Comparison of the outcomes of monopolar and bipolar radiofrequency ablation in surgical treatment of atrial fibrillation.

OBJECTIVE: To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency (RF) ablation used during cardiac surgery to treat atrial fibrillation. METHODS: We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011. Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation, respectively. The sinus rhythm restoration rate, the procedural duration, the frequency of severe perioperative complications, and mortality were compared between the two groups. RESULTS: The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1 ± 12.6 months (P=0.199). The frequencies of severe perioperative complications and mortality were also similar in the two groups. The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation (19.7 ± 4.6 minutes vs. 28.1 ± 8.5 minutes, P< 0.001). CONCLUSIONS: Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery, but bipolar RF ablation is more convenient in practice.

Personalized management of anastomotic leak after surgery for esophageal carcinoma.

OBJECTIVE: To summarize the management of anastomotic leak following surgery for esophageal carcinoma. METHODS: The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma in our hospital from January 2003 to March 2011 were retrospectively analyzed. RESULTS: A total of 36 patients were included, in whom 13 developed cervical anastomotic leak, 18 had intra-thoracic anastomotic leak, and 5 had intra-thoracic gastric necrosis. Of these patients, 7 were treated with resurgery, 6 with esophageal stent implantation, and 23 with conservative treatment. Treatment lasted for 5 to 181 days, averagely 47.0 +/- 31.9 days. After management, 9 patients died (25.0%). Among seven patients with resurgery, four had deceased, two were cured, and one developed leak again and was switched to conservative treatment until discharged. All the 6 patients treated with stent implantation were cured. Of the 24 patients receiving conservative treatment (including one switched from resurgery), 18 (75.0%) were cured and 1 was not cured but survived. CONCLUSIONS: Anastomotic leak following surgery for esophageal carcinoma should be treated individually based on the onset time, location, size, and extent of the leakage. Conservative treatment is still a safe and effective method. The efficacy of stent implantation needs further investigation to confirm.

Pathologic complete response after neoadjuvant tislelizumab and chemotherapy for Pancoast tumor: A case report.

A 60-year-old man was hospitalized because of numbness and weakness in the right upper limb. Magnetic resonance imaging revealed a large mass in the right upper lobe invading the right eighth cervical and first thoracic nerve root. Biopsy pathology confirmed primary lung adenocarcinoma with a clinical stage of cT4N0M0 IIIA, negative for anaplastic lymphoma kinase fusion gene and epidermal growth factor receptor mutations but positive for programmed death ligand 1 (3%). Neoadjuvant tislelizumab and chemotherapy were offered to this patient with Pancoast tumor, and tumor shrinkage of 71% was achieved. After the operation, surgical pathology indicated pathologic complete response (pCR). Circulating tumor cells testing was negative after the first adjuvant treatment. In this case, we provide real-world evidence of encouraging pCR with neoadjuvant tislelizumab and chemotherapy for a patient with Pancoast tumor.

[Relationship between survivin expression and chemosensitivity of human lung cancer cells].

OBJECTIVE: To investigate the relationship between survivin expression and the chemosensitivity in multiple drug resistant human lung cancer cell line METHODS: Human lung cancer cells of the parental cell line H460 and multiple drug resistant cell line H460/cDDP were cultured respectively. RT-PCR and Western blotting were used to detect the mRNA and protein expression of survivin. siRNA targeting survivin was transfected into H460/cDDP cells by Liposomes approach. The expression change of survivin protein after transfection was examined by Western blotting. Cisplatin (DDP) and paclitaxel of different concentrations were added into the culture fluid of the H460/cDDP cells respectively. Methyl thiazolyl tetrazolium (MTT) assay was used to calculate the IC(50) value so as to detect the cytotoxicity of cisplatin and paclitaxel to the cells. RESULTS: The mRNA expression and protein expression of survivin in the H460/cDDP cells were both significantly higher than those in the H460 cells. 24 h, 48 h, and 72 h after transfection of the survivin siRNA the survivin protein expression levels of the H460/cDDP were decreased by 67.0%, 76.2%, and 92.3% respectively. MTT assay showed that the cisplatin IC(50) levels of the H460/cDDP and H460 cells were 6.3 +/- 0.6 mg/L and 0.8 +/- 0.1 mg/L respectively, and the paclitaxel IC(50) levels were 12.7 +/- 1.2 mg/L and 1.5 +/- 0.3 mg/L respectively. 48 h after the transfection of survivin siRNA, the cisplatin and paclitaxel IC(50) levels of the H460/cDDP cells were decreased to 4.0 +/- 0.9 mg/L (P = 0.002) and 8.1 +/- 1.7 mg/L (P = 0.003) respectively. CONCLUSION: The survivin expression of the resistant cell line H460/cDDP was up-regulated compared with that of the parental cell line H460. Survivin siRNA sensitized the H460/cDDP cells to both cisplatin and paclitaxel. Survivin participates in the multiple drug resistance mechanism of human lung cancer cells.

[Diagnostic value of endoscopic ultrasonography and CT in T, N stage of preoperative esophageal cancer].

OBJECTIVE: To evaluate the preoperative endoscopic ultrasonography (EUS) and CT in the diagnosis of TN stage of esophageal cancer. METHODS: Fifty-one hospitalized patients with esophageal cancer in our center from July 2002 to January 2004 were enrolled in this study. According to UICC (1997) TNM clinical stage, the TN stage results of esophageal cancer by EUS and CT examination of above 51 cases were compared with the postoperative pathological TN stage. RESULTS: (1)The accuracy rates of T and N stage by EUS were 82.4%(42/51) and 88.0%(45/51) respectively. The accuracy rates of T and N stage by CT were 52.9%(27/51) and 51.0%(26/51) respectively. The accuracy rates of T and N stage by combination of EUS and CT were 86.3%(44/51) and 90.0%(46/51). (2)The consistent condition among EUS, CT or combination of EUS and CT with pathology: The Kappa of EUS to T and N stage were 0.700(P<0.001) and 0.763(P<0.001). The Kappa of CT to T and N stage were 0.275(P=0.002) and 0.006(P=0.964). The Kappa of EUS+CT to T and N stage were 0.769(P<0.001) and 0.801(P<0.001). (3)Significant differences were found between EUS and CT:PT=0.001(chi(2)=10.079) and PN<0.001(chi(2)=16.730). No significant difference was found between EUS+CT and EUS. CONCLUSIONS: EUS can be used as important and main preoperative examination because of presenting high accuracy rate in the diagnosis of T and N stage of esophageal cancer. EUS+CT does not improve accuracy rate significantly in TN stage diagnosis of esophageal cancer.

[Benign gastric strictures after transthoracic esophagectomy and esophagogastrostomy: an analysis of 9 cases].

OBJECTIVE: To investigate the manifestations,etiology,diagnosis and treatment of benign gastric strictures after transthoracic esophagectomy and esophagogastrostomy. METHODS: From January 1998 to December 2004, 9 cases with benign gastric strictures following esophagectomy were enrolled in the study. The manifestations,radiographic and endoscopic findings, treatment were analyzed retrospectively. RESULTS: The patients included 8 males and 1 female. Benign gastric stricture is characterized by mucosa absence and proliferation of fibrous tissue in the stomach below the stoma. The age ranged from 49 to 71 years old (median age 62). The common symptom was postoperative dysphagia. The length of stricture ranged from 1.5 to 5.0 cm, and the width from 0.1 to 0.5 cm. Seven cases were treated ineffectively with simple dilation,while esophageal stent placement was performed in 8 cases successfully. After follow- up from 5 to 60 months, restenosis occurred for 11 times including stent fall-off for 6 times,stent migration for 1 times, overgrowth of granular tissues for 4 times. Other complications included cervical incision infection and massive hemorrhage in one case respectively. Restenoses were all solved with stent replacement. CONCLUSIONS: Benign gastric stricture should be diagnosed through dysphagia, barium meal and endoscopy. Placement of non-self-expandable stent or whole covered self-expandable metallic stent is the primary treatment.

[Evaluating prophylactic ligation of thoracic duct during radical resection of esophageal carcinoma].

BACKGROUND & OBJECTIVE: Prophylactic ligation of thoracic duct during the radical resection of esophageal carcinoma is usually used to prevent and treat chylothorax, but there is dispute about the effect. Its correlation to other complications and prognosis of esophageal carcinoma patients after operation has seldom been reported. The study was to evaluate its preventive effect on chylothorax and its influences on other complications and prognosis of esophageal carcinoma patients. METHODS: Clinical data from 389 patients who underwent radical transthoracic esophagectomy from Jun. 1991 to Jun. 1996 in Cancer Center of Sun Yat-sen University were retrospectively analyzed. Of the 389 patients, 171 received thoracic duct ligation (ligation group), and 218 had thoracic duct preserved (preservation group). The occurrence rates of chylothorax and other complications, and the survival rates were compared between the 2 groups. RESULTS: The occurrence rates of chylothorax were 1.17% in ligation group and 0.46% in preservation group (P<0.001). The occurrence rates of complication were 18.2% in ligation group and 11.5% in preservation group (P=0.063). Perioperative mortalities were 1.75% in ligation group and 0.92% in preservation group (P=0.658). The 1-, 2-, 3-, and 5-year survival rates were 74.3%, 52.1%, 42.1%, and 29.2% in ligation group, and 74.3%, 53.2%, 43.1%, and 29.8% in preservation group (P=0.992, 0.819, 0.841, 0.902). CONCLUSION: Prophylactic ligation of thoracic duct during esophagectomy for patients with esophageal carcinoma could not prevent chylothorax effectively, and has no obvious influence on the occurrence of other complications and survival of the patients after operation.

[Meta-analysis of postoperative adjuvant chemotherapy for localized esophageal carcinoma].

BACKGROUND & OBJECTIVE: Although adjuvant chemo-therapy is a component of combined therapy for esophageal cancer, whether it can effectively improve the survival rate remains controversial. This study was to evaluate the efficacy of adjuvant chemotherapy on advanced localized esophageal carcinoma after radical surgery. METHODS: Randomized clinical studies on surgery plus chemotherapy and surgery alone for patients with localized esophageal carcinoma from Jan. 1995 to Jun. 2005 were selected from CBMDisc, CNKI, and PubMed databases. RevMan4.2 software was used for meta-analysis. RESULTS: Seven reports were included in the meta-analysis and a total of 864 patients had been included. Compared with that of the patients underwent surgery alone, the 3-year survival rate of the patients underwent surgery plus adjuvant chemotherapy was significantly elevated, with the combined relative risk (RRs) of 0.83 (P=0.009, 95% confidence interval = 0.71-0.95). CONCLUSION: Postoperative adjuvant chemotherapy can improve the 3-year survival rate of the patients with esophageal carcinoma.

Influence of culture conditions on laccase production and isozyme patterns in the white-rot fungus Trametes gallica.

Laccase production by the white-rot fungus Trametes gallica was studied, using twelve different media under static or shaking condition. The results indicated that organic nitrogen sources such as tryptone and peptone strongly improved laccase production. The application of an amino acid mixture and a lignin preparation also increased the formation of laccase, which was not observed in the presence of potato extract. Native polyacryl amide gel electrophoresis (PAGE) followed by laccase activity staining using guaiacol as the substrate was performed to analyze the laccase isozyme patterns under the different culture conditions employed. Zymograms revealed a total of twenty different laccase activity bands that appeared in individual patterns, dependent on the respective culture condition applied. This indicates that both the medium composition and the mode of incubation (static or shaking) influenced the laccase isozyme gene expression. This was the first time to report so many laccase isozymes in a fungus. Native PAGE with silver staining showed that laccases were the main protein productions in several media providing a potentially convenient way in purifying laccases from T. gallica.