Objective To evaluate the reliability of video-assisted mini-thoracectomy(VAMT) for the diagnosis and treatment of patients with pulmonary peripheral nodules.Methods A total of 55 patients with pulmonary peripheral nodules(1 case of multiple nodules and 54 cases of solitary nodule) underwent VAMT.The surgery included wedge resection in 23 patients and lobectomy with lymph node dissection in 32 patients(The lobectomy was performed by using conventional combined with thoracoscopic instruments.A self-made lymph node clamp was applied for lymph node dissection).Results The operation was successfully accomplished under thoracoscopy in all the 55 patients.The operation time was 35~180 min(mean,109 min) and the intraoperative blood loss was 50~400 ml(mean,122 ml).No blood transfusion was required.Postoperative complications included air leakage in 1 patient(discharge on the 32 postoperative day) and delayed wound healing in 1 patient(discharge on the 19 postoperative day).The length of postoperative hospital stay of the other 53 patients was 4~11 days(mean,8.3 days).Final pathological diagnosis showed 15 cases of benign lesions,38 cases of primary lung carcinoma,1 case of atypical adenomatous hyperplasia,and 1 case of metastatic lung cancer.The benign lesions were cured by wedge resection.Anatomic lobectomy with lymph node dissection was performed in 32 patients with primary lung cancer.Of other 6 patients with terminal lung cancer,4 patients were conservatively treated because of an extensive dissemination and 2 patients received a palliative wedge resection because of poor pulmonary functions.Conclusions Video-assisted mini-thoracectomy is helpful for the diagnosis and treatment of pulmonary peripheral nodules.Its long-term effects for clinical early-stage lung cancer need further follow-up investigations.

Background and purpose:VATS lobectomy has gained popularity for lung cancer around the world.Complete anatomic resections and node dissections are routinely being performed at many centers under VATS,but some thoracic surgeons are concerned regarding the safety,benefit and radical resection of this operative method.Our study is to evaluate the reliability and feasibility of pulmonary resection by video-assisted mini-thoractomy(VAMT) for patients with lung cancer.Methods:72 patients with lung cancer received either lobectomy and systemic lymph node dissection by video-assisted mini-thoracotomy(VAMT group;n=32) or conventional thoracotomy(conventional group;n=40),lobectomy was performed by conventional or thoracoscopic instruments,specific lymph node clamps were applied for lymph node dissection.Results:VAMT was successfully performed without significant postoperative complication and blood transfusion.No significant differences were observed in the two groups with respect to the length of operation and the total groups of dissected lymph nodes.This study showed that VAMT is a minimally invasive surgery without impairing of the outcome and needed less operative blood loss and shorter postoperative hospitalization compared to conventional thoracotomy.Conclusions:Major pulmonary resection by video-assisted minithoractomy for patients with lung cancer is safe,reliable and less invasive,it is consistant with the surgical standard of lung cancer.Its long-term benefit needs to be clarified after further follow-up.

Purpose:To evaluate the clinical effects and indications of surgical treatment of non small lung cancer invading the left atrium and great vessels and trachea carina. Methods:From August 1998 to Auguest 2003, we performed operations on patients with non-small lung cancer invading the left atrium in 3 cases, invading the descending aorta in 1 case, invading trachea carina in 3 cases; all the patients have been examined to exclude distant metastasis, including nuclear bone scan to exclude bone metastasis; there were 2 cases of left pneumonectomy and one of right pneumonectomy invading the left atrium, there were 3 cases of right sleeve pneumonectomy invading the trachea carina. For the cases invading the descending aorta, we performed the operation with atrium-aorta bypass, Pathology examination: all of the cases were squamous lung cancer, staging of T 4N 0M 0 for 6 cases,T 4N 2M o for 1 case. Results:No complication, follow up: 6 cases survived more than 1 year,1 case survived more than 9 months;4 cases were alive for more than 3 years, 1 case invading the atrium died in 30 months because of brain metastasis,1 case invading the carina died in 15 months because of pulmonary infection. Conclusions:For localized advanced non-small lung cancer invading the aorta and invading the carina and the atrium, if we selected the patient correctly and with a good surgical technique with complete radical resection of the tumor ,we can acquire good results.

Purpose: To evaluate the causes and management of bronchial pleural fistula after pneumonectomy. Methods: Retrqspective analysis for Bronchus-pleural fistula( BPF) of 16 cases after pneumonectomy of 820 cases of lung cancer in our hospital. BPF occurred in right peumonectomy( 13/320) is more than in left pneumonectomy(3/500) . BPF occurred in the positive stump of bronchus ( 10/41) more than in negative stump of bronchus (6/779) ; BPF occurred in preoperative chemotherapy cases( 5/110) more than in non-preoperative chemotherapy cases( 11/710), No BPF occurred in the 70 cases in which the bronchial stump was covered by autogenous tissue. The management principle in early stage is thoracocentesis and wash with antibiotics; after identification of the infection in thoracic cavity or BPF, closed drainage for thorax was done. If the results of drainage are not very good, open drainage is necessary. Results: 2 cases were discharged with completely healing, (the cavity of 1 case was washed again and again with 5% NaHC03and urokinase , another case was operated again to cover the BPF using muscle flaps 3 days after the first operation), 8 cases were discharged with closed drainage, 4 cases were discharged with open drainage changing the wound covering every day, the BPF did not heal for a long time after open drainage in 1 case, 1 case died of function failure of body organs. Conclusions: BPF is related to management of the bronchial stump and radical resection for tumor, It is a useful method to cover the bronchial stump with autogenous tissues to decrease BPF's, especially for right pneumonectomy and preoperative chemotherapy or radiotherapy cases. The management principle of BPF is thoracocentesis for early cases, especially washing with antibiotics and 5% NaHC03and urokinase repeatedly, closed drainage when necessary is also a good method for curing empyema and BPF.

Objecttive To investigate the possibility of repairing articular cartilage defects with the mesenchymal stem cells (MSCs)- seeded type Ⅰ collagen-glycosaminoglycan(CG) matrices after being cultured with the chondrogenic differentiation medium.Methods The adherent population of MSCs from bone marrow of 10 adult dogs were expanded in number to the 3rd passage. MSCs were seeded into the dehydrothennal treatment (DHT) cross-linked CG matrices; 2 × 106 cells per 9-mm diameter samples were taken.Chondrogenic differentiation was achieved by the induction media for 3 weeks. Cell contractility was evaluated by the measuement of the cell-mediated contraction of the CG matrices with time in culture. The in vitro formation of the cartilage was assessed by an assay employing immunohistochemical identification of type Ⅱ collagen and by immunohistochemistry to demonstrate smooth muscle actin (SMA).The cells seededing CGs were implanted into cartilage defects of canine knee joints. Twelve weeks after surgery, the dogs were sacrificed and results were observed. Results There was significant contraction of the MSCs-seeded DHT cross-linked CG scaffolds cultured in the cartilage induction medium. After 21 days, the MSC-seeded DHT cross-linked matrices were contracted to 64.4% ± 0.3%; histologically, the pores were fotmd to be compressed and the contraction coupled with the newly synthesized matrix, transforming the MSCsseeded CG matrix into a solid tissue in most areas. The type Ⅱ collagen staining was positive. The SMA staining was positive when these MSCs were seeded and the contracted CGs were implanted into the cartilage defects of the canine knee joints to repair the cartilage defects. The function of the knee joints recovered and the solid cartilaginous tissue filled the cartilage defects. Conclusion The results demonstrates that MSCs grown in the CG matrices can produce a solid cartilaginous tissue containing type Ⅱ collagen after being cultured with the chondrogenic differentiation medium and implanted into cartilage defects. We hypothesize that the following steps can be performed in the chondrogenic process: ①MSCs express SMA, resulting in matrix contraction, thus achieving a required cell density (allowing the cells to operate in a necessary society); ②Cells interact to form a type Ⅱ collagen-containing extracellular matrix (and cartilaginous tissue); ④Other factors, such as an applied mechanical stress, may be required to form a mature cartilage with the normal architecture.

Objective To determine the nutrients contents in muscle of Culter erythropterus and evaluate its nutritive value. Method The nutrients composition was analysed by general method. Results The contents of moisture, crude protein, total fat, total sugar and ash were 78.29%, 18.31%, 0.97%, 1.18% and 1.17%, respectively. The total amount of AA, EAA, NEAA and FTAA was 71.93%, 31.61%, 40.32% and 25.57%, respectively. 26 kinds of FA were identified. There were 6 kinds of SFA, 20 kinds of UFA. The contents of SFA, MUFA and PUFA were 26.26%, 29.61% and 39.91%, respectively. The contents of DG, TG, FFA, Cho and PL were 3.69%, 11.71%, 23.60%, 0.54% and 60.46%, respectively. Conclusion The crude protein and PUFA were high in muscle of Culter erythropterus. It was beneficial for health to eat it regularly.

The paper elucidated the necessity of programmed operation in competence education of medical postgraduate students.This paper introduced the specific methods of programmed operation mode,exactly as selection of the best,scientific combination,coordination and arrangement,allocation of responsibility to individual,exact procedures,succession and development.The seven years practice experience in their colleges testified that these operational methods aroused the enthusiasm of postgraduate students' participation in campus activities and trained postgraduate student cadres.Meanwhile,these methods activated the campus culture and atmosphere and enhanced the comprehensive competence of postgraduates wholly.

Objective To compare the difference in clinical prognosis of patients with low malignant obstructive jaundice treated by percutaneous biliary stent insertion across or above the duodenal papilla.Methods 56 patients with malignant biliary obstruction were reviewed retrospectively.Stents were placed above the duodenal papilla in 31 cases (group A) and across the duodenal papilla in 25 cases (group B).Total bilirubin reduction rate after 4-7 days of the procedure, biliary infection rate and stent occlusion rate were evaluated and compared between two groups.Results Mean survival periods were 180.3±142.5 days for group A and 178.6±137.7 days for group B (P=0.840).Total bilirubin level was decreased by 42.0±43.6% for group A and by 41.4±28.7% for group B after 4-7 days of the procedure(P=0.950);clinical success rates were 93.5% for group A and 92.0% for group B (P=1.0).Post-procedure cholangitis occurred in 7 cases (22.6%) in group A and 5 cases (20.0%) in group B (P=0.815).Stent occlusion rates were 22.6% and 28.0% for group A and group B (P=0.642).Conclusion For patients with lower malignant biliary obstruction, both of the two modalities of stent placement are safe and effective treatment.Stent placement across the duodenal papilla do not increase the development of stent occlusion or cholangitis compared with stent placement above the duodenal papilla.

Objective To evaluate the safety and effectiveness of multi-mode interventional therapy for complications occurring after renal transplantation.Methods The clinical data of 26 patients with complications occurring after renal transplantation were retrospectively analyzed.Vascular and non-vascular complications were treated with different interventional techniques,and the curative effects were analyzed.Results Vascular complications were observed in 19 patients and non-vascular complications were seen in 7patients.The technical success rate of interventional therapy was 100％.One week after the treatment,the total creatinine level (SCr) was significantly improved,which decreased from preoperative (372.7±295.5)μmol/L to postoperative (184.3±138.4) μmol/L (P＜0.001).No severe complications occurred.Further analysis indicated that no statistically significant differences in patient's general condition,kidney donor source,anastomosis method existed between vascular intervention group and non-vascular intervention (P＞0.05).However,the onset time of vascular complications was markedly earlier than that of non-vascular complications (1.8± 1.4 months vs.118.3 ±54.4 months),the difference was statistically significant (P＜0.001).During the follow-up period lasting for 4-55 months (mean of 18.6 months),3 patients developed recurrence of complications;interventional therapy had to be carried out in 2 patients and their creatinine level returned to normal after treatment,and transplanted renal artery embolization had to be performed in the other patient as whose pseudoaneurysm became enlarged.Conclusion For the treatment of complications occurring after renal transplantation,interventional therapy is less-invasive,rapidly-effective and safe,this technique can timely and effectively improve the renal function and save the transplanted kidney.

Objective To investigate the feasibility, safety and efficacy of transarterial embolization with low concentration of n-butyl cyanoacrylate(NBCA) in rabbit VX2 liver tumor models. MethodsTwenty-four rabbits were implanted with VX2 hepatic tumors into the left hepatic lobes, and were scanned with CT to measure the volume of the tumor after 14 days. They were randomly divided into three groups with 8 rabbits assigned to each group. Transarterial embolization was conducted with physiological saline in control group A, with pure Lipiodol in group B, with 2.5% NBCA in group C. Hepatic toxicity was evaluated by blood biochemical analysis of the plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST). One week later, the volumes of the tumors were measured by CT again. Tumor growth rate was the ratio of tumor's volume at 7th day after embolization to the tumors' volume before embolization. The survival periods of the rabbits of the three groups after treatment were also recorded. The data of ALT and AST mean values from each group were analyzed with repeated measurement analysis of variance (ANOVA). Tumor growth rates and survival periods were analyzed by using one-way ANOVA. Results All animal models were successfully established and underwent interventional catheterization. Both ALT and AST mean values of the rabbits in group A, B and C at each time point before and after embolization were significantly different (ALT F=10.508, 16.443, 19.828, respectively; AST F=23.696, 23.334, 15.594, respectively)(P＜0.05). ALT in group A, B, C were (49.4±13.5), (115.2±48.8), (124.7±49.4)U/L, while AST in group A, B, C were (52.3±12.0), (128.3±50.1), (137.0±66.9)U/L 4 days after embolization. The ALT and AST mean values were significantly elevated 4 days after embolization in group B and group C compared with those before embolization and those of group A 4 days after treatment(P＜0.05). However, the ALT and AST mean values showed no statistically significant difference in all the groups before embolization and 7 days after embolization. On the other hand, the growth rates of the tumors differed significantly among the three groups(F=110.865, P=0.000). The group C showed significantly lower tumor growth rate (0.839±0.144)% than the group A(2.978±0.547)%(P=0.000), but no significantly different tumor growth rate compared with group B(0.871±0.0725)%( P=0.845). Consequently, the survival period of the animals in group C(38.9±4.0) days was significantly longer than that in group A(32.1±3.1)days (P=0.006), while it was not significantly different from that in group B(36.9±4.8)days(P=0.366). ConclusionsTransarterial embolization with low concentration of NBCA was feasible and safe. It could be a new option of treatment for HCC and might have potential further clinical value.