Objective:To investigate the clinical characteristics,diagnosis and surgical treatment of the substernal goitre.Methods:28 cases of substernal goiter operated were retrospectively analyzed.All were histopathologically proven.Results:This group included 25 secondary cases of cervical goitre and 3 primary cases.The clinical manifestations were cervical mass(25/28),thoracic discomfort(23/28) and dyspnoea(8/28).The preoperative diagnoses were established mainly on the basis of chest X ray combining with ~(131)Ⅰ scan.There was no operative mortality postoperatively, but 1 patient(3.6%)complicated with transient dysphonia and 3 cases relapsed.Conclusion:Chest X ray and ~(131)Ⅰ scan are helpful for making a diagnosis of substernal goiter before operation.Surgical removal of the tumor is the best choice with satisfactory prognosis.

OBJECTIVE:To evaluate the analgesic efficacy and safety of tramadol im.on pain after thoracic surgery.MET_ HODS:34cases after thoracic surgery were given tramadol im.in a dose of1.5mg/kg.The analgesic effect and adverse effect were observed.RESULTS:The significant effective rate of pain relief was41.2%and effective rate was38.2%with a total effective rate of79.4%.Some adverse effects including temporary nausea,vomiting,perspiration,dysuria were observed in a part of the patients.No respiratory inhibition was found.CONCLUSION:Tramadol(1.5mg/kg)im.is safe and effective in treatment of the pain after thoracic surgery.

Objective To investigate the variation of procalcitonin(PCT)level and the significance of PCT for the diagnosis of infection during perioperative period of valve replacement for rheumatic heart disease.Methods Routine blood testing and procalcitonin(PCT)level were measured in the perioperative period of 56 patients with rheumatic heart disease receiving valve replacement.Prophylactic antibiotics management was given based on the serum procalcitonin level especialy that 3 days after operation or later.The postoperative infective complications and the duration of prophylactic antibiotics management were recorded and assessed.Results The duration of prophylactic antibiotics for all patients were 4.6 ± 2.0 days.Six patients were suffered from poor incision healing and one was suffered from pulmonary infection.There were no severe postoperative infective complications.The PCT of the patients without postoperative infection rise to peak level on the 1st day after operation and return to normal on the 3rd day.There was no significant difference in the PCT levels between the two groups.The duration for PCT descending to 0.25 mg/L was 3.7 ± 2.5 days.The PCT level of the patients suffered from pulmonary infection went up again after infection on the 5th day and return to normal on the 9th day.No severe postoperative infective complications happened after withdrawn of prophylactic antibiotics if PCT had descended tobelow 0.25 mg/L after operation.Conclusions The serum PCT level may be a good parameter for the prediction or diagnosis of infective complication in the perioperative period of patients undergoing valve replacement for rheumatic heart disease.It can be a useful marker to guide the use of prophylactic antibiotics.

Objective To investigate the effects of glucocorticoid on the changes of serum cortisol and 24-hour urinary cortisol in patients undergoing rheumatic valve replacement.Methods 86 patients undergoing rheumatic valve replacement were respectively given 1000 mg methylprednisolone during extracorporeal circulation and intravenously injected 10 mg dexamethasone on the first three days after operation.The enzyme-linked immunosorbent assay (ELISA) was taken to detect the serum cortisol concentration and 24-hour urinary cortisol on the day before operation,the 1st,3rd,5th,and 7th day after surgery.The postoperative complications such as the surgical incision and pulmonary infection were observed during the recovery days.Results Serum cortisol concentrations for patients with different preoperative cardiac function classifications had no significant difference at each observation point during the perioperative period (P＞0.05).Serum cortisol concentration showed a downward trend during the first 3 days after surgery.The serum cortisol level on the 3rd day after surgery was lower compared with that before surgery (P＜0.05),whereas 3 days later the serum cortisol concentration increased gradually and got back to the preoperative levels on the 5th day after surgery.The 24-hour urinary cortisol rose to the peak level on the 1st day after surgery,then decreased to the preoperative level on the 3rd day after surgery (P＞0.05).All the patients recovered.No one died or had complications such as pulmonary infection or incisions healing problems.Conclusions The effects of corticosteroids on perioperative serum cortisol levels in patients with rheumatic heart disease were not clearly correlated with preoperative cardiac function classification.Using glucocorticoid in the first three days after surgery reveals transient inhibitory effect on serum cortisol secreting,however,the cortisol level can quickly go back to the preoperative level after stopping giving glucocorticoid.

Objective To investigate the prognostic factors in patients with esophygectomy after oncologic esophagectomy by analyzing the long-term survival .Methods 104 patients underwent esophagectomy for cancer were retrospectively reviewed from 2007 to 2008 in this hospital ,and the investigation was carried on in questionnaire ,following up 3 years .Various ways ,such as Life Tables ,Kaplan-Meier and Cox regression analysis ,were used to evaluate long-term survival .Results (1)A total of 61 patients died in 3 years .The median survival time was 35 .23 months .The cumulative survival rates at 1 ,2 and 3 year after surgery were 87% , 62% ,and 48% respectively ,and death hazard in 24th month after surgery was the highest .(2)In univariate analysis :drinking ,pres-ence of lymph node metastasis and TNM staging were significant factors that influenced long-term survival .(3)Multivariate analy-sis :lymph node(RR = 2 .399 ,P= 0 .002 ,95% CI :1 .385 to 4 .154) ,drinking(RR = 0 .470 ,P = 0 .008 ,95% CI :0 .269 to 0 .882) ,di-gestive tract construction(RR= 1 .910 ,P= 0 .018 ,95% CI :1 .118 to 3 .262) were the isolated factor influencing the prognosis .Con-clusion Patients after oncologic esophagectomy generally suffer poor survival .The presence of lymph node metastasis ,drinking and different methods of reconstraction are statistically significant factors influencing long-term survival .

OBJECTIVETo investigate the effect of 1,25-dihydroxyvitamin D(3) and 5-fluorouracil, either alone or in combination, on the expression of IGFBP-3 in human esophageal carcinoma 109 cell xenograft in nude mice.

METHODSIn vitro cultured esophageal carcinoma Eca-109 cells were inoculated subcutaneously in BALB/c mice. The tumor-bearing mice were randomly divided into control group (A), 1,25-dihydroxyvitamin D(3) group (B), 5-fluorouracil group (C), and 1,25-dihydroxyvitamin D(3) plus 5-fluorouracil group (D). 1,25-dihydroxyvitamin D(3) and 5-fluorouracil were administered at the doses of 2.5 ug/kg and 25 mg/kg via intraperitoneal injections, respectively, and the mice in the control group received saline injection only. The tumor growth was observed and the expression of IGFBP-3 in the tumor xenograft was detected using immunohistochemistry. An automatic biochemistry analyzer was used to determine serum calcium levels, and Von Kossa staining was utilized for observation of calcium deposition in the kidneys.

RESULTSCompared with that in group A, the xenograft in groups B, C, and D all showed a lowered growth rate with a smaller tumor volume, and presented with stronger IGFBP-3 positivity and significantly higher levels of IGFBP-3 protein expression (P<0.05). In group D, the protein expression of IGFBP-3 was significantly increased compared with that in groups B and C (P<0.05). Compared with that in group A, serum calcium level was slightly increased in groups B, C, and D, , but no obvious calcium deposition was found in the kidney tissue sections.

CONCLUSIONBoth 1,25-dihydroxyvitamin D(3) and 5-fluorouracil can inhibit the growth of the tumor xenograft in nude mice, and their combination is more effective. This effect is probably associated with increased protein expression of IGFBP-3 in the xenograft tumor. No calcium deposition occurs in the kidney tissue of the tumor-bearing mice.

Animals ; Cell Line, Tumor ; Fluorouracil ; pharmacology ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; metabolism ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Vitamin D ; analogs & derivatives ; pharmacology ; Xenograft Model Antitumor Assays

Objective To investigate the risk factors and diagnostic value of severe acute kidney injury(AKI)after type A aortic dissection,and to analyze the efficacy of different dialysis strategies of renal replace-ment therapy on severe AKI.Methods The clinical data of 69 patients with severe AKI after type A aortic dissection operation in this hospital from January 2019 to December 2021 were retrospectively collected.The patients were divided into the severe group(dialysis treatment,24 cases)and the mild group(without conduc-ting filtration treatment,45 cases).The clinical data were compared between the two groups,and the risk fac-tors and diagnostic value for the severe AKI occurrence after type A aortic dissection surgery by univariate and multivariate regression and receiver operating characteristic(ROC)curve.The changes of postoperative treat-ment indicators were compared and the efficacy of different dialysis strategies were analyzed.Results The in-cidence rate of severe AKI after surgery was 34.78％.The univariate and multivariate logistic regression ana-lyses results showed that preoperative serum creatinine increase(OR=0.98,95％CI:0.97-0.99,P=0.02),total extracorporeal circulation time prolongation(OR=0.99,95％CI:0.97-0.99,P=0.02)and postopera-tive 24 h blood transfusion volume increase(OR=0.99,95％CI:0.98-0.99,P＜0.01)were the independent risk factors for postoperative severe AKI occurrence in the patients with type A aortic dissection.The ROC curve analysis suggested that the combination of total time of extracorporeal circulation,preoperative serum creatinine value and postoperative 24 h blood transfusion volume had good diagnostic value for postoperative severe AKI occurrence in the patients with type A aortic dissection.The sensitivity,specificity and area under the curve were 91.10％,75.00％and 0.90 respectively.Early performing filtration and continuous renal re-placement therapy(CRRT)in the severe AKT had better effect.Conclusion The independent risk factors for postoperative severe AKI occurrence in type A aortic dissection include preoperative serum creatinine in-crease,intraoperative total extracorporeal circulation time prolongation and postoperative 24 h blood transfu-sion volume increase,and the three combination has good predictive value for severe AKI.Early detection and timely using renal replacement therapy could improve severe AKI,CRRT has a better effect for AKI than in-termitlent hemodialysis(IHD).

Objective    To investigate the clinical efficacy of unilateral antegrade selective cerebral perfusion (UASCP) compared to bilateral antegrade selective cerebral perfusion (BASCP) in aortic surgery. Methods    PubMed, EBSCO, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Database were searched from establishment of each database to January 2019 to identify clinical studies on prognosis of UASCP versus BASCP in aortic surgery patients. The quality of randomized controlled trials was assessed by Cochrane risk assessement tool. The quality of non-randomized controlled trials was assessed by the Newcastle-Ottawa Scale ( NOS). Meta-analyses were presented in terms of odds ratio (OR) with 95% confidence interval (CI) by using RevMan 5.3 software. Results    Sixteen eligible studies including 3 randomized controlled trials, 2 propensity matching score studies, and 11 retrospective case control studies including 4 490 patients were identified. The 3 randomized controlled trials were with high bias risk. The NOS score of the other 13 studies was more than 6 stars. Pooled analysis showed no significant difference between the UASCP and BASCP groups in terms of permanent neurological dysfunction (PND) (OR=0.93, 95%CI 0.74 to 1.18, P=0.57), temporary neurological dysfunction (TND) (OR=1.26, 95%CI 0.94 to 1.69, P=0.12), acute kidney injury rate (OR=1.11, 95%CI 0.79 to 1.55, P=0.55), 30-day mortality (OR=0.94, 95%CI 0.67 to 1.32, P=0.72), length of ICU stay (OR=–0.64, 95%CI –1.66 to 0.37, P=0.22) and hospital stay (OR=–0.35, 95%CI –2.38 to 1.68, P=0.74). Conclusion    This meta-analysis shows that UASCP and BASCP administration do not result in different mortality and neurologic morbidity rates. However, more studies with good methodologic quality and large sample are still needed to make further assessment.

Objective To compare the effectiveness of different β-blockers for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. Methods Databases of PubMed, Science Direct, Web of Science, The Cochrane Library, SinoMed, CKNI, VIP, WanFang were searched by the computer from inception to April 31, 2022 to collect randomized controlled studies on the comparison of the effectiveness of different β-blockers for preventing POAF. Two investigators independently screened the literature and extracted information. The quality of the literature was evaluated using Cochrane bias risk tool, and RevMan 5.3 and STATA 17.0 were used for meta-analysis. Results A total of 17 randomized controlled studies with 3 290 patients were included. Direct meta-analysis showed that landiolol and metoprolol were more effective than placebo (P≤0.001), and carvedilol was more effective than metoprolol in preventing the development of POAF (P<0.001). Network meta-analysis showed that landiolol, carvedilol and metoprolol were more effective than placebo in preventing the incidence of POAF (P<0.05). Landiolol and carvedilol were more effective than metoprolol, and carvedilol were more effective than nebivolol (P<0.05). The surface under the cumulative ranking curve from high to low were carvedilol, landilol, propranolol, atenolol, metoprolol, and nebivolol. Conclusion Carvedilol and landilol have different degrees of improvement in the occurrence of POAF, and carvedilol has the best preventive effect. More studies are required to verify the strength of evidence due to the limited sample size.

Objective    To analyze the perioperative safety and the short-term prognosis of non-small cell lung cancer (NSCLC) patients with preoperative arrhythmia. Methods    The clinical data of NSCLC patients treated in the Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University from August 2020 to March 2021 were collected and observed. The patients were divided into an arrhythmia group and a control group according to whether there was arrhythmia in the 24 h ambulatory electrocardiogram examination report before operation. The incidence of intraoperative and postoperative cardiovascular events and short-term prognosis were compared between the two groups. Results     A total of 466 patients were included in this study, including 338 patients in the arrhythmia group, 176 males and 162 females, with a median age of 68.0 (63.0, 72.0) years, and 128 patients in the control group, 59 males and 69 females, with a median age of 66.5 (60.0, 72.0) years. A total of 26 patients (7.7%) in the arrhythmia group were placed with temporary pacemakers before operation. There was no significant difference in the incidence of cardiovascular related events between the two groups [100 (29.6%) vs. 28 (21.9%), P=0.096]. The incidence of postoperative arrhythmia events in the arrhythmia group was higher than that in the control group [112 (33.1%) vs. 11 (8.6%), P<0.001]. The average postoperative ICU stay in the arrhythmia group was longer than that in the control group (1.1±0.7 d vs. 1.0±0.6 d, P=0.039). Conclusion    Preoperative arrhythmia does not increase the risk of intraoperative cardiovascular events in NSCLC patients, but increases the incidence of postoperative arrhythmia events and prolongs ICU stay.