Objective: To evaluate the effects of one lung ventilation on hemodynamics and blood gas during thoracoscopic surgery in piglets. Methods: Eight domestic pigs weighting (7.1±0.7) kg were included in this study. The anaesthesia was maintained with 1% isoflurance. After tracheotomy, an endotracheal tube was positioned in the left mainstem bronchus. Hemodynamic parameters as well as blood gas analyses were obtained using Swan-Ganz and arterial catheter. Results: During one lung ventilation, pulmonary artery pressure increased from (15.8±1.5) mm?Hg to (19.5±2.3) mm?Hg. Arterial oxygen saturation, blood gas analyses and other hemodynamic parameters remained unchanged. Conclusion: One lung ventilation was well tolerated in regard to hemodynamics and blood gas analyses in piglets.

BACKGROUNDTo study the diagnostic value of detection of p16 methylation of sputum exfoliated cells for peripheral lung cancer.

METHODSBefore operation, p16 methylation of the sputum exfoliated cells was detected in 20 normal persons and 50 patients with peripheral pulmonary nodi by p16 methylation-specific PCR (MSP) for judging the nature of the nodi. The results were compared with pathological reports after operation.

RESULTSThe p16 MSP positive rate of sputum exfoliated cells of peripheral lung cancer patients (27/44, 61.4%) was much higher than that of benign pulmonary nodi (1/6, 16.7%) and normal persons (3/20, 15.0%)(Chi-Square=4.281 and 11.869 respectively, both P < 0.05). No significant difference of p16 MSP positive rate of sputum exfoliated cells was found between benign pulmonary nodi and normal persons (Chi-Square= 0.136, P > 0.05). No significant difference of p16 MSP positive rate of sputum exfoliated cells was found between squamous cell carcinoma (13/18, 72.2%) and adenocarcinoma (8/19, 42.1%) (Chi-Square=3.416, P > 0.05 ). If the positive p16 MSP of sputum was chosen as criterion for peripheral lung cancer, its positive predictive value, negative predictive value, sensitivity and specificity were 96.4%, 22.7%, 61.4% and 83.0% respectively.

CONCLUSIONSThe detection of p16 methylation of sputum exfoliated cells is contributable to the diagnosis of lung cancer.

Objective Foregut cyst of the mediastinum is an uncommon but important mediastinal disease,representing 40% to 50% of all the mediastinal cysts.The purpose of present study was to summarize the clinical feature and surgical treatment of mediastinal foregut cysts in patients admitted to the authors' hospital,and to emphasize the important role of video-assisted thoracic surgery(VATS)played in the treatment of mediastinal foregut cysts.Methods Data of 51 cases of mediastinal foregut cysts confirmed by pathological examination from 1993 to 2006 were retrospectively reviewed.Results 29 male and 22 female patients were involved in the present study.Among all the cases,24(47%)manifested no conspicuous symptom,and the remainders showed various symptoms such as chest pain,dyspnea,cough etc.The findings of magnetic resonance imaging(MRI)were more helpful than that of CT in diagnosis.In the present series,5 cysts were located in the antero-superior mediastinum,18 in the middle mediastinum and 28 in the posterior mediastinum.All patients underwent operation,including 15 minimal invasive surgeries such as VATS.35 cysts were excised completely and 16 cysts were resected partially.Pathological examination confirmed that,there were 42 bronchogenic cysts,7 esophageal cysts and 2 gastro-enterogenous cysts.There was no postoperative death or major complications,but minor complications occurred in 3 patients.During an average of 26 months of follow-up(ranged 2 to 56 months),no recurrence or malignant degeneration was found.Conclusion Mediastinal foregut cysts are rarely diagnosed definitely before operation,and it should be surgically treated because its pathology can only be established after surgical extirpation.Video-assisted thoracoscopic surgery is the first choice for the treatment of mediastinal foregut situated,especially for those situated in the middle and posterior mediastinum.

Objective To explore the effect of pre-treatment of subcutaneous injection of ketamine on remifentanil induced hyperalgesia and K+/Cl-cotransporter 2,KCC2) expression on spinal cord of rats.Methods60 male adult SD rats were randomly divided into five groups(n=12 in each group):control group (group C),the incision group(group I),the incision plus remifentanil group(group I+R),the incision plus ketamine group(group I+K) and the incision plus remifentanil and ketamine group(group I+R+K).Mechanical withdrawal threshold (MWT) was evaluated at 24 hours before incision(T0),2 hours,6 hours,24 hours and 48 hours after incision(T1~T4).The lumbar spinal cords of rats were taken out at T4 time point and the KCC2 detected was detected by immunofluorescence analysis and western blot analysis.ResultsCompared with group C(T1(14.5±1.7)g,T2(14.2±1.1)g,T3(13.9±1.8)g,T4(14.2±1.1)g),MWT of other groups at T1 (I(5.6±0.8)g,I+R(3.2±1.0)g,I+K(6.8±1.7)g,I+R+K(5.1±1.6)g),T2 (I(6.9±1.0)g,I+R(4.3±1.2)g,I+K(8.0±1.4)g,I+R+K(6.2±1.5)g),T3 (I(7.6±0.9)g,I+R(5.4±1.1)g,I+K(10.3±1.2)g,I+R+K(7.1±1.1)g),T4 (I(8.9±1.1)g,I+R(7.5±1.4)g,I+K(11.3±1.2)g,I+R+K(8.3±1.2)g)and the expression of KCC2 at T4 decreased (P<0.05).Compared with group I(T1(5.6±0.8)g,T2(6.9±1.0)g,T3(7.6±0.9)g,T4(8.9±1.1)g),MWT of group I+R (T1(3.2±1.0)g,T2(4.3±1.2)g,T3(5.4±1.1)g,T4(7.5±1.4)g) decreased at all time points after incision (T1~T4)(P<0.05) and the expression of KCC2 at T4 decreased significantly (P<0.05).Compared with group I(T1(5.6±0.8)g,T2(6.9±1.0)g,T3(7.6±0.9)g,T4(8.9±1.1)g),MWT of group I+K (T1(6.8±1.7)g,T2(8.0±1.4)g,T3(10.3±1.2)g,T4(11.3±1.2)g) increased at all time points after incision (T1~T4)(P<0.05) and the expression of KCC2 at T4 increased (P<0.05).Compared with group I+R(T1(3.2±1.0)g,T2(4.3±1.2)g,T3(5.4±1.1)g,T4(7.5±1.4)g),MWT of group I+R+K (T1(5.1±1.6)g,T2(6.2±1.5)g,T3(7.1±1.1)g,T4(8.3±1.2)g) increased at all time points after incision (T1~T4)(P<0.05) and the expression of KCC2 at T4 increased (P<0.05).ConclusionPre-treatment of subcutaneous injection of ketamine can reduce the hyperalgesia of rats induced by remifentanil and reduce the inhibition of KCC2 expression on dorsal horn of spinal cord.

Objective To evaluate the role of spinal neuronal Mas-related gene receptor C (MrgC) in the maintenance of bone cancer pain (BCP) in mice.Methods A total of 132 SPF male C3H/HeJ mice, aged 8-10 weeks, weighing 18-22 g, were randomly divided into 4 groups (n=33 each) using a random number table: sham operation group (S group) , BCP group, bovine adrenal medulla peptide 8-22 (BAM8-22, a highly selective MrgC agonist) group (group BAM), and MrgC antibody group (group MA).BCP was produced by injecting α-MEM 20 μl containing 2×105NCTC2472 cells into the distal medullary cavity of right femur bone.While α-MEM 20 μl was injected only in group S.The artificial cerebrospinal fluid 5 μl was injected intrathecally in S and BCP groups, and BAM 8-22 8 nmol/5 μl and MrgC antibody 5 μl were injected intrathecally in BAM and MA groups, respectively, once a day for 7 consecutive days starting from the day 14 after inoculation of the tumor cells.At 1 day before inoculation (T0), before administration (T1) , and at 14, 16 19 and 21 days after inoculation (T2-5, at 0.5 h before the initial administration and 2 h after each administration) , the number of spontaneous flinches (NSF) and mechanical paw withdrawal threshold (MWT) were measured.Five animals selected from each group at each time point were sacrificed, and the lumbar enlargement segments of the spinal cord were removed for determination of MrgC expression in the spinal neurons (by immunofluorescence).Results Compared with group S, NSF was significantly increased, MWT was decreased, and the expression of MrgC was up-regulated at T1-5 in BCP, BAM and MA groups.Compared with group BCP, NSF was significantly decreased, MWT was increased, and the expression of MrgC was up-regulated at T2-5 in group BAM, and NSF was significantly increased, MWT was decreased, and the expression of MrgC was down-regulated at T2-5 in group MA.Conclusion Spinal neuronal MrgC is involved in the maintenance of BCP in mice.

Objective To evaluate the effect of verapamil on the expression of K+-Cl-cotransporter 2 (KCC2) in spinal dorsal horns during remifentanil-induced hyperalgesia in a rat model of incisional pain.Methods Thirty-two pathogen-free healthy adult male Sprague-Dawley rats,aged 6-7 weeks,weighing 250-300 g,were divided into 4 groups (n=8 each) using a random number table:control group (group C),incisional pain group (group Ⅰ),incisional pain plus remifentanil plus verapamil group (group I+R+ V) and incisional pain plus remifentanil group (group I+R).Normal saline was subcutaneously infused in group C.A 1 cm long incision was made in the plantar surface of the right hindpaw in anesthetized rats in group Ⅰ.Verapamil 5 mg/kg was intraperitoneally injected at 10 min before establishment of the incisional pain model in group I+R+V.In I+R and I+R+V groups,the model of incisional pain was established,and remifentanil was subcutaneously infused for 30 min at a rate of 80 μg · kg-1 · h-1 simultaneously.The mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured at 1 day before establishment of the model (T0) and 2,6,24 and 48 h after establishment of the model (T1-4).The rats were sacrificed after measurement of MWT at T4,and the lumbar enlargement segments of the spinal cord were harvested for determination of the expression of KCC2 by immunofluorescence.Results Compared with group C,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in the other groups (P＜0.05).Compared with group Ⅰ,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in group I+R (P＜0.05).Compared with group I+R,the MWT was significantly increased at T1-4,and the expression of KCC2 was up-regulated in group I+R+V (P＜0.05).Conclusion The mechanism by which verapamil reduces remifentanil-induced hyperalgesia is related to up-regulation of the expression of KCC2 in spinal dorsal horns in a rat mnodel of incisional pain.

BACKGROUNDTo study the correlation between the intensity of facilitative glucose transporter(GLUT1) expression and prognosis in stage I and II non-small cell lung cancer (NSCLC).

METHODSEighty-seven specimens were immunohistochemically stained using an antibody against GLUT1 antigen, and the intensity of GLUT1 expression was assessed by computer image analysis system in NSCLC with pathologic stage I and II.

RESULTSEighty-one cases of NSCLC (93.1%) were GLUT1 positive. The intensity of GLUT1 expression (optic density) was significantly higher in lymph node metastasis positive group than that in negative group ( 0.340 7 ±0.070 3 vs 0.276 5±0.082 4, P < 0.05). The patients with high GLUT1 expression ( > 0.298 1 ) had significantly lower survival time than those with low GLUT1 expression (≤ 0.298 1 )(P < 0.05 ).

CONCLUSIONSGLUT1 is closely correlated with the prognosis of NSCLC patients in stage I and II.

OBJECTIVETo access the feasibility, safety and accuracy of endoscopic ultrasonography guided fine-needle aspiration (EUS-FNA) in patients with suspected lung neoplasm and metastatic mediastinal lymph nodes.

METHODSUsing a linear array scanning endosonography (Pentax FG32-UA) and a 22-guage GIP (Medi-Globe) needle, we performed EUS-FNA in 10 patients including 6 patients with lung mass and enlarged mediastinal lymph nodes, 1 patient with a mass in the right lung, 1 patient with a mass near the esophagus, and 2 patients with extensive enlarged mediastinal lymph nodes. The data collected included lesions types, complications and diagnostic accuracy.

RESULTSEUS-FNA revealed small cell carcinoma in 5 patients, squamous cell carcinoma in 1, adenocarcinoma in 1, and benign lymph nodes in 2. Malignancy was confirmed by follow-up in 7 patients, and benign tumor was confirmed by mediastinoscopy, thoracoscopy or follow-up in 2 patients. In 1 patient, FNA sample was not diagnosed because of inadequate specimen. None of the patients had complications caused by any procedures.

CONCLUSIONEUS-FNA is safe, reliable and accurate in diagnosis of suspicious lung neoplasm and mediastinal lymph node.

Adult ; Aged ; Biopsy, Needle ; Endosonography ; Female ; Humans ; Lung ; pathology ; Lung Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Male ; Mediastinum ; Middle Aged

OBJECTIVESTo calculate the rate of detection for mediastinal lymph nodes and to set up a criteria for the diagnosis of metastatic mediastinal lymph nodes in lung neoplasm by means of endoscopic ultrasonography (EUS).

METHODSIn 21 patients with lung cancer who underwent preoperative EUS on mediastinal lymph nodes, 103 lymph nodes detected by EUS were resected and confirmed pathologically all. The difference between benign and malignant lymph nodes was analysed statistically.

RESULTSThe rates of metastatic lymph nodes detected by EUS were significantly higher than these of non-metastatic lymph nodes (chi(2) = 11.752, P = 0.01) in levels 5, 7, 8, and 9 of mediastinal lymph node staging map (Union Internationale Contre le Cancer, 1997). The mean long and short axis of metastatic lymph nodes were significantly longer than those of non-metastatic lymph nodes (short axis: t = 4.541, P = 0.000; long axis: t = 3.278, P = 0.002). Metastatic lymph nodes showed some characteristic ultrasonographic features, including short axis >/= 1.0 cm, long axis >/= 1.5 cm, and clear boundary. According to the equation P((1)) = 1/[1 + e(-(-2.963 + 2.041 X1 + 1.681 X2))], the lymph nodes were assumed to be malignant when P((1)) >/= 0.5. The accuracy, sensitivity, specificity of this methods were 72.8%, 72.7%, 72.9% respectively, and were superior to those of CT for the same nods in levels 5, 7, 8 and 9 (chi(2) = 6.812, P = 0.013).

CONCLUSIONEUS is an effective method of diagnostic evaluation of mediastinal lymph nodes of lung cancer.

Adult ; Aged ; Endosonography ; methods ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Mediastinum ; pathology ; Middle Aged

BACKGROUNDTo study p16 methylation status and p16 mRNA transcription of BEP2D cells during its malignant transformation.

METHODSNormal BEP2D cell and BEP2D cells irradiated by α particle for 20 weeks (R-20), 21 weeks (R-21), 35 weeks (T-35) and 54 weeks (T-54) respectively were chosen to study the p16 methylation status by methylation-specific PCR (MSP). Meanwhile, RT-PCR was used to study p16 mRNA transcription of the above cells.

RESULTS(1) p16 methylation was found in R-20, R-21, T-35 and T-54 cells, but not in normal BEP2D cell. (2) The p16 mRNA transcription levels of R-20, R-21, T-35 and T-54 cells were much lower than that of normal BEP2D cell.

CONCLUSIONSThe p16 methylation occurs in the early stage of lung cancer. The methylation of p16 gene may cause the inactivation of p16 gene.