Objective To explore the effects of smog and elastase on the pulmonary functions and histology during the pathogeny of rabbits' chronic obstructive pulmonary emphysema. Methods Forty-eight New Zealand rabbits were divided into smoking, elastase, combined and control groups,and given smog produced from cigarette or injected elastase into trachea. Seven weeks later, pulmonary functions, artery blood gas analysis and pulmonary histology were detected. Results Compared with control group, vital volume (V T),forced expiratory volume in 0 3 second (FEV 0 3 ),FEV 0 3 /FVC (forced expiratory capacity), PaO 2,PaCO 2,total lung capacity (TLC),functional residual capacity (FRC), density of alveolar septum (Ds), number of alveolus (Na) and diameter of alveolus (Da) in both elastase (P0 05). Morphological changes of obstructive emphysema were noticed under naked eyes and optical microscope in combined group, while only slight changes could be seen in elastase group. No above change was observed in smoking group. Conclusions Rabbits' obstructive pulmonary emphysema can be induced by elastase, and smog can increase its induction and formation.

Objective To evaluate the therapeutic effect of single-sided lung volume reduction surgery (LVRS) with different resection volumes on obstructive emphysema in rabbit. Methods Obstructive emphysema was reproduced in 50 New Zealand white rabbits with smog and elastase, and they were randomly divided in equal number into emphysema (A), small volume LVRS (B), moderate volume LVRS (C), large volume LVRS (D), and shame operation (E) groups. LVRS with different resection volumes was carried out groups B, C, and D. Pulmonary functions, artery blood gas analysis and pulmonary histology were determined 8 weeks later. Results Compared with those in group A, vital volume (V T), 0.3 second forced expiratory volume (FEV 0.3), FEV 0.3/FVC (forced expiratory capacity), PaO 2, density of alveolar septum (Ds) and number of alveolus (Na) were increased postoperatively, and PaCO 2, total lung capacity (TLC), functional residual capacity (FRC) and diameter of alveolus (Da) were decreased in group C (P0.01). Morphological improvements of emphysema were noticed under naked eye and optical microscope only in C group. Conclusion Single-sided LVRS with appropriate resection volume can improve effectively obstructive pulmonary emphysema in rabbit.

BACKGROUND: Rehabilitation exercise and conservative treatment do not bring about good therapeutic effect for severe obstructive emphysema.And lung volume reduction surgery (LVRS) is an effective method for this kind of disease. How much emphysematous tissue should be resected in LVRS to achieve the best curative effect has been a concern.OBJECTIVE: To evaluate the pulmonary functional and alveolar morphologic changes in emphysematous rabbits after unilateral LVRS, and to compare the effects of different resection volumes.DESIGN: A completely randomized and controlled trial.SETTING: Thoracic Surgery Center of Daping Hospital of the Third Military Medical University of Chinese PLA.MATERIALS: This study was completed at the Laboratory of Thoracic Surgery Center of Daping Hospital of the Third Military Medical University of Chinese PLA from Frebruary 2003 to August 2003. Totally 50 New Zealand white male rabbits of cleaning grade were involved. These animals were divided randomly into groups of emphysema (A), less volume LVRS (B), middle volume LVRS (C), larger volume LVRS (D), and shame operation (E) .METHODS: Making of the rabbit emphysema model: Rabbits were put into an organic glass box and they inhaled passively smog produced from the cigarettes. Within seven weeks, 15 cigarettes (Yinxiang .Brand) were lighted for about 30 minutes every time, once per day and five times a week. Elastase for 3 mL(2000 U/kg) from porcine pancreas (SERVA Co.,Ltd) was injected into the rabbits' trachea in the fourth week. Intervention for different groups: Rabbits in Group A received no operation at all. Animals in other four groups were given general anesthesia by muscular injec tion of Sumianxin Ⅱ and they were then fixed supinely on the operation table. The rabbits were intubated with a 3-mm endotracheal tube and mechanically ventilated (HX-200 ventilator) with a tidal volume of 12 mL/kg and a respiratory rate of 40-50/minute. Thoracotomy was conducted through anterolateral incision of the fourth right intercostals area. The upper and lateral pulmonary tissues of the first lobe of the right lung were resected in Group B. For group C, the upper and lateral pulmonary tissues of the first and the second lobes of the lung were resected. For Group D, the upper and lateral pulmonary tissues of the first, second and the third lobes of the right lung were resected. The pulmonary removal was about a half of the total volume of the lobe. The specimens were removed, followed by 3-0 mattress suture of the wounds. Then, fibrin sealant was insufflated to avoid air leakage after the operation. Thoracotomies without any resection of lung parenchyma were carried out in Group E. Histologic inspection and quantitatively morphologic analysis of the left lung was postoperatively carried out eight weeks later.MAIN OUTCOME MEASURES: Quantitative analysis of pulmonary functions and alveolar morphology in rabbits with emphysema after lung volume reduction surgery with different resection volumes RESULTS: All the fifty rabbits were analyzed, and there were ten animals in each group. ① Comparison of ventilation volume in each group: In Group C, vital volume (VT), forced expiratory volume in 0.3 s (FEV0.3),FEV0.3/forced expiratory capacity (FVC) were all higher than those of Group A [(6.69±0.83) mL, (6.39±1.35) mL, (64.5±16.1)％; (5.76±0.84) mL,(5.23±1.37)mL, (50.2±15.6)％, P＜ 0.05], while functional residual capacity (FRC) was lower than that in group A [(14.3±1.9)mL; (19.3±3.1)mL, P＜ 0.05].Compared with Group A, no obvious difference in the above lung functions of Groups B, D and E was observed (P ＞0.05). ② Histopathological observation results: In group C, obvious repairs to dilatation and destruction of alveolar ducts or cyst were observed and the aggregation of macrophage and neutrophils in the end-terminal bronchiole decreased. In Group D, the inflammatory cells decreased, but alveolar destruction and dilatation became more marked. ③Comparison of the total lung capacity (TLC): TLC of Group C was less than that of group A [(42.1 ±5.8)mL, (58.5±7.6)mL, P＜ 0.05].Compared with group A, no obvious difference in the above lung functions of Groups B, D and E was observed (P ＞0.05). ④ Quantitative analysis result of alveolar morphology: The number of alveoli (Na) and density of alveolar septum (Ds) in Group C were much larger than those of group A [(17.6±3.1)/field, (18.6±2.1)％; (11.3±2.7)/field, (15.2±3.6)％, P＜ 0.05] while the diameter of the alveoli (Da) in Group C was significantly lower than those of Group A[(78.1±7.1),(93.4±10.2)μm, P ＜ 0.05].CONCLUSION: Combination of smog and elastase successfully induced rabbit model of obstructive emphysema. Unilateral LVRS could improve emphysematous rabbits' pulmonary functions. Improved in pulmonary functions was not obvious by LVRS with less (12.5％) or larger (37.5％) resection volume of lung parenchyma. LVRS with appropriate resection volume (25％) could effectively eliminate airway inflammation, alleviate alveolar dilatation and destruction of the residual lung parenchyma, and thus improve pulmonary ventilation function.

0.05).The effectual time for pain relief was2～17days(4.1days in av?erage).Serum calcium level declined after treatment and reduction of bone radioactive isotope collection was found in34pa?tients.The follow-up periods ranged from3months to30months.Fratures were found only in two patients.CONCLUSION:Domestic pamidronate disodium has satisfactory therapeutic effect on postoperative bone metastasis of non-small cell lung cancer.

Objective To study the features of esophageal motility in the cases with myasthenia gravis(MG).Methods 15 healthy controls and 45 patients with MG were tested by using a low-compliance four-lumen hydraulic infusion system,respectively.Focused on the following parameters:PP,UESP,UEP,MEP and MERP.Results There were significant differences of the parameters in between MG cases and healthy controls PP (73.24 ± 31.40) mmHg (1 mmHg =0.133 kPa) vs.(103.78±29.47) mmHg,P=0.002;UESP(41.75 ±21.04) mmHg vs.(60.59 ±17.97) mmHg,P=0.003;UEP (56.63 ±30.26) mmHg vs.(78.98 ±30.14) mmHg,P =0.016;MEP(53.96 ±23.25) mmHg vs.(75.11 ±23.75) mmHg(P =0.004).However,MERP of MG cases or healthy controls seemed to be similar[(-7.76 ± 5.94) mmHg vs.(-7.58 ± 5.76) mmHg,P =0.91).Additionally,the above-mentioned parameters in the cases with generalized myasthenia gravis or dysphagia were significantly different compared with other subtypes or healthy controls (P ＜ 0.01).However,there were no significant differences of the parameters in between ocular MG and healthy controls,or in between MG with and without thymoma.Conclusion The upper and middle part of esophageal motility dysfunction is very common in MG cases,especially in those with dysphagia or generalized MG,characterizing by the declined pressure.Manometry in MG cases can help us classify the subtypes of MG and verify their esophageal motility functions.

Objective To explore the diagnosis and surgical treatment of pulmonary sequestration in adults. Methods Clinical data of 21 cases of pulmonary sequestration whose diagnosis was confirmed by surgical biopsy in our department from March 2009 to February 2016 were retrospectively analyzed. Divided the patients into the thoracotomy group (n=9) and the thoracoscope group (n=12) according to dif-ferent surgical methods, and compared the diagnosis and surgery of the two groups. Results Among the patients, 8 cases were diagnosed as pulmonary sequestration and the remaining 13 cases were misdiagnosed,with the misdiagnosis rate of 61. 9%. Intraoperative exploration dem-onstrated that the abnormal blood vessels were originated from thoracic aorta (n=14,66. 7%),abdominal aorta (n=4,19%),phrenic artery (n=3,14. 3%) and aortic arch (n=1,4. 8%), and there were 20 cases (95. 2%) of intralobar sequestration and 1 case (4. 8%) of ex-tralobar sequestration. Patients underwent thoracotomy and patients underwent video-assisted thoracoscopic surgery were of no significant differences in operative time (P=0. 104),blood loss (P=0. 209),chest tube duration (P=0. 511),drainage volume (P=0. 135) and postoperative hospital stay (P=0. 450). All the patients recovered well after surgery. Conclusion As pulmonary sequestration lacks specific clinical manifestations,missed diagnosis and misdiagnosis are very common in patients. Chest enhanced CT and CT angiography are effective diagnostic methods at present. Both thoracotomy and VATS can achieve good therapeutic effects.

Objective To analyze the perioperative clinical characteristics of non-small cell lung cancer ( NSCLC ) complicated with dermatomyositis ( DM) . Methods Six cases of NSCLC complicated with DM received lobectomy and lymph node dissection by video-assisted thoracoscopic surgery. The same kind of operations were carried out in another six NSCLC cases without DM in the same period. The twelve cases in two groups were 1 ∶ 1 matched study. The operation time, operative blood loss, postoperative pneumonia or atelectasis rate, postop-erative wound recovery, thoracic drainage in postoperative three days, incidence of postoperative atrial fibrillation, perioperative hospital stay were compared between the two groups. Results In operative time, blood loss and thoracic drainage volume in postoperative three days, there was no significant difference in two groups (P>0. 05). In paients with and without DM, the occurrence rate of atrial fibrillation was respectively 50. 00% (3/6) and 16. 66% (1/6), the occurrence rate of postoperative pneumonia or atelectasis was respectively 50. 00%(3/6) and 16. 66% (1/6), and postoperative hospital stay was respectively (16. 28 ± 3. 61) d and (11. 11 ± 2. 92) d. It was of significant differences (P<0. 05). Conclusion Compared with NSCLC patients without DM, postoperative atrial fibrillation and pneumonia or atelec-tasis occured more often in the DM cases. And patients with DM have longer hospital stays.

Objective To review the outeonle of intrathoracic esophageal reconstruction using circular stapler after esophageal or cardiac cancer resection.Methods From June 1996 to April 2007,744 patients underwent tumor removal and intrathoracie esophageal reconstruction in Daping Hospital.Of all patients,658 suffered from thoracic esophageal cancer and the other 86 from cardiac cancer.The operative modalities consisted of gastroesophageal anastomosis at the top of tim thoracic cavity or above the aortic arch in 402 patients,gastroesophageal anastomosis below the aortic arch in 317,and total gastrectomy in 25(esophageal replacement with colon in 21 patients and esophagojejunostomy in 4).Results Anastomotie bleeding oecurred in 5 patients intraoperatively.One patient died of acute respiratory distress syndrome,1 of septic shock and 1 of hepatic failure postoperatively.Psychiatric disorder was observed in 5 patients,respiratory complications in 34,anastomotie fistula in 4,and anastomotic stricture in 20.Three weeks after the operation,the esophageal manometric examination in 25 patients showed that intraesophageal,anastomotie and intragastric pressures were(-0.2±2.0),(1 1.2±4.4)and(2.4±1.5)mm Hg(1 mm Hg=0.133 kPa),respectively.Twenty-four hour pH monitoring demonstrated that 13 patients had abnormal DeMeester score(＞14.72),3 of thenl developed reflux symptoms and got relieved after receiving acid suppression therapy for 1.0-2.2 months.The 13 patients with abnormal DeMeester score were followed up for 3-38 months,and the pH value of the esophagus was back to normal in 2 patients,and it almost remained the same in 9 patients.Two patients died of tumor reculTenee of metastasis.Conclusions Intratlmracic esophageal reconstruction with circular stapler is safe,reliable and able to reduce the postoperative complications such as anastomotic fistula.

Myasthenic crisis (MC) is a severe comorbidity or complication which may be critical to the patients during the treatment or onset of myasthenia gravis.We conduct the review and comment regarding prevention and treatment of MC.

Objective Summing up and analyzing outcome and influencing factors following thymectomy in patients with ocular myasthenia gravis tries to provide clinical evidence for an option of the treatment modalities.Methods From May 2007 to November 2014,thymectomy was performed in 129 patients with ocular myasthenia gravis consisting of 110 patients by Video-assisted thoracoscopic surgery(VATS) and 19 by partial sternotomy.Follow-up information was obtained by outpatient visit and telephone contact.The outcome evaluation after thymectomy was classified into full remission,partial remission,unchanged and deteriorated.Statistical analysis was done using x2 test and Cox regression model.Results There was no perioperative death.Seven(5.4％) postoperative complications occurred and cured after treatment.Follow-up was complete in 123 patients(95.3％) and the mean duration of follow-up was 49(range 21-99) months.Surgical outcome revealed full remission in 40 patients,partial remission in 68,unchanged in 9 and deteriorated in 6 patients.Response(full remission and partial remission) rate was 87.8％ and no benefit(unchanged and deteriorated) rate was 12.2％.Four of 6 patients in deteriorated condition progressed into generalized myasthenia gravis(3.3％).The significant difference was noted in 24 months or less of preoperative clinical duration (P =0.004) and thymic hyperplasia (P =0.001) in postoperative pathology among the full remission,partial remission and no benefit group.On the other hand,there was no statistical difference in sex,age,symptoms,comorbidities,preoperative taking acetylcholinase inhibitor,corticosteroid,surgical approach,and associated thymona among the three groups.Multivariate Cox regression analysis also demonstrated that a preoperative duration of symptoms 24 months or less and postoperative histology being thymic hyperplasia favourably influenced the outcome.Conclusion The role of thymectomy in patients with ocular myasthenia gravis can relieve symptoms effectively and avert or decrease the potential development of generalized symptoms.Thymectomy,which has a low postoperative mortality and morbidity,may be a first-line option of the therapeutic armamentarium to treat ocular myasthenia gravis.Thymectomy via VATS has clinical advantages of minimal trauma,less pain,fast recovery,and the comparable clinical results over via the traditional sternotomy.Therefore,this procedure deserves to be advocated for ocular myasthenia gravis.