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Surgical management of superior sulcus desmoid tumor in the left lung: A case report

Desmoid tumor is a rare, locally-invasive fibromatosis with a high recurrence rate and non-metastatic features. Here, we reported a 62-year male patient with desmoid tumor in the superior sulcus of left lung, complaining of cough, chest pain, limited-movement, and pain on the left upper arm. We performed extended resection of the tumor, including wedge resection of the left upper lobe, resection and anastomosis of partial left subclavian artery, resection of T1 nerve root, cauterization of adhesive pleura, and resection of the left first and second ribs. After surgery, the patient's symptoms were relived. The duration of hospital stay was 8 d. This is the first reported case of surgical treatment for the superior sulcus desmoid tumor.

白介素-2在肺切除术后持续性肺漏气治疗中的应用

目的　观察经胸腔引流管灌注白介素-2治疗肺切除术后持续性肺漏气的临床疗效，探讨该方法在临床治疗中的应用价值。 方法　2012年1月－12月对26例肺切除术后持续性肺漏气患者行白介素-2胸膜腔灌注，观察其疗效及不良反应情况。 结果　15例Ⅰ级漏气、6例Ⅱ级漏气患者经1 次灌注重组人白介素-2后治愈；3例Ⅱ级漏气及1例Ⅲ级漏气经两次注药后治愈；1例Ⅲ级漏气者行3次注药后治愈。从第1次注射药至肺漏气停止时间为1 h～5 d，平均1.3 d。2例出现注药后低热，未观察到其他相关并发症发生。 结论　经胸腔引流管灌注重组人白介素-2治疗肺切除术后持续性肺漏气，其疗效确切，不良反应发生率低，可作为治疗持续性肺漏气的有效方法。

电视纵隔镜诊断不明性质的纵隔或肺部病变

摘要： 目的 探讨电视纵隔镜检查在不明原因纵隔或肺部病变诊断中的可靠性和安全性。 方法 2003年10月至2008年5月我科收治61例不明性质的纵隔或肺部疾病患者，男43例，女18例；年龄16～71岁，平均年龄47岁。采用单腔气管内插管全身麻醉，行电视纵隔镜活检术，经颈入路57例，经胸骨旁入路4例。 结果 术中损伤无名动脉1例，中转开胸止血并活检；另60例均获得满意病理学标本，确切诊断率为100%，敏感性为100%，特异性为100%。病理诊断：纵隔原发性恶性肿瘤9例，纵隔良性肿瘤1 例，淋巴瘤 2例，结核32例，纵隔淋巴结转移12 例，淋巴结反应性增生4例。术后切口愈合不良3例；围术期死亡1例。 结论 电视纵隔镜检查术是一种创伤小、有效的诊断性检查方法，但对伴有上腔静脉综合征患者应重视手术风险。

电视胸腔镜手术中缝线定位法在肺部非浅表小结节活检和切除术中的应用

目的　介绍电视胸腔镜手术中缝线定位法在肺部非浅表结节活检及切除术中的应用。 方法 回顾性分析华西医院胸外科2010年1月至2012年12月间所行的胸腔镜肺小结节楔形切除活检及肺段切除的患者52例的临床资料，其中男26例、女26例，年龄38～81 （54.0±11.6） 岁。术中以腔镜肺叶钳经副操作孔将目标肺叶向主操作孔牵拉，手指通过主操作孔对目标区域进行触诊，探及感知到结节后用2-0带针缝线于结节所投射的肺表面缝合一针作为目标结节切除的牵引线或标记线。 结果 本组52例患者均于胸腔镜下取得病理学诊断，肿瘤直径0.6～2.2（1.6±0.4） cm，且肿瘤与正常肺组织切缘≥2 cm，切缘阴性。原发性肺癌31例（59.6%），其中毛玻璃样病变（GGO）占51.6% （16/31）；转移瘤7例（13.5%）；良性病变13例（25.0%）。本组平均术后住院时间（6.4±2.7） d，主要术后并发症为：术后持续肺漏气＞7 d和术后咯血。全组患者无围手术期死亡。 结论 本方法可使肺部非浅表小结节易于定位，应用条件也无特殊要求，值得推广。

钢筋贯穿胸腹盆腔急诊救治一例

Effect of Uroacitides on Cell Cycle Progression of Breast Cancer Cells

【Abstract】ObjectiveTo investigate the effect of CDAⅡ on the cell cycle progression of breast cancer cells.MethodsThe effects of CDAⅡ on growth curve, cell cycle progression and morphology of breast cancer cell lines MCF7 and MDAMB231 were observed when CDAⅡ and MCF7 or CDAⅡ and MDAMB231 were blended to cultivate in vitro, in comparison with the classical cell differentiation inducer ATRA. ResultsCDAⅡ decreased the growth speed and inhibit proliferation ability in breast cancer cell lines MCF7 and MDAMB231.It caused G0/G1 phase block of cell cycle and reduced the rate of S phase of breast cancer cells. ConclusionCDAⅡ has remarkable effect of anticellproliferation and can induce cell cycle block of G0/G1 on breast cancer cells. This results provide experimental bases for the treatment of breast cancer with CDAⅡ.

Rebalancing theory of shoulder stability mechanism for the diseases related to the shoulder instability and dysfunction of motion

Objective To introduce a new theory of shoulder stability mechanism, rebalancing theory, and clinical application of this new theory for the shoulder instability and dysfunction of motion. Methods Through extensive review of the literature related to shoulder instability and dysfunction of the motion in recent years, combined with our clinical practice experience, the internal relation between passive stability mechanism and dynamic stability mechanism were summarized. Results Rebalancing theory of shoulder stability mechanism is addressed, namely, when the shoulder stability mechanism is destructive, the stability of the shoulder can be restored by the rebalance between dynamic stability mechanism and passive stability mechanism. When dynamic stability is out of balance, dynamic stability can be restored by rebalancing the different parts of dynamic stability mechanism or to strengthen the passive stability mechanism. When passive stability mechanism is out of balance, passive stability can be restored by rebalancing the soft tissue and bone of the shoulder. ConclusionRebalancing theory of shoulder stability mechanism could make a understanding the occurrence, development, and prognosis of shoulder instability and dysfunction from a comprehensive and dynamic view and guide the treatment effectively.

Value of new blood biochemical scoring system in predicting severity and mortality of acute pancreatitis

ObjectiveTo investigate predictive value of a new blood biochemical scoring system (CPWAG scoring system) on severity and mortality of acute pancreatitis (AP).MethodsThe AP patients who met the inclusion and exclusion criteria in our hospital from January 2017 to June 2019 were collected, then were divided into severe acute pancreatitis (SAP) group and non-SAP group according to the latest Atlanta classification. The differences of clinical characteristics and related blood biochemical indicators between the SAP group and the non-SAP group were compared. Univariate logistic regression analysis was used to screen blood biochemical risk indicators related to SAP. The receiver operating characteristic (ROC) curve was used to obtain the best cut-off value corresponding to the maximum Youden index of statistical significant risk factors and was assigned as 0 or 1 point according to different situations. At the same time, the pleural effusion of the BISAP score was included and assigned as 0 (yes) or 1 (no) point, then the CPWAG score was obtained by adding the point of the above indexes.The areas under the ROC curve (AUC) of the CPWAG, BISAP, APACHEⅡ, CTSI, and Ranson scoring systems in predicting severity and death of AP patients were also compared.ResultsA total of 451 patients with AP were included in this study, including 85 patients with SAP and 366 patients with non-SAP. Compared with the non-SAP group, the etiology of AP was mainly biliary (P<0.05), with higher levels of white blood cell count (WBC), C reactive protein (CRP), procalcitonin (PCT), and glucose (P<0.05), greater red blood cell distribution width value (P<0.05), longer prothrombin time (PT) and hospital stay (P<0.05), lower albumin (ALB) and blood calcium levels (P<0.05), higher BISAP, APACHEⅡ, CTSI and Ranson points (P<0.05), and higher proportions of patients with pleural effusion, multiple organ dysfunction syndrome, and death (P<0.05) in the SAP group. The highest score of the CPWAG scoring system included CRP, PCT, WBC, ALB, glucose, blood calcium, and pleural effusion was 7. With the increase of CPWAG score, the proportion of SAP and death patients showed an increasing trend (P<0.001). The AUC of the CPWAG scoring system in predicting SAP was 0.866, which was higher than those of Ranson (AUC=0.722, Z=5.317, P<0.001), APACHEⅡ (AUC=0.706, Z=5.019, P<0.001), and CTSI (AUC=0.805, Z=1.962, P=0.005) scoring system, but which had no statistically significant difference as compared with the BISAP scoring system (AUC=0.819, Z=1.816, P=0.070). The AUC of the CPWAG scoring system in predicting death had a high ability (AUC=0.823), which had no significant differences as compared with the Ranson, APACHEⅡ, CTSI, and BISAP scoring systems (P>0.05).ConclusionThe CPWAG score is valuable in predicting the severity and mortality of AP patients, allowing accurate and early assessment of AP patients.

The value of early scoring system combined with CRP in early diagnosis and prognosis of acute pancreatitis complicated with pulmonary infection

ObjectiveTo analyze the clinical characteristics of acute pancreatitis (AP) complicated with pulmonary infection and to explore the value of BISAP, APACHEⅡ and CTSI scores combined with C-reactive protein (CRP) in early diagnosis and prognosis of AP complicated with pulmonary infection.MethodsFour hundreds and eighty-four cases of AP treated in the Affiliated Hospital of North Sichuan Medical College from January 2018 to January 2020 were selected. After screening, 460 cases were included as the study object, and the patients with pulmonary infection were classified as the infection group (n=114). Those without pulmonary infection were classified as the control group (n=346). The baseline data, clinical characteristics, laboratory test indexes, length of stay, hospitalization cost, and outcome of the two groups were collected, and the risk factors and early predictive indexes of pulmonary infection in patients with AP were analyzed.ResultsHospitalization days and expenses, outcome, fluid replacement within 24 hours, drinking, smoking, age, APACHEⅡ score, BISAP score, CTSI score, hemoglobin (Hb), albumin (ALB), CRP, procalcitonin (PCT), total bilirubin (TB), lymphocyte count, international standardized ratio (INR), blood glucose, and blood calcium, there were significant differences between the two groups (P<0.05). There were no significant difference in BMI, sex, recurrence rate, fatty liver grade, proportion of patients with hypertension and diabetes between the two groups (P>0.05). The significant indexes of univariate analysis were included in multivariate regression analysis, the results showed that Hb≤120 g/L, CRP≥56 mg/L, PCT≥1.65 ng/mL, serum calcium≤2.01 mmol/L, BISAP score≥3, APACHEⅡ score≥8, CTSI score≥3, and drinking alcohol were independent risk factors of AP complicated with pulmonary infection. The working characteristic curve of the subjects showed that the area under the curve (AUC) of CRP, BISAP score, APACHEⅡ score and CTSI score were 0.846, 0.856, 0.882, 0.783, respectively, and the AUC of the four combined tests was 0.952. The AUC of the four combined tests was significantly higher than that of each single test (P<0.05).Conclusions The CRP level, Apache Ⅱ score, bisap score and CTSI score of AP patients with pulmonary infection are significantly higher, which are closely related to the severity and prognosis of AP patients with pulmonary infection. The combined detection of the four items has more predictive value than the single detection in the early diagnosis and prognosis evaluation of AP complicated with pulmonary infection. Its application in clinic is of great significance to shorten the duration of hospitalization and reduce the cost of hospitalization and mortality.

Clinical application and learning curve of uniportal thoracoscopy

ObjectiveTo analyze the operation outcomes and learning curve of uniportal video-assisted thoracoscopic surgery (VATS).MethodsAll consecutive patients who underwent uniportal VATS between November 2018 and December 2020 in Shangjin Branch of West China Hospital of Sichuan University were retrospectively enrolled, including 62 males and 86 females with a mean age of 50.1±13.4 years. Operations included lobectomy, segmentectomy, wedge resection, mediastinal mass resection and hemopneumothorax. Accordingly, patients' clinical features in different phases were collected and compared to determine the outcome difference and learning curve for uniportal VATS.ResultsMedian postoperative hospital stay was 5 days, and the overall complication rate was 8.1% (12/148). There was no 30-day death after surgery or readmissions. Median postoperative pain score was 3. Over time, the operation time, incision length and blood loss were optimized in the uniportal VATS lobectomy, the incision length and blood loss increased in the uniportal VATS segmentectomy, and the postoperative hospital stay decreased in the uniportal VATS wedge resection.ConclusionUniportal VATS is safe and feasible for both standard and complex pulmonary resections. While, no remarkable learning curve for uniportal VATS lobectomy is observed for experienced surgeon.