The curative treatment of choice for stage Ⅰ or Ⅱ non-small cell lung cancer (NSCLC) patients is usually surgical resection and the two surgical resection methods are lobectomy and sublobar resection.At present,the standard resection for early stage NSCLC is lobectomy.But more and more researches involve the sublobar resection for early stage NSCLC and its effect has been controversial.The research of how to improve the outcomes of sublobar resection is also emerging endlessly.The present paper reviews the effect of sublobar resection and the factors of impacting on its curative effect.

Objective To investigate the indications and clinical efficacy of an exclusive right-thoracic approach in esophageal surgery.Methods The clinical data of 35 patients with esophageal disease who underwent an exclusive right-thoracic approach operation from June 2008 to June 2010 at the Affiliated Hospital of Qingdao University were retrospectively analyzed.Of the 35 patients,21 were with esophageal cancer,and their ages were above 70 years,the partial pressure of oxygen of arterial blood (PaO2),maximal voluntary ventilation and forced vital capacity of the first second were (70 ± 9) mm Hg (1 mm Hg =0.133 kPa),51％ ± 9％ and 57％ ± 11％,respectively.Fourteen patients were with benign esophageal disease or low grade malignancy,and their PaO2 maximal voluntary ventilation and forced vital capacity of the first second were (96 ± 13) mm Hg,83％ ± 11％ and 91％± 14％,respectively.Exclusive right-thoracic approach was selected for all the patients,and surgical procedure was selected according to the location of the lesions.Patients were followed up by out-patient examination or phone call till April 2012.Results All the operations were carried out successfully,21 patients with esophageal cancer underwent partial esophagus resection and stomach-esophagus intrathoracic anastomosis through a right-thoracic approach.Of the 14 patients with benign esophageal disease or low grade malignancy,2 patients were with esophageal leiomyoma,3 with esophageal stromal tumor and 1 with esophageal leiomyomatosis underwent partial esophagus resection + intrathoracic anastomosis ; 7 patients with esophageal leiomyoma and 1 with esophageal stromal tumor underwent tumor extirpation.The operation time and operative blood loss were (3.4 ± 1.8)hours and (160 ± 44)ml,respectively.The number of lymph node dissected of the 21 patients with esophageal tumor was 14 ± 5,including 1.1 ± 0.7 lymph nodes dissected near the left gastric artery.No anastomosis fistula and perioperative death were detected,and the duration of hospital stay was (10 ± 4)days.The postoperative PaO2,maximal voluntary ventilation and forced vital capacity of the first second were (66 ± 10)mm Hg,50％± 11％ and 51％ ± 13％ for patients with esophageal cancer,and (94 ± 13) mm Hg,80％ ± 13％ and 87％ ± 16％ for patients with benign esophageal disease or low grade malignancy.All the patients were followed up for 1-2 years,no eating obstruction was detected,and the postoperative 1-and 2-year survival rate were 82.9％(29/35) and 77.1％ (27/35),respectively.Of the 8 patients with esophageal cancer who died postoperatively,1 died of cardiovascular diseases and 7 died of tumor recurrence and metastasis.Conclusion Exclusive rightthoracic appraoch could be used for patients with benign esophageal disease,low-grade malignancy and old esophageal cancer patients with poor pulmonary function.

OBJECTIVE:To study the analgesic and anti-inflammatory action of Lamiphlomis from different growing areas.METHODS:The analgesic action was observed with hot plate test and writhing test and the anti-inflammatory action with xylolinduced ear swelling test and acetic acid-induced peritoneal capillary permeability test in mice.RESULTS:Lamiphl_ omis could obviously inhibit the pain induced by hot plate and acetic acid as well as the ear swelling induced by xylol and the capillary permeability resulting from peritoneal injection of acetic acid.CONCLUSION:Lamiphlomis possesses analgesic and anti-inflammatory action and on this point,the actions of Lamiphlomis from three growing areas are more or less alike.

Objective To observe the outcomes of the modified multiple nerve transfer s combined with the late hand function reconstruction to restore the active pick-up function of the paralyzed upper extremity in patients with total brachial plexus avulsion injuries (TBPAI).Methods 33 patients suffered with TBPAI firstly underwent multiple nerve transfers,which including accessory nerve transfers to neurotize the suprascapular nerve to recover the shoulder abduction,contralateral C7 (CC7) nerve transfers via the modified pre-spinal route with direct coaptation to restore lower trunk function and the musculocutaneous nerve was also neurotized by the transferred CC7 nerve via a cutaneous nerve graft to restore the function of elbow flexion,as well as the phrenic nerve transfers to neurotize the posterior division of lower trunk to restore the function of elbow and finger extension.The patients with muscle recovery were selected to perform the hand function reconstruction at the second stage for restoring the active pick-up function.The patients were chosen as followcriterias:the degree of shoulder abduction attained 30°or more,the motor power of elbow,wrist,and finger flexion attained grade M4 or more,elbow and finger extension attained M3 or more.The methods of hand function reconstruction included wrist fusion and flexor carpal ulnaris opponensplasty,in addition to palmar capsulodesis of the metacarpophalangeal joint.Results The mean follow up was 41±7.7 (range,36-73 months) after the first procedure of multiple nerve transfers,the muscle strength of elbow and finger and wrist flexion attained M 4 as well as the elbow and finger extension achieved M3 or more in 10 patients,all of 10 patients achieved 40°-80°shoulder abduction.8 out of 10 patients had performed the second surgical procedure for hand functional reconstruction.6 of them had successfully recovered the active pick-up function.Conclusions The newly designed procedure of multiple nerve transfers could effectively restore the function of shoulder abduction,elbow,wrist,and finger flexion,as well as elbows and finger extension in patients with TBPAI,combined with the hand functional reconstruction,active pick-up function could be successfully reconstructed.

Objective To evaluate the feasibility and its clinical application of 3.0 T MRI in the assessment of the late gadolinium enhancement in patients with cardiac arrhythmias with phase-sensitive inversion recovery (PSIR) single-shot true fast imaging with steady-state precession (True FISP) sequence.Methods Fifty-six patients with arrhythmia confirmed by electrocardiogram underwent MRI in this prospective study.Late gadolinium enhancement were performed with both PSIR single-shot True FISP (sequence 1) and conventional segmented PSIR Turbo FLASH sequences (sequence 2).The overall image quality (4 scales) was assessed and recorded independently by two experienced radiologists.Statistical analysis was performed with Chi-square test and weighted Kappa test.Results Late gadolinium enhancement of all the 56 patients were successfully examined with the sequence 1 and 2.All the image qualities of sequence 1 reached 3 scales or more and met the requirements of clinical diagnosis,and late gadolinium enhancement lesions were detection in 19 patients.All the sequence 2 images were improperly used for clinical diagnosis of the different degrees of artifacts,especially in patients with severe arrhythmia and those who breath-hold with difficulty.Sequence 1 images were classified as scale 4 in 50 cases and scale 3 in 6 cases by Doctor 1,while scale 4 in 48 cases and scale 3 in 8 cases by Doctor 2,respectively.However,sequence 2 images were classified as scale 2 in 15 cases and scale 1 in 41 cases by Doctor 1,as well as scale 2 in 13 cases and scale 1 in 43 cases by Doctor 2,respectively.Sequence 1 image qualities were significantly higher than those of the segmented sequence 2 (x2 values were 141.329 and 141.177,P＜0.01).Excellent agreements between two observers of the 2 sequences (Kappa values were 0.837 and 0.905,P＜ 0.01) were found.Conclusion PSIR single-shot True FISP sequence provides higher reliability for image quality of late gadolinium enhancement in patients with cardiac arrhythmia,which may be useful for clinical application.

It is difficult to diagnose and treat local recurrence of the rectal cancer after operation. The early diagnosis is crucial for the recurrence of rectal cancer after operation. MSCT perfusion imaging is valuable in the diagnosis of recurrence of rectal cancer after operation. The application of MSCT perfusion imaging following rectal cancer operation was reviewed in this article.

Objective To elucidate the association of fibroblast growth factor 23 (FGF23)with coronary artery calcification in patients with moderate and advanced stage chronic kidney diseases (CKD). Methods Serum intact FGF23 levels in 150 patients with CKD stage 3 to 5 and 25 age- and sex-matched healthy controls were measured by ELISA.The association between FGF23 and coronary artery calcification was studied. Results Serum FGF23 levels in CKD patients were significantly higher than those in healthy controls [196.46 (83.09,355.02) ng/L vs 27.17 (21.63,51.20) ng/L,P＜0.01].The levels of FGF23 were significantly higher in dialyzed patients than those in non-dialyzed patients (P＜0.01),and hemodialysis patients had higher levels as compared to peritoneal dialysis ones [6048.29 (1129.08,34807.45) ng/L vs 1625.80 (602.83,7521.78) ng/L,P＜0.01].The incidence of coronary artery calcification was relatively high in patients with moderate and advanced stage CKD (74/130,56.9％ ).Serum FGF23 level was positively correlated with coronary artery calcification score (CaS) (r=0.177,P＜0.05).Logistic regression analysis showed that age (β=0.091,OR=1.095,P＜0.01),duration of dialysis (β=2.013,OR=7.483,P＜0.05) and FGF23 level (β=0.838,OR=2.311,P＜0.05) were independent risk factors for coronary artery calcification in patients with moderate and advanced stage CKD.ROC curve of coronary artery calcification revealed that area under curve (AUC) of FGF23 was 0.705 (P＜0.01).With the cut-off value of FGF23 as 786.73 ng/L,the diagnostic sensitivity and specificity in coronary artery calcification were 62.5％ and 75.9％.ROC curve of coronary artery calcification showed that AUC of alkaline phosphatase (AKP) was 0.626 (P=0.017).With the cutoff value of AKP as 79.75 U/L,the diagnostic sensitivity and specificity in coronary artery calcification were 84.5％ and 41.5％.There was no diagnostic value of serum phosphorus in coronary artery calcification. Conclusions Serum FGF23 level is correlated with coronary artery.calcification in patients with moderate and advanced stage CKD.The sensitivity of FGF23 is lower and the specificity is higher than those of AKP for the diagnosis of coronary artery calcification.

Surgery has remained the cornerstone of lung cancer therapy. Sleeve lobectomy, which is featured by not only the maximal resection of tumors but also the maximal preservation of functional lung parenchyma, has been proved to be a valid therapeutic option for the treatment of some centrally located lung cancer . Evidence points toward equivalent oncologic outcomes with improved survival and quality of life after sleeve resections compared with pneumonectomy. However, the postoperative morbidities and the long-term results after sleeve lobectomy remain controversial, especially in relation to nodal involvement and after induction therapy. With the development of technology, minimally invasive procedures have been performed more and more widely.

Humans ; Female ; Breast Neoplasms/genetics* ; Prognosis ; Gene Expression Profiling ; Biomarkers, Tumor/genetics* ; Gene Expression Regulation, Neoplastic/genetics* ; Receptor, ErbB-2/metabolism* ; Gene Regulatory Networks/genetics*

Objective:To evaluate the techniques and short-term outcomes of pericardial autologous angioplasty for the reconstruction of mediastinal large vessels in the treatment of locally advanced malignant thymoma.Methods:We retrospectively analyzed the clinical data of 6 patients with locally advanced malignant thymoma who received autologous pericardial transplantation for mediastinal great vascular reconstruction in the same treatment group of Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University from April 2017 to October 2018.Results:The operative time of malignant thymoma patients receiving autologous pericardial vascular reconstruction was(192.3±32.5)min, intraoperative blood loss was(105.0±27.5)ml, thoracic drainage time was(4.5±1.5)days, and postoperative hospital stay was(5.3±2.5)days. The postoperative quality of life of the patients was satisfactory. Angiography showed that the reconstructed vessels of the left inus vein were occluded in 1 patient 10 months after the operation, and the reconstructed vessels were unobstructed in the other patients. The average follow-up time of the patients was 34.3 months after surgery. One patient developed chest wall metastasis 23 months after surgery, and his condition was stable after receiving local radiotherapy. The other 5 patients did not occur local recurrence or distant metastasis.Conclusion:The application of autologous pericardium for the reconstruction of mediastinal great vessels in the treatment of malignant thymoma is a safe and effective method, and its clinical application prospect is worth expecting.