Abstract： Objective To investigate clinical characteristics， surgical strategy and prognosis of pulmonary pleomorphic carcinoma， and improve the diagnostic and therapeutic level of pulmonary pleomorphic carcinoma. Methods We retrospectively analyzed clinical data of 7 patients with pulmonary pleomorphic carcinoma who underwent surgical resection from January 2006 to August 2011 in West China Hospital of Sichuan University. There were 5 male patients and 2 female patients with the male/female ratio of 2.5︰1.0 and the mean age of 58.85 （43-69） years old. We also conducted a literature review through PubMed using pulmonary pleomorphic carcinoma and surgery as the key words， and 8 patients with integral clinical data from 2005 to 2011 were identified. There were 7 male patients and 1 female patient with the male/female ratio of 7︰1 and mean age of 70.25 （51-79） years old. All the patients underwent surgical resection and systemic lymph node dissection. Results The mean age of this group was 64.93 （43-79） years old. Among the 15 patients， there were 12 males and 3 females with the male/female ratio of 4︰1. The main symptoms were cough， blood in phlegm， hemoptysis and chest pain. Pathology diagnosis confirmed pleomorphic carcinoma in all the patients. Among the 7 patients of our hospital， there were 3 patients with spindle cell with squamous cell carcinoma， 2 patients with spindle cell with adenocarcinoma， and 2 patients with spindle cell with large cell carcinoma and adenocarcinoma. During follow-up， 3 patients died with the longest survival time of 49 months， and the other 4 patients were still alive. Among the 8 patients in the literature review， there were 4 patients with spindle cell with squamous cell carcinoma， 1 patient with spindle cell with adenocarcinoma， 1 patient with spindle cell with large cell carcinoma and squamous cell carcinoma, and 2 patients with spindle cell with adenocarcinoma and squamous cell carcinoma. During follow-up， 5 patients died with the longest survival time of 22 months， and the other 3 patients were still alive. Conclusion Pulmonary pleomorphic carcinoma is extremely rare and surgical resection is an effective treatment strategy for it.
A microsatellite is a short, repetitive sequence of DNA (usually 2 to 4 nucleotides in length). Multiple primary lung cancers (MPLC) are more than one primary lung cancer lesions arising synchronously in different locations of the same or different side of the lung. These neoplasms may have same or different histological types, but one lesion is not a metastasis from another, as each neoplasm arises independently in the lung. Abnormal microsatellite changes are closely related to the pathogenesis and development of MPLC. In this review, several aspects are discussed:①definition and origin of microsatellite; ②abnormal changes of microsatellite; ③definition and categories of MPLC; ④the influence of microsatellite on early diagnosis, treatment and prognosis of MPLC.
Increasing evidence suggests that there is a close relationship between pulmonary ground-glass opacity (GGO) and early-stage lung cancer, especially bronchial alveolar carcinoma in the early stage. With the use of high-resolution computed tomography (HRCT) and positron emission tomography/computed tomography (PET/CT), more and more GGO patients have been identified. Correct diagnosis and surgical indications should be determined according to the image characteristics including proportion and size of GGO in a pulmonary nodule as well as intraoperative quick pathological examination to avoid unnecessary surgical resection. Therefore, early detection and correct diagnosis of GGO are very important to improve patient prognosis.
The early detection, diagnosis and treatment of lung cancer are the key points to reduce mortality and improve the prognosis. Detecting tumor markers in blood is a minimally-invasive, cost-effective, easy to administer and approachable test. A microsatellite consists of a tract of tenderly repeated DNA motifs that range in length from two to five nucleotides. Microsatellite alterations (MA) have been described as two types: loss of heterozygosity (LOH) and microsatellite instability (MSI). MicroRNA (miRNA) is a noncoding RNA and protein involved in regulating gene expression in the transcription level. In recent years, some miRNA markers and microsatellite alterations show significant tumor association, tissue specific and stability. Therefore, we write this review to discuss the microsatellite alterations and microRNA in blood of lung cancer.
MicroRNA (miRNA) is a noncoding RNA and protein involved in regulating gene expression in the transcription level. Epidermal growth factor receptor (EGFR) is a protein tyrosine kinase receptor and its mutations have been confirmed in non-small cell lung cancer (NSCLC) by a large number of studies in recent years. EGFR tyrosine kinase inhibitor (EGFR-TKI) is widely used for treatment of NSCLC patients with EGFR mutation. In recent years, miRNA is more and more important in tumor metastasis. The role of EGFR mutations in NSCLC has become a hot spot as well. New researches report that the relationship between miRNA and EGFR mutations plays an important role in NSCLC metastasis. Therefore, we write this review to discuss the mechanisms of miRNA and EGFR mutations in metastasis of NSCLC.
Detection of the fraction of exhaled nitric oxide (FeNO) is a safe, simple and easy method to assess airway inflammation noninvasively. Thus, FeNO detection has been paid more attention to diagnosis and guide treatment of pulmonary diseases. The common feature of pneumonia, asthma, chronic obstructive pulmonary disease and chronic cough is the existence of varying degrees of airway inflammation. In this review, FeNO production and its potential pathologic and physiologic role in various pulmonary diseases were discussed.
ObjectiveTo compare the clinical efficacy between right visual double lumen tube (VDLT) intubation and right common double lumen tube (DLT) intubation in lung isolation technique. MethodsA total of 57 patients undergoing thoracoscopic surgery with right DLT lung isolation technique in the First People's Hospital of Chenzhou City and West China Hospital from June 2020 to June 2021 were randomly divided into two groups: a DLT group (n=29, 16 males and 13 females, with a mean age of 54.3±13.2 years) and a VDLT group (n=28, 18 males and 10 females, with a mean age of 55.1±13.7 years) at 1 : 1 with random number table generated by the computer. The clinical data of the two groups were compared. ResultsCompared with the DLT group, the catheter positioning time in the VDLT group was statistically shorter (74.9±47.5 s vs. 151.6±88.9 s, P<0.001), the right upper lung occlusion rate (21.4% vs. 51.7%) and the intraoperative re-adjustment catheterization rate (14.3% vs. 48.3%) were lower (P<0.05). The quality of lung collapses immediately after thoracotomy (67.9% vs. 24.1%) and 20 minutes after thoracotomy (100.0% vs. 75.9%) were improved (P<0.05). There was no significant difference in the rate of fiberoptic bronchoscope assistance for positioning, or the incidence of pharynx pain and hoarseness between the two groups (P>0.05). ConclusionCompared with common DLT, VDLT is more efficient, accurate and intuitive in the location of right bronchial intubation.
With the continuous advancement of internet technology and the widespread internet literacy, the concept of integrated online and offline internet hospitals is gradually being embraced and applied both domestically and internationally. This model's relevance in thoracic surgery lies in its ability to improve efficiency and provide comprehensive, diverse, and personalized medical services to address complex and serious medical conditions. However, the implementation of internet hospitals also presents certain challenges such as hardware conditions and diagnostic risks. Through further research and localization in the future, the integrated online and offline internet hospital model is expected to develop and improve, contributing to better medical services for patients in thoracic surgery clinical practice.
ObjectiveTo investigate clinical outcomes of isolated atrial septal defect (ASD)repair on the beating or non-beating heart through minimally invasive right axillary approach. MethodsForty-five patients underwent isolated ASD repair through minimally invasive right axillary approach in Research Institute of Surgery, Daping Hospital of the Third Military Medical University from September 2009 to August 2011. According to different surgical techniques, all the patients were divided into a beating-heart group and a non-beating heart group. In the beating-heart group, there were 22 patients including 13 males and 9 females with their mean age of 3.2±2.1 years and body weight of 13.1±4.0 kg. There were 20 patients with ostium secundum ASD and 2 patients with ostium primum ASD. Mean ASD diameter in the beating-heart group was 12.2±5.1 mm. In the non-beating heart group, there were 23 patients including 14 males and 9 females with their mean age of 3.5±2.5 years and body weight of 12.9±3.3 kg. There were 18 patients with ostium secundum ASD, 3 patients with sinus venosus ASD, and 2 patients with ostium primum ASD. Mean ASD diameter in the non-beating heart group was 11.6±4.7 mm. Serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST)and highly sensitive cardiac troponin I (cTnI)were examined preoperatively, after weaning from cardiopulmonary bypass (CPB), 6 hours and 24 hours postoperatively. ResultsThere was no in-hospital death. Postoperatively, 1 patient had right atelectasis and another patient had right pneumothorax. CPB time and operation time of the beating-heart group were significantly shorter than those of the non-beating heart group (P < 0.05). There was no statistical difference in intraoperative blood transfusion, mechanical ventilation time, length of postoperative ICU stay or hospital stay, chest drainage within 24 hours postoperatively, or postoperative cardiac function between the 2 groups (P > 0.05). Preoperative levels of CK, CK-MB, AST and cTnI were all within the normal limit, and there was no statistical difference between the 2 groups (P > 0.05). After CPB, CK, CK-MB, AST and cTnI levels increased in both groups, but increased significantly greater in the non-beating heart group (P < 0.05). Postoperative levels of CK, CK-MB, AST and cTnI of the beating-heart group were significantly lower than those of the non-beating heart group (P < 0.05). ConclusionIsolated ASD repair on the beating heart via minimally invasive right axillary approach is a safe and cosmetic procedure with shorter operation time and less myocardial injury.