Current treatment and outcome of esophageal perforation: A single-center experience and a pooled analysis.

BACKGROUND: Esophageal perforation has been one of the serious clinical emergencies, because of the high mortality and complication rates. However, the current prognosis of esophageal perforation and the outcomes of available treatment methods are not well defined. This study attempted to pool the immediate outcomes of esophageal perforation in the past 2 decades. METHODS: The clinical data of 22 consecutive adult patients with esophageal perforation in our center were analyzed. A pooled analysis was also conducted to summarize results from the literatures published between 1999 and 2020. Studies that met the inclusion criteria were assessed, and their methodological quality was examined. RESULTS: The mortality and complication rates in our center were 4.55% and 31.82%, separately. The pooled analysis included 45 studies published between 1999 and 2019, which highlighted an overall immediate mortality rate of 9.86%. Surgical treatments were associated with a pooled immediate mortality of 10.01%, and for conservative treatments of 6.49%. Besides, in the past decade, the mortality and complication rates decreased by 27.12% and 46.75%, respectively. CONCLUSIONS: In the past 2 decades, the overall immediate mortality rate of esophageal perforation was about 10% in the worldwide, and the outcomes of esophageal perforation treatment are getting better in the last 10 years. ETHICS REGISTRATION INFORMATION: LW2020011.

Non-intubated, intravenous anesthesia with spontaneous ventilation versus routine intravenous anesthesia in video-assisted thoracoscopic surgery: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To compare the feasibility and safety of video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation. Methods    A total of 80 patients undergoing VATS (48 wedge resections, 8 sympathectomies, 24 pleural biopsies) between January 2015 and June 2017 were included. Those patients were randomized into two groups. The 40 patients were enrolled as a treatment group (19 males and 21 females at age of 23.3±10.2 years) and received surgery under non-intubated intravenous anesthesia with spontaneous ventilation. And the other 40 patients were enrolled as a control group (21 males and 19 females at age of 22.2±9.9 years) and received surgery under routine intravenous anesthesia with intubated ventilation. Results    Comparing with the control group, the patients of the treatment group had lower white blood cell count (5.8×109±2.4×109 vs. 7.3×109±3.6×109, P<0.001), lower gastrointestinal adverse reaction rate (7.5% vs. 27.5%, P=0.002), lower sore throat rate (5.0% vs. 30.0%, P<0.001), lower cough grade (0.9±0.3 vs 2.1±0.5, P<0.050), shorter drainage time (1.8±1.6 d vs. 3.7±1.8 d, P<0.050) and shorter hospital stay (2.3±1.8 d vs. 5.8±2.3 d, P<0.050). Conclusion    Video-assisted thoracoscopic surgery under non-intubated, intravenous anesthesia with spontaneous ventilation is safe and feasible, which also has certain advantages in reducing the postoperative complications and promoting patients' quick recovery from surgery.

Diagnostic value of circulating miR-21: An update meta-analysis in various cancers and validation in endometrial cancer.

MiR-21 has been identified as one of the most common proto-oncogenes. It is hypothesized that up-regulated miR-21 could be served as a potential biomarker for human cancer diagnosis. However, inconsistencies or discrepancies about diagnostic accuracy of circulating miR-21 still remain. In this sense, miR-21's diagnostic value needs to be fully validated. In this study, we performed an update meta-analysis to estimate the diagnostic value of circulating miR-21 in various human cancers. Additionally, we conducted a validation test on 50 endometrial cancer patients, 50 benign lesion patients and 50 healthy controls. A systematical literature search for relevant articles was performed in Pubmed, Embase and Cochrane Library. A total of 48 studies from 39 articles, involving 3,568 cancer patients and 2,248 controls, were included in this meta-analysis. The overall sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve (AUC) were 0.76 (0.71-0.80), 0.82 (0.79-0.85), 4.3 (3.6-5.1), 0.29 (0.24-0.35), 15 (11-20) and 0.86 (0.83-0.89), respectively. In the validation test, the expression levels of serum miR-21 were significantly higher in benign lesion patients (p = 0.003) and endometrial cancer patients (p = 0.000) compared with that of healthy controls. Endometrial cancer patients showed higher miR-21 expression levels (p = 0.000) compared with benign lesion patients. In conclusion, the meta-analysis shows that circulating miR-21 has excellent performance on the diagnosis for various cancers and the validation test demonstrates that serum miR-21 could be served as a novel biomarker for endometrial carcinoma.

[Study on the association between genetic polymorphism of CYP2E1, GSTM1 and susceptibility of lung cancer].

BACKGROUND: Lung cancer is the leading cause of malignant tumor death among Chinese population. It has been known that the development of lung cancer may be associated with genetic po-lymorphism of some lung cancer related genes. The aim of this study is to evaluate the relationship between genetic polymorphism of metabolizing enzymes and susceptibility of lung cancer in Chinese population. METHODS: Polymorphism of CYP2E1 RsaI/PstI and GSTM1 was detected in 99 patients with lung cancer and 66 patients with benign pulmonary disease by PCR-RFLP and PCR. The association between genetic polymorphism and susceptibility of lung cancer was analyzed. RESULTS: No significant difference in three RsaI/PstI genotype distribution of CYP2E1 was found between lung cancer group and control group (Chi-Square=1.374, P=0.241). (2) The frequency of GSTM1-null genotype in lung cancer group was significantly higher than that in control group (57.6% vs 40.9%, Chi-Square=4.401, P=0.036). (3) The individuals who carried with GSTM1-null genotype had a 1.96 fold increased risk of lung cancer (OR=1.96, 95%CI=1.042-3.689, P=0.037) than those who carried with GSTM1-present genotype. (4) When data were stratified by smoking status, the smokers who carried with c1/c1 genotype had a significantly higher risk of lung cancer (OR=3.525, 95%CI=1.168- 10.638, P=0.025) than those never-smokers who carried with at least one c2 allel. (5) When combination of polymorphism of CYP2E1 RsaI/PstI genotype and GSTM1 genotype was analyzed, compared with individuals who had concurrent present of GSTM1 and at least one c2 allel genotype, the risk of lung cancer for combination of GSTM1 null and c1/c1 genotype was increased significantly (OR=3.449, 95%CI=1.001- 11.886, P=0.050). Considering smoking status, compared with never-smokers who had concurrent present of GSTM1 and at least one c2 allel genotype, the risk of lung cancer for combination of GSTM1 null and c1/c1 genotype was remarkably increased (OR=11.553, 95%CI=1.068-124.944, P=0.044), as well as that for combination of GSTM1 null and at least one c2 allel genotype (OR=13.374, 95%CI=1.258-142.166, P= 0.032). CONCLUSIONS: (1)GSTM1 null genotype is an important factor associated with increased risk of lung cancer. (2) The combination of c1/c1 and GSTM1-null genotype can remarkably increase risk of lung cancer both in smokers and non-smokers.

[A case-control study on the association between genetic polymorphisms of metabolizing enzymes CYP2D6 and susceptibility to lung cancer].

BACKGROUND: Genetic polymorphism in metabolic enzymes, which are involved in metabolism of environmental carcinogens, have been thought to be related to susceptibility of lung cancer. The aim of this study is to investigate the cytochrome P450 2D6(CYP2D6) genetic polymorphism distribution in Han population in Sichuan, China, and to evaluate the relationship between CYP2D6 genetic polymorphism and lung cancer susceptibility. METHODS: PCR-RFLP was used to identify CYP2D6ch genotypes among 150 patients with primary lung cancer and 152 healthy controls, in Han population in Sichuan, China, and case-control study was used to analyze the relationship between genetic polymorphism and lung cancer susceptibility. RESULTS: (1) The distribution frequency of CYP2D6ch C and T allele were 39.5% and 60.5% in control group and 46.3% and 53.7% in lung cancer group, respectively. There was no significant difference between the two groups (P=0.089). (2)The distribution frequency of C/C, C/T and T/T genotypes were 18.4%, 42.1% and 39.5% in control group, and 22.7%, 47.3% and 30.0% in lung cancer group, respectively. No significant difference was found between the two groups (P=0.215). (3) The individuals who carried with Non-T/T genotypes had a 2.084-fold increased risk with squamous cell carcinoma (95%CI 1.024-4.244, P=0.043) than those who carried with T/T genotype. (4) The lighter smokers ( < 30 pack-years) who carried with Non-T/T genotypes had a 2.92-fold increased risk with lung cancer (95%CI 1.087-7.828, P=0.033) than those who carried with T/T genotype. CONCLUSIONS: CYP2D6ch Non-T/T genotypes are factors associated mail:zhouqh@mail.sc.cninfo.net) with increased risk of squamous cell carcinoma and also increase risk of lung cancer among lighter smokers.

[Relationship between genetic polymorphism of GSTT1 gene and inherent susceptibility to lung cancer in Han population in Sichuan, China].

BACKGROUND: Some studies have supposed that glutathione S-transferases (GSTs) may be involved in detoxification of carcinogens, especially from tobacco smoke. Therefore, polymorphism of GSTs has been considered as potential protectors of individual cancer risk. The objective of this study is to investigate the relationship between genetic polymorphism of GSTT1 and inherent susceptibility to lung cancer in Han population in Sichuan, China. METHODS: A case-control study was carried out to compare the distribution frequency of GSTT1 gene polymorphism between lung cancer (n=150) and control healthy individuals (n=152) with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and to analyze the relationship between the GSTT1 gene polymorphism and smoking and the inherent susceptibility of lung cancer. RESULTS: (1) The distribution frequency of GSTT1(-) genotype was 54.7% (82/150) in lung cancer and 38.2% (58/152) in control group respectively (OR=1.681, 95%CI=1.009- 2.803 , P=0.046); (2) GSTT1(-) genotype remarkably increased the risk of squamous cell carcinoma (OR=2.969, 95%CI= 1.511 -5.834, P=0.002) and adenocarcinoma (OR=2.095, 95%CI=1.060-4.140, P= 0.033 ); (3) In smokers, GSTT1(-) genotype significantly increased the risk for lung cancer (OR=4.051, 95%CI=1.959-8.380 , P=0.000); (4) In people with GSTT1(-) genotype, smoking markedly increased the risk for lung cancer (OR=53.885, 95%CI=11.789-246.302, P=0.000); (5) In heavy smokers (≥20 packyears), GSTT1(-) genotype could remarkably increase the risk of lung cancer (OR=4.296, 95%CI=1.649-11.190, P=0.003). CONCLUSIONS: (1) People with GSTT1(-) genotype have significantly increased risk for lung cancer in Han population in Sichuan, China, especially for squamous cell carcinoma. (2) GSTT1(-) genotype interacts synergistically with smoking on lung cancer risk. The more the cigarettes smoke, the higher the risk of lung cancer increases in those people who are smokers with GSTT1(-) genotype.

[Diagnosis and treatment of pulmonary sclerosing hemangioma].

BACKGROUND: To investigate the diagnosis and treatment of pulmonary sclerosing hemangioma (PSH). METHODS: The clinical features, radiographic manifestations and treatment of 21 patients with PSH were reviewed. RESULTS: None of the 21 patients was diagnosed as PSH preoperatively. There were 18 females and 3 males, and the average age was 48.0 years in this group. Twelve patients were symptom free. The plain chest roentgenograms showed a well defined, homogeneous, round or oval nodulous shadow in most cases. All patients received operation. There was no postoperative morbidity and mortality. Postoperative follow-up showed a good prognosis. CONCLUSIONS: Preoperative diagnosis of PSH is quite difficult. PSH should be suspected in middle to old aged female patients who show a well defined, homogeneous, round or oval shadow in plain chest roentgenograms. PSH has a good prognosis if it is treated surgically.