Objective To assess the usefulness video-assisted mediastinoscopy (VM) for diagnosis of disease characteristic with mediastinal mass. Analyze the correlations of clinical features of the disease with the pathologic diagnosis. Methods Between July 2000 and March 2006, 97 undiagnosed patients with mediastinal mass in chest radiography underwent biopsy of mediastinal lesions by either cervical mediastinoscopy (n=69) or parasternal mediastionoscopy (n=28). We also analyzed the correlation of symptoms, location and extent of the lesion with the pathologic diagnosis. Results All 97 patients recovered smoothly without postoperative complications. Histologic diagnosis was obtained in 96 patients. Patients with hoarse, dysphagia and superior vena cava obstruction syndrome indicate malignant lesions (26/26). The most common diseases in the super-anterior mediastinum are lymphoma(7/19), thymoma(4/19) and small cell lung cancer(SCLC) (4/19);The most common disease in the middle mediastinum are metastasis of non small cell lung cancer(11/37), sarcoidosis (9/37)and SCLC(7/37); The most possible disease involved both mediastinum and lung hilar lymph-node are scalerdosis(32/41) and SCLC(5/41). Conclusion Mediastinoscopy is effective and safe methods to establish a histologic diagnosis in patients with mediastinal mass. It is possible to make primary evaluation on some of these patients according to the typical symptoms and location, extent of the mass involvement.

Objective To evaluate the efficacy and safety of video-assisted thoracoscopic surgery in the treatment of esophageal leiomyoma.Methods Clinical data of 49 patients with esophageal leiomyoma from September 1996 to February 2009 treated by video-assisted thoracoscopic enucleation were reviewed retrospectively.Three or four trocars were used during the operation.The procedure of the surgery was similar to that of open thoracoscopic enucleation.Results In the 49 patients,video-assisted thoracoscopic leiomyoma enucleation was successfully completed in 42 cases.The other 7 patients were converted to open thoracotomy because of the following reasons:dense pleural adhesion in 2,location failure of small tumor(

Objective Based on the mathematical models established in Department of Thoracic Surgery of Peking University People's Hospital for predicting malignant probability for solitary pulmonary nodules ( SPN),another continuous 145 patients with SPN were assessed to verify the accuracy of the model comparing with foreign models (Mayo model and VA model).Methods A retrospective cohort study in our institution included 145 patients with definite pathological diagnosis of SPN from Oct 2009 to Aug 2011,72 males and 73 females,average age (59.4 ± 12.2 ) years old.Clinical data included age,gender,course of disease,symptoms,history and quantity of smoking,time of smoking cessation,history of tumor,family history of tumor,tumor site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,and cavity.These raw data were incorporated into our model,Mayo model and VA model,the probability of malignant in every patient was calculated separately according to methods described before.The sensitivity and specificity of these 3 models were evaluated then.Afterwards,calibration of the 3 models was assessed by the Hosmer-Lemeshow (H-L) test.Discrimination was tested by calculating the area under curve ( AUC ) after the receiver operating characteristic (ROC) curve was drawn.Results 32.4％ (47 in 145 patients) of the nodules were malignant,and 67.6％ (98 in 145 patients) were benign in this group.Verified the accuracy of our model with sensitivity of 94.9％,specificity of 66.0％,positive predictive value of 85.3％ and negative predictive value of 86.1％.The H-L test showed good fitting in all models ( P ＞0.05 ).The AUC for our model was 0.874 ±0.035,and 0.784 ± 0.041 in Mayo model (P =0.004 compared to our model),0.754 ± 0.041 in VA model (P =0.002 compare to our model).And,there was not significant statistical difference between Mayo model and VA model (P ＞0.05 ).Our model has the best precision indexed by AUC,which were statistically significant differential compared with Mayo model and VA model.Conclusion The model established by our center has superior value than foreign counterparts in predicting the probability of malignant or benign in patients with SPN.

Objective To explore the effect and method of the theory teaching of general practice course for eight-year program of clinical medical students. Methods The course of General Medicine was set up for 87 students from two grades in their fourth school year. All of them attended a closed-book exami-nation when they finished the lectures. The satisfaction rates, necessity and the suggestion of teaching and assessment were collected from the questionnaire. Results The examination results of the two grade students were (80.92±7.26) and (83.76±5.75); The satisfaction rate was 40.2％ (35/87); Necessity of the courses was between 3.6 to 4.1 (5-point-Likert-scale). The way of teaching method students chose was dif-ferent by course content. Conclusion The theory teaching of general practice course for eight-year program of clinical medical students needs more reform from curriculum designing, teaching methods, faculty train-ing and evaluation methods.

ObjectiveSummarize 500 cases of non-small cell lung cancer (NSCLC) that has accepted complete videoassisted thoracoscopic (VATs) lobectomy procedure in People's Hospital of Peking University,to report the mid-term follow-up results,and to evaluate the safety and effectiveness of VATs lobectomy.MethodsBetween September 2006 and September 2011,500 cases of non-small cell lung cancer that has accepted complete thoracoscopic lobectomy in the People's Hospital of Peking University were reviewed (267 male,233 female).Median patient age was 62.3 years.The average maximal diameter of solid tumors was 2.65cm.There are 496 cases of initial treat patients and 4 cases of operation after radiation and chemotherapy.This group consisted of lobectomies of left upper lobe ( n =129),left lower lobe ( n =73 ),right upper lobe ( n =163 ),right middle lobe x( n =47 ),right lower lobe( n =89 ).The operation procedure was complete VATs lobectomy combined with systematic lymph node resection ( at least 3 groups of lymph nodes in the mediastinum area),including 480 cases of purely lobectomy,13 cases of compound lobectomy (pulmonary lobe + pulmonary lobe,or pulmonary lobe + pulmonary segment),3 cases of segmentomy,2 cases of pneumonectomy,1 case of sleeve lobectomy and 1 case of bilateral lobectomy.ResultsAll procedures were carried out smoothly without serious complication,except 1 case of death of an advanced age patient due to multi-organ failure after the operation period.The average surgical duration was 198.1 min,and average blood loss was 214.6ml.There are 5 cases of postoperative hemorrhage,identified as pulmonary artery residual ooze blood,in which 4 cases of bleeding were stopped through re-operation,and 1 case was improved through conservative treatment.The median lymph nodes dissection was 5.7 group and median number of resected lymph nodes was 16.9.The median postoperative chest tube drainage duration was 7.8 day,and median postoperative hospital stay was 10.2 day.There were 45 cases (9.0％) of conversion to open thoracotomy and 87 cases ( 17.4％ ) of slight complications,including 32 cases of cardiac abnormalities,such as continuous arrhythmia,28 cases of air leakage beyond seven days,9 cases of pulmonary infections or atelectasis,6 cases of chylothorax,and 16 cases of other complications.The results of pathology show 363 cases of adenocarcinoma,85 cases of squamous carcinoma,12 cases of adenosquamous carcinoma,28 broncho-alveolar cell carcinoma,6 cases of large cell lung cancer and 6 cases of other lung cancer.The 1-year disease free survival (DFS) was 90.2％ and 1-year overall survival (OS) was 94.3％.The 3-year DFS was 76.4％ and 3-year OS was 81.3％.ConclusionCompletely video-assisted Thoracoscopic lobectomy procedure was a safe and effctive procedure for patients with non-small cell lung cancer.

ObjectiveTo evaluate thd cell biologic changes in thd non-small-cell lung cancer(NSCLC) which PTEN gene were activated by double-stranded RNA(dsRNA).MethodsSpecific dsRNA was designed.First,the promoter region of PTEN gene was determined by Promoter 2.0 program,then the CpG island in the promoter was found by CpGisland searcher software and the possible target non-CpG sequence that dsRNA might activate were defined by SiRNA Target Finder software.dsRNA were synthesized at Genechem Company( Shanghai,China).Then the specific dsRNA was transfected into A549 and H292 cells which were stored in our laboratory using Lipofectamine 2000 ( Invitrogen,USA) according to manufacture's instruction.Total celluar RNA was isolated.The expression of PTEN mRNA in transfected,control and mock group were determined by real-time quantitative polymerase chain reaction.Cell profiferation was investigated on days 1 to 5 by using Cell Counting Kit-8 according to the manufature's technical manual.Cell invasion ability was assessed by Transwell method that transmembrane cells were counted,and cell bycle distribution were studied by flow cytometer(FCM) using CycleTESTTM PLUS DNA Reagent Kit.ResultsAfter the introduction of dsRNA into the A549 cells,the PTEN mRNA expressin was upregulated to (4.35 ±0.42) folds compared with the mock and control cells.And in H292 cells,the mRNA expression of PTEN was upregulated to (3.92 ± 0.20) folds.It confirmed the RNA activation phenomenon in the PTEN gene in NSCLC cells.Compared with the control group,the number of alive transfected cells did not decreased in the cell proliferation assay.In the cell invasion test we found that the transmembrane A549 cells were 122.4 ±11.2 vs.150.7 ±13.1 in transfected group and control group respectively.In the cell cycle distribution we found dsRNA in duced part ofthe transfected cells arrested in G1 phase and a corresponding decrease in S-phase population was observed,though this change was not statistically significant.Conclusion The expression of PTEN mRNA could by enhanced by inducing the specific dsRNA into the A549 and H292 cells,though no evidence was found that after the activation of silenced PTEN,the cell proliferation and invasion ability were significantly changed.

ObjectiveTo study the risk factors of mediastinal lymph node metastasis in patients with ≤3 cm peripheral non-small cell lung cancer.MethodsFrom January 2000 to December 2010,a total of 281 patients with NSCLC[152 men and 129 women,aged ( 60.31±12.13) years;≤ 3 cm in diameter]underwent lobectomy or partial resection with systematic mediastinal lymphadenectomy in hospital .Clinical data included age,gender,symptoms,history and quantity of smoking history,history of tumor,family history of tumor,site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,cavity were collected compaired and analyzed.Single and multi-variate analysis was performed to determine the independent risk of occult N2 nodal involvement.ResultsLogistic regression analysis show seven clinical characteristics (fleshless( OR:22.262),history of tumor(OR:5.485),diameter( 0R:3.788),density( OR;5.850),traction of pleural (OR:1.371),border ( OR:8.259) and cavity (OR:7.124) were risk factors.ConclusionFleshless,history of tumor,diameter,density,traction of pleural and the border and cavity were independent predictors of malignancy in patients with ≤3 cm peripheral non-small cell lung cancer.

Objective The aim of this study is to evaluate the efficacy and safety of preoperative Computed Tomography (CT)-guided microcoil localization for pulmonary ground-glass opacity.Methods We performed CT-guided Microcoil localization in 30 patients with 32 pure ground glass opacities between December 2012 and September 2013.All 30 patients underwent CT-guided micmcoil localization under local anesthesia with a 21G needle percutaneous lung biopsy.All patients accepted video-assisted thoracic surgery after the localization the same day or the next day.Results We located 32 pure ground glass opacitiesin 30 patients.The mean lesion diameter was 0.94 cm,the average depth from the visceral pleura was 0.71 cm,all leisons were successfully located by microcoil,asymptomatic pneumothorax was observed in seven patients,pulmonary hematoma was observed in two patients,pain was observed in one patient,dislodgement was found in one patient during the operation.None of these cases needed surgical treatment.Pathologic diagnoses of the target leisions were as follows:adenocarcinoma in situ (n =17),adenocarcinoma(n =9),atypical hyperplasia(n =4),inflammation (n =2).After the placement of preoperative CT-guided microcoil localization for pulmonary ground-glass opacity,all the 32 pulmonary pure ground-glass opacities resection success rate was 100％.Conclusion Preoperative CT-guided microcoil localization for pulmonary pure ground-glass opacity is a safe and effective way to improve the accuracy of surgical resection.

Objective Summarize cases of blood loss exceed 400 ml in completely video-assisted lobectomy procedure,and retrospective analysis the cause of injury of blood vessels in the operation and discuss the intro-operative measurement.Methods From September 2009 to April 2013,1006 patients underwent VATs lobectomy in our institution,with a median blood loss of 206.7 ml.There were 125 patients that the blood loss were exceed 400 ml (82 male,43 femal) with a median age of 62.0 years.The median diameter of the solid tumor was 3.2 cm.The lobectomy consist of 42 cases of right upper lobe,40 cases of left upper lobe,19 cases of right lower lobe,15 cases of left lower lobe and 9 cases of right middle lobe.The procedure consist of 99 cases of simple lobectomy,4 cases lobectomy combine with partial chest wall resection,16 cases of compound lobectomy,3 cases of sleeve lobectomy with bronchoplasty and 3 casesof pneumonectomy.The main procedure was completely video-assisted anatomical lobectomy with mediastinal lymphadenectomy as we have reported.Results All procedures were uneventful,with a median operative time of 269.3 minutes,a median blood loss of 666.1 ml.Among 125 cases with ＞ 400 mlof blood loss,there were 3 cases of injury of pulmonary vein,2 cases were repaired endoscopiclly (In one ease,the bleeding point was clipped directly and repaired with 5-0 non-absorbable suture.In another case,the pericardium was opened,the hilar vessels were blocked,and the wound was repaired with 5-0 non-absorbable suture) and 1 case that the vein was torn and massive bleeding occurred when passing an instrument through the posterior wall of the vein and conversion to open thoracotomy was performed to control bleeding and repair the vein with 5-0 non-absorbable suture.There were 13 cases of injury of pulmonary artery,in 2 cases that the proximal trunk of ipsilateral pulmonary artery was blocked endoscopically and hemostasis was assured and then repaired the pulmonary artery with 5-0 non-absorbable suture endoscopiclly and in 11 case,conversion to open thoracotomy was performed to control bleeding and to repair the artery.The median duration of chest tube drainage was 8.0 days; median length of hospital stay was 11.1 days.There were 22 cases need blood transfusion in the operation or postoperation.All patients recovered well,47 patients (36.0％) experienced a minor complication.Conclusion Injury of blood vessels was common and troublesome in completely thoracotomy lobectomy,and always lead to conversion to thoracotomy.The surgeon should deal with it based on the character of vessles,condition of injury and experience of the surg con.

Objective Summarize all cases received completely thoracoscopic lobectomy,analyze the influence of lymph nodes in conversion thoracotomy and its measurements.Methods Between September 2006 to April 2013,1006 patients (545 males,461 females,median age 60 years,ranged from 13 to 86 years)received completly thoracoscopic lobectomy,including segmectomy(n =13),simple lobectomy(n =846),compound lobectomy(n =131),pneumonectomy (n =8),sleeve lobectomy(n =8).The main procedure was completely video-assisted anatomical lobectomy with mediastinal lymphadenectomy as we have reported.Results The average operative time in the conversion thoracotomy group was significantly longer[(272.7 ± 67.2) min versus (186.9 ± 58.1) min,P =0.001] compared with completely endoscopic surgery group,the average blood loss was significantly increased[(564.2 ±507.7) ml versus(158.0 ± 121.0) ml,P =0.001],the drainage time was significantly longer [(8.9 ± 5.0) days versus (6.6 ± 3.5) days,P =0.001] and the postoperative hospital stay was significantly longer [(12.5 ± 7.7) days versus(9.2 ± 5.8) days,P =0.001].Conclusion Interference of lymph doeds was the main reason for conversion to thoracotomy on VATs lobectomy.It may prolonged the operative time,increase the blood loss in operation and delay the postoperative recovery of the patients.Select the proper indication of conversion thoracotomy may reduce the negative effects of conversion thoracotomy.