Comparison Between Intraoperative Two-Space Injection Thoracic Paravertebral Block and Wound Infiltration as a Component of Multimodal Analgesia for Postoperative Pain Management After Video-Assisted Thoracoscopic Lobectomy: A Randomized Controlled Trial.

OBJECTIVE: To compare paravertebral block under thoracoscopy with wound infiltration at an early stage after video-assisted thoracic lobectomy surgery. DESIGN: A prospective, randomized, triple-blinded, placebo-controlled trial. SETTING: A single-center university hospital. PARTICIPANTS: Patients scheduled for video-assisted thoracic lobectomy surgery between February 20, 2014 and June 1, 2014 randomly were allocated into paravertebral block (PVB) (n = 35) and infiltration (n = 35) groups. INTERVENTIONS: In the PVB group, 0.5% ropivacaine was injected into the paravertebral space by the surgeon under direct vision with placebo infiltration of saline in the wounds. In the infiltration group, the wounds were infiltrated with 0.5% ropivacaine by the surgeon with a placebo paravertebral block. Subsequently, patient-controlled intravenous morphine analgesia and paracoxib were administered. MEASUREMENTS AND MAIN RESULTS: The primary endpoints were visual analog scale (VAS) pain scores at rest and on cough 0, 2, 6, and 24 hours after surgery. The secondary endpoints were the total morphine during postoperative 0 hours to 24 hours, adverse events, and patient satisfaction with the analgesia. Sixty-one patients completed the study. VAS score on cough at each time point was significantly lower (p<0.05) and median (25th, 75th) morphine consumption was lower in the PVB group than in the infiltration group (26 [10, 35] mg and 42 [29, 58] mg, p<0.001, respectively). There was no difference in VAS score at rest. Patients in the PVB group had higher satisfaction with analgesia than in the infiltration group (p = 0.003). CONCLUSIONS: As part of the multimodal postoperative analgesia, intraoperative paravertebral block provided better dynamic pain relief and reduced morphine consumption compared with local wound infiltration.

Upregulation of long noncoding RNA LINC00152 promotes proliferation and metastasis of esophageal squamous cell carcinoma.

Purpose: Esophageal cancer is a major cause of cancer-related mortality worldwide. The long noncoding RNA LINC00152 has been confirmed to play an oncogenic role in many cancers. However, the expression pattern and function of LINC00152 in human esophageal squamous cell carcinoma (ESCC) remain unclear. Materials and methods: We evaluated LINC00152 expression in ESCC by qPCR and in situ hybridization. Proliferation, apoptosis, cell cycle, migration and invasion were examined in ESCC cells knocked down for LINC00152 knockdown by siRNA. Furthermore, an mRNA microarray was performed in ESCC cells with LINC00152 knockdown. Results: LINC00152 was significantly upregulated in human ESCC clinical samples (P<0.001) and cell lines (P=0.008), and LINC00152 overexpression was related to lymphatic metastasis (P=0.03) and advanced pTNM classification (P=0.005). Furthermore, ESCC patients with LINC00152 overexpression had significantly shorter overall survival (P=0.007), and LINC00152 overexpression was an independent risk factor for overall survival of ESCC patients. LINC00152 knockdown inhibited the proliferation, migration and invasion of ESCC cells in vitro. In addition, mechanistic investigations through mRNA array and immunoblot analyses demonstrated that LINC00152 regulated the expression of several cell cycle-related proteins and SNARE (soluble N-ethylmaleimide-sensitive factor attachment protein receptors) interactions in vesicular transport pathway proteins. Conclusion: Our research indicated that LINC00152 exhibits oncogenic functions in ESCC and may represent a potential new target for ESCC therapy.

Effects of neoadjuvant chemotherapy combined with radiotherapy in patients with advanced esophageal carcinoma.

We analyzed the improvement of survival time and the effects of neoadjuvant chemotherapy combined with radiotherapy on treating patients with advanced esophageal carcinoma. Retrospectively, 43 patients were selected with esophageal carcinoma who were administered neoadjuvant chemotherapy combined with radiotherapy. According to gender, and tumor staging, the nearest neighbor matching was carried out. Eighty-six patients (1:2) who received neoadjuvant chemotherapy and 129 patients (1:3) who underwent surgery only were taken and compared for clinical outcomes. It was found that in the combination group, the median survival time was prolonged and the 1-year survival rate improved. The diameter of tumors was significantly reduced, and the surgical resection, margin negative and total effective rates improved. In addition, the recurrence rate significantly decreased, whereas quality of life scores significantly increased (p<0.05). The comparison of overall incidence of complications was not statistically significant (p>0.05). Tumor staging, location, and diameter after neoadjuvant therapy, as well as therapeutic regimen, treatment cycle, margin negative rate and effective rate were independent risk factors for significantly influencing survival outcomes and time (p<0.05). In conclusion, neoadjuvant chemotherapy combined with radiotherapy can be utilized to treat advanced esophageal carcinoma improve survival time and promote prognosis.

[Carinal resection and reconstruction, and bronchoplasty and pulmonary arterioplasty in the treatment of central-type lung cancer].

BACKGROUND: Boonchoplasty can not only remove tumor but also reserve lung tissue maximally, and it becomes an alternative choice for patient with poor pulmonary function who could not accept pneumonectomy. The aim of this study is to summarize the experience of carinal resection and reconstruction, bronchoplasty and pulmonary arterioplasty in the treatment of central-type lung cancer. METHODS: From March, 1987 to March, 2005, A total of 79 patients with central-type lung cancer underwent operation. The operations included: left bronchoplasty (34 cases) combined with pulmonary arterioplasty in 10 cases and partial resection of left atrium in 3 cases; right bronchoplasty (45 cases) combined with carinal resection in 14 cases and segmentplasty in 5 cases, pulmonary arterioplasty in 5 cases, partial resection of superior vena cava wall in 5 cases. RESULTS: There were no perioperative deaths. Twenty-eight cases (35.4%) had postoperative complication. The 1-, 3-and 5-year survival rate were 86.1%, 55.2% and 32.1% respectively. CONCLUSIONS: Proper selection of carinal resection, bronchoplasty and pulmonary arterioplasty can expand the indications. They can reduce the ratio of pneumonectomy and improve the postoperative quality of life and the prognosis of lung cancer patients.

Efficacy of an absorbable polyglycolic acid patch in surgery for pneumothorax due to silicosis.

BACKGROUND: We conducted a retrospective study to evaluate the efficacy and safety of an absorbable polyglycolic acid (PGA) patch in surgery for refractory pneumothorax due to silicosis. METHODS: A retrospective analysis was performed of 56 patients who received thoracotomy or thoracoscopic surgery for refractory pneumothorax due to silicosis between 1995 and 2010. An absorbable PGA patch was used as a reinforcement or repair material after resection of the bulla in 24 operations and it was not used in another 32 operations. Clinical outcomes were compared between the two groups (with a PGA and without a PGA). RESULTS: We found that the duration of postoperative chest drainage (5.04±1.12 days vs. 8.19±1.60 days, p<0.01) and hospital stay after the operation (8.33±1.34 days vs. 11.56±1.50 days, p<0.01) were significantly shorter in patients who used an absorbable PGA patch in the operation compared with those who did not use a PGA patch. The incidence of initial air leakage (58.3% [14/24] vs. 93.8% [30/32], p<0.05) and relapse rate of pneumothorax in 6 months (4% [1/24] vs. 25% [8/32], p<0.05) were also significantly lower in patients who used an absorbable PGA patch in the operation compared with those who did not use a PGA patch. No related adverse effects of the absorbable PGA patch occurred after the operations. CONCLUSIONS: Use of an absorbable PGA patch as a reinforcement or repair material in surgery for refractory pneumothorax due to silicosis can reduce postoperative air leakage and improve clinical outcome.