China ; Humans ; Lung Neoplasms ; diagnosis ; therapy ; Practice Guidelines as Topic ; standards

Objective To explore expression of the minichromosome maintenance 2 (MCM2)protein and the mucin-like cell surface adhesion molecule CD24 in non-small cell lung cancer (NSCLC) and their relationship with its prognosis. Methods Seventy-three patients of NSCLC diagnosed for the first time and received surgical treatment in Xuanwu Hospital, Beijing were selected for the study. Expression of the MCM2 and CD24 in pathological specimens of the patients was measured by immunohistochemistry and their relationship with its prognosis was analyzed retrospectively. Results High-level expression of the MCM2 and CD24 was seen in 42 and 54 of 73 NSCLC patients, accounting for 57. 5 percent and 74. 0 percent,respectively. Risk of death for the patients with high-level expression of the MCM2 or the CD4 was significantly higher as compared to those with low-level expression ( P ＜ 0. 05 ). Risk of death for patients with both high-level expression of the MCM2 and CD24 was significantly higher than that in those with only high-level expression of the MCM2 or the CD24 (HR =2. 59, 95%CI 1.40 -4. 80, P=0. 002) and in those with both low-level expression of them ( HR = 15.32, 95 % CI = 2.07 - 113.41, P = 0. 008 ). But there was no significant difference in risk of death between patients with high-level expression of the MCM2 or CD24 and those with low-level expression of both of them ( HR = 5. 60, 95% CI 0. 79 - 44. 82, P = 0. 083 ), and cumulative survival rate of patients with both high-level expression of the MCM2 and CD24 was significantly lower than those with only high-level expression of the MCM2 or the CD24 ( P = 0. 001 ). Conclusions Both expression of the MCM2 and the CD24 are independent prognostic factors for NSCLC and combined detection of the two markers have higher prognostic value for it.

Objective To investigate the expression of MCM2 and its prognostic significance in non-small cell lung cancer (NSCLC). Methods The expression of MCM2 was measured by immunohistochemistry in 73 cases of NSCLC and 10 cases of normal lung tissue. The correlations between the expression of MCM2 and clinic-opathological parameters and prognosis were investigated. Results There was no MCM2 expression in normal lung tissue and positive rate of MCM2 expression was 87.7% in NSCLC. The difference between the two groups was significant (P<0.001). The expression of MCM2 in poorly differentiated NSCLC patients was significantly higher than that in moderately- and well-differentiated NSCLC patients (P=0.008). The expression of MCM2 in patients with squamous carcinoma was higher than that in patients with adenocarcinoma (P=0.005). The hazard ratio was significantly higher(RR=3.389, 95 % CI=1.803-7.146,P<0.001), and the accumulated survival rate was significantly lower (P=0.001) in NSCLC patients with higher MCM2 expression than that of lower expression. MCM2 was independent prognostic factor of NSCLC patients (P=0.041). Conclusion MCM2 could reflect the reproductive activity of NSCLC and has some clinical significance for assessing the development and prognosis of NSCLC. MCM2 was a potential target for future treatment.

Objective To investigate the clinical significance of intraperitoneal perfusion of IL-2 combined with Addi injection for ascites re-growth control after decompression of abdominal compartment syndrome induced by malignant ascites.Methods 69 patients with abdominal compartment syndrome induced by malignant ascites,after tube decompression and paracentesis,were given intraperitoneal perfusion therapy,and they were randomly divided into two groups.42 cases in the observation group were given with 0.9％ sodium chloride injection 50mL + IL-23 millions u and Addie injection 50-60mL,once a week,a total of 2-3 times;27 cases in the control group were given with 0.9％ sodium chloride injection 50mL and cisplatin 40mg,once a week,a total of 1-3 times.Results In the observation group,CR 25 cases (59.5％),PR 11 cases (26.2％),NC 6 cases (14.3％),the total effective achieved in 36 cases (85.7％).In the control group,CR 11 cases (40.7％),PR 6 cases (22.2％),NC 10 cases (37.0％),the total effective achieved in 17 cases (62.96％).The effective rate of the observation group was significantly better than that of the control group,there was statistically significant difference(x2 =4.78,P ＜ 0.05).The qualities of life of the observation group were improved,8 cases were stable,lower in 2 cases,the effective rate was 76.2％,which of the control group were improved,10 cases were stable,lower in 4 cases,the effective rate was 48.1％.The effective rate of the observation group was significantly better than that of the control group,there was statistically significant difference (x2 =5.70,P ＜ 0.05).Conclusion Intraperitoneal perfusion of IL-2 combined with Addi injection for ascites control after decompression of abdominal compartment syndrome induced by malignant ascites is a new method,which is worthy of clinical application.

OBJECTIVE To discuss the therapeutic effect of one stage surgical treatment in the multiple primary hypopharyngeal and cervical thoracic esophageal carcinoma.METHODS The thoracoscopy group: dissecting the esophagus and mediastinal lymph node assisted with thoracoscope, and then opened abdominal cavity to make gastric tube. Head and neck group: doing the cervical lymph node dissection, total laryngectomy, total hypopharyngectomy and total esophagectomy, and then anastomosis of the pharynx with gastric tube. All cases were received conventional radiotherapy and chemotherapy after operation.RESULTS All the cases in this group were successfully underwent the one stage operation. The postoperative complications were pulmonary infection in 3 cases, pleural effusion in 2 cases and tracheal tear in one case. No anastomotic fistula or postoperative deaths occurred. The 3 and 5 year survival rates were 63.6% and 50.0% respectively.CONCLUSION It should take necessary examinations of cervical thoracic esophagus to prevent missing the multiple primary carcinoma of the hypopharyngeal carcinoma. The total laryngectomy, total hypopharyngectomy and total esophagectomy, and anastomosis of the pharynx with gastric tube for multiple primary hypopharyngeal and cervical thoracic esophageal carcinoma is a feasible and active treatment method.

Objective To compare the clinical application of three-dimensional (3D) and two-di-mensional (2D) imaging systems in thoracoscopic lobectomy for non-small cell lung cancer ( NSCLC). Methods In 2014 and 2016, the patients with NSCLC undergoing thoracoscopic lobectomy with 2D or 3D imaging systems were performed by a single experienced surgeon. The baseline characteristics and perioper-ative data of the patients were collected and analyzed. Results In 2014, 19 patients underwent 3D thora-coscopic lobectomy and the other 23 patients underwent 2D thoracoscopic lobectomy. Compared to 2D thora-coscopic lobectomy group, 3D thoracoscopic lobectomy group had a significantly shorter operative time [(147.0 ±23.9)min vs (179.1 ±54.4)min,P=0.016], a smaller volume of intraoperative blood loss [(142. 1 ± 69. 3)ml vs (203. 0 ± 90. 4)ml,P=0. 018]. In 2016, 36 patients underwent 3D thoracoscopic lobectomy and the other 32 patients underwent 2D thoracoscopic lobectomy. No significant differences were found between two groups in terms of preoperative indicators. Conclusions To some extent, 3D thoracos-copy reduces the operation difficulty, shortens the operative time and reduces intraoperative blood loss. However, with the accumulation of surgical experience, 2D can effectively compensate for the disadvantages of thoracoscope.

As an important carrier in the information construction of modern hospitals, electronic medical record is becoming more and more refined and intelligent. This paper introduces the standardized and structured electronic medical record system of thoracic surgecal department and puts forward the effect evaluation and prospect. 
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Electronic Health Records ; standards ; statistics & numerical data ; trends ; Humans ; Thoracic Diseases ; diagnosis ; surgery ; Thoracic Surgical Procedures ; methods ; standards

BACKGROUNDTo explore the feasibility of extended resection in selective patients with centrally located lung cancer.

METHODSFrom January, 1987 to December, 2001, lobectomy or pneumonectomy combined with extended resection of trachea, bronchus, heart or great vessels were carried out in 134 patients with centrally located lung cancer. The operations included bronchoplastic procedures in 80 cases, extended resection and reconstruction of left atrium and/or great vessels in 54 cases (32 cases with contemporary bronchoplasty).

RESULTSOperative death occurred in one case. Postoperative complications happened in 16 cases (11.9%). One hundred and seventeen cases (94.4%) were followed up. The 1-, 3-, 5-year survival rate was 84.7% (61/72), 56.7% (34/60) and 45.7% (21/46) respectively, while of those combined with tracheo bronchoplasty and/or cardiovascular reconstruction, the 1-, 3-, 5-year survival rate was 69.2% (36/52), 46.8% (22/47) and 22.2% (8/36) respectively. (P < 0.05), while expression of KAI1 mRNA did not relate to mutant P53 protein expression (P > 0.05).

CONCLUSIONSExtended resection combined with tracheo-bronchoplasty and/or cardiovascular reconstruction is feasible for selected patients with centrally located lung cancer and could improve the survival and life quality of patients.

Objective:To investigate the difference of HRCT imaging features between COVID-19 and the ground-glass opacity(GGO) lesion of early-stage lung carcinoma, standardize the diagnosis and treatment process of ground-glass opacity(GGO) degeneration during the epidemic.Methods:A total of 34 patients with diagnosed COVID-19 who confirmed by positive results of the new coronavirus nucleic acid test were collected as observation group 40 patients with pathologically diagnosed early-stage lung carcinoma whose preoperative HRCT examination showed pure ground glass lesions and received surgical intervention were recruited from the Department of Thoracic Surgery (The First Affiliated Hospital of Xiamen University) from January 2018 to December 2019 as the control group. The HRCT imaging features of these two groups of patients were compared and statistically analyzed.Results:The HRCT imaging features of the new type of COVID-19 showed significant difference by characteristics of multiple lesions, lesion rapid variation within 3 days, reticular pattern, vacuolar sign and clear boundary compared to the GGO lesion of early-stage lung carcinoma( P<0.05). The chinical and imaging characteristic the sex, age, with pleural effusion or not and the lesion location showed no significant difference between these 2 groups ( P>0.05). Conclusion:Contrast with inert early lung carcinoma lesions, COVID-19 disease developed rapidly. Imaging dynamic examination can provide evidences to distinguish Novel Coronavirus Pneumonia and early-stage lung carcinoma.

Objective    To analyze the value of structured electronic medical records for pulmonary nodules in increasing the ability of outpatient service and hospital management by resident physicians. Methods    We included 40 trainees [94 males and 26 females aged 22-31 (26.45±2.81) years] who were trained in the standardized training base for surgical residents in our hospital from January 2018 to January 2021. The trainees were randomly divided into two groups including a structured group using the structured electronic medical record for pulmonary nodule and an unstructured group using unstructured electronic medical record designed by our department. The time of completing hospitalization records and first-time course records, the quality of course records, the accuracy of issuing admission orders, the quality of teaching rounds, and patient’s satisfaction between the two groups were analyzed and compared. Results    (1) The average time in the structured group to complete inpatient medical records was significantly shorter than that of the unstructured group (53.61±8.12 min vs. 84.25±16.09 min, P<0.010); the average time in the structured group to complete the first-time course record was shorter than that of the unstructured group (13.20±5.43 min vs. 27.51±8.62 min, P<0.010), and there was a significant statistical difference between the two groups. (2) The overall teaching round quality score of the students in the structured group was significantly higher than that in the unstructured group (84.21±15.61 vs. 70.91±12.28, P<0.010). (3) The score of the medical record writing quality of the structured group was significantly higher than that of the unstructured group (80.25±9.22 vs. 74.22±5.40, P<0.010). Conclusion    The structured electronic medical record specific for pulmonary nodules can effectively improve the training efficiency in the standardized training of surgical residents, improve the clinical ability to deal with pulmonary nodules, improve the integrity and accuracy of key clinical data collected by students, and improve doctor-patient relationship.