Objective To explore the causes,prevention and treatment of postoperative respiratory failure in patients with lung cancer.Methods The clinical data of 659 patients,admitted in Changzheng Hospital from Jan.2000 to Dec.2006,with lung cancer and suffered from postoperative respiratory failure were analyzed retrospectively.Preoperative lung function,past medical history,the etiology and preventive procedures,and the treatment methods for postoperative respiratory failure were also reviewed.Results Postoperative respiratory failure was occurred in 42 of 659 cases,the incidence was 6.4%,and all the 42 cases occurred in 1 to 5 days after operation.The major etiopathogenisis of postoperative respiratory failure included respiratory infection,bronchial asthma,operative wound,postoperative incision pain,preoperative cardiopulmonary dysfunction,etc.The respiratory failure was controlled in 37 of the 42 cases by mechanical ventilation and symptomatic treatment.Two cases died of multiple organ failure,another 2 cases died of respiratory distress syndrome and 1 case died of severe respiratory tract infection,the mortality was 11.9%.The preoperative lung function indexes of patients with postoperative respiratory failure were significantly lower than that of those patients without postoperative respiratory failure(P

Objective: To investigate the feasibility of tracheal prosthesis made from biomaterials in the replacement of the circumferential tracheal defects. Methods: Surgical resection and replacement of the cervical trachea with different prosthesis was performed in 16 mongrel dogs. Bronchoscopic, roentgenographic, macroscopic and histopathologic examinations were employed to evaluate the efficacy of the tracheal substitutes. Results: In group A (with type-I prosthesis, n=8), one dog died from prosthetic dehiscence on 96th days postimplantation, another one died from anastomotic leakage caused by severe infection in cervical incision on postoperative 45th days. The other 6 of group A had uneventful postoperative courses and did not show any respiratory symptoms. Tracheal prostheses were completely healed with the recipient's trachea and combined in its integrity. Varied degrees of epithelial lining were observed to have formed near both the anastomotic ends. In addition, many scattered and varied sizes of neo-ossification substances were found at the sites surrounding implanted prostheses. In group B ( type-II prosthesis ,n=4), dehiscence and dislocation of implanted prostheses often occurred with time after operation, which inevitably resulted in severe and fatal postoperative complications .In group C (type-III prosthesis, n=4), all 4 dogs died within 28 days after operation. The leading causes of death were mesh exposure, collapse, infection and air leakage from implanted prosthesis itself. Conclusion: Type-I tracheal prosthesis is a suitable alternative method in reconstruction of tracheal defects, which appears very promising for the clinical application, with further improvements in promoting the epitheli alization completely.

Objective To report the surgical treatment results of cardiac and esophageal cancer of remnant stomach. Methods From 1980 to 2002, 30 patients with cardiac and esophageal cancer of remnant stomach were treated surgically. Results Primary cardiac and esophageal carcinoma of remnant stomach developed in male patients more than females. Of 30 patients, 21(70%) underwent subtotal gastrectomy with Billroth II reconstruction at first time. The mean interval between two operations was 13.5 years. Clinical symptoms frequently included abdominal distension, pain and hemorrhage. Thirty patients received radical resection. Conclusion Cancer in remnant stomach should be suspected in patients undergoing subtotal gastrectomy 5 years and over have clinical symptoms of upper gastrointestinal tract. Early diagnose and early curative resection should be done. For cardiac cancer of remnant stomach, total gastrectomy with “P” loops and Roux-en-Y esophagojejunostomy reconstruction were recommended. This procedure have advantage in retaining enough food storage preventing reflux esophagitis and allowing resection of esophagus long enough to avoid cancer remnant. For esophageal cancer of remnant stomach, colon reconstruction after the resection of esophageal cancer is recommended.

ObjectiveTo investigate the effect of low density lipoprotein(LDL) and oxidized low density lipoprotein(ox-LDL) on the secretion of endothelin(ET) and whether LDL to be oxidized and modified by ox-LDL in vitro.MethodsEndothelial cell strain ECV-304 was incubated with different concentration of LDL(50 and 100 mg/L),ox-LDL(50 and 100 mg/L) or LDL+ox-LDL(50mg/L) for 24 hours,then cells and cultured medium were collected.ET in cells and cultured medium were detected with radioimmunoassay.ResultsBoth of LDL and ox-LDL enhanced the secretion of ET in cultured endothelial cells;the effect of ox-LDL was more markedly than LDL.LDL+ox-LDL had a greater effect than any of the two lipoproteins alone.ConclusionLDL and ox-LDL may have the ability to promote the secretion of ET in cultured endothelial cells and LDL can be oxidized and modified by ox-LDL in vitro.

By means of literature review,the authors initiated the behavior expression system of hospitals' social responsibilities,which is further refined and revised with questionnaires and Delphi method.13 expressions of such behavior expressions were determined,namely “providing quality of care to patients”,“undertaking rescue assignment for emergencies”,and “fulfilling government-assigned tasks”.All of the 13 expressions were supported by 75％ of the experts during the second round of experts consultation.

The mode of using standardized patients has been applied in cardiothoracic surgery teaching to assess students efficiency.It alleviates the conflict of the shortage of resource for clinical teaching and improves the quality of teaching and achieves good results.

Objective:To prepare 2 composites using different proportions of hydroxyapatite and collagen and to assess their structural and biological properties, so as to pave a way for preparing tissue engineering chest wall scaffold.Methods: Two kinds of hydroxyapatite/collagen composites were prepared according to the weight ratios of 11 and 12; collagen sponge served as control. Then the structures of the 2 composites and the collagen sponge were observed under SEM. In vivo study was conducted to assess the biocompatibility and biodegradation of the composites by gross inspection and histological examination. Results: The collagen sponge had a 3-D network structure with fluey collagen fibers and poor mechanical strength, and its structure was damaged within 2 weeks after implantation and was completely absorbed 4 weeks later. The hydroxyapatite and collagen were well mixed in the composite with a hydroxyapatite to collagen ratio of 12; the composite had homogeneous 3-D porous structure (size of the pore being 100-400 m) and showed good biocompatibility: maintained its porous structure 4 weeks after implantation and was absorbed within 8 weeks. In composite with hydroxyapatite to collagen ratio of 11, the hydroxyapatite particles were separated from collagen fiber and conglomerated into masses, and the composite resulted in severe tissue reaction after implantation.Conclusion: When mixed with a reasonable proportion of hydroxyapatite, the collagen sponge has improved structure, biodegradable performance, and biocompatibility; the composite may be a novel scaffold for tissue engineering chest wall reconstruction.

Objective To evaluate a new TNM staging system inclusive of intraperitoneal free cancer cells in terms of postoperative survival of patients with gastric cancer. Methods Free cancer cells (FCC) in the peritoneal washes of gastric cancer patients were estimated by measuring CEA mRNA levels using real-time RT-PCR. After 5-year follow-up, we get the cut-off value of CEA mRNA level by using MedCalc software to analyze the ROC curve. When CEA levels are more than the cut-off value, it may considered as FCC(+), and then using FCC(+) as distant metastasis (MI) to make a new TNM staging and analyze patients life-span. Results (1) Under the ROC curve analysis, when the cut-off value of CEA mHNA level was at 31.21 copies/ml, the Youden's index is the highest. (2) When FCC (+) considered as M1 to make a new TNM staging, the 5-year survival rate showed as below: Ⅰ-Ⅱ, P=0. 134; stage Ⅱ-Ⅲ P=0.004 and Ⅲ-Ⅳ P=0.022,repecetively. Conclusion (1) The best cut-off value of CEA mRNA levels for FCC in peritoneal washes is 31.2 copies/ml. (2) Our study demonstrated that application of FCC(+) in the TNM staging may have a better estimation of prognosis of patients suffering from advanced gastric cancer.

Objective: To replace esophageal defects with artificially composed biodegradable materials and non-biodegradable materials. Met hods: A two-layered tube consisting of a collagen-chitosan sponge and an inner polyurethane stent was used to replace 5 cm esophageal segmental defect s in 15 dogs. The inner polyurethane stent was removed endoscopically at weekly intervals from 2 or 4 weeks. Results: Partial regeneration of es ophageal epithelia was observed in 5 dogs at week 2, and progressing constricti on occurred and the dogs became unable to swallow within 1 month. In the 10 dog s that the polyurethane stent was removed at week 4, regenerated esophageal tiss ue successfully replaced the defects, and complete epithelization was observed 1 month after surgery. Complete regeneration of esophageal mucosa structures, inc luding mucosal smooth muscle and mucosal glands were observed 3 months after surgery, and partial regeneration of esophageal muscle tissue was also observed 6 months after surgery. Conclusion: Our artificial prosthesis i n reconstruction of the cervical esophagus segment in dogs is feasible. Through temporary polyurethane tube, collagen-chitosan sponge provides a three-dimensi onal structure suitable for the regeneration and sufficient degradation time for the complete regeneration of esophagus.

Objective To evaluate the semi-quantitative parameters of dynamic contrast enhanced MRI (DCE MRI) with double echo in the diagnosis of breast tumors.Methods Thirty eight patients suspected of breast tumour underwent DCE MRI with double echo examination by using 3.0 T whole-body MR scanner with a sixteen-channel phased-array breast coil.Semi-quantitation of both pharmacokinetic and perfusion parameters were performed including peak enhancement ratio (PER),time from contrast agent arrive to peak enhancement (Tmax),and maximum signal intensity loss (MSIL).The mean PER,Tmax and MSIL of the breast cancer,fibroma and other benign lesions were calculated.One-way ANOVA and receiver operating characteristic curve (ROC) analysis were used to compare the differences between malignant and benign lesions.Results The mean PER,Tmax and MSIL of the lesions were as follows:0.61 ± 0.09,(164.9 ± 20.5) s,and 0.31 ± 0.03 for breast cancers (n =20) ; 0.46 ± 0.07,(183.2 ± 13.7) s,and 0.17± 0.03 for fibromas (n =10) ; 0.23 ± 0.06,(139.4 ± 23.6) s,and 0.24 ± 0.07 other benign lesions (n =8),respectively.There were significant differences among 3 groups in all semi-quantitative parameters (F =4.319,4.154,4.752,respectively.P ＜ 0.05).The areas under the ROC curve of PER,Tmax and MSIL for the diagnosis of malignant lesions were 0.513,0.794 and 0.769,respectively.The sensitivity of PER,Tmax,and MSIL were 60.0％,80.0％ and 62.5％ and the specificity were,62.5％,75.0％ and 90.0％,respectively,with the maximum Youden'index as cut off value.When combining the 3 semi-quantitative parameters,the sensitivity,specificity and accuracy for differential diagnosis of breast tumors were 95.0％ (19/20),83.3％ (15/18),and 89.4％ (34/38),respectively.Conclusion The semi-quantitation of pharmacokinetic parameters (PER,Tmax) and perfusion data (MSIL) can be simultaneously estimated in a dynamic contrast enhanced MRI with double echo in breast lesions.The Accuracy for differential diagnosis of breast tumors can be improved when judge by combination of PER,Tmax and MSIL.