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Acute myocardial infarction (AMI) and acute ischemic stroke (AIS) are leading causes of death and disability in the world population. Cardio-cerebral infarction (CCI) is a rare clinical syndrome of AMI combined with AIS, which refers to the critical symptoms of simultaneous acute focal neurological deficits and precordial pain or electrocardiogram changes. The incidence of CCI ranges from 0.09% to 1.6%, but patients have a critical condition, poor prognosis, and high mortality and disability rates. Due to the complexity of the condition, diverse etiology, and limited evidence and mechanistic research, the management of patients with CCI is challenging. This article summarizes the pathogenesis related to CCI, the effectiveness of drug treatment, indications for endovascular treatment, and the selection of surgical sequence, with the aim of shortening thrombolysis/endovascular treatment time and improving outcomes of patients.
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Objective:To summarize the experience of surgical methods without repairing the fistula for 92 cases with gastrointestinal intrathoracic fistula.Methods:The surgical methods without repairing the fistula were performed through VATS, small incision assisted with VATS or thoracotomy. The focus of the surgery was to promote lung expansion, eliminate the residual cavity of chest cavity and keep effective drainage. After entering the chest cavity from the affected side, wash chest cavity with a large amount of warm normal saline and sterilize intermittently with iodophor to ensure the sterile environment in the pus cavity. Then completely remove the pleural cellulose or fiberboard on visceral pleura to promote lung expansion, eliminate the residual cavity of the chest cavity. The fistula was covered tightly and supported firmly by the visceral pleura on the lung. Multiple T-tubes were placed in thoracic cavity and fistula to keep effective postoperative drainage.Results:Among 92 cases, 85 cases were cured and the cure rate was 92.4% (85/92).7 cases died and the mortality rate was 7.61% (7/92). The 7 dead cases include 5 cases with esophagogastric anastomotic fistula (the death of 3 cases was cause by aortic esophagogastric fistula, the death of 1 case was cause by thoracic gastric tracheal fistula and 1 case was dead because of pulmonary infection and respiratory failure), 1 case with esophageal rupture (the cause of death was septic shock ), and 1 case with esophageal perforation(the cause of death was pulmonary infection and respiratory failure).Conclusion:Most of the surgeries without repairing gastrointestinal intrathoracic fistula are conducted simply through VATS or small incision assisted with VATS., which is safe and effective.
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Objective:To review the experience of closure of the left-main-bronchial stump fistula using endoscopic liner cutter staplers through the right thoracic approach and I stage or staged treatment for the left pyothorax.Methods:6 patients with the left-main-bronchial stump fistula after left pneumonectomy combined with pyothorax were treated by closing the left-main-bronchial stump using endoscopic liner cutter staplers through the right thoracic approach, and pleura was used to cover the distal and proximal incisional margin of the stump respectively. The thoracic T-tube drainage was used in the I stage or staged treatment for the left pyothorax.Results:All patients were survived without recurrence of the bronchopleural fistula. 4 patients were observed to have no recurrence of pyothorax when 1 patient had recurrence of pyothorax and was treated with intermittent T-tube drainage.1 patient operated with left-thoracic fenestration in the past was treated with drainage waiting for secondary operation.Conclusion:The right thoracic approach seemed to be a safer and more effective method than the transsternal transpericardial approach in cases with the left-main-bronchial stump fistula combined with pyothorax. The use of endoscopic liner cutter staplers reduced the risk of bleeding, infection and recurrence of fistula. The T-tube drainage in the I stage or staged treatment for the left pyothorax was considered to be an easier way for treatment.
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Objective To investigate the factors related to death of thoracic trauma emergency in children.Methods Total 528 children and infants aged 0-14 years with thoracic injuries , including 317 boys and 211 girls, admitted in emergency department from January 2010 to January 2014 were included in the study.The factors related to emergency death were investigated by using conditional logistic analysis.Results Among 528 cases, emergency death occurred in 34 cases with an emergency mortality rate of 6.44%.Single-factor analysis showed that emergency death was correlated with complication with other organ trauma, the time of first medical intervention , the time of arriving at first contact hospital , the rank of first contact hospital , hypoxemia and causes of injuries ( all P0.05).Logistic analysis showed that the time of first medical interventio n>30 min ( B=1.467,95%CI:0.412-0.975), complication with other organ trauma (B=2.342,95%CI:0.415-0.943), hypoxemia (B=2.915,95%CI:0.749-0.819), and first visiting to tertiary hospital (B=-1.861,95%CI:1.023-1.742) were influencing factors of emergency death.Conclusion The results indicate that to improve the success rate of emergency treatment of thoracic trauma in children , it is necessary to reduce the time of first medical intervention and to correct the hypoxemia promptly.
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Objective To study the expressions of snail mRNA and protein in human non-small cell lung cancer (NSCLC) and their correlations to patient clinical features.Methods Real-time fluores-cence quantitative PCR (qRT-PCR) and immunohistochemical were used to analyze the expressions of snail in a total of 41 pairs of NSCLC tissues,12 specimens of normal lung tissues.Results The expressions of snail mRNA in NSCLC tissues were significantly higher than the corresponding adjacent tissues (P ＜ 0.01).The expression rate of snail protein of NSCLC tissues (25/41) were significantly higher than that in adjacent tissues (2/41,P ＜ 0.01).There was no snail expression in non-cancerous lung tissues.The level of mRNA and protein in snail was associated with lymph node metastasis and clinical stage of non-small cell lung cancer (P ＜ 0.05).Conclusion The higher expression of snail may promote the metastasis of lung cancer.The expressions of snail are related to the development of human non-small cell lung cancer.
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Objective To investigate the effect of TCF21 on human non-small cell lung cancer A549 cells , and to reveal the role of TCF21 in the development of NSCLC. Methods Overexpression of TCF21 in NSCLC A549 cells was mediated by lentivirus vector. TCF21 protein expression was identified by Western blotting assay. The experimental group, negative control group and the blank control group were set up. A549 cells were subcuta-neously seeded in BALB/c nude mice on the left armpit. Results TCF21 was successful overexpressed in the ex-perimental group. Compared with the negative control group and the blank control group , the tumor growth was slow, and the final tumor volume was significantly reduced in the experimental group. Conclusion Overexpression of TCF21 can inhibit the tumor growth of NSCLC in nude mice , indicating that TCF21 may play an important role in NSCLC development.
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Background and purpose:Esophageal cancer is one of the common malignant tumors in our country. Anastomotic stenosis is a common complication after resection of esophageal cancer, seriously affecting the quality of life of patients after operation. By changing anastomosis, this study explored the methods for prevention of anastomotic stenosis after esophageal cancer surgery.Methods:Patients were randomly divided into groups. Patients admitted on odd dates were placed in the control group whereas patients admitted on even dates were placed in the experimental group. Patients in the control group were treated with gastroesophageal anastomosis using anastomat for gastroesophageal anastomosis. Anastomotic stomach was contracted by purse string suture at first, and then treated with stapler gastroesophageal anastomosis, before the gastroesophageal anastomosis was carried out on patients in the experimental group. After 6 months’ follow-up, the incidences of anastomotic stenosis between the two groups were compared.Results:The postoperative anastomotic stenosis rate in the control group was 19.2%, while that in the exper-imental group was 0%. There were statistically signiifcant differences between them (χ2=22.8,P<0.005). The incidence of anastomotic stenosis in the control group was signiifcantly higher than that in the experimental group.Conclusion:Anastomotic stomach contracted by purse string suture before stapler gastroesophageal anastomosis can effectively reduce the occurrence of anastomotic stenosis after esophageal cancer surgery.
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Objective To investigate the transcription factor 21 (transcription factor 21 ,TCF21) gene on human lung cancer A549 cells sensitivity to chemotherapy .Methods Using lentivirus technology in A549 lung cancer cells highly expressed genes TCF21 ,fluorescence quantitative PCR ,Western Blot analysis were used to analyse the expression of the target gene ,MTT assay was used to detect the effect of TCF21 lung adenocarcinoma A549 cells on cisplatin (cis‐Dichlorodiamineplatinum ,DDP) chemosen‐sitivity ,and colony assay was used to detect the effect of overexpression of TCF21 lung adenocarcinoma A549 cells on radiosensitiv‐ity .Results After 72 h ,with the increasing concentration of DDP (0 ,0 .625 ,1 .250 ,2 .500 ,5 .000 ,10 .000 mg/L) ,corresponding in‐hibition rates in each group increased ,and the inhibition rate of the high expression group was significantly higher in empty vector group and untransfected group (P<0 .05) ,no significant difference between the two then;overexpression TCF21 group with drug concentration and time and increase the rate of high expression inhibition corresponding increase (P<0 .05) ;after receiving X radi‐ation ,non‐transfected group ,untransfected plus radiotherapy group ,vector group ,vector plus radiotherapy group ,high expression and high expression + radiotherapy colony formation rates were:95 .17% ± 2 .85% ,88 .20% ± 2 .03% ,93 .80% ± 4 .17% , 85 .60% ± 2 .42% ,71 .67% ± 3 .21% ,56 .00% ± 2 .65% .Conclusion TCF21 gene expression can significantly enhance the sensitiv‐ity to radiotherapy and chemotherapy DDP A549 lung cancer cells .
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Objective To discover the excision repair cross-complementing 1 (ERCC1) expression in non-small cell lung cancer (NSCLC) patients and explore the prognostic value of ERCC1 .Methods The ERCC1 mRNA expressions in NSCLC was tested from 85 tumor tissues and 34 adjacent tissue samples from patients who were after the surgery were used by semi-quantitative RT-PCR .The data of clinical features and progression-free survival (PFS) and overall survival (OS) were linked to ERCC1 expression by retrospective analysis .Results In 85 patients ,the ERCC1 negative ones had a significantly longer survival than the ERCC1 posi-tive expression ones (PFS ,P=0 .001;OS ,P=0 .001) .During the multivariate analysis ,ERCC1was found to be a significant factor in PFS and OS (P=0 .018 and P=0 .027) .Conclusion NSCLC patients who were undertaken platinum-based adjuvant chemother-apy after surgery could use the detection of ERCC1 mRNA as a determinant factor for the prognosis predicting of individualized treatment .
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Objective To investigate the relationship of the serum level of IL-23 and MMP-9 with the clinicopathologic features in patients with esophageal squamous cell carcinoma (ESCC). Methods 48 pathologically confirmed ESCC patients and 30 Endoscopic biopsy of benign were included in this study. The serum levels of IL-23 and MMP-9 were examined by enzyme-linked immunosorbent assay (ELISA). Results Serum IL-23 level in patients with ESCC was significantly higher than that in controls (t = 26.66, 16.89, P<0.05). Furthermore, Pearson′s correlation analysis revealed that serum IL-23 was positively correlated with the serum MMP-9 level in ESCC patients (r = 0.790, P < 0.05). Statistical analysis showed that enhanced serum IL-23 significantly correlated with the degree of differentiation and lymph node metastasis. Conclusion Overexpression of IL-23 may involve in the occurrence and development of ESCC. IL-23 may contribute to tumorinvasion and metastasis by stimulating the expression of MMP-9.
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Objective Background and objective Bioinformatics technology found the TCF21 gene has difference expression in non-small cell lung cancer (NSCLC) and benign lung tissue.To explore TCF21 mRNA and protein expression in nonsmall cell lung cancer and its methylation of the promoter region is the aim of this study.Methods Use RT-PCR,Western blot and Pyrosequencing detected TCF21 gene mRNA,protein and the methylation of the promoter region respectively in 97 cases of non-small cell lung cancer and 21 cases of benign lung tissue.Results TCF21 gene mRNA-positive expression were detected 23 cases (23.71％) and 14 cases (66.67％) in 97 cases of NSCLC cancer tissue and 21 cases of benign lung tissue,the average gray value of TCF21 protein expression levels in NSCLC cancer tissue is 0.49 ± 1.78,while it is 1.48 ± 1.58 in benign lung tissue,the TCF21 gene promoter region have varying degrees methylation in NSCLC cancer tissue and benign lung tissue,and the significant of methylation frequency was found statistically significant between NSCLC cancer tissue and benign lung tissue,also it has higher frequency of 49.04％ and 51.37％ respectively at point 1 and 5 in NSCLC cancer organizations.Conclusion TCF21 gene mRNA and protein expression were statistically significant in NSCLC cancer tissue and benign lung tissue,the TCF21 gene promoter region average methylation frequency was significantly higher than that in benign lung tissue cells.
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Objective To observe the effect of smoking on the great saphenous vein tension. Methods The rings of great saphenous vein in 3mm long of selected from 31 patients with coronary artery bypass grafting were divided into three groups :smoking over 10 years( group A, n = 12 ), ex-smoking over 1 years ( group B, n =9 ) and non-smoking( group C, n =10). The changes of the tone were measured in organ chamber at 37℃ with a constant supply of oxygen when vasoconstriction induced by phenylephrine ( 10 -9 - 10 -5 mmol/L), and vasodilatation by acetylcholine ( 10 -9 - 10 -5 mmol/L) or nitroglycerin( 10 -9 - 10 -4 mmol/L)after the rings were precontracted by 10 -5 mmol/L phenylephrine. Results Vasoconstriction induced by phenylephrine and vasodilatation by nitroglycerin is no significant difference among three groups. Compared with group A, vasodilatation by acetylcholine was significantly increased in group B or C, while there is no significant difference between group B and C. Conclusion Smoking has a deleterious effect on the endothelial function of great saphenous vein, however, smoking cessation over 1 year may help to restore the endothelial function impaired by smoking.
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<p><b>BACKGROUND</b>Melanoma antigen genes (MAGE genes) are tumor specific genes. In this study the expressions of MAGE-1, -2, -3 and -4 genes in lymph nodes of patients with non-small cell lung cancer (NSCLC) at mRNA level were investigated and the role of MAGE genes was analyzed in the diagnosis of occult micrometastasis in lymph nodes of patients with NSCLC.</p><p><b>METHODS</b>One hundred and eleven stations of lymph nodes from 53 patients with NSCLC were studied to detect mRNA for MAGE-1, -2, -3 and -4 genes by using reverse transcription-polymerase chain reaction (RT-PCR) assay.</p><p><b>RESULTS</b>The expression rate in samples of lymph nodes using RT-PCR (41.4%, 46/111) was significantly higher than that using routine histopathological examination (27.9%, 31/111). Of the 80 stations of lymph nodes without invasion of the tumor confirmed by routine histopathological examination, at least one of these genes was expressed in (23.8%) (19/80) out of the samples. Of the 31 stations of lymph nodes with invasion of the tumor confirmed by routine histopathological examination, at least one of these MAGE genes was expressed in 87.1% (27/31) out of the samples. In the lymph nodes of the patients with non-cancerous diseases, the MAGE-1, -2, -3 and -4 were not expressed at mRNA level.</p><p><b>CONCLUSIONS</b>Micrometastasis in lymph nodes of patients with NSCLC could be diagnosed by investigating the expressions of MAGE genes at mRNA level. Detection of MAGE-1, (-2,) -3 and -4 might be helpful to diagnoze micrometastasis in lymph node and to increase the accuracy of TNM stages in NSCLC.</p>