ObjectiveTo explore the application value of CT-guided microcoil localization in pulmonary nodule (diameter≤15 mm) surgery.MethodsThe clinical data of 175 patients with pulmonary nodules who underwent single utility port video-assisted thoracoscopic surgery at Nanjing Drum Tower Hospital from August 2018 to December 2019 were retrospectively analyzed. According to whether CT-guided coil localization was performed before operation, they were divided into a locating group and a non-locating group. There were 84 patients (34 males, 50 females, aged 57.8±8.8 years) in the locating group and 91 patients (46 males, 45 females, aged 57.6±10.8 years) in the non-locating group. The localization success rate, localization time, incidence of complications, surgical and postoperative conditions were analyzed between the two groups.ResultsAll 84 patients in the locating group were successfully located, and localization time was 19.0±3.6 minutes. Among them, 19 (22.6%) patients had a small pneumothorax, 4 (4.8%) pulmonary hemorrhage and 2 (2.4%) coil shift; 6 (7.1%) patients had mild pain, 3 (3.6%) moderate pain and 1 (1.2%) severe pain. Sex (P=0.181), age (P=0.673), nodule location (P=0.167), nature of lesion (P=0.244), rate of conversion to thoracotomy (P=0.414), rate of disposable resection of nodules (P=0.251) and postoperative hospital stay (P=0.207) were similar between the two groups. There were significant differences in nodule size (P<0.001), nature of nodule (P<0.001), the shortest distance from nodule to pleura (P<0.001), operation time (P<0.001), lung volume by wedge resection (P=0.031), number of staplers (P<0.001) and total hospitalization costs (P<0.001) between the two groups.ConclusionCT-guided microcoil localization has the characteristics of high success rate, and is simple, practicable, effective, safe and minimally invasive. Preoperative CT-guided microcoil localization has important clinical application value for small pulmonary nodules, especially those with small size, deep location and less solid components. It can effectively shorten the operation time, reduce surgical trauma and lower hospitalization costs, which is a preoperative localization technique worthy of popularization.
目的 探讨乳房肿物体表定位膜对乳腺彩超结果的影响。方法 回顾性分析2010年12月至2011年1月期间，笔者所在医院乳腺门诊检查触诊阴性的180例患者共236个乳房肿物贴膜前后的彩超检查结果，分析其血运、边界、钙化及分级情况的变化。结果 贴膜后，236个肿物中有2个血运情况有变化，7个边界有变化，5个钙化情况有变化，5个分级有变化，但贴膜前后乳房肿物的血运（P=0.500）、边界（P=0.136）、钙化（P=0.082）及分级（P=0.172）变化情况比较差异均无统计学意义。结论 乳房肿物体表定位膜不影响乳房肿物的彩超检查结果。
ObjectiveTo identify causal effects and potential mechanisms of oxidative stress (OS) genes in lung cancer. MethodsOS-related genes were extracted from the GeneCards database. Integration analysis of genome-wide association study (GWAS) data for lung cancer with gene expression and DNA methylation quantitative trait loci (eQTL and mQTL) in blood was performed using the summary data-based Mendelian randomization (SMR) approach to determine the causal relationship between OS genes and lung cancer risk. Colocalization analysis of OS gene QTLs and lung cancer risk loci was performed to gain insight into the potential regulatory mechanisms of lung cancer risk. ResultsA potential causal relationship between OS-related genes and lung cancer was identified by SMR analysis. AGER expression level was found to be associated with lung cancer risk [OR=1.944, 95%CI (1.431, 2.640), P<0.001], and ATF6B expression level was associated with lung cancer risk [OR=1.508, 95%CI (1.287, 1.767), P<0.001]. Meanwhile, ATF6B methylation level was associated with lung cancer risk. ConclusionOS-related genes are associated with lung cancer, which may be a potential site of action for anti-cancer drugs.
ObjectiveTo explore technical essentials and safety of laparoscopic cholecystectomy (LC) guided by gallbladder ampulla localization on an imaginary clock for cholecystitis.MethodsA retrospective study of 8 707 continuous patients with mild cholecystitis who underwent LC from July 1998 to February 2018 at a single institution was conducted. Among them, 3 168 patients were treated by the traditional LC from July 1998 to February 2007 (a traditional LC group), 5 539 patients were treated by the LC with the guidance of the gallbladder ampulla localization on an imaginary clock from March 2007 to February 2018 (a gallbladder ampulla localization group). The conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury, operative time, intraoperative blood loss, and postoperative hospital stays were compared between the traditional LC group and the gallbladder ampulla localization group.ResultsThere were no significant differences in the gender, age, course of disease, and type of cholecystitis between these two groups (P>0.050). The rates of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury and the operative time, intraoperative blood loss and postoperative hospital stays in the traditional LC group were 3.00% (95/3 168), 0.13% (4/3 168), 0.09% (3/3 168), 0.03% (1/3 168), (43.6±12.6) min, (18.7±3.3) mL, (3.6±2.7) d, respectively, which in the gallbladder ampulla localization group were 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), (32.2±10.5) min, (12.4±3.5) mL, (3.5±2.8) d, respectively. The differences of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding rates, and the operative time and intraoperative blood loss were statistically significant between these two groups (P<0.050). The differences of the bile leakage without bile duct injury rate and postoperative hospital stays were not statistically significant between the two groups (P>0.050).ConclusionThis study shows that gallbladder ampulla localization on an imaginary clock is useful for ductal identification so as to reduce bile duct injury and improve safety of LC in case of no conversion to open surgery.
ObjectiveTo explore the safety and feasibility of 3D precise localization based on anatomical markers in the treatment of pulmonary nodules during video-assisted thoracoscopic surgery (VATS).MethodsFrom June 2019 to April 2015, 27 patients with pulmonary nodules underwent VATS in our Hospital were collected in the study, including 3 males and 24 females aged 51.8±13.7 years. The surgical data were retrospectively reviewed and analyzed, such as localization time, localization accuracy rate, pathological results, complication rate and postoperative hospital stay.ResultsA total of 28 pulmonary nodules were localized via this method. All patients received surgery successfully. No mortality or major morbidity occurred. The general mean localization time was 17.6±5.8 min, with an accuracy of 96.4%. The mean diameter of pulmonary nodules was 14.0±8.0 mm with a mean distance from visceral pleura of 6.5±5.4 mm. There was no localization related complication. The mean postoperative hospital stay was 6.7±4.3 d. The routine pathological result showed that 78.6% of the pulmonary nodules were adenocarcinoma.Conclusion3D precise localization based on anatomical markers in the treatment of pulmonary nodules during thoracoscopic surgery is accurate, safe, effective, economical and practical, and it is easy to master with a short learning curve.
ObjectiveTo investigate the preoperative localization of pulmonary glabrous nodules.MethodsA total of 192 patients admitted to General Hospital of Northern Theater Command from April 2012 to September 2019 were selected for the study. There were 95 males and 97 females at an age of 56.47±11.79 years. All patients completed preoperative examination, and were divided into a positioning group (n=97) and a non-positioning group (n=95) according to whether the preoperative positioning was performed. And the surgical indicators between the two groups were compared. According to the substance of ground-glass opacity, they were divided into a pure ground-glass nodules group (n=23) and a mixed ground-glass nodules group (n=74) in the positioning group and a pure ground-glass nodules group (n=14) and a mixed ground-glass nodules group (n=81) in the non-positioning group . According to the size and distance of the nodules from the pleura and whether the nodules could be detected, the corresponding linear function was obtained.ResultsThe operative time of methylene blue localization group was shorter than that of the no localization group. In the scatter plot, the corresponding diameter and depth of the nodules and the corresponding coordinate points which can be explored were described. And linear regression was performed on all the coordinate points to obtain the linear function: depth=0.648×diameter–1.446 (mm). It can be used as an indication for the preoperative localization of pure ground-glass nodules in Da Vinci robotic surgery. Linear function: depth=0.559 5×diameter+0.56 (mm). It can be used as an indication of preoperative localization of mixed ground-glass nodules in Da Vinci robotic surgery.ConclusionThis equation can be used as a preoperative indication for clinical peripheral pulmonary ground-glass nodules.
目的探讨钼靶X线导丝定位切除触诊阴性乳腺病灶手术的临床应用价值。 方法对291例299个触诊阴性乳腺病灶在钼靶X线指引下经导丝定位并切除活检，确定病理类型。 结果299个触诊阴性乳腺病灶中乳腺癌病灶42个（14.05%），癌前病变40个（13.38%），良性病变257个（85.95%），其中乳腺癌灶多表现为簇状或弥漫细点状钙化，乳腺癌病灶中原位癌22个（52.38%，22/42），浸润癌Ⅰ期13个（30.95%，13/42），Ⅱ期4个（9.52%，4/42），Ⅲ期3个（7.15%，3/42）。40例乳腺癌患者（2例为双侧癌）均长期随访，最长随访时间为10年，复发转移2例。应用钼靶X线诊断乳腺癌的灵敏度为92.86%（39/42）；特异度为95.33%（245/257），诊断比值比（DOR）为265.42。 结论钼靶X线导丝定位病灶切除技术可提高触诊阴性乳腺病灶的早期诊断率，指导手术切除病灶，其组织损伤小，可靠性高，促进了乳腺癌二级预防，适合二级医院广泛应用。
目的 总结840例小切口胆囊切除术的经验体会。方法 我院应用新器械行小切口胆囊切除术840例，男302例，女538例，年龄16～64岁； 胆囊结石832例，胆囊息肉8例。其手术指征与大切口胆囊切除术相同。术中应用小切口自动伸开架、深部送结器、小切口带灯拉钩、缝合胆囊肝床之外科扣锁钳、肝脏直角灯钩以及为防止在小切口内手术时遗失纱布而特制的气囊纱布； 同时，确保手术能在小切口内完成，术前进行了周密检查以排除肝、胆、胃之肿瘤，并于术前行动态胆囊底B超定位检查，以确定小切口之位置和了解手术难易。结果 840例中行择期手术737例，急诊手术103例； 手术历时平均30分钟； 住院时间3～4天。术后全部患者均获随访，其满意度为98.5%(827/840)。因照明障碍误伤右肝管1例，因胆囊颈结石嵌顿误伤胆总管1例。结论 应用小切口及自制手术器械行胆囊切除术，避免了LC及传统开腹术的一些弊端，效果确切，便于患者接受。
Magnetic ferrite nanoparticles (MFNPs) have great application potential in biomedical fields such as magnetic resonance imaging, targeted drugs, magnetothermal therapy and gene delivery. MFNPs can migrate under the action of a magnetic field and target specific cells or tissues. However, to apply MFNPs to organisms, further modifications on the surface of MFNPs are required. In this paper, the common modification methods of MFNPs are reviewed, their applications in medical fields such as bioimaging, medical detection, and biotherapy are summarized, and the future application directions of MFNPs are further prospected.
Objective To develop an innovative recognition algorithm that aids physicians in the identification of pulmonary nodules. MethodsPatients with pulmonary nodules who underwent thoracoscopic surgery at the Department of Thoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School in December 2023, were enrolled in the study. Chest surface exploration data were collected at a rate of 60 frames per second and a resolution of 1 920×1 080. Frame images were saved at regular intervals for subsequent block processing. An algorithm database for lung nodule recognition was developed using the collected data. ResultsA total of 16 patients were enrolled, including 9 males and 7 females, with an average age of (54.9±14.9) years. In the optimized multi-topology convolutional network model, the test results demonstrated an accuracy rate of 94.39% for recognition tasks. Furthermore, the integration of micro-variation amplification technology into the convolutional network model enhanced the accuracy of lung nodule identification to 96.90%. A comprehensive evaluation of the performance of these two models yielded an overall recognition accuracy of 95.59%. Based on these findings, we conclude that the proposed network model is well-suited for the task of lung nodule recognition, with the convolutional network incorporating micro-variation amplification technology exhibiting superior accuracy. Conclusion Compared to traditional methods, our proposed technique significantly enhances the accuracy of lung nodule identification and localization, aiding surgeons in locating lung nodules during thoracoscopic surgery.