To retrospectively analyze the clinical data of 48 patients with allergic bronchopulmonary aspergillosis (ABPA) at Shanghai Pulmonary Hospital.There were 23 males and 25 females with a mean age of (36 ± 15) years.Their clinical manifestations included wheeze,cough,sputum production,sputum plugs,fever,hemoptysis,weight loss,chest pain,weakness and night sweats.They had a high peripheral blood eosinophilia,a higher serum total IgE,a higher level of aspergillosis fumigatus-specific IgE and positive immediate skin-prick test to aspergillus fumigatus.Aspergillus species were detected in sputum samples of 26 patients.Chest computed tomography (CT) was performed in 48 patients.There were patchy infiltrations (n =45),transient infiltrations (n =40),central bronchiectasis (n =35) and mucoid impaction (n =18).Obstructive ventilation dysfunction was confirmed by lung function test.

Objective To explore the efficacy of laparoscopic Toupet fundoplication treatment of hiatal hernia combined with gastroesophageal reflux disease.Methods Forty one patients' medical record information of hiatal hernia combined with gastroesophageal reflux disease that underwent laparoscopic Toupet fundoplication were collected in Xinjiang Uygur Autonomous Region People's Hospital from October 2012 to October 2015.Thirty six cases were adopted pure hiatal hernia suture,2 cases were used biological patch repair,1 case used Johnson PHY patch repair,1 case used Bade patch repair,and 1 case used Tyco hiatal hernia dedicated anti-blocking patch repair.These patients were carried out 24 hours esophageal pH monitoring,esophageal manometry,gastroesophageal reflux disease questionnaire (GERDQ) score and postoperative complications before surgery and 6 months postoperative.The clinical efficacy of laparoscopic Floppy Nissen fundoplication treatment of hiatal hernia combined with gastroesophageal reflux disease was retrospectively analyzed.Results There was no perioperative deaths and serious complications during perioperation.The reflux symptoms were significantly improved postoperative.There was significantly lower in reflux time [(1.40 ± 2.10) h],the number of reflux (29.83 ± 19.71),acid reflux time percentage [(6.47 ± 8.79) ％],and DeMeester score (7.28 ± 7.38) than the preoperative [(2.04 ± 1.91) h,(120.40 ±82.72),(9.90 ±9.27)％,and (28.23 ±42.16),respectively].GERD Q scale score (7.18 ± 1.33) was significantly lower than preoperative (10.91 ± 2.02) with statistically significant difference (P ＜0.05).lower esophagealsphincter (LES) pressure [minimum resting breathing (7.24 ± 6.86) mmHg,and mean resting breathing (12.91 ± 6.89) mmHg] was significantly increased than preoperative [(0.70 ±6.15) mmHg,and (7.33 ± 7.72) mmHg,respectively].Residual pressure [average (8.16 ± 3.82) mmHg,and maximum (16.10 ± 12.05)mmHg] was significantly increased than preoperative [(4.36 ±4.77) mmHg,and (7.49 ± 5.15) mmHg,respectively].Relaxation rate [(58.50 ± 25.47) ％] was significantly reduced than preoperative [(62.27 ± 27.55) ％].However,swallowing invalid [(11.25 ± 21.04) ％]was increased than preoperative [(6.36 ± 10.26)％],with statistically significant difference (P ＜0.05).The median follow-up was 10 months,and there was no recurrence during follow-up.ConclusionsLaparoscopic Toupet fundoplication can effectively inhibit reflux symptoms,and increase LES pressure,which is worthy of promotion.However,there is slightly higher incidence of postoperative dysphagia.

Lung transplantation is an effective treatment for many end-stage lung diseases. Lung cancer was considered to be a contraindication of lung transplantation for a long time. However, multifocal diffuse adenocarcinoma has been indicated for lung transplantation nowadays. In the preoperative course of lung transplantation for chronic end-stage lung diseases, patients should be examined thoroughly to exclude malignant tumors. If malignant tumors were incidentally found in recipient' s explanted lung, a careful evaluation of tumor stage and the prognosis of recipient is needed. Lung transplantations for metastatic lung tumors have only been reported in a few case reports, limiting the application of transplantation in current clinical practice.

OBJECTIVETo investigate the clinical efficacy of argon plasma coagulation (APC) combined with laparoscopic hiatal hernia repair and fundoplication in the treatment of hiatal hernia associated with Barrett esophagus.

METHODSA total of 61 cases of hiatal hernias with Barrett esophagus from June 2010 to January 2014 in the Department of Minimal Invasive Surgery, Hernia and Abdominal wall Surgery, People's Hospital of Xinjiang Uyhur Autonomous Region were prospectively enrolled and were randomly allocated into two groups by computer system. Twenty-nine patients received esomeprazole 40 mg/d after APC treatment for 8 weeks (APC with medicine group). Thirty-two patients underwent laparoscopic hiatal hernia repair and Nissen fundoplication after APC treatment (APC with surgery group). All the patients were reviewed by gastroscope and pathologic examination at half a year and one year after operation respectively. Differences of disease improvement and recurrence between the two groups were evaluated.

RESULTSIn APC with medicine group, the Barrett's esophagus was relieved after one or two times of APC treatment, however, gastroscope and pathology revealed recurrence of Barrett's esophagus in 7 cases at half a year, and cumulative 16 cases of recurrences were detected after one year follow-up(16/29, 55.2%). In APC with surgery group, only one patient had recurrent Barrett's esophagus at half a year, and a total of two at one year follow-up by gastroscope examination(2/32, 6.3%). Significantly low recurrence rate of Barrett's esophagus was observed in APC with surgery group compared to APC with medicine group(P<0.01). Furthermore, recurrent hiatal hernia was detected in only one case in APC with surgery group. No esophageal cancer was found in both groups during follow-up.

CONCLUSIONAPC combined with laparoscopic hiatal hernia repair and fundoplication is an ideal method for patients with hiatal hernia and Barrett's esophagus.

OBJECTIVETo compare the efficacy and safety between laparoscopic total extraperitoneal prosthetic (TEP) and Lichtenstein herniorrhaphy in the treatment of inguinal hernia (IH).

METHODSClinical data of 158 IH patients at our hospital from October 2015 to October 2016 were retrospectively analyzed. Among 158 patients, 85 patients underwent TEP (TEP group), and 73 underwent Lichtenstein herniorrhaphy(Lichtenstein group). Patients of TEP group received general anesthesia. The space between suprapubic space and iliac fossa was separated with attention to protect the spermatic cord during the operation so as to avoid excessive separation. When the patch was placed, the internal margin exceeded the contralateral pubic tubercle, the lateral margin reached the anterior superior iliac spine, there was at least 2 cm overlap between the superior margin and the joint tendon, the lower margin was inserted into the suprapubic bladder space(Retzius space), and the lateral lower margin was at least 6 cm to internal ring. Lichtenstein group received local anesthesia or continuous epidural anesthesia and all underwent routine Lichtenstein herniorrhaphy. Operative time, postoperative conditions and recurrence were compared between two groups.

RESULTSAmong these 158 patients, 129 were male and 29 were female, with an age ranging from 26 to 75 years (median 42 years). Baseline data were not significantly different between two groups(all P>0.05). There was no perioperative death and serious complications in two groups. The difference was not statistically significant in operative time[(47.6±5.4) minutes vs. (48.9±6.3) minutes, t=0.238, P=1.024]. But TEP group was better than Lichtenstein group in terms of intraoperative blood loss [(7.53±2.31) ml vs. (11.41±4.49) ml, t=5.783, P=0.032], postoperative bedtime [(1.25±0.32) days vs. (2.83±0.52) days, t=5.294, P=0.041], postoperative hospital stay [(2.38±1.14) days vs. (3.46±1.81) days, t=5.482, P=0.037], and postoperative pain score (1.27±0.47 vs. 3.42±1.93, t=5.639, P=0.034). Follow-up was 12-16 months (median 10 months). In TEP and Lichtenstein group after operation, incision infection occurred in both 1 case, edema of the scrotum or labia minora developed in 2 patients and 3 cases respectively, chronic pain was found in one and 2 cases respectively. The patients were followed up for 5 to 16 months(median 10 months), and recurrences was observed in 1 case both in TEP group and Lichtenstein group respectively.

CONCLUSIONLaparoscopic total extraperitoneal prosthetic is safe and effective in the treatment of inguinal hernia, which is better than Lichtenstein herniorrhaphy in fast recovery, less trauma and more comfort, and worthy of clinical promotion.

OBJECTIVETo compare the efficacy and safety among laparoscopic Nissen, Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease (GERD).

METHODSClinical data of 276 patients of hiatal hernia complicated with GERD undergoing operation in our hospital from December 2012 to January 2015 were retrospectively analyzed, including 149 patients of laparoscopic Nissen fundoplication (Nissen group), 41 of laparoscopic Toupet fundoplication (Toupet group), and 86 patients of laparoscopic Dor fundoplication (Dor group). Esophageal reflux status, esophageal manometry, GERD Q rating scale, and postoperative recovery were compare among the three groups.

RESULTSReflux status was improved significantly in the three groups after operation(all P<0.05),except that the efficacy in reducing reflux episodes and reflux longest time was not obvious in Toupet group(P>0.05). There were no significant differences in postoperative reflux time, acid reflux time ratio, reflux longest time ratio, DeMeester score among the three groups (all P>0.05). Pairwise comparison showed that Dor group was significantly better than Toupet group in reducing the number of reflux episode(14.36±10.58 vs. 29.83±19.71) and long-reflux (0.64±0.21 vs. 6.20±3.48)(both P<0.05), but Nissen group was better than these two groups in reducing the number of long-reflux (0.38±0.16, P<0.05). As compared to pre-operation, the postoperative esophageal sphincter pressure and residual pressure increased significantly, and the relaxation rate reduced significantly (all P<0.05), while the episode of ineffective swallowing increased significantly in Toupet group (11.25±2.04 vs. 6.36±3.26, P<0.05). The contrast in esophageal manometry between Toupet and Dor group showed that Dor group was better than Toupet group in the recovery of lower esophageal sphincter pressure (mean resting breathing) [(20.69±13.95) mmHg vs.(12.91±6.89) mmHg] and the decrease of ineffective swallowing [9.15±6.44 vs. 11.25±2.04](both P<0.05), while such results of Dor group were similar to Nissen group[(19.87±10.40) mmHg, 6.15±2.95, all P>0.05]. The GERD Q scores were significantly decreased after operation in 3 groups(Nissen group:10.94±2.20 vs.7.41±1.43, t=11.667, P=0.001; Toupet group: 10.91±2.02 vs.7.18±1.33, t=5.109, P=0.005; Dor group: 10.69±1.69 vs. 7.10±1.30, t=7.610, P=0.002). There was no significant difference in GERD Q scores among three groups (F=1.465, P=0.207). The operative time, blood loss, hospital stay and complications were not significantly different among 3 groups (all P>0.05). Follow-up period was 12-51 months (median 19 months), and no significant difference in recurrence was found [Nissen group: 2 cases (1.3%), Toupet group: 1 case (2.4%), Dor group: 1 case (1.2%), χ=0.363, P=0.834].

CONCLUSIONSIt is safe and feasible for these three laparoscopic fundoplications to the treatment of hiatal hernia complicated with GERD. But laparoscopic Nissen and Dor fundoplication are better than Toupet fundoplication in reducing the number of reflux episodes, suppressing long reflux, increasing lower esophageal sphincter pressure (mean resting respiration) and decreasing the incidence of postoperative dysphagia.

Blood Loss, Surgical ; Comparative Effectiveness Research ; Endoscopy, Gastrointestinal ; methods ; Esophageal Sphincter, Lower ; physiology ; surgery ; Fundoplication ; methods ; Gastroesophageal Reflux ; complications ; surgery ; Hernia, Hiatal ; complications ; surgery ; Humans ; Length of Stay ; Manometry ; Operative Time ; Postoperative Complications ; epidemiology ; Recurrence ; Retrospective Studies ; Treatment Outcome

Objective To compare the effect of spermatic vessels and testicular function between totally extraperitoneal prosthetic (TEP) and transabdominal preperitoneal hemia repair (TAPP) in male patients with inguinal hernia.Methods Forward-looking inclusion of 186 male patients with IH in our hospital from October 2015 to January 2018.All of them were randomly divided into two groups by computer code,105 patients underwent totally extraperitoneal prosthetic (TEP Group),and 81 patients underwent transabdominal preperitoneal hernia repair (TAPP Group).The operation time,the postoperative time of spontaneous getting out of bed,the time of hospitalization after operation,the pain score on the first day after operation,the condition of spermatic cord vessels,testicular function and complications of the two groups were compared before and 4 weeks after operation.Results There was no perioperative deaths and serious complications during perioperative in the two groups.No patient was transfered to open the abdomen.There was no statistically significance in operation time,the postoperative time of spontaneous getting out of bed,the time of hospitalization after operation,the pain score on the first day after operation [(47.57 ± 5.38)min vs (48.93 ±6.27)min;(1.25 ±0.32)d vs (1.38 ±0.52)d;(2.38 ± 1.14)d vs (2.46 ± 1.81)d;(1.27 ±0.47) point vs (1.42 ± 1.93)point].There was no significant difference in spermatic artery diameter,blood flow velocity,semen quality and serum testosterone between TEP group and TAPP group before and 4 weeks after operation (P ＞ 0.05).However,in TAPP group,the diameter of spermatic vein was wider and the blood flow velocity 4 weeks after operation was slower than that before operation,with statistically significant difference [(2.08 ± 0.23) mm vs (1.97 ± 0.11) mm;(1.72 ± 0.12) cm/s vs (1.94 ± 0.03)cm/s,P ＜ 0.05].In addition,TEP group was better than TAPP group in the diameter of spermatic vein and the velocity of blood flow 4 weeks after operation,with statistically significant difference [(1.98 ± 0.14) mm vs (2.08 ±0.23)mm;(1.87 ±0.16)cm/s vs (1.72 ±0.12)cm/s].There were both 1 cases of incision infection in TEP and TAPP group after operation (0.95％,1.23％).In TEP group,2 patients (1.90％)developed edema of the scrotum or labia minora,and there were 3 cases (3.70％) in TAPP group.The patients were followed up for 3-16 months (median 10 months),and there were 1 recurrences in group TAPP.There was no significant difference in postoperative complications (P =0.582).Conclusions Both TEP and TAPP were safe and effective in the treatment of inguinal hernia.And both of them had no significant effect on spermatic artery and testicular function.However,the effect of TEP on spermatic blood flow was less than that of TAPP.

Objective To investigate the correlation between serum laminin (LN),type collagen (ⅣC),type procollagen N-terminal peptide (PⅢNP),hyaluronic acid (HA) and the severity as well as the prognosis of idiopathic pulmonary fibrosis (IPF).Methods From February 2015 to July 2016,160 IPF patients and 160 healthy subjects as controls were enrolled in this retrospective study.Serum LN,ⅣC,PⅢNP,and HA were analyzed in IPF patients and healthy controls.Pulmonary function test and chest high resolution computed tomography (HRCT) were carried out in IPF patients.Demographics and clinical characteristics,the percentage of forced vital capacity in the prediction value (FVC％pred),the percentage of diffusing capacity of the lung for carbon monoxide in the prediction value (DLCO％pred),and HRCTscore were collected.IPF patients were followed up.Results (1)There were no significant difference between two groups in age and sex ratio.The proportion of smoker in IPF patients was significantly higher than that in healthy controls(P ＜ 0.01).(2)Serum LN(P ＜ 0.01),ⅣC(P ＜ 0.01),PⅢNP(P ＜ 0.01),and HA(P ＜ 0.01) were significantly increased in the patients with IPF compared with the healthy controls.(3)Serum LN,ⅣC,PⅢNP,and HA of IPF patients positively correlated with HRCT score,all P ＜ 0.01,and negatively correlated with FVC％pred and DLCO％pred (all P ＜ 0.05).(4)Serum LN(P ＜ 0.01),ⅣC(P ＜ 0.05),PⅢNP(P ＜ 0.01),and HA(P ＜ 0.01) in acute exacerbation IPF patients were significantly higher than those in the stable IPF patients.(5)Serum LN(P ＜ 0.01),ⅣC(P ＜0.01),PⅢNP(P ＜ 0.01),and HA(P ＜ 0.01) in the survived patients were significantly lower than those inthe dead patients.Conclusions Serum LN,ⅣC,PⅢNP,and HA may reflect IPF prognosis and the severity of IPF.

Background and purpose:As one of the most fatal malignant tumors in China, the morbidity and mortality of lung cancer remain high. Early diagnosis and normative treatment is the key to improve the prognosis of lung cancer. The aim of this study was to explore the practice of early lung cancer screening with low-dose spiral computed tomography (CT) based on the current situation in community health service, with integration of superior resources of med-ical institutions at all levels in Shanghai.Methods:From Aug. 2013 to Aug. 2014, we screened high-risk population in selected communities of Minhang District, Shanghai, for early diagnosis of lung cancer with low-dose spiral CT combined with multidisciplinary comprehensive treatment models including minimally invasive surgery, exploring the medical service network covering prevention, diagnosis, treatment, rehabilitation and follow-up.Results:Screening population is 11 332 (male 7 144, female 4 188); Twenty-nine cases with pathological diagnosis of malignant tumor, including 27 cases of pri-mary lung cancer, 1 case of lung metastasis, 1 case of breast cancer. The morbidity of primary lung cancer is 238.26×10-5. There were 22 cases of Stage 0-Ⅰ lung cancer accounting for 81.48% of all diagnosed primary lung cancer.Conclusion:Based on community health service, screening with low-dose spiral CT could improve the early diagnosis rate of lung can-cer with feasibility and validity, which could be applicable in qualified eligible medical center and community in China.

Objective:To explore the airway pathogen characteristics and examine the correlation between donor-derived pathogens and post-transplant outcomes in patients after lung transplantation (LT).Methods:Between January 1, 2015 and December 31, 2019, retrospective review was conducted for clinical and microbiological data of 88 LT recipients.Airway pathogen percentage of different microorganisms and evolution of drug-resistance were examined.Drug-resistant pathogen positive group (n=71) and negative group (n=17) were assigned according to whether or not drug-resistant pathogens were detected.Survival analysis was conducted by Log-rank with 3-year follow-ups.Between April 11, 2020 and September 5, 2020, prospective study was conducted in 14LT recipients.The potential pathogenic bacteria from donor lungs were detected by metagenomic next generation sequencing and the impact of those bacteria was examined on 1-year post-transplantation outcome in 2020.Microbial diversity and richness were shown with Shannon index.The outcome variables included heart rate, neutrophil count, lymphocyte count, immunoglobulin level and pulmonary spirometry.ANOVA and Pearson's correlation analysis were performed for elucidating the relationship between airway microbiota and post-LT outcomes.Results:From 2015 to 2019, 88 recipients were recruited and 992 strains of airway pathogens were isolated, including bacteria 796 strains and fungi 196 strains.Gram-negative bacteria (704 strains) accounted for 88.4% of all bacteria.The detection rates of Gram-positive bacteria, Klebsiella pneumonia (Kp), Acinetobacter baumannii (Ab), Stenotrophomonas maltophilia and Candida increased in 2019 than that in 2015 (8.2% vs. 5.3%, 13.6% vs. 13.2%, 33.2% vs. 17.5%, 6.5% vs. 5.3%, 26.6% vs. 20.2%). Drug resistance rate of Kp to imipenem was 68.18% in 2019 and drug resistance rate of Ab to imipenem 98.44%.The 3-year survival rate was 46.3% and 35.3% in drug-resistance positive and negative groups and the difference was insignificant ( P=0.410). Fourteen recipients were enrolled in 2020.Potential pathogenic bacteria could be detected in all donor samples.Five recipients carried the same bacteria and two died during 1-year follow-up.Nine recipients did not carry the donor-derived pathogens and two died during 1-year follow-up.The diversity of donor/recipient-derived airway microbiota (Shannon index) showed no correlation with the outcomes of 1-year follow-up by Pearson's correlation test. Conclusions:Gram-negative bacteria predominated in airway pathogens of recipients post-LT.The drug resistance rate to imipenem remained high.The donor/recipient-derived pathogen isolates showed no correlation with immediate outcomes post-LT.