Pub Date : 2019-10-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.10.004
Honglei Zhao, Sichong Qian, Kai Zhang, Hong Liu, Xu-dong Pan, T. Bai, Jun Zheng, Yong-min Liu, Junming Zhu, Li-Zhong Sun
Objective To find out what the exact impact of renal malperfusion on short- and long-term postoperative prognosis of ATAAD patietns. Methods 218 patients with ATAAD undergoing surgical repair from June 2009 to May 2012 . Mean age was(47.8±10.7) years and 170 were male(78.0%). Based on computed tomographic angiography and laboratory test, 48 patients were diagnosed with preoperative renal malperfusion(22.0%). Clinical data were compared between two groups and risk factors for short- and long-term mortality identified using Cox regression. Results Patients with renal malperfusion showed significantly higher incidences of short-term mortality(22.9% vs 8.3%, P=0.023), long-term mortality(87.0% vs 72.9%, P=0.003) and postoperative acute kidney failure(20.8% vs 4.1%, P<0.001). Renal malperfusion was the risk factor for short-term mortality(OR 2.92, 95%CI 1.31-6.63, P=0.009) and long-term mortality(OR 2.56, 95%CI 1.32-4.94, P=0.005). Conclusion Renal malperfusion significantly increases the postoperative risk of short-term mortality, long-term mortality and incidence of postoperative acute renal failure in patients with ATAAD. Key words: Acute type A aortic dissection; Renal malperfusion; Mortality; Acute renal failure
{"title":"The research focus on short- and long-term postoperative prognosis of acute type A aortic dissection patient complicated with renal malperfusion","authors":"Honglei Zhao, Sichong Qian, Kai Zhang, Hong Liu, Xu-dong Pan, T. Bai, Jun Zheng, Yong-min Liu, Junming Zhu, Li-Zhong Sun","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.004","url":null,"abstract":"Objective \u0000To find out what the exact impact of renal malperfusion on short- and long-term postoperative prognosis of ATAAD patietns. \u0000 \u0000 \u0000Methods \u0000218 patients with ATAAD undergoing surgical repair from June 2009 to May 2012 . Mean age was(47.8±10.7) years and 170 were male(78.0%). Based on computed tomographic angiography and laboratory test, 48 patients were diagnosed with preoperative renal malperfusion(22.0%). Clinical data were compared between two groups and risk factors for short- and long-term mortality identified using Cox regression. \u0000 \u0000 \u0000Results \u0000Patients with renal malperfusion showed significantly higher incidences of short-term mortality(22.9% vs 8.3%, P=0.023), long-term mortality(87.0% vs 72.9%, P=0.003) and postoperative acute kidney failure(20.8% vs 4.1%, P<0.001). Renal malperfusion was the risk factor for short-term mortality(OR 2.92, 95%CI 1.31-6.63, P=0.009) and long-term mortality(OR 2.56, 95%CI 1.32-4.94, P=0.005). \u0000 \u0000 \u0000Conclusion \u0000Renal malperfusion significantly increases the postoperative risk of short-term mortality, long-term mortality and incidence of postoperative acute renal failure in patients with ATAAD. \u0000 \u0000 \u0000Key words: \u0000Acute type A aortic dissection; Renal malperfusion; Mortality; Acute renal failure","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"21 1","pages":"593-597"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89695888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.10.006
Q. Zeng, Jiagen Li, F. Lyu, Jin-feng Huang, Liangze Zhang, Shugeng Gao, Jun Zhao
Objective To analyze the causes and correlative factors of high perioperative blood transfusion demand in patients with lung tumor, and to discuss the influence of high blood transfusion demand on patients’ postoperative recovery and its predictive factors. Methods From November 2007 to October 2017, clinical data of patients who had underwent surgery for lung tumors in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences were collected. A total of 83 cases with perioperative transfusion of red blood cells ≥5U were classified as high transfusion demand group. Another 83 cases were selected from the rest of the patients with transfusion of red blood cells <5U as normal transfusion demand group. Related clinical and transfusion data were summarized to analyze the causes of high blood transfusion demand and its effect on postoperative recovery, univariate and multivariate logistic regressions were used to analyse correlative factors. Results From November 2007 to October 2017, 23 898 patients with lung tumor underwent surgery in our department and the high blood transfusion demand rate was 0.35%. In the last 10 years, the ratio of high transfusion demand was 0.61%(46/7 503) in the first 5 years versus 0.23%(37/16 395) in the later 5 years(P<0.01). By contrasting high transfusion demand group and normal transfusion demand group, the ratio of thoracoscopic surgery was 42.17%(35/83) vs. 26.51%(22/83)(P<0.05), the ratio of postoperative blood transfusion was 39.76%(33/83) vs. 22.90%(19/83)(P<0.05) and the ratio of left upper lung surgery was 24.10%(20/83) vs. 12.05%(10/83)(P<0.05). The ratio of patients with preoperative comorbidities was 21.69%(18/83) in the high transfusion demand group versus 8.43%(7/83) in the normal transfusion demand group(P<0.05), and the ratio of patients with anemia was 57.83%(48/83) vs. 52.63%(30/83)(P<0.05). The incidence of complications was 39.76%(33/83) in the high transfusion demand group versus 18.07%(15/83) in the normal transfusion demand group(P<0.01), and the incidence of Infection-related complication were 25.30%(21/83) vs. 8.43%(7/83)(P<0.01). Conclusion For perioperative high blood transfusion demand in lung tumors, there were significant differences between different operation approaches, site of operation and phase of blood transfusion. The perioperative high blood transfusion demand may also increase the risk of postoperative complications, comorbidities or anemia were its predictive factors. Key words: Lung tumor; High blood transfusion demand; Influencing factor; Postoperative complications
{"title":"Causes analysis and evaluation of correlative factors of high perioperative blood transfusion demand for patients with lung tumors","authors":"Q. Zeng, Jiagen Li, F. Lyu, Jin-feng Huang, Liangze Zhang, Shugeng Gao, Jun Zhao","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.006","url":null,"abstract":"Objective \u0000To analyze the causes and correlative factors of high perioperative blood transfusion demand in patients with lung tumor, and to discuss the influence of high blood transfusion demand on patients’ postoperative recovery and its predictive factors. \u0000 \u0000 \u0000Methods \u0000From November 2007 to October 2017, clinical data of patients who had underwent surgery for lung tumors in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences were collected. A total of 83 cases with perioperative transfusion of red blood cells ≥5U were classified as high transfusion demand group. Another 83 cases were selected from the rest of the patients with transfusion of red blood cells <5U as normal transfusion demand group. Related clinical and transfusion data were summarized to analyze the causes of high blood transfusion demand and its effect on postoperative recovery, univariate and multivariate logistic regressions were used to analyse correlative factors. \u0000 \u0000 \u0000Results \u0000From November 2007 to October 2017, 23 898 patients with lung tumor underwent surgery in our department and the high blood transfusion demand rate was 0.35%. In the last 10 years, the ratio of high transfusion demand was 0.61%(46/7 503) in the first 5 years versus 0.23%(37/16 395) in the later 5 years(P<0.01). By contrasting high transfusion demand group and normal transfusion demand group, the ratio of thoracoscopic surgery was 42.17%(35/83) vs. 26.51%(22/83)(P<0.05), the ratio of postoperative blood transfusion was 39.76%(33/83) vs. 22.90%(19/83)(P<0.05) and the ratio of left upper lung surgery was 24.10%(20/83) vs. 12.05%(10/83)(P<0.05). The ratio of patients with preoperative comorbidities was 21.69%(18/83) in the high transfusion demand group versus 8.43%(7/83) in the normal transfusion demand group(P<0.05), and the ratio of patients with anemia was 57.83%(48/83) vs. 52.63%(30/83)(P<0.05). The incidence of complications was 39.76%(33/83) in the high transfusion demand group versus 18.07%(15/83) in the normal transfusion demand group(P<0.01), and the incidence of Infection-related complication were 25.30%(21/83) vs. 8.43%(7/83)(P<0.01). \u0000 \u0000 \u0000Conclusion \u0000For perioperative high blood transfusion demand in lung tumors, there were significant differences between different operation approaches, site of operation and phase of blood transfusion. The perioperative high blood transfusion demand may also increase the risk of postoperative complications, comorbidities or anemia were its predictive factors. \u0000 \u0000 \u0000Key words: \u0000Lung tumor; High blood transfusion demand; Influencing factor; Postoperative complications","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"177 1","pages":"603-607"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74963358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.10.003
Zhaolei Jiang, J. Mei, M. Tang, N. Ma, Hao Liu, Sai'e Shen, Fang-bao Ding, Chunrong Bao
Objective To summarize the safety and effect of modified surgery for hypertrophic obstructive cardiomyopathy(HOCM) with concomitantly significant mitral regurgitation(MR) through a single transaortic approach. Methods From January 2008 to June 2018, 93 patients with HOCM and significant MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. Preoperative left ventricular outflow tract pressure gradient(LVOTPG) was 51-199 mmHg(1 mmHg=0.133 kPa). Preoperative interventricular septum thickness(IVST) was 17-30 mm. All patients had significant MR with SAM phenomenon. The modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach was performed under cardiopulmonary bypass and aortic crossclamp. Results All patients successfully underwent the surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. No early death and interventricular septal perforation were occurred. In the early postoperative period, two patient(2.15%) received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG(7-31 mmHg) and IVST(11-19 mm) were significantly decreased compared with the preoperative values(P<0.05). All patients had none or trivial MR. The mitral valve pressure gradient(MVPG) was 0-6 mmHg. SAM phenomenon disappeared in all patients. At a mean follow-up of(40.53±27.11) months, no patient had significant residual left ventricular outflow tract obstruction. All patients had none or trivial MR. No SAM phenomenon occurred. Conclusion Modified surgery of Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach could be safely and effectively applied for patients with HOCM and concomitantly significant MR. Key words: Hypertrophic obstructive cardiomyopathy; Mitral regurgitation; Edge to edge; Mitral valvuloplasty
{"title":"Modified surgery for hypertrophic obstructive cardiomyopathy with concomitantly significant mitral regurgitation through a single transaortic approach","authors":"Zhaolei Jiang, J. Mei, M. Tang, N. Ma, Hao Liu, Sai'e Shen, Fang-bao Ding, Chunrong Bao","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.003","url":null,"abstract":"Objective \u0000To summarize the safety and effect of modified surgery for hypertrophic obstructive cardiomyopathy(HOCM) with concomitantly significant mitral regurgitation(MR) through a single transaortic approach. \u0000 \u0000 \u0000Methods \u0000From January 2008 to June 2018, 93 patients with HOCM and significant MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. Preoperative left ventricular outflow tract pressure gradient(LVOTPG) was 51-199 mmHg(1 mmHg=0.133 kPa). Preoperative interventricular septum thickness(IVST) was 17-30 mm. All patients had significant MR with SAM phenomenon. The modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach was performed under cardiopulmonary bypass and aortic crossclamp. \u0000 \u0000 \u0000Results \u0000All patients successfully underwent the surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. No early death and interventricular septal perforation were occurred. In the early postoperative period, two patient(2.15%) received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG(7-31 mmHg) and IVST(11-19 mm) were significantly decreased compared with the preoperative values(P<0.05). All patients had none or trivial MR. The mitral valve pressure gradient(MVPG) was 0-6 mmHg. SAM phenomenon disappeared in all patients. At a mean follow-up of(40.53±27.11) months, no patient had significant residual left ventricular outflow tract obstruction. All patients had none or trivial MR. No SAM phenomenon occurred. \u0000 \u0000 \u0000Conclusion \u0000Modified surgery of Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach could be safely and effectively applied for patients with HOCM and concomitantly significant MR. \u0000 \u0000 \u0000Key words: \u0000Hypertrophic obstructive cardiomyopathy; Mitral regurgitation; Edge to edge; Mitral valvuloplasty","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"200 1","pages":"588-592"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76973394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.10.013
Yuan Tian, Yanxiao Liang, H. Pang
Congenital heart defects(CHD) are the most common birth defects in China. However, the etiology of most CHD remains unclear. In recent years, with the development of molecular diagnostic techniques, some researchers began to pay attention to microRNA in CNVs detected in CHD children. However, microRNA in CNVs(miRNA-CNVs) as a genetic mechanism in CHD is not known with certainty. So the research progress of the relationship between microRNA, CNVs, miRNA-CNVs and CHD were summarized in this paper.
{"title":"Research progress on microRNA and miRNA-CNVs congenital heart defects","authors":"Yuan Tian, Yanxiao Liang, H. Pang","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.013","url":null,"abstract":"Congenital heart defects(CHD) are the most common birth defects in China. However, the etiology of most CHD remains unclear. In recent years, with the development of molecular diagnostic techniques, some researchers began to pay attention to microRNA in CNVs detected in CHD children. However, microRNA in CNVs(miRNA-CNVs) as a genetic mechanism in CHD is not known with certainty. So the research progress of the relationship between microRNA, CNVs, miRNA-CNVs and CHD were summarized in this paper.","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"66 2 1","pages":"636-640"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90948571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.10.010
Yang Yang, Tie-Quan Sui
Objective To evaluate the analgesic effect of a new combined analgesic mode in the early stage of non-operative treatment of adult traumatic rib fractures. Methods A total of 93 patients with rib fractures who did not receive surgical treatment from January 2014 to January 2018 were prospectively included, and randomly divided into the traditional analgesia group, subcutaneous analgesia group and combined analgesia group(31 cases each). There were 56 males and 37 females totally with a median age of(47.3±13.2)years. All patients have moderate to severe pain with VAS scores greater than 5. Traditional analgesia group: lornoxicam 8 mg intravenous injection twice daily. Subcutaneous analgesia group: only subcutaneous self-controlled analgesia pump was used for treatment. Combined analgesia group: on the basis of the traditional analgesia group, subcutaneous self-controlled analgesia pump was added for treatment, and the dosage of the pump drug was the same as that of subcutaneous analgesia group. The VAS scores at tranquillization and cough were compared before analgesia treatment(T1), 24 h(T2), 48 h(T3) and 72 h(T4) after analgesic treatment in each group during bed brake within 3 days after injury. The VAS scores after 78 hours of analgesic treatment during ambulation were compared. When sudden pain with VAS score greater than 7 occurred within 72 hours of bed staying treatment in each group, the average daily use times of bucinnazine hydrochloride 100mg remedial analgesia were compared. The number of adverse reactions such as nausea and pneumonia in each group was compared. Results The VAS scores of resting pain and cough pain at the observation time point(T2-T4) in the combined analgesia group were better than those in the subcutaneous analgesia group and the traditional analgesia group, showing a significant difference(P<0.05). When getting out of bed, there were significant differences in pain scores among the three groups, and the pain score of the combined analgesia group was the lowest. There was a significant difference among the three groups in the number of daily additions of bucinnazine hydrochloride during remedial analgesia(P<0.05), the combined analgesia group was the least. Between the two groups of patients using analgesic pump, the number of self-compressions in the combined analgesia group was lower than that in the subcutaneous analgesia group(P<0.05). The incidence of pneumonia in the combined analgesia group was lower than that in the other two groups and the incidence of other adverse reactions such as nausea was lower than that in the simple analgesia group. Conclusion In the early stage of non-operative treatment of traumatic rib fractures in adults, the multi-mode analgesic effect of traditional intravenous intermittent administration combined with subcutaneous continuous administration is superior to the single analgesic mode of traditional intravenous or subcutaneous administration with no obvious adve
{"title":"Application of multi-mode combined analgesia in the early stage of non-operative treatment of traumatic rib fractures in adults","authors":"Yang Yang, Tie-Quan Sui","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.010","url":null,"abstract":"Objective \u0000To evaluate the analgesic effect of a new combined analgesic mode in the early stage of non-operative treatment of adult traumatic rib fractures. \u0000 \u0000 \u0000Methods \u0000A total of 93 patients with rib fractures who did not receive surgical treatment from January 2014 to January 2018 were prospectively included, and randomly divided into the traditional analgesia group, subcutaneous analgesia group and combined analgesia group(31 cases each). There were 56 males and 37 females totally with a median age of(47.3±13.2)years. All patients have moderate to severe pain with VAS scores greater than 5. Traditional analgesia group: lornoxicam 8 mg intravenous injection twice daily. Subcutaneous analgesia group: only subcutaneous self-controlled analgesia pump was used for treatment. Combined analgesia group: on the basis of the traditional analgesia group, subcutaneous self-controlled analgesia pump was added for treatment, and the dosage of the pump drug was the same as that of subcutaneous analgesia group. The VAS scores at tranquillization and cough were compared before analgesia treatment(T1), 24 h(T2), 48 h(T3) and 72 h(T4) after analgesic treatment in each group during bed brake within 3 days after injury. The VAS scores after 78 hours of analgesic treatment during ambulation were compared. When sudden pain with VAS score greater than 7 occurred within 72 hours of bed staying treatment in each group, the average daily use times of bucinnazine hydrochloride 100mg remedial analgesia were compared. The number of adverse reactions such as nausea and pneumonia in each group was compared. \u0000 \u0000 \u0000Results \u0000The VAS scores of resting pain and cough pain at the observation time point(T2-T4) in the combined analgesia group were better than those in the subcutaneous analgesia group and the traditional analgesia group, showing a significant difference(P<0.05). When getting out of bed, there were significant differences in pain scores among the three groups, and the pain score of the combined analgesia group was the lowest. There was a significant difference among the three groups in the number of daily additions of bucinnazine hydrochloride during remedial analgesia(P<0.05), the combined analgesia group was the least. Between the two groups of patients using analgesic pump, the number of self-compressions in the combined analgesia group was lower than that in the subcutaneous analgesia group(P<0.05). The incidence of pneumonia in the combined analgesia group was lower than that in the other two groups and the incidence of other adverse reactions such as nausea was lower than that in the simple analgesia group. \u0000 \u0000 \u0000Conclusion \u0000In the early stage of non-operative treatment of traumatic rib fractures in adults, the multi-mode analgesic effect of traditional intravenous intermittent administration combined with subcutaneous continuous administration is superior to the single analgesic mode of traditional intravenous or subcutaneous administration with no obvious adve","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"5 1","pages":"623-628"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90149071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.10.005
Jiashun Cao, Fan Yang, Weipeng Zhu, Qiu Li, Z. Long, Donghong Chen
Objective To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection. Methods 171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64.1±7.7) years. 54.4% had a history of smoking. The diameter of the tumors was(3.3±1.9) cm; Central-type tumor were 59 cases(34.5%), peripheral 112 cases(65.5%), upper lobe 95 cases(55.6%) and lower lobe 76 cases(44.4%). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors. Results The metastasis rate of station 4L was 21.6%. Tumor size, locations(central type/upper lobe), operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univariate analysis. Tumor size(OR=1.611, P=0.032) and location of upper lobe(OR=2.823, P=0.008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2.5cm. The metastatic rate of 4L was 32.6% when tumor size larger than 2.5 cm and 7.9% when tumor size smaller than 2.5cm.Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7. Conclusion Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2.5 cm or located at upper lobe. Key words: Lung tumor; Lymph node metastasis
{"title":"Pattern of 4L LN metastasis in left lung cancer and its influence on complete resection","authors":"Jiashun Cao, Fan Yang, Weipeng Zhu, Qiu Li, Z. Long, Donghong Chen","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.005","url":null,"abstract":"Objective \u0000To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection. \u0000 \u0000 \u0000Methods \u0000171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64.1±7.7) years. 54.4% had a history of smoking. The diameter of the tumors was(3.3±1.9) cm; Central-type tumor were 59 cases(34.5%), peripheral 112 cases(65.5%), upper lobe 95 cases(55.6%) and lower lobe 76 cases(44.4%). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors. \u0000 \u0000 \u0000Results \u0000The metastasis rate of station 4L was 21.6%. Tumor size, locations(central type/upper lobe), operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univariate analysis. Tumor size(OR=1.611, P=0.032) and location of upper lobe(OR=2.823, P=0.008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2.5cm. The metastatic rate of 4L was 32.6% when tumor size larger than 2.5 cm and 7.9% when tumor size smaller than 2.5cm.Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7. \u0000 \u0000 \u0000Conclusion \u0000Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2.5 cm or located at upper lobe. \u0000 \u0000 \u0000Key words: \u0000Lung tumor; Lymph node metastasis","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"51 1","pages":"598-602"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84454082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.10.007
Kai Li, Yue-jun Chen, G. Xiao, Qiu-yi Zou, Yi Tang, Wen-Chieh Huang, Zan Li
Objective To evaluate the clinical value of the the hypopharynx and chest esophageal carcinoma. Methods 20 patients surgical treatment data of the hypopharynx and chest esophageal carcinoma from January 2013 to July 2019 were reviewed. Results The simultaneous hypopharynx and esophageal carcinoma 11 cases. The heterochronic hypopharynx and chest esophageal carcinoma 9 cases. 20 cases are all squamous cell carcinoma. The synchronus operation included total pharyngolaryngo esophagectomy, gastric tube interposition pharyngo gastric anastomic, neck and mediastinal lymph nodes dissection, tracheostomy. The heterochronic operation included the first stage radical hypopharygealectomy, the second stage radical esophagealectomy. Postoperative complications included in hospital death in one, double pneumonia in 3 and anastomosis stricture in one case. Pharynx gastric fistula in 2. Swallowing function were all recovered. Conclusion Although laryngo pharyngo esophagectomy and pharyngogastric anastomoses for the hypopharynx and chest esophageal carcinoma is a simple and acceptable procedure, the quality of life is not satisfactory. And although colon interpasation for esophageal replacement is complicated the quality of life is the best. Key words: Esophageal-neoplasms; Hypopharyngeal-neoplasms; Surgery
{"title":"Surgical treatment of the hypopharynx and chest esophageal carcinoma","authors":"Kai Li, Yue-jun Chen, G. Xiao, Qiu-yi Zou, Yi Tang, Wen-Chieh Huang, Zan Li","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.007","url":null,"abstract":"Objective \u0000To evaluate the clinical value of the the hypopharynx and chest esophageal carcinoma. \u0000 \u0000 \u0000Methods \u000020 patients surgical treatment data of the hypopharynx and chest esophageal carcinoma from January 2013 to July 2019 were reviewed. \u0000 \u0000 \u0000Results \u0000The simultaneous hypopharynx and esophageal carcinoma 11 cases. The heterochronic hypopharynx and chest esophageal carcinoma 9 cases. 20 cases are all squamous cell carcinoma. The synchronus operation included total pharyngolaryngo esophagectomy, gastric tube interposition pharyngo gastric anastomic, neck and mediastinal lymph nodes dissection, tracheostomy. The heterochronic operation included the first stage radical hypopharygealectomy, the second stage radical esophagealectomy. Postoperative complications included in hospital death in one, double pneumonia in 3 and anastomosis stricture in one case. Pharynx gastric fistula in 2. Swallowing function were all recovered. \u0000 \u0000 \u0000Conclusion \u0000Although laryngo pharyngo esophagectomy and pharyngogastric anastomoses for the hypopharynx and chest esophageal carcinoma is a simple and acceptable procedure, the quality of life is not satisfactory. And although colon interpasation for esophageal replacement is complicated the quality of life is the best. \u0000 \u0000 \u0000Key words: \u0000Esophageal-neoplasms; Hypopharyngeal-neoplasms; Surgery","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"65 1","pages":"608-611"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90359891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.10.011
Hongchao Wei, C. Gu, Yang Yu, Chuan Wang, M. Gao, Haitao Li, Jing-xing Li
Objective To observe the cardiomyocytes regeneration after myocardial infarction in Chinese small pigs, analyze the mechanism of myocardial fibrosis after myocardial regeneration. Methods Nine Chinese small pigs, weight 18-20 kg, 6 pigs in the experimental group(to ligate LAD at the equal blood flow point), and 3 in the control group(no any operation was performed). Monitor the hemodynamics of the left ventricle. Cardiac specimens were taken after 4 weeks of LAD ligation, the left ventricle was divided into 17 segments, and fixed in 4% paraformaldehyde for 1 week. Hematoxylin-Eosin/(HE) staining, PTAH、Ki-67-DAB and α-sarcomeric-actin-DAB staining for pathological observation. Results Four weeks of LAD ligation, different range of infarct size could be found in all the 17 segment of left ventricle. There was significant systolic pressure difference between the proximal and distal part in the left ventricular cavity. After 4 weeks of LAD ligation, there were a large number of new cardiomyocytes around the infarction area, which connected with the original mature cardiomyocytes directly. Large number of disassembled cardiomyocytes in the infarcted area and myocardial fibers were broken, cell structure disappeared, and nuclei were scattered in fibrotic tissues. Conclusion New cardiomyocytes after myocardial infarction were derived from the mature cardiomyocytes. Myocardial regeneration, cell disintegration, and myocardial fibrosis were performed synchronously under the influence of myocardial tension. Key words: Acute myocardial infarction; Myocardial regeneration; Fibrillation; Myocardial tension; Heart failure
{"title":"The synchronous mechanism of myocardial regeneration-cell disintegration-myocardial fibrosis and its relationship with heart failure","authors":"Hongchao Wei, C. Gu, Yang Yu, Chuan Wang, M. Gao, Haitao Li, Jing-xing Li","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.011","url":null,"abstract":"Objective \u0000To observe the cardiomyocytes regeneration after myocardial infarction in Chinese small pigs, analyze the mechanism of myocardial fibrosis after myocardial regeneration. \u0000 \u0000 \u0000Methods \u0000Nine Chinese small pigs, weight 18-20 kg, 6 pigs in the experimental group(to ligate LAD at the equal blood flow point), and 3 in the control group(no any operation was performed). Monitor the hemodynamics of the left ventricle. Cardiac specimens were taken after 4 weeks of LAD ligation, the left ventricle was divided into 17 segments, and fixed in 4% paraformaldehyde for 1 week. Hematoxylin-Eosin/(HE) staining, PTAH、Ki-67-DAB and α-sarcomeric-actin-DAB staining for pathological observation. \u0000 \u0000 \u0000Results \u0000Four weeks of LAD ligation, different range of infarct size could be found in all the 17 segment of left ventricle. There was significant systolic pressure difference between the proximal and distal part in the left ventricular cavity. After 4 weeks of LAD ligation, there were a large number of new cardiomyocytes around the infarction area, which connected with the original mature cardiomyocytes directly. Large number of disassembled cardiomyocytes in the infarcted area and myocardial fibers were broken, cell structure disappeared, and nuclei were scattered in fibrotic tissues. \u0000 \u0000 \u0000Conclusion \u0000New cardiomyocytes after myocardial infarction were derived from the mature cardiomyocytes. Myocardial regeneration, cell disintegration, and myocardial fibrosis were performed synchronously under the influence of myocardial tension. \u0000 \u0000 \u0000Key words: \u0000Acute myocardial infarction; Myocardial regeneration; Fibrillation; Myocardial tension; Heart failure","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"102 1","pages":"629-634"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90965645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.10.009
Delin Liu, Yuguang Wang, Min-Na Wang, Yuan Liu, Li-Shan Cheng, Qifeng Zhang, Xiaoxue Yin, Wei Liu, G. Ye
Objective To investigate the prognostic value of arterial blood lactate for patients with cardiogenic shock receiving extracorporeal membrane oxygenation(ECMO). Methods A retrospective analysis was conducted. Twenty-three patients diagnosed with cardiogenic shock receiving veno-arterial(V-A) ECMO admitted to department of Emergency Intensive Care Unit(EICU) of Beijing Luhe Hospital Affiliated to Capital Medical University from January 2017 to December 2018 were enrolled. Results There were 10 cases in the survival group and 13 cases in the death group. Compared with survival group, APACHE-Ⅱ score was higher, CRRT applied higher percentage, PH and oxygenation index was worse in the death group(P 0.05). On the 2nd day of ECMO operation, CRRT usage time was shorter and daily liquid balance was more negative in the survival group(P<0.05). APACHE-Ⅱscore, initial lactate at EICU, lactate at ECMO 8 h and lactate at ECMO 12 h had predictive value for 30-day death of patients. The area under ROC curve(AUC) of initial lactate at EICU was 0.845, and 95% confidence interval(95%CI)=0.653-1.000. The AUC of ECMO 8 h lactate was 0.836, 95%CI: 0.634-1.000. The AUC of ECMO 12 h lactate was 0.873, 95%CI: 0.697-1.000. The AUC of APACHE-Ⅱscore was 0.891, 95%CI: 0.717-1.000. The sensitivity and specificity of prognosis prediction were 72.7% and 100% when lactate was more than 7.3 mmol/L at the time of admission into EICU as the optimal critical value. Conclusion Arterial blood lactate could be used as an important marker for evaluating the prognosis of cardiogenic shock patients on ECMO. The value of lactate clearance rate may be affected by combined CRRT. Key words: Lactate; Extracorporeal membrane oxygenation; Cardiogenic shock; Prognosis
{"title":"Prognostic value of arterial blood lactate for patients with cardiogenic shock receiving extracorporeal membrane oxygenation","authors":"Delin Liu, Yuguang Wang, Min-Na Wang, Yuan Liu, Li-Shan Cheng, Qifeng Zhang, Xiaoxue Yin, Wei Liu, G. Ye","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.10.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.10.009","url":null,"abstract":"Objective \u0000To investigate the prognostic value of arterial blood lactate for patients with cardiogenic shock receiving extracorporeal membrane oxygenation(ECMO). \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted. Twenty-three patients diagnosed with cardiogenic shock receiving veno-arterial(V-A) ECMO admitted to department of Emergency Intensive Care Unit(EICU) of Beijing Luhe Hospital Affiliated to Capital Medical University from January 2017 to December 2018 were enrolled. \u0000 \u0000 \u0000Results \u0000There were 10 cases in the survival group and 13 cases in the death group. Compared with survival group, APACHE-Ⅱ score was higher, CRRT applied higher percentage, PH and oxygenation index was worse in the death group(P 0.05). On the 2nd day of ECMO operation, CRRT usage time was shorter and daily liquid balance was more negative in the survival group(P<0.05). APACHE-Ⅱscore, initial lactate at EICU, lactate at ECMO 8 h and lactate at ECMO 12 h had predictive value for 30-day death of patients. The area under ROC curve(AUC) of initial lactate at EICU was 0.845, and 95% confidence interval(95%CI)=0.653-1.000. The AUC of ECMO 8 h lactate was 0.836, 95%CI: 0.634-1.000. The AUC of ECMO 12 h lactate was 0.873, 95%CI: 0.697-1.000. The AUC of APACHE-Ⅱscore was 0.891, 95%CI: 0.717-1.000. The sensitivity and specificity of prognosis prediction were 72.7% and 100% when lactate was more than 7.3 mmol/L at the time of admission into EICU as the optimal critical value. \u0000 \u0000 \u0000Conclusion \u0000Arterial blood lactate could be used as an important marker for evaluating the prognosis of cardiogenic shock patients on ECMO. The value of lactate clearance rate may be affected by combined CRRT. \u0000 \u0000 \u0000Key words: \u0000Lactate; Extracorporeal membrane oxygenation; Cardiogenic shock; Prognosis","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"12 1","pages":"617-622"},"PeriodicalIF":0.0,"publicationDate":"2019-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81528922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.09.010
Zulei Zhang, Wei Yang, Yi Gong, M. You, Weichang Xu, Chao Lu, Xiao Dong
Objective To explore the differences in brain protection between anterograde cerebral perfusion(ACP) and retrograde cerebral perfusion(RCP) in aortic arch surgery. Methods Aortic arch circulatory surgery, ACP and RCP techniques were searched at the Cochrane Library, PubMed, EMBASE, Wanfang Database and the Chinese Biomedical Database from January 2013 to December 2018. Cohort studies were then performed with early postoperative death, transient neurological dysfunction(TND), stroke, and transient ischemic attack(TIA). For each study, data on endpoints in the ACP and RCP groups were used to generate risk ratios(RR) and 95% confidence intervals(CI). The funnel chart was used to test publication bias. Results A total of 6 692 patients were enrolled in 12 studies, of which 3 902 patients received low-temperature circulatory arrest plus ACP, and 2 790 patients received low-temperature circulatory arrest plus RCP. Summary analysis showed that the early postoperative death(RR=0.83, 95%CI=0.51-1.35, P=0.46), stroke(RR=1.09, 95%CI=0.91-1.31, P=0.33), transient neurological dysfunction(RR=0.81, 95%CI=0.17-3.91, P=0.80) and transient ischemic attack(RR=1.00, 95%CI=0.74-1.34, P=1.00) in both groups were no significant differences(all P>0.05). Conclusion There are no significant differences in postoperative mortality and neurological dysfunction between antegrade cerebral perfusion and retrograde cerebral perfusion in the aortic arch surgery. Combined with hypothermic circulatory arrest, it can be selected according to the actual situation of aortic arch surgery. Key words: Aortic arch surgery Antegrade cerebral perfusion Retrograde cerebral perfusion Brain protection
{"title":"Meta-analysis of the effects of anterograde and retrograde cerebral perfusion in aortic arch surgery","authors":"Zulei Zhang, Wei Yang, Yi Gong, M. You, Weichang Xu, Chao Lu, Xiao Dong","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.09.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.09.010","url":null,"abstract":"Objective \u0000To explore the differences in brain protection between anterograde cerebral perfusion(ACP) and retrograde cerebral perfusion(RCP) in aortic arch surgery. \u0000 \u0000 \u0000Methods \u0000Aortic arch circulatory surgery, ACP and RCP techniques were searched at the Cochrane Library, PubMed, EMBASE, Wanfang Database and the Chinese Biomedical Database from January 2013 to December 2018. Cohort studies were then performed with early postoperative death, transient neurological dysfunction(TND), stroke, and transient ischemic attack(TIA). For each study, data on endpoints in the ACP and RCP groups were used to generate risk ratios(RR) and 95% confidence intervals(CI). The funnel chart was used to test publication bias. \u0000 \u0000 \u0000Results \u0000A total of 6 692 patients were enrolled in 12 studies, of which 3 902 patients received low-temperature circulatory arrest plus ACP, and 2 790 patients received low-temperature circulatory arrest plus RCP. Summary analysis showed that the early postoperative death(RR=0.83, 95%CI=0.51-1.35, P=0.46), stroke(RR=1.09, 95%CI=0.91-1.31, P=0.33), transient neurological dysfunction(RR=0.81, 95%CI=0.17-3.91, P=0.80) and transient ischemic attack(RR=1.00, 95%CI=0.74-1.34, P=1.00) in both groups were no significant differences(all P>0.05). \u0000 \u0000 \u0000Conclusion \u0000There are no significant differences in postoperative mortality and neurological dysfunction between antegrade cerebral perfusion and retrograde cerebral perfusion in the aortic arch surgery. Combined with hypothermic circulatory arrest, it can be selected according to the actual situation of aortic arch surgery. \u0000 \u0000 \u0000Key words: \u0000Aortic arch surgery Antegrade cerebral perfusion Retrograde cerebral perfusion Brain protection","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"6 1","pages":"546-550"},"PeriodicalIF":0.0,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75426204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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