The clinical treatment of locally advanced thymic epithelial tumors still faces many challenges, a multidisciplinary treatment model based on surgery is the main treatment method. In recent years, the surgical treatment of locally advanced thymic epithelial tumors has progressed rapidly, especially in the field of minimally invasive treatment. But controversies still exist and there are concepts needed to be clarified and principles to abide by. This article focuses on current status and recent progress in diagnosis and treatments of locally advanced thymic epithelial tumors.

Objective: To analyze the risk factors of acute kidney injury (AKI) after isolated heart valve prosthesis implantation (HVPI) in relevant patients. Methods: We retrospectively studied 400 patients who received isolated HVPI in our hospital. The demographic characteristics and pre-, intra-, post-operative information were collected to conduct uni- and multi-variantanalysis. Results: The pre-operative serum creatinine level in 400 patients was 85.0 (72.0, 98.0) μmol/L and post-operative level was 104.5 (80.0, 146.3) μmol/L, the elevation was 20.9% (1.6%, 57.9%),P<0.05. Multi Logistic regression analysis indicated that age>50years (OR=2.12, 95% CI 1.13-3.95),hypertension history (OR=4.07, 95% CI1.23-13.47), cardiopulmonary bypass time>180 minutes (OR=5.38, 95% CI 1.63-17.77), post-operative hemoglobin<70 g/L (OR=0.20, 95% CI 0.06=0.74), serum glutamic-pyruvic transaminase>100 u/L (OR=12.10, 95% CI 2.28-64.23), pleural fluid drainage at the day of operation> 500 ml (OR=2.12, 95% CI 1.13-3.95), extubation after 24 hours of operation (OR=3.94, 95% CI 2.07-7.52), combining low cardiac output syndrome (OR=4.64, 95% CI 1.06-20.29) were the independent risk factors for AKI occurrence in patients after HVPI, allP<0.05. Conclusion: Post-HVPI AKI was associated with many factors. At prior operation, it was mainly related to the age and hypertension; during theoperation, it was mainly related to cardiopulmonary bypass time; at post-operation, it was mainly related to delayed extubation, low cardiac outputsyndrome, anemia, increased pleural lfuid drainage and serum glutamic-pyruvic transaminase.

Objective To investigate the expression of tumor necrosis factor alpha(TNF-α)and its relationship with infiltrating lymphocytes in lichen planus(LP).Methods Tissue specimens were obtained from the lesions of 60 patients with LP and normal skin of 20 human controls.Immunohistochemical SP method was used to detect the expression of TNF-α,and infiltrating lymphocytes were counted in TNF-α-positive tissue sections.Results TNF-α was expressed in 72％ of the LP specimens but in none of the control specimens(P ＜ 0.01).Positive staining for TNF-α was mainly located in the membrane of prickle cells,cytoplasm or membrane of dermal infiltrating lymphocytes.The expression of TNF-α in LP was uncorrelated with age,sex or disease course(all P ＞ 0.05),but was positively correlated with infiltrating lymphocyte number (rs =0.47,P ＜ 0.01).Conclusion TNF-α seems to play a certain role in the pathogenesis of LP.

Objective To analyze the clinical features of rectal and perianal inflammatory myofibroblastic tumor and evaluate its diagnosis and treatment.Method Clinicopathological data of 3 cases diagnosed as inflammatory myofibroblastic tumor from January,2005 to June,2011 were retrospectively reviewed.Results Inflammatory myofibroblastic tumor presents as infiltrative growth mass with rich vascularization on CT or MRI,and is difficult to distinguish from hemangioma and other rectal tumors.Preoperative biopsy usually fails to ascertain the entity of mass,and pathological examination of the whole resected specimen with immunohistochemical staining is needed to make final diagnosis.All 3 cases underwent sphincter preserving surgery.One case received a second radical operation 16 months after primary resection because of local recurrence.All patients are followed up to now,with a survival time of 67 months,55 months,and 35 months respectively.Conclusions Rectal and perianal inflammatory myofibroblastic tumor is difficult to diagnose on preoperative imaging examinations or biopsy.Immunohistochemical staining is needed to make final diagnosis.Sphincter preserving surgery with complete tumor removal could achieve long term survival.

Objective To develop a standard and procedural protocol for the perioperative management of thymectomy for myasthenia gravis(MG) patients and thus to reduce the incidence of MG crisis.Methods From June 1996 to March 2016,466 MG cases received thymectomy we continuously explored key technologies of surgical treatment for MG 466 patients,there were 209 male cases and 259 female cases,with age ranging from 5 to 77 years and chief complaint history ranging from 12 days to 18 years.Symptoms included drooping eyelids,double vision,weakness,shortness of breath,coughing,dysarthria,and difficulties in swallowing and chewing.According to the modified Osserman classification,there were 248 type Ⅰ MG cases,58 type Ⅱa MG cases,66 type Ⅱb MG cases,71 type Ⅲ MG cases,and 23 type Ⅳ MG cases respectively.116 cases received thymecotomy via full sternotomy,204 cases via J type semi-sternotomy,and 146 case via thoracoscopy (including 13 cases via sub-xiphoid approach).Results Perioperatively one case died of sudden death,another patient died of respiratory failure after the second operation for metastatic thymoma,with a mortality rate of 0.42％ (2/466);13 cases had M G crisis (13/466);Six cases underwent tracheotomy (6/466);2 cases had plasmapheresis hypotonic syndrome (accounting for 3.4％ in plasmapheresis cases) and were reoperated to stop bleeding.Postoperatively pathological diagnosis was made,including three thymic atrophy cases,272 thymic hyperplasia cases,178 thymoma cases,and 13 thymic cyst cases.Conclusion A standard and procedural protocol for the perioperative management of thymectomy for MG patients can be developed,which can reduce the morbidity of MG crisis and the incidence of tracheotomy.

Objective: To investigate the incidence of adverse event following immunization (AEFI) with 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) in Jiaxing City, Zhejiang Province, so as to provide insights into safety monitoring and evaluation of PCV13. Methods: Surveillance data of AEFI with PCV13 in Jiaxing City from 2020 to 2022 were collected from the AEFI Monitoring Information Management System of the Immunization Planning System of Chinese Disease Prevention and Control Information System, including demographic information, vaccination time, time of AEFI occurrence and clinical symptoms, and the reported incidence, population and district distribution, and clinical symptoms of AEFI with PCV13 were descriptively analyzed. Results: Totally 455 cases of AEFI with PCV13 were reported in Jiaxing City from 2020 to 2022, with a reported incidence rate of 232.33/105 doses. There were 431, 21 and 3 cases of general, abnormal, coincidence and psychogenic reactions, with reported incidence rates of 220.07/105 doses, 10.72/105 doses and 1.53/105 doses, respectively, and no reports of causal reaction, vaccine quality accident and vaccination accident. The AEFI cases included 258 boys and 197 girls, with a boy/girl ratio of 1.31∶1, and 288 children at ages of less than a year (63.30%). The largest number of AEFI was reported in Haining City (87 cases, 19.12%), and there were 349 AEFI cases (76.70%) within 24 hours following vaccination. The clinical symptoms mainly included redness and swelling, fever and induration, with reported incidence rates of 132.76/105 doses (260 cases), 109.27/105 doses (214 cases), and 55.66/105 doses (109 cases), respectively. There were 450 cases cured and 5 cases improved in 455 cases of AEFI. Conclusions General reaction is the predominant AEFI in Jiaxing City from 2020 to 2022, with mild symptoms. Most AEFI occurs within 24 hours following vaccination, and has a good prognosis.

OBJECTIVEBased on the different physiological characteristics of the mastoid skin and soft tissue of Chinese congenital microtia malformation, the Nagata two-stage method was respectively applied for ear reconstruction, and the clinic experience were investigated in this study.

METHODAccording to the mastoid skin and soft tissue difference in the thickness and tightness, 280 patients diagnosed with congenital microtia were divided into four types: thin and tight, thin and loose, thick and tight, thick and loose type. 90 cases of thin and loose type accepted the Nagata method of ear reconstruction surgery.

RESULTSWith average 7.8 months follow up, 84.4% (76/90) cases using Nagata two-stage method were satisfied with the outcome of the reconstructed ear including three dimensional position and subunit appearance. There were no postoperative complication related to chest wall deformity or affected normal physical function.

CONCLUSIONSThe Nagata two-stage method is appropriate management choice for Chinese congenital microtia. Based on the different physiological characteristics of the mastoid skin and soft tissue, the selection of different operational should be beneficial to the ear reconstruction of Chinese congenital microtia malformation.

China ; Congenital Microtia ; surgery ; Ear, External ; surgery ; Humans ; Mastoid ; Otologic Surgical Procedures ; Reconstructive Surgical Procedures ; Skin ; Thoracic Wall

OBJECTIVETo investigate the relationship among -75 bp/+83 bp polymorphism in apolipoprotein A1 (apo A1) gene, lipids levels and the occurrence of coronary atherosclerosis disease (CAD).

METHODSWe determined distributions of two MspI polymorphisms of the apo A1 gene at -75 bp and +83 bp, and blood lipids levels among 137 Chinese patients (92 with CAD and 45 in the control group) in relation to circulating lipids and coronary angiography.

RESULTSThe demographic information for 137 subjects showed that subjects with CAD tended to have more unfavorable lipoprotein variables. Genotype distributions at both sites were different between the CAD and control groups. Furthermore, the control group had higher M1-/M2- frequencies than the CAD group (M1: P < 0.005; M2: P < 0.05) and the "M1-" (A) and "M2-" alleles were associated with increased high-density lipoprotein cholesterol (HDL-C) (M1-: P < 0.0001; M2-: P < 0.05) and apo A1 (M1-: P < 0.0001; M2-: P < 0.05) levels. "M1-" and "M2-" were significantly negatively correlated with CAD (P < 0.01 and P < 0.05, respectively).

CONCLUSIONSOur results suggest that changes from G to A at the -75 bp site and from C to T or G to A at the +83 bp site do increase circulating levels of apo A1 and HDL-C. And those individuals with these changes are likely to have a lower risk of developing CAD.

Apolipoprotein A-I ; blood ; genetics ; Case-Control Studies ; Cholesterol, HDL ; blood ; Coronary Artery Disease ; blood ; genetics ; Female ; Humans ; Lipids ; blood ; Male ; Middle Aged ; Polymorphism, Genetic

OBJECTIVETo investigate whether patients, who are at risk of major acute coronary events, are safe to undergo and benefit from early intervention after using simvastatin.

METHODSThe study was a randomized, open, two-dosage-controlled trial to evaluate the safety and benefits of simvastatin administered to 197 patients (10 mg group, n = 98 and 20 mg group, n = 99), within 48 hours of hospitalization for a diagnosis of unstable angina or acute myocardial infarction (MI), with total cholesterol (TC) >/= 180 mg/dL or low-density lipoprotein cholesterol (LDL-C) >/= 100 mg/dL. Lipid levels were measured immediately, followed by the 3rd, 6th and 12th month after admission and all adverse events were recorded during follow-up.

RESULTSTC levels fell by 10.15% and 14.52% in the 10 mg and 20 mg groups (P < 0.05), and LDL-C levels fell 13.87% and 19.38% in the 10 mg and 20 mg groups, respectively (P < 0.01), 12 months after using simvastatin. The rates of achieving target TC reached 26.3% and 36.5% in the 10 mg and 20 mg groups (P < 0.01), and that of LDL-C reached 28.2% and 40.3% in the 10 mg and 20 mg groups, respectively (P < 0.01). There were higher rates of MI and re-hospitalization resulting from angina pectoris and revascularization in the 10 mg group compared with the 20 mg group.

CONCLUSIONSThe results suggest that early intervention with the HMG-CoA reductase inhibitor, simvastatin, in acute coronary syndromes is possible and safe. It also indicates that the clinical dosage of simvastatin are relatively smaller than that for satisfactory lipid control in patients with acute coronary syndromes.

Acute Disease ; Aged ; Cholesterol ; blood ; Cholesterol, LDL ; blood ; Coronary Disease ; blood ; drug therapy ; Female ; Follow-Up Studies ; Humans ; Hypolipidemic Agents ; therapeutic use ; Male ; Middle Aged ; Simvastatin ; therapeutic use

To investigate the clinical efficacy of extended thymectomy by subxiphoid approach video-assisted thoracoscopic surgery(VATS) for myasthenia gravis. Methods We retrospectively analyzed the clinical date of 64 cases of myasthenia gravis treated by subxiphoid approach VATS in the same surgical team from September 2015 to April 2018. The patients were equally divided into 4 groups(A, B, C and D) according to the date of operation. Comparisons were made among the four groups in operation time, blood loss during operation, rate of conversion to thoracotomy, postoperative complications, postoperative hospital stay, duration and amount of postoperative chest tube drainage, frequenlly of surgery. The operative effect of different stage was analyzed. Results There were no intraoperative deaths. 1 patient(group A) was converted to thoracotomy. 3 patients(2 cases of group A; 1 case of group D) had lung infection. 1 patient(group B) developed myasthenia crisis after surgery, and the rest patients showed obvious improvement in postoperative myasthenia symptoms. No significant differences were found in postoperative complications, rate of conversion to thoracotomy, postoperative hospital stay, duration and amount of postoperative chest tube drainage among the 4 groups(P >0. 05). The operation time was significantly longer in group A(186. 25 ± 25. 79) min than the other 3 groups [B(128. 75 ± 16. 28) min, C(135. 00 ± 21. 29) min, D(128. 75 ± 19. 62)min], P <0. 05. The blood loss in surgery was significsntly more in group A(110. 00 ±38. 82)ml than that in the other 3 groups[B(63. 75 ±28. 26)ml, C(58. 13 ±27. 86)ml, D(58. 75 ±25. 00)ml], P <0. 05, while no statistical difference was found among group B, C and D. The frequency of surgery was increased from 1. 6 cases in group A to 2. 3, 2. 7 and 2. 7 cases one month in B, C and D, respectively. Conclusion The results of the present study have shown that subxiphoid approach VATS thymectomy is safe and feasible for the treatment of MG patients. For thoracic surgeons with certain experience in thoracoscopic technique, a plateau of the surgical skill of the subxiphoid opproach can be reached after learning curve procedures.