Abstract： The principles of 2010 National Comprehensive Cancer Network（NCCN） clinical practice guidelines in non-small cell lung cancer address that anatomic pulmonary resection is preferred for the majority of patients with non-small cell lung cancer and video-assisted thoracic surgery (VATS) is a reasonable and acceptable approach for patients with no anatomic or surgical contraindications. By reviewing the literatures on general treatment, pulmonary segmentectomy, pulmonary function reserve, and the anatomic issue of early stage non-small cell lung cancer surgery, the feasibility and reliability of thoracoscopic pulmonary segmentectomy are showed.
ObjectiveTo study the mechanism of the effect on invasion and metastasis of colorectal cancer by down-regulating c-Met gene.Methodsc-Met genes were knocked down in SW480 cells, differential genes were screened by gene chip, functional cluster analysis of differential genes was carried out, and IPA was used to analyze the interaction network of cell signal pathway and related differential genes, as well as the ralationship between related genes and upstream regulatory molecules. The related genes in the suppressed signal pathway were selected for qPCR verification.ResultsAfter knockdown of c-Met, the number of up-regulated genes and down-regulated genes in SW480 cells was 399 and 286, respectively. Cluster analysis showed that c-Met knockdown had a great effect on the gene expression level of SW480 cells, IPA pathway analysis showed that HGF signaling pathway was suppressed, and after c-Met knockdown, IPA interaction network suggested that AKT2, PIK3CA, and MAP2K4 in HGF pathway were down-regulated, and qPCR verified that the above genes were also down-regulated, which was consistent with the results of microarray.Conclusionc-Met may affect the invasion and metastasis of colorectal cancer through the regulation of AKT2, PIK3CA, and MAP2K4 in HGF pathway.
ObjectiveTo investigate the efficacy of uniportal video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy.MethodsThe clinical data of 15 patients who underwent uniportal VATS anatomic basal segmentectomy between June 2020 and December 2020 were retrospectively reviewed. There were 4 males and 11 females with a median age of 53 (32-70) years. The incisions were placed in the fifth intercostal space across the mid-axillary line. All basal segmentectomies were performed through the interlobar fissure or inferior pulmonary ligament approach following the strategies of single-direction and stem-branch.ResultsAll patients underwent basal segmentectomy successfully with no conversion to multi-portal procedure or thoracotomy. The median operation time was 120 (90-160) min, median intraoperative blood loss was 20 (10-50) mL, median drainage time was 3 (2-5) d, and median postoperative hospital stay was 4 (4-10) d. The maximum diameter of the lesion in the resected basal segment was 1.2 (0.7-1.9) cm. The median resected lymph nodes were 7 (5-12). There was no evidence of nodal metastases. One patient suffered postoperative atelectasis and subsequent pneumonia. No perioperative death occurred.ConclusionUniportal VATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.
Objective To evaluate the safety and effect of seromuscular layer anastomosis in small intestinal suture. Methods Forty patients with hepatobiliary and pancreatic diseases undergoing biliojejunostomy or cystojejunostomy were randomly divided into seromuscular layer anastomosis group (n=20) and two-layer anastomosis group (n=20) before operation， which received Roux-en-Y end-to-side jejunal seromuscular layer anastomosis and two-layer anastomosis, respectively. Intestinal anastomotic complications and other indexes such as anus venting time were recorded in each group. Results Neither group had intestinal anastomotic complications such as leakage, stricture, obstruction and hemorrhage. Time of venting to normal were (3.6±0.9) d and (3.6±0.8) d in seromuscular layer and two-layer anastomosis group respectively, there was no significant difference between them (Pgt;0.05). Conclusion Seromuscular layer anastomosis is a safe and effective method of small intestinal anastomsis.
ObjectivesTo evaluate the predicting value of bedside pulmonary ultrasound in bronchopulmonary dysplasia (BPD) in premature infants.MethodsPremature infants with gestational age below 28 weeks or birth weight below 1 500 g admitted to NICU of Chengdu Women and Children’s Central Hospital from June 2018 to June 2019 were included. Pulmonary bedside ultrasound monitoring was performed on the 3rd, 7th, 14th and 28th day after admission, and the characteristic ultrasound images were recorded and scored. BPD were diagnosed by NICHD standard. The clinical data and pulmonary ultrasound data were compared and analyzed. Then diagnostic value of bedside pulmonary ultrasound in BPD of premature infants were analyzed.ResultsA total of 81 children involving 32 BPD and 49 non-BPD were included. The sensitivity (Sen), specificity (Spe) and area under curve (AUC) of receiver operating characteristic (ROC) of the "alveolar-interstitial syndrome" within 3 days after birth and the "fragment sign" on 28 days after birth were 81.25%, 51.02%, 0.66 and 31.25%, 97.96%, 0.65, respectively. The lung ultrasound scores in the BPD group on the 3rd, 7th, 14th, and 28th day after birth were 71.99.%, 68.39%, 0.71; 87.50%, 57.14%, 0.72; 78.13%, 73.47%, 0.76 and 56.25 %, 75.51%, 0.66. Sen, Spe and ROC AUC of comprehensive evaluation of lung ultrasound predicted the occurrence of BPD been 81.25%, 63.27%, and 0.85.ConclusionsThe comprehensive evaluation of combination of "alveolar interstitial syndrome" image characteristics within 3 days after birth, "fragment sign" image characteristics after 28 days, and lung ultrasound score at different times after birth can predict the premature infants with bronchopulmonary dysplasia.
Numerical simulation of stent deployment is very important to the surgical planning and risk assess of the interventional treatment for the cardio-cerebrovascular diseases. Our group developed a framework to deploy the braided stent and the stent graft virtually by finite element simulation. By using the framework, the whole process of the deployment of the flow diverter to treat a cerebral aneurysm was simulated, and the deformation of the parent artery and the distributions of the stress in the parent artery wall were investigated. The results provided some information to improve the intervention of cerebral aneurysm and optimize the design of the flow diverter. Furthermore, the whole process of the deployment of the stent graft to treat an aortic dissection was simulated, and the distributions of the stress in the aortic wall were investigated when the different oversize ratio of the stent graft was selected. The simulation results proved that the maximum stress located at the position where the bare metal ring touched the artery wall. The results also can be applied to improve the intervention of the aortic dissection and the design of the stent graft.
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.
ObjectiveTo explore the treatment strategies for patients with fever and pulmonary complications after thoracic surgery during COVID-19 epidemic.MethodsThe clinical data of 537 patients who ungerwent selective surgery at the Department of Thoracic Surgery, Shangjin Branch of West China Hospital between February and December 2020 were retrospectively analyzed, including 242 (45.1%) males and 295 (54.9%) females aged 53.3±13.4 years. We have established a procedure for the patients with fever and pulmonary complications after thoracic surgery to investigate the cause of the disease and track risk factors.ResultsThe overall postoperative complication rate was 16.4% (88/537), and 1 (0.2%) patient died. Of 537 patients, 179 (33.3%) patients were enrolled in our model according to the inclusion criteria: ratio of males [112 (62.6%) vs. 130 (36.3%), P<0.010], patients with a history of smoking [74 (41.3%) vs. 87 (24.3%), P<0.010], or with esophageal cancer surgery [36 (20.1%) vs. 15 (4.2%)], or with traditional thoracotomy [14 (7.8%) vs. 4 (1.1%)] was higher than that of the other patients. Patients in our process due to fever or pulmonary complications had longer ICU stay and postoperative hospital stay (P=0.010). Logistic regression multivariate analysis showed that gender was an independent risk factor for postoperative fever or pulmonary complications.ConclusionIn low-risk areas of the epidemic, the treatment process is simple and feasible, and the cause traceability and corresponding treatment can basically be completed within 24 hours. At the same time, the treatment process has been running stably for a long time.
Objective To assess the value of precise hepatectomy in treatment of primary hepatocellular carcinoma. Methods Three-dimensional (3D) models from MR image were reconstructed by 3D-Doctor software in 32 patients with primary hepatocellular carcinoma scheduled for liver resection between July 2007 and Sept 2009. From these 3D models, the vena cava, portal vein, hepatic vein, and short hepatic vein images were reconstructed, total liver volume, tumor volume, functional liver volume and ratio of functional liver volume to standard liver volume (SFLVR) were calculated. The patients were followed-up for 1-27 months, with an average of 12 months. Results The anatomic detail of liver veins and its relationship with the tumor could be displayed clearly in liver 3D models. By the 3D models, total liver volume was calculated as （1 353±419）ml, tumor volume as （287±248） ml, functional liver volume as （830±289） ml, and SFLVR as （71±22）%. Of 32 patients with hepatocellular carcinoma, right hemihepatectomy was performed in 8 cases, left hemihepatectomy in 2, and segmental or limited resection in 22. All operations were completed successfully. Postoperative complications included pulmonary infection in 1 case, bile leak in 1, moderate ascites (500-3 000 ml) in 8, and massive ascites (gt;3 000 ml) in 2 including one patient developed hepatic failure. Six and 12-month survival rates were 100% and 87%. Three, 6, and 12-month disease-free survival rates were 78%, 72%, and 72%. Conclusions Precise hepatectomy technique provides an accurate picture of liver veins anatomy and its relationship with the tumor， and allows the procedure to be simulated preoperatively for adequate and safe hepatectomy.
Objective To investigate effect of hepatocyte growth factor (HGF) after lentivirus-mediated RNA interference (RNAi) targeting c-Met on invasion of colonic carcinoma cell line SW480. Methods The experiment was assigned into 3 groups: NC group, the normal cells were infected by the shRNA negative control virus (the NC-20 andNC-40 represented the negative group which were added 20 ng/mL and 40 ng/mL respectively HGF after being infected); KD group, the normal cells were infected by the shRNA-c-Met target virus (the KD-20 and KD-40 represented the interfered group which were added 20 ng/mL and 40 ng/mL HGF respectively after being infected; KD1, KD2, KD3, and KD4 represented the different RNAi targets for the purpose gene); CON group, the normal cells were not infected by any virus. The lentiviral vector shRNA-c-Met was constructed and verified by polymerase chain reaction (PCR) and DNA sequencing. The SW480 cells were infected with the shRNA-c-Met after packed with lentivirus plasmid. Fourty-eight hours transfection later, the c-Met mRNA of the transfected SW480 cell was detected by real time PCR and the c-Met protein was examined by Western blot. Seventy-two hours after transfection, the cell apoptosis was detected by flow cytometry and the invasions in the different cells with stable transfection were detected by Transwell test. Results The RNAi sequence targeting c-Met gene was successfully inserted into the lentiviral vector. The shRNA-c-Met transfection resulted in an obviously reduced expression of c-Met mRNA in the SW480 cells. The efficency of gene knock down of the KD4 (the cells with No.4 target spot knocked down) was 81.4%. The shRNA-c-Met tansfection resulted in an obviously reduced expression of c-Met protein in the SW480 cells. After transfection, the apoptosis rate of the KD group was significantly higher than that in the NC group (P<0.001) or the CON group (P<0.001). The invasion ratios in the NC group, NC-20 group, and NC-40 group were significantly higher than those in the KD group (P<0.001), KD-20 group (P=0.015), and KD-40 group (P=0.017), respectively; which in the NC-20 group and NC-40 group were increased as compared with the NC group (P<0.001,P<0.001), and in the NC-40 group was increased as compared with the NC-20 group (P=0.005). The invasion ratios in the KD-20 group and KD-40 group were increased as compared with the KD group (P<0.001,P<0.001), and in the KD-40 group was increased as compared with the KD-20 group (P=0.014). Conclusion Lentivirus-mediated RNAi targeting c-Met could effectively suppress expression of c-Met in SW480 cells and could reduce invasion of HGF on SW480 cells with knocked down c-Met.