), P<0.01), GSK3β((0.74±0.04), (0.29±0.02), P<0.01) and p-NR2B((0.96±0.11), (0.71±0.04), P<0.05) in spinal cord increased. Compared with the WT+ CCI group, the PWMT of the Akt3 -/-+ CCI group was obviously lower((0.34±0.20)g , (0.49±0.12)g, P<0.05), and the expression of p-Akt((0.90±0.08), (1.02±0.17), P<0.05)decreased, and the expression of GSK3β((0.74±0.04), (0.57±0.09), P<0.01) and p-NR2B((0.96±0.11), (0.91±0.08), P<0.05) increased. Conclusion:After Akt3 gene knockout, the aggravation of neuropathic pain after sciatic nerve ligation may be related with the change of Akt/GSK3β/NR2B expression.

Expression of IGF-1 in serum and phosphorylated IGF-1 receptor in spinal cord in mouse model of bone cancer pain / 中华行为医学与脑科学杂志

Objective To investigate the expression of insulin-like growth factors-1(IGF-1)in ser-um and phosphorylated IGF-1 receptor in spinal cord in mouse model of bone cancer pain. Methods Sixty male C3H/HeJ mice weighed 18-22 g were randomly divided into Sham group(n=30)and Tumor group(n=30). The mice in Tumor group were inoculated with NCTC fibrosarcoma cells in the right femur bone marrow cavity. Paw withdrawl mechanical threshold(PWMT)and the number of spontaneous flinches(NSF)were measured on 1d before inoculation and on 4 d,7 d,10 d,14 d,21 d after inoculation(n=8). At each time point,the mice of each group were taken blood by removal eyeball and the samples of blood were obtained to detect the expression of IGF-1 by enzyme-linked immunosorbent assay(n=4). The mice after taken blood on 14 d after inoculation were perfused and the samples of spinal cord lumber(L3~5)segment were obtained to detect the expression of phosphorylated IGF-1 receptor by immunofluorescence assay(n=6). Results Com-pared with Sham group,PWMT was significantly decreased(P<0.05)and NSF was significantly increased(P<0.05)on 7~21 d after inoculation. Compared with baseline value and Sham group(baseline value(27.33± 0.52)pg/ml,Sham group(29.11±1.86)pg/ml,(24.51±3.61)pg/ml,(23.33±4.59)pg/ml,(25.29±2.99) pg/ml),the expression of IGF-1 in serum was significantly increased on 7~21 d after inoculation in Tumor group((39.76±3.92)pg/ml,(36.93±2.18)pg/ml,(38.85±2.40)pg/ml,(39.70±2.62)pg/ml). The mean fluorescence intensity of phosphorylated IGF-1 receptor was significantly higher on 14d after inoculation in Tumor group(2.40±0.11)compared with Sham group(0.05±0.01). Conclusion Expression of IGF-1 in serum and phosphorylated IGF-1 receptor in spinal cord were significantly increased in mice with bone cancer pain,and this change may be involved in the development and maintenance of bone cancer pain.

The influence of ketamine on KCC2 in spinal cord of rat in remifentanil-induced hyperalgesia / 中华行为医学与脑科学杂志

Objective To explore the effect of pre-treatment of subcutaneous injection of ketamine on remifentanil induced hyperalgesia and K+/Cl-cotransporter 2,KCC2) expression on spinal cord of rats.Methods60 male adult SD rats were randomly divided into five groups(n=12 in each group):control group (group C),the incision group(group I),the incision plus remifentanil group(group I+R),the incision plus ketamine group(group I+K) and the incision plus remifentanil and ketamine group(group I+R+K).Mechanical withdrawal threshold (MWT) was evaluated at 24 hours before incision(T0),2 hours,6 hours,24 hours and 48 hours after incision(T1~T4).The lumbar spinal cords of rats were taken out at T4 time point and the KCC2 detected was detected by immunofluorescence analysis and western blot analysis.ResultsCompared with group C(T1(14.5±1.7)g,T2(14.2±1.1)g,T3(13.9±1.8)g,T4(14.2±1.1)g),MWT of other groups at T1 (I(5.6±0.8)g,I+R(3.2±1.0)g,I+K(6.8±1.7)g,I+R+K(5.1±1.6)g),T2 (I(6.9±1.0)g,I+R(4.3±1.2)g,I+K(8.0±1.4)g,I+R+K(6.2±1.5)g),T3 (I(7.6±0.9)g,I+R(5.4±1.1)g,I+K(10.3±1.2)g,I+R+K(7.1±1.1)g),T4 (I(8.9±1.1)g,I+R(7.5±1.4)g,I+K(11.3±1.2)g,I+R+K(8.3±1.2)g)and the expression of KCC2 at T4 decreased (P<0.05).Compared with group I(T1(5.6±0.8)g,T2(6.9±1.0)g,T3(7.6±0.9)g,T4(8.9±1.1)g),MWT of group I+R (T1(3.2±1.0)g,T2(4.3±1.2)g,T3(5.4±1.1)g,T4(7.5±1.4)g) decreased at all time points after incision (T1~T4)(P<0.05) and the expression of KCC2 at T4 decreased significantly (P<0.05).Compared with group I(T1(5.6±0.8)g,T2(6.9±1.0)g,T3(7.6±0.9)g,T4(8.9±1.1)g),MWT of group I+K (T1(6.8±1.7)g,T2(8.0±1.4)g,T3(10.3±1.2)g,T4(11.3±1.2)g) increased at all time points after incision (T1~T4)(P<0.05) and the expression of KCC2 at T4 increased (P<0.05).Compared with group I+R(T1(3.2±1.0)g,T2(4.3±1.2)g,T3(5.4±1.1)g,T4(7.5±1.4)g),MWT of group I+R+K (T1(5.1±1.6)g,T2(6.2±1.5)g,T3(7.1±1.1)g,T4(8.3±1.2)g) increased at all time points after incision (T1~T4)(P<0.05) and the expression of KCC2 at T4 increased (P<0.05).ConclusionPre-treatment of subcutaneous injection of ketamine can reduce the hyperalgesia of rats induced by remifentanil and reduce the inhibition of KCC2 expression on dorsal horn of spinal cord.

Effect of verapamil on expression of K+·Cl-cotransporter 2 in spinal dorsal horns during remifentanil-induced hyperalgesia in a rat model of incisional pain / 中华麻醉学杂志

Objective To evaluate the effect of verapamil on the expression of K+-Cl-cotransporter 2 (KCC2) in spinal dorsal horns during remifentanil-induced hyperalgesia in a rat model of incisional pain.Methods Thirty-two pathogen-free healthy adult male Sprague-Dawley rats,aged 6-7 weeks,weighing 250-300 g,were divided into 4 groups (n=8 each) using a random number table:control group (group C),incisional pain group (group Ⅰ),incisional pain plus remifentanil plus verapamil group (group I+R+ V) and incisional pain plus remifentanil group (group I+R).Normal saline was subcutaneously infused in group C.A 1 cm long incision was made in the plantar surface of the right hindpaw in anesthetized rats in group Ⅰ.Verapamil 5 mg/kg was intraperitoneally injected at 10 min before establishment of the incisional pain model in group I+R+V.In I+R and I+R+V groups,the model of incisional pain was established,and remifentanil was subcutaneously infused for 30 min at a rate of 80 μg · kg-1 · h-1 simultaneously.The mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured at 1 day before establishment of the model (T0) and 2,6,24 and 48 h after establishment of the model (T1-4).The rats were sacrificed after measurement of MWT at T4,and the lumbar enlargement segments of the spinal cord were harvested for determination of the expression of KCC2 by immunofluorescence.Results Compared with group C,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in the other groups (P＜0.05).Compared with group Ⅰ,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in group I+R (P＜0.05).Compared with group I+R,the MWT was significantly increased at T1-4,and the expression of KCC2 was up-regulated in group I+R+V (P＜0.05).Conclusion The mechanism by which verapamil reduces remifentanil-induced hyperalgesia is related to up-regulation of the expression of KCC2 in spinal dorsal horns in a rat mnodel of incisional pain.

General anesthesia management for seven cases pregnant with severe pulmonary hypertension and receiving cesarean section / 中国医师进修杂志

Objective To summarize the experience of general anesthesia management in pregnant women with pulmonary hypertension who had to undergo cesarean section. Methods Clinical data, anesthesia methods and outcome of 6 pregnant women with pulmonary hypertension were analyzed. Among them, 1 case of patent ductus arteriosus had to undergo cesarean section twice, because the interval time of twice cesarean section was longer (2 years), and the number of pregnant women was counted to 7 cases. Results Seven patients had to undergo cesarean section with general anesthesia, and all the pregnant women′s hemodynamic were stable during the operation. After operation, 1 pregnant woman discharged from hospital against the doctor′s advices because of massive brain infarction, and the others were all rehabilitated. Seven newborns status:preterm in 3 cases, cardiopulmonary resuscitation in 2 cases, the Apgar score of the others newborns was 9-10 scores. Conclusions Pregnant women with pulmonary hypertension have high peri-operative risk, especially those who undergo general anesthesia. To improve the survival rate, anesthetist should reinforce the perioperative care, maintain oxygen supply, reduce the stress response, maintain the preload and blood pressure, and avoid the increasing of pulmonary pressure.

Role of spinal neuronal Mas-related gene receptor C in maintenance of bone cancer pain in mice / 中华麻醉学杂志

Objective To evaluate the role of spinal neuronal Mas-related gene receptor C (MrgC) in the maintenance of bone cancer pain (BCP) in mice.Methods A total of 132 SPF male C3H/HeJ mice, aged 8-10 weeks, weighing 18-22 g, were randomly divided into 4 groups (n=33 each) using a random number table: sham operation group (S group) , BCP group, bovine adrenal medulla peptide 8-22 (BAM8-22, a highly selective MrgC agonist) group (group BAM), and MrgC antibody group (group MA).BCP was produced by injecting α-MEM 20 μl containing 2×105NCTC2472 cells into the distal medullary cavity of right femur bone.While α-MEM 20 μl was injected only in group S.The artificial cerebrospinal fluid 5 μl was injected intrathecally in S and BCP groups, and BAM 8-22 8 nmol/5 μl and MrgC antibody 5 μl were injected intrathecally in BAM and MA groups, respectively, once a day for 7 consecutive days starting from the day 14 after inoculation of the tumor cells.At 1 day before inoculation (T0), before administration (T1) , and at 14, 16 19 and 21 days after inoculation (T2-5, at 0.5 h before the initial administration and 2 h after each administration) , the number of spontaneous flinches (NSF) and mechanical paw withdrawal threshold (MWT) were measured.Five animals selected from each group at each time point were sacrificed, and the lumbar enlargement segments of the spinal cord were removed for determination of MrgC expression in the spinal neurons (by immunofluorescence).Results Compared with group S, NSF was significantly increased, MWT was decreased, and the expression of MrgC was up-regulated at T1-5 in BCP, BAM and MA groups.Compared with group BCP, NSF was significantly decreased, MWT was increased, and the expression of MrgC was up-regulated at T2-5 in group BAM, and NSF was significantly increased, MWT was decreased, and the expression of MrgC was down-regulated at T2-5 in group MA.Conclusion Spinal neuronal MrgC is involved in the maintenance of BCP in mice.

Positron emission tomography with special tracers in pulmonary abnormalities / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the value of positron emission tomography (PET) with (11)C-choline (CH), (11)C-methionine (MET), (18)F-fluorothymidine (FLT), and (11)C-acetate (AC) in diagnosis of pulmonary abnormalities and the features of pulmonary abnormalities in PET.</p><p><b>METHODS</b>From June 2002 to June 2007, 100 patients with pulmonary nodules or masses confirmed by CT scans received PET with special tracers. Fifty-eight patients received CH-PET, 16 patients received MET-PET, 22 patients received FLT-PET, 4 patients received AC-PET. PET data was analyzed by visual method and semiquantitative method with standard uptake value (SUV). Diagnoses were compared with pathology and follow-up survey.</p><p><b>RESULTS</b>For identification of pulmonary neoplasms with CH-PET, the sensitivity, specificity and accuracy were 84.2% (32/38), 57.9% (11/19) and 75.4% (43/57). In cancer cases, SUV had no correlation with tumor size or age. For identification of pulmonary neoplasms with MET-PET, the sensitivity, specificity and accuracy were 6/7, 6/9 and 75.0% (12/16). In cancer cases, SUV had not correlation with tumor size or age. For identification of pulmonary neoplasms with FLT-PET, the sensitivity, specificity and accuracy were 85.7% (12/14), 2/8 and 63.6% (14/22). In cancer cases, SUV had not correlation with tumor size or age. In AC-PET, only 1 case of pulmonary metastasis of kidney clear cell carcinoma showed acetate avid. Two squamous cell carcinoma and 1 adenocarcinoma didn't appear abnormal in AC-PET.</p><p><b>CONCLUSION</b>CH, MET, FLT, AC are valuable in diagnosing but also lead to false positive and false negative.</p>

Clinical pathological study on nodal micrometastases of non-small-cell lung cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the practicability of detecting the micrometastases in lymph nodes of no-small-cell lung cancer (NSCLC) by means of the immunohistochemical (IHC) staining.</p><p><b>METHODS</b>The lymph node samples were taken from the patients with NSCLC during the operations. Firstly, each resulting tissue block was processed for routine paraffin embedding. Then the 6 approximately 10 serial sections were chosen, each 5 microm thick, from every paraffin block of the lymph node. Finally, the first and the second last sections of each lymph node were stained by hematoxylin eosin (HE), and the other serial sections were used for the IHC staining examination with the monoclonal antibody against cytokeratin 19.</p><p><b>RESULTS</b>The paraffin embedded sections of 195 regional lymph nodes from 25 patients with NSCLC were examined by HE staining. Thirty lymph nodes in 9 patients revealed gross nodal metastases, and none of lymph node in 25 patients showed micrometastatic tumor cells. Frozen tissue sections from 135 regional lymph nodes that were staged as free of metastases by HE staining were screened by IHC staining. Thirty-one lymph nodes in 9 patients showed micrometastatic tumor cells. Five of sixteen patients staged as PN(0) had hilum lymph nodal micrometastases, versus four of nine patients with stage PN(1) had mediastinal lymph nodal micrometastases. There was a significant difference between two groups (chi(2)=52.900, P=0.0193).</p><p><b>CONCLUSIONS</b>Conventional HE staining can accurately detect gross nodal metastases in the lymph nodes of patients with NSCLC, but is unfit for detecting lymph nodal micrometastases. IHC staining analysis can significantly facilitate the detection of occult micrometastatic tumor cells in lymph nodes of NSCLC, and its assessment of nodal micrometastases can provide a refinement of TNM stage for partial patients with stage I to II NSCLC.</p>

Fluorine-18 fluorodeoxyglucose-positron emission tomography imaging of carcinoma of cardia or fundus of stomach / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value of fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) in carcinoma of cardia or fundus of stomach.</p><p><b>METHODS</b>From April 1999 to April 2005, 57 patients with carcinoma of cardia or fundus of stomach were imaged with FDG-PET. FDG-PET imaging were analyzed by visual method combined with semiquantitative analysis. The results were compared with pathological findings and follow-up results.</p><p><b>RESULTS</b>In 29 untreated patients, 25 T(2) to T(4) tumors were all FDG avid and 4 T(1) cases showed nothing abnormal at the primary site. In 24 patients performed curative operation 40 resected enlarged lymph nodes beyond 1 cm were diagnosed correctly by FDG-PET. FDG-PET revealed distant metastases in 5 patients and corrected them from curative surgery candidates to late stage. In 28 treated patients FDG-PET confirmed 22 cases with recurrence or metastasis.</p><p><b>CONCLUSIONS</b>FDG-PET has limited value in confirming T stage in carcinoma of cardia or fundus of stomach. It showed potential in N and M staging and predicting treatment response.</p>

Fluorine-18 fluorodeoxyglucose uptake in patients with benign pulmonary nodules / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the features of fluorine-18 fluorodeoxyglucose (FDG) uptake in patients with benign pulmonary nodules.</p><p><b>METHODS</b>From October 1998 to July 2004, 47 patients with benign pulmonary nodules were imaged with FDG-positron emission tomography (PET). Diagnoses were confirmed by surgery. FDG-PET data was analyzed by visual method and semi-quantitive method. When pulmonary nodules with abnormal FDG intake appeared in PET scans confirmed by visual method, their maximum and mean standard uptake value (SUVmax and SUVmean) and SUV of normal lung (SUVlung) were measured using semiquantitative method.</p><p><b>RESULTS</b>Twenty-one cases showed nothing abnormal in PET scans, including 17 calcification and fibrosis, 2 hamartomas and 2 sclerosing hemangiomas. 26 pulmonary nodules were detected by FDG-PET (17 active tuberculous, 6 inflammatory pseudotumors, 3 cryptococcosis). FDG uptake of these 26 nodules was higher than that of normal lung (SUVmax, SUVmean and SUVlung were 3.04 +/- 1.65, 2.48 +/- 1.35 and 0.40 +/- 0.07, respectively, P < 0.001). Correlations were not found between FDG uptake and nodule size or SUV of normal lung or age or blood glucose level in these 26 patients (P > 0.05). SUV in 9 cases (9/26, 35%) were beyond 2.5.</p><p><b>CONCLUSIONS</b>Some benign pulmonary nodules were FDG avid.</p>

Clinical diagnosis and surgical treatment of primary pulmonary lymphoma / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics, the principles of diagnosis and surgical treatment for primary pulmonary lymphoma.</p><p><b>METHOD</b>Ten patients with primary pulmonary lymphoma were treated surgically and their clinical characteristics, the experiences of clinical diagnosis and surgical treatment were analyzed. The tumors located in left upper lobe in 2, left lower lobe in 1, right upper lobe in 3, right middle lobe in 3 and right lower lobe in 1. The main symptoms were cough and (or) hemoptysis. Imageological representations (X-ray and CT scanning of thorax) were similar to primary pulmonary carcinoma. Broncho-fibroscopic examination was performed on all cases with negative findings. Eight cases were mistakenly diagnosed as primary pulmonary carcinoma by imageological representations. Only 2 cases were diagnosed as primary pulmonary lymphoma by percutaneous needle biopsy and pathologic examination. All cases received pneumonectomy, ipsilateral hilar and mediastinal lymphadenectomy. All cases with non-Hodgkin's lymphoma received regular chemotherapy (MOPP and ABVD scheme for 1 case with Hodgkin's disease respectively, CHOP for 8 cases with non-Hodgkin's lymphoma), and 3 cases received radiotherapy postoperatively.</p><p><b>RESULTS</b>Eight cases were non-Hodgkin's lymphoma (B-type) and 2 cases were Hodgkin's disease (mixed type) confirmed by pathological examination. Six cases with non-Hodgkin's lymphoma (3 cases for stage IE, 2 cases for stage II 1E, and 1 case for stage II 2E W) had been surviving for 18-42 months until the follow-up. Two cases with non-Hodgkin's lymphoma (stage II 2E, B-cell, low-grade) and 2 cases with Hodgkin's disease (stage IE and II 2E, mixed type) died in 24, 32, 8 and 17 months postoperatively respectively.</p><p><b>CONCLUSIONS</b>Primary pulmonary lymphoma is a rare type of malignant lung neoplasm without special clinical features. The preoperative diagnosis is difficult. Treatment modalities include surgical treatment, radiotherapy and regular chemotherapy postoperatively.</p>

Value of carbon-11 choline positron emission tomography in patients with pulmonary abnormalities / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the value of carbon-11 choline (CH) positron emission tomography (PET) in patients with pulmonary nodules.</p><p><b>METHODS</b>From September 2002 to December 2004, 39 patients with pulmonary nodules were imaged with CH-PET. CH-PET data was analyzed by visual method and semiquantitative method. When pulmonary nodules with abnormal CH uptake appeared in PET scans confirmed by visual method, their maximum and mean standard uptake value (SUVmax and SUVmean) were measured using semiquantitative method. Diagnoses were confirmed by surgery or biopsy and follow-up survey.</p><p><b>RESULTS</b>Twenty-four cancerous and 3 inflammatory nodules and 1 bronchogenic cyst were detected by CH-PET and were diagnosed malignant with visual method. Three bronchial alveolar carcinoma, 2 metastatic tumor from kidney and colon, 3 fibrous nodules, 1 cryptococcosis, 1 hamartoma and 1 sclerosing hemangioma showed nothing abnormal in PET scans. For identification of pulmonary nodules with CH-PET, the sensitivity was 89% (24/29), the specificity was 60% (6/10), and the accuracy was 77% (30/39). There were differences in SUV between 8 squamous cell carcinomas and 9 adenocarcinomas (Z = -2.937, -2.887, P < 0.01). In diagnosing 70 resected enlarged lymph nodes beyond 1 cm in 17 lung cancer patients, CH-PET had the sensitivity of 86% (25/29), the specificity of 90% (37/41), and the accuracy of 89% (62/70). CH-PET confirmed 7 distant metastases in 25 lung cancer patients. In 5 cases suspected brain metastases CH-PET identified 2 cases positive correctly.</p><p><b>CONCLUSIONS</b>CH-PET can confirm malignant pulmonary nodules, but still there were false positive and false negative cases. CH-PET can evaluate N stage effectively in patients with lung cancer. CH-PET can depict brain metastases accurately.</p>

Pleuro-pneumonectomy in the treatment of pulmonary carcinoma complicated with diffuse pleural metastasis and malignant pleural effusion / 中国肺癌杂志

<p><b>BACKGROUND</b>According to the international standard in TNM staging of pulmonary carcinoma, pulmonary carcinoma complicated with diffuse pleural metastasis and malignant pleural effusion belongs to IIIB stage. In the past, non-operative therapy was employed, but both the therapeutic efficacy and the quality of life of patients were poor. The purpose of this study is to find out a complex treatment for this disease.</p><p><b>METHODS</b>Total pleuro-pneumonectomy was performed in 55 cases of patients with pulmonary carcinoma complicated with diffuse pleural metastasis and malignant pleural effusion from December 1978 to February 2003. The patients were followed up postoperatively, and the quality of life and survival period of them were observed.</p><p><b>RESULTS</b>In all the cases, only 2 patients died of operation. Satisfactory recovery and remarkable relief of symptoms such as short breath, dyspnea and chest pain were found in all the other patients. After a follow-up period of 1-25 years, local recurrence was found in 6 cases (11.3%), and distant metastasis in 42 cases (79.2%). A total of 48 patients died of tumor, with survival period ranging from 5-40 months (average survival period: 15 months; median survival period: 14 months), and 5 patients were still alive in good health.</p><p><b>CONCLUSIONS</b>(1) Patients appropriated for operation should be carefully selected in case that postoperative complications influence their smooth recovery; (2) Tumor tissues should be removed as clear as possible; (3) During the operation, close attention should be paid to the protection of incisions; (4) Removal of the tumor tissues can reduce the tumor load, effectively clean the immunosuppressive factors in malignant pleural effusion, and break the immunity block status, which provides basis for the following comprehensive therapy; (5) The quality of life of the patients can be improved and the median survival period can be prolonged by the operation; (6) The long-term survival rate of patients is still unsatisfactory.</p>

Surgical treatment of primary pulmonary cryptococcosis / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the clinical feature, diagnosis and treatment of primary pulmonary cryptococcosis.</p><p><b>METHODS</b>From 1996 to 2004, 11 patients with primary pulmonary cryptococcosis were surgical treated and confirmed by histologic study. At the same period, 2715 patients with pulmonary abnormalities received surgery. Their clinical data were retrospectively reviewed.</p><p><b>RESULTS</b>Sixty-four percent (7/11) of the patients were symptomatic at the time of diagnosis. All 11 cases were misdiagnosed as lung cancer or inflammatory or tuberculosis by X-ray and CT scan before surgery. Three cases received fluorine-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) scan and their primary pulmonary lesions showed FDG avid. All 11 patients were treated by antibiotics and antituberculosis therapy but no responses appeared. Primary pulmonary cryptococcosis was diagnosed by ultrasound-guided fine needle aspiration biopsy in only 2 cases, but antifungal therapy was not effective. All 11 patients underwent thoracotomy and their pulmonary cryptococcosis were resected. Only 1 patient with multiple nodules received antifungal therapy postoperatively. No recurrence was found in any patients.</p><p><b>CONCLUSIONS</b>Primary pulmonary cryptococcosis is non-specific and can be confused with lung cancer, tuberculosis, etc. The pulmonary abnormalities should be resected unless the diagnosis is established. Antifungal therapy is not necessary in patients whose abnormality has been resected thoroughly.</p>

Detection of blood dissemination during the operation of lung cancer and its significance / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the possibility of dissemination of lung cancer cells through blood during the operation for lung cancer.</p><p><b>METHODS</b>The blood samples were taken from 52 patients with non-small cell lung cancer (NSCLC) and 5 patients with benign lung diseases at four different intervals during the operation. The transcription of carcinoembryonic antigen (CEA) messenger ribonucleic acid was assayed by means of nested reverse transcriptase polymerase chain reaction (RT-PCR). A549 (a human adenocarcinoma cell line) served as positive control. The sensitivity has been tested using quantificationally diluted A549 cells.</p><p><b>RESULTS</b>The CEA mRNA positive rates of all four time spots are as follows: 31% (16/52) at beginning of the operation (sample taken from peripheral vein), 54% (28/52) at ligating the pulmonary vein (peripheral vein), 54% (28/52) at ligating the pulmonary vein (pulmonary vein) and 54% (28/52) at 1 hour after ligating the pulmonary vein (peripheral vein). There is no relationship between the tumor identity and the positive rate of CEA mRNA. The positive rate of CEA mRNA is higher in patients with centrally located lung cancer than that in patients with peripherally located lung cancer, similar phenomenon is also found between patients with advanced lung cancer and the patients with early stage of lung cancer. No negative control samples was found to be positive for CEA mRNA, the sensitivity of our test was 1 x 10(-6).</p><p><b>CONCLUSIONS</b>The cancer cell dissemination during operation was demonstrated indirectly in our study, the time of pulmonary vein ligation (later or earlier) may affect the quantity of tumor cells released into circulation. Patients with lung cancer of central type and late TNM stage have more possibility of cancer cell dissemination during operation. More effective means may be needed to avoid the dissemination of cancer cells.</p>

The diagnostic value of determination of p16 methylation of sputum exfoliated cells for peripheral lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To study the diagnostic value of detection of p16 methylation of sputum exfoliated cells for peripheral lung cancer.</p><p><b>METHODS</b>Before operation, p16 methylation of the sputum exfoliated cells was detected in 20 normal persons and 50 patients with peripheral pulmonary nodi by p16 methylation-specific PCR (MSP) for judging the nature of the nodi. The results were compared with pathological reports after operation.</p><p><b>RESULTS</b>The p16 MSP positive rate of sputum exfoliated cells of peripheral lung cancer patients (27/44, 61.4%) was much higher than that of benign pulmonary nodi (1/6, 16.7%) and normal persons (3/20, 15.0%)(Chi-Square=4.281 and 11.869 respectively, both P < 0.05). No significant difference of p16 MSP positive rate of sputum exfoliated cells was found between benign pulmonary nodi and normal persons (Chi-Square= 0.136, P > 0.05). No significant difference of p16 MSP positive rate of sputum exfoliated cells was found between squamous cell carcinoma (13/18, 72.2%) and adenocarcinoma (8/19, 42.1%) (Chi-Square=3.416, P > 0.05 ). If the positive p16 MSP of sputum was chosen as criterion for peripheral lung cancer, its positive predictive value, negative predictive value, sensitivity and specificity were 96.4%, 22.7%, 61.4% and 83.0% respectively.</p><p><b>CONCLUSIONS</b>The detection of p16 methylation of sputum exfoliated cells is contributable to the diagnosis of lung cancer.</p>

Fluorodeoxyglucose-positron emission tomography in carcinoma of the esophagogastric junction / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the value of fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) in carcinoma of the esophagogastric junction.</p><p><b>METHODS</b>From December 1998 to April 2002, 27 patients were imaged with FDG-PET and FDG avid masses in the esophagogastric junction were found in every patient. FDG-PET data was analyzed by visual method and standardized uptake value (SUV). FDG-PET results were compared with pathological results and follow-up survey.</p><p><b>RESULTS</b>16 carcinomas of the esophagogastric junction and 11 non-specific FDG-avid masses of normal stomach were all considered malignant by visual method. Maximum and mean Standard uptake value (SUV) of cancer were 6.71 +/- 2.75 and 5.46 +/- 2.31, respectively; SUVmax and SUVmean of non-specific FDG avid mass were 2.99 +/- 0.67 and 2.38 +/- 0.51 respectively; SUV of cancer was higher than that of non-specific FDG avid mass (Z = -4.171, Z = -4.195, P < 0.01).</p><p><b>CONCLUSIONS</b>FDG-PET has limited value in differentiating carcinoma of the esophagogastric junction from non-specific FDG avid mass of normal stomach.</p>

Relationship between overexpression of facilitative glucose transporter-1 and fluorodeoxyglucose uptake in primary human lung adenocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the relationship between the overexpression of facilitative glucose transporter-1 (Glut1) and fluorine-18 fluorodeoxyglucose (FDG) uptake in patients with primary lung adenocarcinoma.</p><p><b>METHODS</b>From April 1999 to March 2001, 24 patients with lung adenocarcinoma were imaged with FDG positron emission tomography (PET) before surgery. Their maximum and mean standard uptake value (SUVmax and SUVmean) of tumor and SUV of normal lung (SUVlung) were measured. The expression of Glut1 of all 24 cases was studied in paraffin sections by SP immunohistochemistry.</p><p><b>RESULTS</b>All 23 tumors tested were Glut1 positive. (35 +/- 23)% of tumor cell area was positive and staining intensity was (3.7 +/- 0.9). All tumors of the patients could be detected by FDG-PET. FDG uptake of tumor was higher than that of normal lung (P < 0.01). SUVmax, SUVmean and SUVlung were (5.46 +/- 3.32), (4.05 +/- 2.54) and (0.43 +/- 0.15) respectively. Correlations were found among Glut1 expression and FDG uptake and tumor size (P < 0.01).</p><p><b>CONCLUSION</b>Glut1 overexpression is universal in the lung adenocarcinoma and correlate with FDG uptake.</p>

Study on p16 methylation status of BEP2D cells during its malignant transformation / 中国肺癌杂志

<p><b>BACKGROUND</b>To study p16 methylation status and p16 mRNA transcription of BEP2D cells during its malignant transformation.</p><p><b>METHODS</b>Normal BEP2D cell and BEP2D cells irradiated by α particle for 20 weeks (R-20), 21 weeks (R-21), 35 weeks (T-35) and 54 weeks (T-54) respectively were chosen to study the p16 methylation status by methylation-specific PCR (MSP). Meanwhile, RT-PCR was used to study p16 mRNA transcription of the above cells.</p><p><b>RESULTS</b>(1) p16 methylation was found in R-20, R-21, T-35 and T-54 cells, but not in normal BEP2D cell. (2) The p16 mRNA transcription levels of R-20, R-21, T-35 and T-54 cells were much lower than that of normal BEP2D cell.</p><p><b>CONCLUSIONS</b>The p16 methylation occurs in the early stage of lung cancer. The methylation of p16 gene may cause the inactivation of p16 gene.</p>