ObjectiveTo evaluate the feasibility of the completely thoracoscopic lobectomy for clinical N0 and postoperatively pathological N2 non-small-cell lung cancer(NSCLC).MethodsFrom Sep.2006 to Jan.2010, 216 patients with NSCLC received completely thoracoscopic lobectomy in our center.Two hundred and six patients were clinical N0 preoperatively(103 males and 103 females, median age of 62.3 years, rang 29 to 85 years).They were divided into two groups based on postoperatively pathological staging, pN0 group and pN2 group.Some perioperative factors including age, gender,tumor size,tumor location,pathological type, pathological differentiation,rate of conversion to thoractomy,operation time,blood loss,lymph node dissection, time of drainge, hospitalization and complications were studied and compared between two groups.Results There were 203 cases of lobectomy, 2 cases of composite lobectomy and 1 case of pneumonectomy.All procedures were carried out safely without serious complication except for one operative death result from respiratory failure.There were 168 cases in pN0 group and 38 cases in pN2 group.Age and gender were similar between two groups.The tumor size in pN0 group was smaller than that in pN2 group [ (2.6 ± 1.6) cm vs (3.7 ± 1.9) cm, P = 0.001 ].The tumors in pN0 group were lesser appearance in the bilateral lower lobes (31.0％ vs 50.0％, P = 0.026).There was a approximate proportion of adenocarcinoma in two groups (82.7％ vs 73.7％, P = 0.181), but the proportion of poorly differentiated carcinoma in pN0 group was significantly lower than that in pN2 group(19.0％ vs 42.1％, P = 0.002).There were no differences in the rate of conversion to thoractomy(7.1％ vs 7.9％, P = 1.000), operation time[ (196.1 ± 53.7) min vs (208.6 ± 56.8) min, P = 0.202 ], blood loss[ (253.2 ±247.9) ml vs(279.0±183.3) ml, P=0.475], time of drainage[ (7.7 ±3.2) days vs (9.7 ±6.3) days,P=0.066], hospitalization[ (10.6 ±4.6) days vs (13.0 ±7.6) days, P =0.063]and complications(12.5％ vs 21.1％,P =0.171).The stations of mediastinal lymph node dissection were equivalent in two groups(3.1 ± 1.2 vs 3.3 ± 1.1, P =0.237) , but there were fewer numbers of mediastinal lymph node dissection in pN0 group (9.9 ± 6.8 vs 12.7 ± 8.4, P =0.038).ConclusionCompletely thoracoscopic lobectomy is a feasible surgical therapy for cN0-pN2 non-small-cell lung cancer without loss of curability.

OBJECTIVETo evaluate the effectiveness of manual therapy and traction for lumbar disc herniation and analyze the current status of this kind of randomized clinical trial (RCT).

METHODSDatabase of CNKI, VIP, WANFANG, PubMed and OVID were searched. Some relevant journals were manually retrieved. A total of 2 874 literatures on manual therapy and traction for lumbar disc herniation were collected, of which 17 articles met the inclusion criteria. The Jadad score scale was used to evaluate the quality,and RevMan5.0 was used for meta-analysis of literatures.

RESULTSThe results of the meta-analysis of all trials involved were as followed:the combined effect of the effective rate was RR = 1.10, 95% CI [1.06, 1.14], the combined effect of the cure rate was RR = 1.36, 95% CI [1.21,1.52], the combined effect of the VAS was RR = 1.37, 95% CI [1.28, 1.45], the combined effect of the JOA was RR = 4.75, 95% CI [4.40, 5.09].

CONCLUSIONThe overall quality of the current RCT researches about manual therapy for lumbar disc herniation was lower,and did not support the conclusion that manual therapy was more effective than traction for lumbar disc herniation.

Humans ; Intervertebral Disc Displacement ; surgery ; therapy ; Lumbar Vertebrae ; surgery ; Musculoskeletal Manipulations ; methods ; Randomized Controlled Trials as Topic ; Traction ; methods

Objective To discuss the safety, completeness and efficiency of the completely thoracoscopic lobectomy for non-small-cell lung cancer(NSCLC) which the tumor's diameter was larger than 5 centimeters. Methods From September 2006 to December 2009, 214 patients of NSCLC received completely thoracoscopic lobectomy in our center. There were 108 males and 106 females with median age of 62.5 years( range from 29 to 85 years). Patients were divided into two groups, group A ( diameter≥5 cm) and group B ( diameter ＜5 cm). We compared all the factors of age, gender, pathological type, location,rate of conversion to thorsctomy, operation time, blood loss, lymph node dissection, pathological stage, time of drainge, hospitalization, complications, overall survival and recurrence between two groups. Results Surgical procedures included lobectomy in 211 cases, composite lobectomy in 2 and pneumectomy in 1. All procedures were carried out safely without serious complication except one operative death result from respiratory failure. There were 30 cases in group A and 184 in group B. Age and gender were similar between two groups. The proportion of squamous cell carcinoma in group A was higher than it in group B (46.7% vs. 13.6% ,P ＜0.001 ). There were no differences in safety factors such as rate of conversion to thorsctomy( 16.67% vs. 7.61%,P =0.204), operation time[(214.0 ±58.1)min vs. (198.6 ±55.1)min, P=0.160], blood loss [(283.3 ±179.7)ml vs. (248.5 ±25.7)ml, P=0.559] and complications (13.33% vs. 14.67%,P=1.000). The completeness factors of lymph node dissection stages (5.0 ± 2.4 vs. 5.0 ± 1.7, P = 0.990 ) and numbers( 19.1 ± 10.1 vs.15.8 ± 8.8, P = 0.065 ) were equivalent between two groups. The estimated overall survival at 1 year was 81.25% for group A and 92.63% for group B ( P = 0.226). The recurrence of two groups was 3.45% vs. 2.23% (P = 0.532 ), respectively.Conclusion Completely thoracoscopic lobectomy can be done safely,completely and efficiently for non-small-cell lung cancer which the tumor's diameter was larger than 5 centimeters.

Objective To optimize operative techniques of completely video-assisted thoracoscopic lobectomy by reviewing the experience of Peking University People's Hospital. Methods From September 2006 to August 2010, 408 patients (214 males,194 females) with median age of 58.6 years (range from 15 to 86 years) underwent completely thoracoscopic lobectomy. All procedures were conducted under general anesthesia with double lumen intubation. The thoracoscope was introduced through 7th or 8th intercostals space on the mid-axillaries line. The 4 cm long utility incision was made on the 4th or 5th intercostals space anterior axillary's line without rib-spreading. A third retraction incision located on the 7th or 8th intercostals space sub-scapular line. The surgeon stands on the ventral side of patient using an electrocautery hook and a suction device through the utility incision. Anatomic lobectomy was performed with systemic mediastinal lymph node dissection for lung cancer patients. Results All procedures were carried out smoothly with no case of serious complication. There was 1 case death because of respiratory failure of pulmonary fungal infection during the operative period. The average surgical duration was 195 minutes, and average blood loss was 249 ml with no blood transfusion required. There were 35 cases (8.6%) of conversion to open thoracotomy, including interference by lymph nodes, bleeding, inflammatory adhesion of Artery and large size tumors.The results of pathology show 322 cases of malignant disease and 86 cases of benign disease. Conclusion To grasp the core technique of completely thoracoscopic lobotomy may make the procedure undergone smoothly, and may shorten the learning curve.

X-linked sideroblastic anemia (XLSA) is caused by mutations of erythroid-specific 5-aminolevulinate synthetase (ALAS2) gene. In this study a eukaryotic expression vector of ALAS2 was constructed and transfected into eukaryotic cells to observe the expression of ALAS2 gene. The full length cDNA of ALAS2 gene was inserted into plasmid pDs-red2-N1, named pDs-red2-N1/ALAS2. Then, the vector was transfected into K562 cells via electroporation. At 48 hours after transfection, total RNA from K562 cells was extracted, expressions of ALAS2 gene and protein with red fluorescence in the K562 cells were detected by RT-PCR and flow cytometry, respectively. The vector was also transfected into COS 7 cells via liposome. Both mRNA and protein expression in COS7 cells were detected by RT-PCR and fluorescence microscopy. The result showed that after the pDs-red2-N1/ALAS2 eukaryotic expression vector was digested by KpnI and BamHI, two fragments of 4 700 bp and 1 764 bp were displayed by electrophoresis on agarose gel. Sequence method confirmed that the sequence was correct. RT-PCR amplified the total RNA extracted from the transfected K562 and COS7 cells, and could find mRNA of ALAS2 gene that can't be found in K562 and COS7 cells usually. The expressions of both fluorescein and ALAS2 were significantly increased. The percentage of positive cells reached about 19.2% and 10.7%, respectively. ALAS2 expression lasted for 10 days in COS7 cells and the peak was at the third day. It is concluded that the eukaryotic expression vector of ALAS2 gene is successfully constructed; K562 and COS7 cells transfected with the vector via electroporation and liposome can express ALAS2 protein. So, the vector has the potential in gene replacement and can be used for patients with XLSA in future.
5-Aminolevulinate Synthetase ; genetics ; Anemia, Sideroblastic ; genetics ; therapy ; Animals ; COS Cells ; Chromosomes, Human, X ; Genetic Linkage ; Genetic Therapy ; Genetic Vectors ; Humans ; K562 Cells ; Microscopy, Fluorescence ; Reverse Transcriptase Polymerase Chain Reaction

BACKGROUNDCompletely video-assisted thoracoscopic lobectomy is a reasonable treatment for early-stage non-small-cell lung cancer (NSCLC). At present, the indication for this procedure is stage Ia and Ib peripheral lung cancer (≤ 5 cm); however, for larger tumors, it remains controversial whether this surgical technique is comparable to open lobectomy. This study aimed to evaluate the safety, completeness, and efficacy of thoracoscopic lobectomy, and to compare this technique with open lobectomy for the treatment of non-small-cell lung cancer when the tumor's diameter was greater than 5 cm.

METHODSFrom May 2001 to April 2011, 802 patients underwent a lobectomy for treatment of non-small-cell lung cancer at our center. In 133 patients, the tumor was > 5 cm. There were 98 men and 35 women, median age 63 years (range: 29 - 81 years). We divided the patients into two groups, group V (completely video-assisted thoracoscopic surgery), and group T (open lobectomy), and evaluated the two groups for age, gender, tumor size, pathological type, location, duration of surgery, blood loss, lymph node dissection, pathological stage, time of drainage, hospitalization, complications, overall survival and recurrence.

RESULTSThere were 46 cases in group V and 87 cases in group T. Age, gender, tumor size, location, pathological type and stage were similar between the two groups. Group V had shorter operative duration ((186.5 ± 62.8) minutes vs. (256.7 ± 67.5) minutes, P < 0.001) and reduced bleeding ((218.5 ± 174.6) ml vs. (556.9 ± 187.2) ml, P < 0.001). There were no significant differences between the two groups in complications, lymph node dissection, time of drainage and hospitalization. The recurrence between the two groups was equivalent (2.4% vs. 3.8%, P = 0.670). The overall survival at 1, 2 and 3 years was 95.1%, 81.6% and 69.6% for group V and 88.3%, 78.8% and 64.0% for group T. Kaplan-Meier survival curves showed that there was no significant differences between the two groups (P = 0.129).

CONCLUSIONSCompletely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety, completeness, and efficacy, but had a shorter operative duration, and reduced bleeding. This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size > 5 cm.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; surgery ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pneumonectomy ; adverse effects ; methods ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; adverse effects ; methods ; Treatment Outcome

Objective To evaluate the value of autofluorescence bronchoscope (AFB) in airway examination in central type lung cancer. Methods From Sep 2009 to Mar 2010 ,29 patients ( 23 men , 6 women , median age 62.2 years , range from 34 to 81 years) underwent AFB procedure. There were 3 lesions located at trachea, 1 at right main bronchus, 9 at right upper lobe, 1 at right median bronchus, 1 at right middle lobe, 4 at right lower lobe, 1 at left main bronchus, 9 at left upper lobe.There were 21 preliminary diagnostic cases and 8 postoperative surveillance cases. All procedure was performed under combination of local anaesthesia and general anaesthesia. All patients underwent white light bronchoscopy followed by AFB procedure.All of the suspicious abnormal sites were recorded and biopsied for pathological examination. Results All procedures were safely performed without death or serious complications. 100 specimens were obtained for pathologic examination. Malignant lesion was diagnosed in 39 and non-malignancy in61. All malignant sites were detected by AFB, however WLB missed 12 sites.The sensitivity of AFB and WLB for malignancy were 100% and 69.2%, respectively. In 21 preliminary diagnostic cases,AFB detected all malignancy sites, but WLB missed 23 sites, in which 9 were malignant sites. In 8 rechecked patients, AFB detected all malignancy sites, but WLB missed 7 sites, in which 3 were malignant sites. Conclusion Autofluorescence bronchoscopy could be more accurate in judging the extent of the tumor invasion, more sensitive in finding multiple lesions in airway, more sensitive in detecting early cancer recurrence in postoperative surveillance patients.

Objective:To investigate the expression of HBV X, gene mutation in M type phospholipase 2 receptor (PLA 2R) in hepatitis B associated membranous nephropathy (HBV-MN) and its possible pathogenesis. Methods:According to the result of PLA 2R immunofluorescence detection in renal tissue, 103 patients with HBV-MN confirmed by renal biopsies were divided into two groups: PLA 2R positive group (n=66) and PLA 2R negative group (n=37). T test was used to compare the clinical biochemical measurements between the two groups. According to MN I stages (mild pathological injury) and MN II-III stage (severe pathological injury) of HBV-MN pathological stage, One-way ANOVA analysis was used to compare the pathological injury of kidney between the two groups. Spearman correlation analysis was used to compare the expression intensity of PLA 2R and pathological injury of kidney. Finally, the mutation sites of HBx gene in the two groups were analyzed. Results:There was significant difference in 24 h urinary protein between the two groups ( t=2.803, P=0.006). However, there was no significant difference in serum albumin level ( t=-0.313, P=0.755), serum creatinine ( t=-0.332, P=0.741), cholesterol ( t=0.312, P=0.756) and complement C3 ( t=0.589, P=0.557) between the two groups. There was significant difference between the two groups in MN stage I ( X2=7.449, P=0.006) and MN stage II-III ( X2=10.15, P=0.034). Secondly, the correlation analysis of Spearman between PLA 2R staining intensity and different MN pathological stages was statistically significant ( r=0.325, P=0.008). Finally, the mutation of HBx gene sequence between the two groups was analyzed, and it was found that the mutation at nt1753 site might be related to the expression of PLA2R. Conclusions:The positive expression of PLA 2R in renal tissue was found in 2/3 HBV-MN patients. The PLA 2R positive group was accompanied by the increase of urinary protein excretion and the aggravation of renal pathological injury. At the same time, nt1753 site mutations in HBx gene are related to the expression of PLA 2R, which may be an important pathogenesis of PLA 2R positive HBV-MN.

A case of paraneoplastic cerebellar ataxia syndrome caused by immune checkpoint inhibitors(ICI)was treated with ofatumumab(OFA).The patient is a 57-year-old male.He used"Camrelizumab"immunotherapy for his previous history of small cell lung cancer.The main reason was"walking unsteadily for more than one year and shaking his head involuntarily for more than one month".After admission,the head MRI,chest CT,electroencephalogram,lumbar puncture and other related examinations were improved.The antibody spectrum of paraneoplastic neurological syndrome was anti-GAD65 antibody IgG(+),and the case was then diagnosed as the immune checkpoint inhibitor-related paraneoplastic neurological syndromes(PNS)of nervous system.After OFA treatment(20 mg/time),the symptoms were obviously improved.This paper analyzes the clinical features and diagnosis and treatment approaches of this case,in order to improve clinicians'understanding of the disease and provide reference for clinical diagnosis and treatment of similar cases.

BACKGROUNDMediastinal lesions are often difficult to diagnose in clinical practice because of the unique anatomical position of the mediastinum, which makes performance of biopsy difficult. The value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lung cancer and mediastinal lymph node staging has been widely accepted. However, few studies have been conducted on the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of mediastinal lesions. The current study was conducted to investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and differential diagnosis of isolated mediastinal lesions without lung abnormalities.

METHODSWe retrospectively analyzed the data of patients with isolated mediastinal lesions without lung abnormalities for whom endobronchial ultrasound-guided transbronchial needle aspiration examination was performed at the Department of Thoracic Surgery of Peking University People's Hospital, between September 2009 and December 2010. For patients who could not be diagnosed with endobronchial ultrasound-guided transbronchial needle aspiration, surgical biopsy or more than 6 months of clinical and imaging follow-up was carried out.

RESULTSEndobronchial ultrasound-guided transbronchial needle aspiration was performed for 60 patients with isolated mediastinal lesions. Correct diagnosis was made in 48 cases. Nineteen cases were malignant, and 29 were benign. The rate of correct diagnosis was 80%. The sensitivity, specificity, and accuracy of endobronchial ultrasound-guided transbronchial needle aspiration in distinguishing benign from malignant mediastinal lesions were 95%, 100%, and 98%, respectively. The examination was tolerable for all patients. No associated complications were observed.

CONCLUSIONEndobronchial ultrasound-guided transbronchial needle aspiration is a safe and effective method of diagnosing mediastinal lesions.

Adolescent ; Adult ; Aged ; Biopsy, Fine-Needle ; methods ; Female ; Humans ; Male ; Mediastinal Neoplasms ; diagnosis ; diagnostic imaging ; Mediastinum ; diagnostic imaging ; pathology ; Middle Aged ; Retrospective Studies ; Ultrasonography ; Young Adult