[Summary] Pectus excavatum ( PE ) is a posterior intrusion of the chest wall into the thoracic cavity . Although the physiological and psychological consequences vary , for a large number of patients the lesions are troublesome enough that they need corrective surgery .The minimally invasive repair of pectus excavatum ( Nuss procedure ) has been performed safely , effectively , and extensively .The current situations and progresses associated with the Nuss procedure were reviewed .

Aiming at the problems in the post competency training of eight year clinical medical students such as the deficiency of humanistic spirit and communication ability,insufficient capacity of clinical skills training and clinical problem-solving,the lacl of academic research ability and innovative spirit,and according to the practical requirements for clinical personnel,we elaborated the required post competence for eight-year medical students on the basis of its basic concept and intention.We proposed strengthening the cultivation of eight-year medical students by improved course plan and cultivation process,perfected assessment system,enhanced construction of teachers in order to make the students competent to their posts,and we also made some beneficial attempts in formulating and implementing the talent training scheme based on post competency.

Objective To report our experience on video-assisted thoracoscopic surgery(VATS)and perioperative management for patients over 70 years old.Methods From May 1998 to May 2008,78 patients over 70 years old were treated by VATS.Operative risk was evaluated by measuring forced expiratory volume in first second(FEV1),diffuse capacity of carbon monoxide(DLCO),and left ventricular ejection fraction(LVEF),and artery blood gas analysis and exercise test before the operation.VATS(n=46)or video-assisted minithoracotmy(n=32)was carried out under general anesthesia with a double-lumen tube.Extubation was delayed in 11 patients after the procedures and mechanical ventilation was employed to smooth anesthesia recovery.Results Postoperative pathological examination showed primary lung cancer in 20 cases,benign pulmonary lesions in 26,pleural mesothelioma in 3,malignant pleural metastasis in 5,empyema in 5,benign mediastinal tumor in 15,hiatal hernia in 3,and esophageal leiomyoma in 1.Postoperative morbidity was 33.3%(26/78)in this series,none of the patients died during the operation;the perioperative mortality was 2.6%(2/78).Conclusions VATS is safe for elderly patients.Satisfying outcomes can be achieved through strict preoperative evaluation,proper operative method and active management for postoperative complications.

Objective To investigate the efficacy of thoracoabdominal mini-incision surgery for the treatment of gastric cardia cancer. Methods Radical resection of gastric cardia cancer was performed on 60 patients from January 2002 to January 2007. Thoracoabdominal mini-incision was used in 30 cases, and posterolateral thoracotomy was carried out in the other 30 patients. The data of the two groups were retrospectively analyzed. Results The operations were accomplished without death or severe complications in all the patients. Compared with the posterolateral thoracotomy group, thoracoabdominal mini-incision group had shorter incisions [(12.4?0.7) cm vs (19.2?2.0) cm, t=-17.577, P=0.000], shorter operation time [(207.3?76.1) min vs (260.0?85.6) min, t=-2.519, P=0.015], earlier postoperative ambulation [(2.3?0.5)d vs (3.4?0.5) d, t=-8.521, P=0.000], less thoracic drainage [(276.7?58.7) ml vs (308.7?59.5) ml, t=-2.097, P=0.040], less analgesic (pethidine) requirement [(66.7?27.3) mg vs (113.3?45.4) mg, t=-4.818, P=0.000], shorter duration of oxygen use [(3.8?2.0) d vs (5.1?2.6) d, t=-2.171, P=0.034], and higher arterial oxygen saturation[(97.6?2.7)% vs (96.1?2.7)%,t=2.152,P=0.036]. No significant difference was observed between the two groups in the number of dissected thoracic lymph nodes (1.87?0.43 vs 1.93?0.37, t=-0.579, P=0.565), number of dissected celiac lymph nodes (4.00?0.45 vs 3.97?0.49, t=0.247, P=0.806), postoperative hospital stay [(11.8?1.0) d vs (12.0?1.2) d, t=-0.701, P=0.486), pulmonary infection (2 vs 5, ?2=0.647, P=0.421), atrial fibrillation (2 vs 4, ?2=0.185, P=0.667) and positive surgical margins (0 vs 1, ?2=0.000, P=1.000). The two groups were followed up for (36.3?13.9) months and (36.3?16.5) months, respectively (t=0.024, P=0.981), no significant difference was detected between them in the 1- and 3-year survival cases (19 vs 22, ?2=0.487, P=0.485; and 10 vs 12, ?2=0.194, P=0.660) and chest pain (2 vs 3, ?2=0.000, P=1.000) during the period. Conclusions By using a thoracoabdominal mini-incision, gastric cardia cancer can be resected completely with less trauma. The approach is ideal for clinical application.

0.05). Sixteen patients in the video-assisted thoracic surgery group were followed up for a mean of 42.9 months (20-88 months), during which no recurrence was detected. In the minithoracotomy group, 18 patients received an 18-to 71-month follow-up (mean, 41.2 months), none of them had recurrence. Conclusions The outcomes of both the operations are satisfying for middle-aged or elderly patients with spontaneous pneumothorax. However, video-assisted thoracic surgery should be the first choice.

Objective To evaluate the efficacy of video-assisted mini-thoracoscopy(VAMT) for radical resection of lung cancer.Methods From April 2002 to December 2008,radical resection of lung cancer was performed on 39 patients by VMAT in our hospital.A 1.5-cm and a 7-to 10-cm incision were made during the operation.Both standard surgical instruments and thoracoscopic set were used to treat the pulmonary vessels,perform lobectomy,and remove the lymph nodes in the mediastinum and pulmonary portal.Results The operation was completed in all of the cases.No peri-operative death occurred.The patients received chest drainage for 4 to 7 days after the operation(mean,4.5 days).Post-operative pathological examination showed primary non-small cell lung cancer(NSCLC) in 37 cases,metastatic cancer in 1,and carcinoid in 1.In the 37 patients with NSCLC,9 were stage Ⅰa,13 were Ⅰb,5 were Ⅱa,7 were Ⅱb,2 were Ⅲa,and 1 was Ⅲb.Follow-up was available in 35 patients for up to 2 to 12 months in 4,13 to 24 months in 15,25 to 36 months in 8,37 to 48 months in 6,and 49 to 60 months in 2 cases.Among the 35 cases,totally 4 patients died of tumor recurrence or metastasis,1 patient survived with tumor,and the other 30 survived without tumor.The 1-and 3-year survival rate of stage Ⅰ and Ⅱ were 100%(21/21) and 91%(10/11) respectively.All of the 3 stage Ⅲ patients died of recurrence or metastasis in 19,11,and 14 months respectively after the surgery.Conclusions VAMT is effective for radical resection of lung cancer in a short term.Combination of traditional procedure and VAMT is safe and reliable for the disease.

Humans ; International Cooperation ; Mediastinitis ; pathology ; physiopathology ; surgery ; Time Factors

ObjectiveTo explore the migration, effect on axon growth of olfactory ensheathing cells (OECs) transplanted in contused spinal cord of rats. Methods8 adult female rats were induced spinal cord contusion at T10 cord by NYU impactor (H=25 mm), and received OECs transplantation in 1 mm rostral and caudal to injury site，or injury site. Other 4 adult female rats were uncovered the spinal cord at T8-10 cord, and injected GFP+OECs at T10 cord. 1 week after transplantation, all animals were executed and the T8-11 cord (15 mm long) contained the entire injury site were observed for the migration of OECs and immunostained for neurofilament (NF) and myelin basic protein (MBP). ResultsThe OECs injected in injury site largely migrate longitudinally and laterally from the injection site, OECs injected in 1 mm rostral and caudal to injury site of contused spinal cord, migrate longitudinally and laterally from the injection site to the injury site in white and gray matter, and some along the central canal. OECs injected in normal spinal cord migrated longitudinally and laterally from injection site, too. The transplanted OECs expressed a little NF and MBP. ConclusionThe transplanted OECs are able to migrate in spinal cord and promote axon regeneration and remyelination.

Objective To explore the effect of olfactory ensheathing cell (OEC) transplantation combined with walking training on neurofunction recovery in rats after spinal cord contusion. Methods Forty adult female rats aged (75 ± 1 ) days were subjected to experimental spinal cord contusion at the T10 level using a New York University impactor at a height of 25 mm. They were then divided into 4 groups: ( 1 ) an OEC transplantation combined with walking training (OEC-walking training) group, (2) an OEC transplantation (OEC) group, (3) a walking training combined with Dulbecco's modified Eagle medium injection (DMEM) (walking training-DMEM) group, and (4) aDMEM injection (SCI-DMEM) group. The OEC transplants and DMEM injections were performed 2 weeks post-injury. Walking training began at the 7th day post-injury and consisted of daily sessions (once daily, 5 days a week for 10 weeks) of quadrupedal treadmill training, starting from 15 min and gradually increasing to 30 min daily, at speeds starting from 3 m/min and gradually increasing in accordance to the condition of the rats. Locomotor function recovery of the rats' hindlimbs was evaluated weekly using the Basso, Beattie and Bresnahan (BBB) locomotor rating scale.The expression of tyrosine hydroxylase ( TH ) was detected in the injured region of the lumbar spinal cord. Results The BBB scores of rats in the OEC-walking training group and the walking training-DMEM group improved significantly from the 4th week post-injury compared to the SCI-DMEM injection group. Rats in the OEC transplantation group had a significant improvement in BBB scores at the 5th to 8th weeks post-injury. At the end of the 11th week post-injury, the average BBB scores were 13.14 ± 0.24 in the OEC-walking training group, 11. 64 ± 0.56 in the OEC transplantation group, 12.29 ±0.64 in the walking training-DMEM group and 11.07 ± 0.84 in the SCI-DMEM group.The OEC-walking training group scored significantly higher than the other 3 groups. Although the number of TH-positive neurons in the lumbar spinal cord was not significantly different among the groups, the morphology of TH-positiveneurons in the OEC-walking training group and the walking training-DMEM group was different from those in the OEC transplantation group and the SCI-DMEM group. Conclusions OEC transplantation combined with walking training can effectively promote the functional recovery of the hindlimb. The plasticity of the descending TH system and of motoneurons of the ventral horn of the lumbar spinal cord might mediate the changes.

BACKGROUND:There is controversial on which method is preferred for the treatment of humeral shaft fractures, plate or intramedul ary nail fixation? Some studies have compared the effect of those two methods, but the results are different. While the results of the systematic research and the Meta-analysis on the comparative studies is also different due to the differences in the number and the extraction of the researches.
OBJECTIVE:To systematical y evaluate the efficacy of plating versus intramedul ary nail fixation in the treatment of adult humeral shaft fracture.
METHODS:A computer-based retrieve was conducted in PubMed database, MEDLINE database, Cumulative Index to Nursing&Al ied Health Literature, Evidence-Based Medicine database, CBM database, Wanfang database and CNKI database for the randomized or quasi-randomized control ed trials on the comparison of plating and intramedul ary nail fixation in the treatment of adult humeral shaft fracture. The quality of these trials was critical y assessed according to Jadad. The effective data were extracted for Meta-analysis by Stata 12.0 software.
RESULTS AND CONCLUSION:Total y, 15 randomized or quasi-randomized control ed trials were col ected including four quasi-randomized control ed trials and 11 randomized control ed trials. The results showed that intramedul ary nail fixation may increase the risk of complications (odds ratio=0.37(0.19, 0.59), P=0.00). Bias Egger’s test of P=0.91 showed there was no significant publication bias. The risk of re-operation of intramedul ary nail fixation was increased (odds ratio=0.28(0.14, 0.57), P=0.00) with the Egger’s test of P=0.69. The incidence of shoulder impingement of intramedul ary nail fixation was significantly higher than that of pate fixation (odds ratio=0.13(0.05, 0.35), P=0.00), and there were no significant differences in postoperative infection, nonunion, implant failure, iatrogenic nerve palsy, operation time and bone union time between two methods. The results showed that compared with plate fixation, intramedul ary nail fixation may increase the incidence of shoulder impingement, complications and re-operation, while there were significant differences in postoperative infection, nonunion, implant failure, iatrogenic nerve palsy, operation time and bone union time between two methods.