恶性气道狭窄患者介入治疗的临床分析

目的 研究介入技术对恶性气道狭窄患者的治疗效果。方法 综合分析2014年6月~2018年1月期间接受介入治疗的恶性气道狭窄患者27例的临床资料,分析其病因、接受介入治疗的方式、介入治疗的效果及安全性。结果 恶性气道狭窄病因包括肺鳞癌、小细胞肺癌、肺腺癌、食管癌、腺样囊性癌及淋巴瘤等,接受介入治疗的方式有支架、冷冻、氩气刀、高频电刀。恶性气道狭窄患者经介入治疗后,气促评分较治疗前改善明显。在临床疗效评价中,显效7例,部分有效15例,轻度有效5例,总有效率81.48%。介入治疗安全性较高,无严重并发症发生。结论 肺鳞癌是引起恶性气道狭窄的主要病因,支气管镜下接受介入治疗,能有效缓解患者症状,安全性高,并能提高患者生活质量。

Clinical studies on inferior right hepatic veins

BACKGROUND: Many small veins are called accessory, short hepatic veins in addition to the right, middle and left hepatic veins. The size of these veins varied from a pinhole to 1 cm; the size of inferior right hepatic veins (IRHVs) is thicker than that of short hepatic veins or more than 1 cm. occasionally. Adults have a higher incidence rate of the IRHV. DATA SOURCES: A literature search of the PubMed database was conducted and research articles were reviewed. RESULTS: The size of IRHVs is related to the size of the right hepatic vein, i.e. the larger the diameter of the right hepatic vein, the smaller the diameter of the IRHVs, and vice versa. The IRHVs are divided into superior, medial and inferior groups, separately named the superior, medial and inferior right hepatic veins according to the position of the IRHV entering the inferior vena cava. The superior right hepatic vein mainly drains the superior part of segment VII, and the medial right hepatic vein drains the middle part of segment VII. A thicker IRHV mainly drains segment VI and the inferior part of segment VII and a thinner IRHV drains the inferior part of segment V. CONCLUSIONS: The clinical significance of these studies on IRHVs is varied: (1) Hepatic caudate lobe resection could be introduced after study on the veins of that lobe. (2) It is very important to identify the draining region of the IRHV for guiding hepatic segmentectomy. The postero-inferior area of the right lobe can be preserved along with the hypertrophic IRHV even if the entire main right hepatic vein is resected during segmentectomy of VII and VIII with right hepatic vein resection for patients with primary liver cancer. (3) The ligation of the major hepatic vein for the treatment of juxtahepatic vein injury is recommended because of severe hemorrhagic shock and difficulty in exposure. (4) It is very helpful to decide therapeutic modalities for Budd-Chiari syndrome.

Hepatic segmentectomy combined with major hepatic vein resection for preserving remnant liver lobe

BACKGROUND: Impairment of liver function is the most serious complication that occurs after liver resection or in cirrhotic liver. Postoperative hepatic failure, which is mainly preceded by insufficient remnant liver function and/or postoperative septic complications, is the major cause of hospital mortality. This study was undertaken to evaluate hepatic segmentectomy combined with major hepatic vein (MHV) resection for preserving the remnant liver lobe in the treatment of resectable primary liver cancer. METHODS: From 1997 to 2007, six patients with primary liver cancer underwent hepatic segmentectomy with MHV resection, and three patients with hepatic vein injury had ligation of the MHV. The remnant liver lobe was preserved after hepatic segmentectomy combined with MHV resection or ligation. RESULTS: The preserved liver lobe with normal structure could maintain hepatic function and showed no evidence of atrophy or swelling after hepatic segmentectomy combined with MHV resection or ligation. CONCLUSIONS: After the right inferior hepatic vein is confirmed, and the MHV is occluded experimentally before hepatic segmentectomy combined with MHV resection, progressively deteriorating congestion does not occur in the preserved segment. Ligation or resection of the two MHVs must be avoided in patients with hepatic cirrhosis who have to undergo hepatic segmentectomy combined with MHV resection. Ligation of the MHV in patients with juxtahepatic vein injury is a simple and effective therapeutic modality.

Triptolide prolonged allogeneic islet graft survival in chemically induced and spontaneously diabetic mice without impairment of islet function

BACKGROUND: Triptolide (TPT) is a diterpenoid triepoxide extracted from the Chinese herb Tripterygium wilfordii Hook. F. It exhibits potent immunosuppressive and anti-inflammatory properties. This study was undertaken to investigate its effects on prolongation of islet allograft survival in rodents. Additionally, we investigated whether TPT would be toxic to islet function in vivo. METHODS: We transplanted BALB/c islets to either chemically induced diabetic C57BL/6 mice or spontaneously diabetic non-obese diabetic (NOD) mice. TPT was injected within 2 weeks or continuously, until rejection, in the two combinations. Then, we evaluated the toxicity of TPT on islet function by daily injection to naive BALB/c or diabetic BALB/c that was cured by syngeneic islet transplantation under the kidney capsule. Mice injected with cyclosporine A (CsA) or vehicle served as controls. Intraperitoneal glucose tolerance tests (IPGTTs) performed at 4 and 8 weeks in the naive BALB/c group, and at 2, 4, 6, and 8 weeks in the syngeneic transplanted group. RESULTS: The medium survival time of islets allograft from TPT treated C57BL/6 and NOD recipients were 28.5 days (range 24-30 days, n=10) and 33.0 days (range 15-47 days, n=6), respectively, and they were significantly different from those of the vehicle treated controls, which were 14.0 days (range 13-16 days, n=6) and 5.0 days (range 4-10 days, n=6), respectively (all P<0.0001). The IPGTT demonstrated that there was no difference between the TPT treated and vehicle treated groups, either in the normal or syngeneic transplanted islet BALB/c mice. However, CsA injection impaired islet function in both normal and syngeneic transplanted mice as early as 4 weeks. CONCLUSION: TPT prolonged islets allograft survival in a chemically induced diabetic or an autoimmune diabetic murine model without impairment of islet function. (Hepatobiliary Pancreat Dis Int 2010; 9: 312-318)

Distribution of natural killer cells and T-lymphocyte subsets in peripheral blood,gallbladder cancer and surrounding tissue

BACKGROUND: The patient with malignant tumor always show immunologic function drawback and ingravescent with tumor development, especially in the aspect of cell-mediated immunity. This study was undertaken to define the relationship between the immune function of local cells and cancer development by investigating the distribution of natural killer (NK) cells and T-lymphocyte subsets in peripheral blood, the cancer tissue and the tissue surrounding gallbladder carcinoma. METHODS: The numbers of CD4(+) and CD8(+) T-lymphocytes and NK cells were measured by flow cytometry in samples taken from gallbladder cancer tissue, the surrounding tissues and peripheral blood of 38 patients, and compared with the numbers in the peripheral blood and gallbladder tissue of 30 patients with cholecystitis as controls. RESULTS: The numbers of CD4(+) and CD8(+) T-cells and NK cells in gallbladder cancer tissues were significantly higher than those in the surrounding tissue and gallbladder with gallstone. However, the ratio of CD4(+)/CD8(+) was lower in the cancer tissue than that in the surrounding tissue and tissue from gallbladders with gallstones. The distribution of CD4(+) and CD8(+) T-cells and NK cells in mucous membrane of cholecystitis gallbladder and that in the tissue surrounding gallbladder cancer were significantly different. CONCLUSIONS: Disproportionate and imbalanced distribution of NK cells and subsets of T-lymphocytes occurs in the mucous membrane proper of gallbladder cancer and surrounding tissue. Although gallbladder cancer tissue has higher expressions of CD4(+), CD8(+) and NK cells, the immune function is low or in an inhibited state. In gallbladder cancer immunization therapy, local cellular immunological function should be enhanced and the protective barrier improved.

Isolated liver perfusion for regional chemotherapy in rats

BACKGROUND: In the isolated liver perfusion (ILP) technique, the liver is temporarily isolated from the systemic circulation in order to infuse large doses of chemotherapeutic agents through the hepatic inflow. The hepatic tissue can show a drug concentration higher than that after systemic chemotherapy, and a general toxic reaction from chemotherapeutic agent is avoided. In a modified ILP model in rats, we explored the distribution of the chemotherapeutic agent, fluorouracil (5-FU) in the systemic circulation and in the hepatic tissue, and assessed the pathological changes in the liver. METHODS: 306 Sprague-Dawley rats were randomly divided into 4 groups: control, ILP without 5-FU, ILP with 5-FU at different doses, and infusion of 5-FU through the portal vein. All animals were subjected to modified ILP, and 5-FU concentrations in the hepatic tissue and the systemic blood were determined at different time points. Levels of thromboxane B-2 (TXB2) and 6-keto-prostaglandin F-1 alpha (6-keto-PGF(1 alpha)), and changes in hepatic function, pathology and liver enzymes were assessed. RESULTS: ILP through the portal vein at three dosages (25, 50 and 100 mg/kg) resulted in significantly higher 5-FU concentrations in the liver tissue for 50 and 100 mg/kg and there was only a small leakage of 5-FU from the perfusion system into the systemic circulation. The pathological findings revealed that the liver tissue tolerated ILP below the maximum tolerance dose (MTD) of 5-FU. If the 5-FU dose exceeded the MTD the ultrastructure and the enzymatic activity of hepatocytes were clearly affected The change of TXB2 and PGF(1 alpha) balance were closely related to the injury of hepatic tissue caused by ILP with 5-FU doses greater than the MTD. CONCLUSIONS: Hepatic tissue sustains a higher drug concentration using ILP than that from systemic chemotherapy, and avoids a general toxic reaction to the drug entering into the systemic circulation. Evident injury may not occur in hepatocytes, and the changes of liver function are slight and transient by using ILP with no more than the MTD of 5-FU.

Minimally invasive perventricular VSD closure without cardiopulmonary bypass mid-term results from multi-centers

Objective Transesophageal echocardiography (TEE) guided,minimally invasive perventricular device occlusion of ventricular septal defects (VSDs) without cardiopulmonary bypass (CPB) has been applied in multiple centers. We reported experiences and the mid-term results. Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in the study. There were 235 maled and 197 females,aged from 3 months to 15 years,with a body weight varying from 4.0 to 26.0 kg.

RET proto-oncogene mutation analysis in a pedigree with multiple endocrine neoplasia 2A

Objective To discuss clinical diagnosis and treatment of multiple endocrine neoplasia ( MEN) 2A,and report the mutation of RET proto-oncogene in a pedigree of three patients with MEN 2A. Methods Bilateral adrenalectomy was performed on two of the three

Bendamustine combined with pomalidomide and dexamethasone in relapsed multiple myeloma with extramedullary disease:a multicenter study

Objective To evaluate the efficacy and safety of bendamustine combined with pomalidomide and dexamethasone(BPD regimen)in the treatment of relapsed multiple myeloma(MM)with extramedullary disease.Methods This open,single-arm,multicenter prospective cohort study included 30 relapsed MM patients with extramedullary disease diagnosed in seven hospitals,including Qingdao Municipal Hospital.

Assosiation of angiopoietin-like protein 2with lower extremity arterial disease in type 2 diabetes mellitus

Objective To study the assosiation of angiopoietinlike protein 2(ANGPTL2)with lower extremity arterial disease in type 2 diabetes mellitus.Methods A total of360 type 2 diabetic patients were divided into three groups:without(group A),with mild to moderate(group B),and severe(group C)lower extremity arterial disease according to the ankle brachial index.And。

Effects of inhaled nitric oxide in neonatal hypoxemic respiratory failure from a multicenter controlled trial

Background Hypoxemic respiratory failure （HRF） is one of the most common causes for neonatal infants requiring aggressive respiratory support. Inhaled nitric oxide （iNO） has been established routinely as an adjunct to conventional respiratory support in developed countries. The aim of this study was to investigate effects of iNO in neonates with HRF in resource limited condition with no or limited use of surfactant, high frequency oscillatory ventilation （HFOV） and extracorporeal membrane oxygenation.Methods A non-randomized, open, controlled study of efficacy of iNO was conducted over 18 months. Eligible term and near-term neonates from 28 hospitals with HRF （oxygenation index ＞15） were enrolled prospectively into two groups as either iNO or control. Oxygenation improvement and mortality as primary endpoint were determined in relation with dosing and timing of iNO, severity of underlying diseases, complications and burden. Intention-to-treat principle was adopted for outcome assessment. Response to iNO at 10 or 20 parts per million （ppm） was determined by oxygenation in reference to the control （between-group） and the baseline （within-group）.Results Compared to 93 controls, initial dose of iNO at 10 ppm in 107 treated infants significantly improved oxygenation from first hour （P=0.046）, with more partial- and non-responders improved oxygenation with subsequent 20ppm NO （P=0.018）. This effect persisted on days 1 and 3, and resulted in relatively lower mortalities （11.2% vs. 15%）whereas fewer were treated with surfactant （10% vs. 27%）,HFOV （＜5%） or postnatal corticosteroids （＜10%） in both groups. The overall outcomes at 28 days of postnatal life in the iNO-treated was not related to perinatal asphyxia,underlying diseases, severity of hypoxemia, or complications,but to the early use of iNO. The cost of hospital stay was not significantly different in both groups.Conclusions With relatively limited use of surfactant and/or HFOV in neonatal HRF, significantly more responders were found in the iNO-treated patients as reflected by improved oxygenation in the first three days over the baseline level. It warrants a randomized, controlled trial for assessment of appropriate timing and long-term outcome of iNO.

Feasibility study of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting

Objective To investigate the feasibility of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting(OPCABG).Methods Upon the approval of institutional Ethics Committee and informed consent,forty patients ASAⅡorⅢaged 52-77 yr with BMI(body mass index)【

Relationship between the levels of lipid metabolism and coronary atherosclerotic lesions

Objective To explore the relationship between the levels of lipid metabolism and coronary atherosclerosis.Methods The data of 182 patients with suspected coronary atherosclerotic lesions were retrospectively analyzed.All patients underwent coronary digital subtraction angiography(DSA),and those with coronary atherosclerotic lesions were recorded as the study group,otherwise as the control group.

Role of histone demethylase KDM6B in HBx-mediated podocyte-macrophage transdifferentiation

Objective To explore the expression of lysine (k)-specific demethylase 6B (KDM6B) in the renal tissues of hepatitis B virus-associated glomerulonephritis (HBVGN) patients and human podocytes transfected with hepatitis B virus X (HBx) gene,and its role in HBxmediated podocyte-macrophage transdifferentiation(PMT).

Relationship between promoter methylation of the Runx3 and Rassf1a genes and Dnmt1 expression in gastric cancer

Objective To analyze the promoter methylation of the human runt-related transcription factor3(Runx3) and ras-association domain family1a(Rassf1a) genes and Dnmt1protein expression in gastric cancer and

Therapeutic efficacy and prognosis in the treatment of lung cancer by video-assisted thoracoscopic surgery

To the editor： Video-assisted thoracoscopic surgery （VATS） lobectomy is now considered the standard approach in the treatment of non-small cell lung cancer （NSCLC）.＇ However, the major approach for thoracoscopy-assisted lobectomy is by direct visualization and does not rely solely on the use of a fiber optic thoracoscope in VATS lobectomy in China. Therefore, we conducted a comprehensive assessment of VATS lobectomy in the treatment of NSCLC to elucidate the safety and efficacy of this approach as compared with that of conventional thoracotomy.

Severe acute interstitial lung disease induced by crizotinib therapy in a patient with c-Met amplification non-small cell lung cancer

To the editor： Severe acute interstitial lung disease is not uncommon during and after irradiation of the lung, but is very rare during crizotinib treatment. We reported here one case of severe acute interstitial lung disease after one month crizotinib treatment.

Pulmonary sequestration with its feeding vessel originating from the proximal right coronary artery

To the editor： Pulmnonary sequestration is an uncommon congenital anomaly in which the arterial supply derives most frequently from the thoracic or abdominal aorta and other origins of blood supply are rarely described. Here we report a patient with the blood supply of pulmonary sequestration originating from right coronary artery （RCA）.