Acute pancreatitis (AP), characterized by complex complications, substantial treatment expenses, and elevated mortality rates in severe instances involving multi-organ dysfunction and post-recovery challenges, has traditionally been addressed through Traditional Chinese Medicine (TCM) based on the “Hot Disease” theory. Recent research, however, indicates potential adverse effects from over-relying on this approach with bitter and cold purgative herbals. Evolving from this, a novel methodology, conceptualized by Professor ZHANG Zailiang, integrates the theory of typhoid fever, miscellaneous diseases and epidemic febrile diseases. This paradigm shift encompasses the entire AP spectrum, emphasizing early interventions for organ damage, proactive complication management, and meticulous post-recovery care. It proposes a comprehensive, tailored strategy for monitoring disease evolution and convalescence, signaling a significant advancement in the AP treatment paradigm, particularly in the context of TCM’s role in critical care.
Systematic lymph nodes dissection has been a standard procedure in lung cancer surgery, while the manipulation of mediastinal lymph nodes for early stage lung cancer remains controversial since surgeons have been weighing the advantages and disadvantages of different methods of lymph node dissection. With an increasing in early stage non-small cell lung cancer patients in recent years, there are more and more intensive studies especially focusing on the mediastinal lymph nodes dissection of clinical stage ⅠA lung cancer. In this review, the lymph nodes management of clinical stage ⅠA non-small cell lung cancer, especially systematic lymph nodes dissection and sampling as well as lobe-specific lymph node dissection, are summarized.
Objective To evaluate the short-term effectiveness of arthroscopic single-bundle reconstruction of anterior cruciate ligament (ACL) being centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels. Methods Between September 2008 and September 2010, 33 patients with chronic ACL ruptures underwent arthroscopic reconstruction with four-stranded hamstring tendons in single-bundle. There were 19 males and 14 females, aged 22-33 years (mean, 26.4 years). Injuries were caused by traffic accident in 15 cases, by falling in 13 cases, and by sports in 5 cases. The location was the left knee in 20 cases and the right knee in 13 cases. The average time from injury to surgery was 6 months (range, 2-20 months). ACL reconstruction could be optimized when single-bundle grafts were centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels. KT-1000 test, Lachman test, and pivot-shift test were used to evaluate the knee stability, and the International Knee Documentation Committee (IKDC) and Lysholm scores to assess the knee function. Results Primary healing of incision was obtained in all patients, who had no complications of intra-articular infection, deep venous thrombosis of the lower extremity, and injury of blood vessels and nerves. All the patients were followed up 18.6 months on average (range, 13-24 months). At 1 year after operation, the results of Lachman test were negative in 31 cases and I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 4, II degree positive in 26, and III degree positive in 3) (Z= — 5.42, P=0.00). The results of pivot-shift test were negative in 31 cases, I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 15 and II degree positive in 18) (Z= — 5.17, P=0.00). The KT-1000 results of examination (134 N) showed that the side difference of anterior laxity was (1.2 ± 0.7) mm at 25° flexion and (0.8 ± 0.6) mm at 70° flexion, showing significant differences when compared with preoperative ones [(7.8 ± 2.1) mm and (5.0 ± 1.8) mm] (t=16.19, P=0.00; t=13.28, P=0.00). The IKDC score was significantly increased from 39.6 ± 4.5 at preoperation to 95.1 ± 1.6 at postoperation (t= — 78.88, P=0.00), and Lysholm score was significantly increased from 48.3 ± 3.6 at preoperation to 92.0 ± 2.5 at postoperation (t= — 42.00, P=0.00). Conclusion It is a reliable procedure to restore the stability of the knee that arthroscopic single-bundle reconstruction of ACL is centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels.
The precise resection and suture of bronchia, vascular and pulmonary tissue are the key techniques in thoracic surgery. Mechanical suture technique has gradually become a routine operation in thoracic surgery. However, at present, there is still a lack of consensus and guidelines on the application of this technique in thoracic surgery, neither strong evidence-based medical support. In this study, we discuss the application standard of mechanical suture technique in thoracoscopic surgery, irregular treatment techniques, intraoperative complications, and management principles to promote the standardized application of mechanical suture technique. We also explain the shortcomings of the technique in order to promote the further improvement and perfection.
Compared to traditional suturing, lung stapling using automatic staplers offers advantages such as smaller trauma, faster wound healing, ease of operation, and lower complication rates, making it widely used in clinical practice. However, there are significant differences in bronchial tissue thickness at different anatomical locations, and the market is flooded with various types of staplers. Currently, there is a lack of recommended stapling schemes for bronchial staplers at different anatomical locations. This article reviews the development and application of automatic staplers and summarizes some types of staplers that are currently used in clinical practice, with the aim of promoting the formation of individualized stapler selection protocols for minimally invasive thoracic surgery based on the Chinese population.
ObjectiveTo evaluate the safety and effect of day surgery in minimally invasive surgical treatment of early-stage lung cancer by enhanced recovery after surgery (ERAS).MethodsWe included the patients discharged from the day surgery ward of thoracic surgery after surgery in Shanghai Pulmonary Hospital between June and November 2019. We retrospectively analyzed surgical indications of day surgery, management and perioperative medical history of the patients. A total of 517 patients were included, with 156 male and 361 female patients aged 46.4±10.9 years. A total of 45 patients underwent single port VATS segmentectomy and 472 patients underwent single port VATS wedge resection.ResultsThe average operation duration was 33.7±18.5 min. The average intraoperative blood loss was 28.5±21.4 mL. There was no intraoperative blood transfusion or conversion to thoracotomy. Postoperative pain score was 2.1±0.2. The average hospitalization was 1.94±0.89 days. The total hospitalization cost of the patients was 34686.51±6228.09 Yuan, which was 29.93% lower than the same surgery methods in the general ward. A percentage of 98.2% patients were satisfied or very satisfied in the patient satisfaction survey.ConclusionDay surgery and ERAS are effective and safe in minimally invasive surgery of early-stage lung cancer. It can also speed up the postoperative recovery of patients, improve the occupancy efficiency of hospital beds and save the medical cost.
Lung cancer is the most common cancer and the leading cause of cancer-related death in China. Early screening of lung cancer proves to be effective in improving its prognosis. The National Comprehensive Cancer Network (NCCN) has updated and released version 2, 2022 NCCN clinical practice guidelines for lung cancer screening in July, 2022. Based on high-quality clinical evidence and the latest research progress, the guidelines have developed and updated criteria for lung cancer screening which have been widely recognized by clinicians around the world. Compared with Chinese lung cancer screening guidelines, this article will interpret the updated content of the brand new 2022 NCCN screening guidelines, providing some reference for the current lung cancer screening practice in our country.
ObjectiveTo compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections.MethodsThe patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed.ResultsThere was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041).ConclusionSegmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.