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Short-term outcomes of robot-assisted esophagectomy

Xiaobin ZHANG ; Yu YANG ; Bo YE ; Yifeng SUN ; Xufeng GUO ; Haiyong GU ; Rong HUA ; Teng MAO ; Zhigang LI

Journal of Chinese Physician.2017;19(7):970-973. doi:10.3760/cma.j.issn.1008-1372.2017.07.003

Objective To investigate our early results of robot-assisted esophagectomy (RAE) and present our learning curve experience with the largest study from one-single institution of China.Methods Between November 2015 and April 2017,a series of consecutive patients undergoing RAE at Shanghai Chest Hospital were reviewed.The patients'demographics,operative and postoperative outcomes were demonstrated.Results A total of 154 patients underwent RAE during the study.All patients received Mckeown esophagectomy and extensive thoraco-abdominal two-field lymph node dissection.Of these,122 were male and 32 were female.The mean total operative duration was 179-445 (271.0 ±61.5) min and the operative duration of the thoracic phase was 51-142 (96.7 ± 27.0)min.The mean estimated blood loss was 100 -1 000 (230.4 ±74.4)ml.The pathological results showed that 150 had squamous cell carcinoma,2 had adenocarcinoma,and 2 had small cell carcinoma.The R0 resection was 92.2％.The mean number of lymph node dissection was 11-64 (20.4 ± 8.5) and the lymph node sampling rate along left and right recurrent laryngeal nerve (RLN) were 92.2％ and 88.3％.The morbidity was present in 64 of 154 patients (41.6％).The major complications rate was anastomotic leak (12.3％),and vocal cord paralysis (16.9％).Intensive care unit (ICU) hospital stay time was 0-27 (2.7 ± 3.6) d,the median length of hospital stay was 7-81 (15.8 ± 11.6)days.There was no 90-day mortality.Conclusions RAE is a safe and feasible alternative for treatment of esophageal cancer.RAE can improve the efficacy of lymph node dissection,especially for the lymphadenectomy along recurrent laryngeal nerve.

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The study of 5-Hydroxytryptamine 2B receptor-nanodisc self-assembling and its ligand binding activity

Shuyan DAI ; Fang PENG ; Jun LI ; Lingzhi QU ; Longying JIANG ; Xiaojuan CHEN ; Ming GUO ; Meiying SHAO ; Yongheng CHEN

Journal of Chinese Physician.2017;19(7):984-987. doi:10.3760/cma.j.issn.1008-1372.2017.07.006

Objective To explore the application of nanodisc in functional and drug discovery research of G protein-coupled receptor (GPCR).Methods The purified recombinant 5-Hydroxytryptamine 2B receptor (5-HT2BR) was reconstituted into nanodisc complex.Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and size exclution chromatography were performed to evaluate the reconstitution reaction,followed by the use of surface plasmon resonance to validate the ligand-binding activity of 5-HT2BR after reconstitution.Results 5-HT2B R was effectively self-assembled into nanodisc while maintained its binding activity toward the antagonist SB204741.Conclusions The presented study provided potential application of 5-HT2B R-nanodisc for the development of subtype-selective drugs against 5-HT2B R and the fundamental of utilizing nanodisc for GPCR structural and functional studies as well as drug discovery.

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Evaluation of the therapeutic effect of interventional therapy of paravalvular leakage (PVL) after mitral and aortic valve replacement-7 cases

Xiaofeng LI ; Yang LIU ; Jiayou TANG ; Chennian XU ; Xiuling YANG ; Ping JIN ; Xin MENG ; Hongling LI ; Rui MA ; Min CHEN ; Shiqiang YU ; Jian YANG

Journal of Chinese Physician.2017;19(7):979-983. doi:10.3760/cma.j.issn.1008-1372.2017.07.005

Objective To evaluate the efficacy of interventional therapy via apical approach in complex mitral valve paravalvular leakage (PVL).Methods From January 2014 to December 2016,interventional therapy by apical approach was used in 7 patients with mitral valve PVL after mechanical valve replacement.There were 5 male and 2 female with mean age of 42-64 (51.3 ± 7.1) years.Six patients had a history of previous infective endocarditis.There were 3 cases of NYHA heart function =Ⅲ,and 4 cases =Ⅳ.The period of time between interventional therapy and previous operation was 6.5-8 (3.6 ± 3.1) years,with mitral regurgitation volume:9.5-23.1 (13.3 ± 4.7)ml.Interventional therapy of small incision method via the left sixth intercostal was carried out in the catheterization laboratory or the hybrid operation room with the patient under general anesthesia.Follow-up evaluation included peri-operational mortality,complications,improvement of cardiac function,hemolysis and postoperative residual mitral regurgitation.Results The success rate of total operation was 100％.The average operation time was 90-300 (145.7 ± 71.8) min,and the DSA radiation time was 6-25 (12.1 ± 6.5)min,with average hospitalization time of 5-12 (10.2 ± 3.5)d.The main post-operative complications included 1 case of hemoptysis,1 case of hematuria and acute renal failure,and 2 cases of blood transfusion,with blood transfusion volume of 1 200 ml and 3 290 ml,respectively.During the follow-up,there was no death.Mitral regurgitation volume decreased to 0 -1.0(0.43 ± 0.45) ml (P ＜ 0.05).All patients had improved heart function in different degree and no serious complications.Conclusions Interventional therapy via apical approach in complex mitral valve PVL has the advantages of being a simpler and safer approach,less trauma,shorter time of hospitalization,faster post-operative recovery and lower treatment cost.Its disadvantages are high difficult operation,strict indications and high technical requirements for the surgeon.By improving operation skills,choosing individualized occluders and treatment of early hemolytic complications,the success rate and long-term effect of interventional therapy can get further improved.

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Clinical application of the da vinci robotic system for lung cancer

Yu HAN ; Hecheng LI

Journal of Chinese Physician.2017;19(7):974-978. doi:10.3760/cma.j.issn.1008-1372.2017.07.004

For early-stage lung cancer,the treatment is given priority to surgery.As a new approach of minimally invasive surgery,three-dimensional and high definition view,and better dexterity robotic platform and tremor filtering system are the main advantages of da vinci robot compared to video-assisted thoracic surgery.In recent years,the technique of robot surgery has become more and more mature and has already been used in the treatment for lung cancer.However,its safety and postoperative outcomes should be evaluated in detailed.As a consequence,the comparison of robotic,video-assisted thoracic surgery and thoracotomy surgery for lung cancer has become a hot spot in recent clinical research.

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Relationship between the clinical onset of cerebral infarction in anterior cycle and properties of carotid atheromatous plaque

Aie ZHAO ; Liya WEI ; Yuhua JIN ; Haijun ZHANG

Journal of Chinese Physician.2014;16(11):1521-1523,1529. doi:10.3760/cma.j.issn.1008-1372.2014.11.019

Objective To investigate the relationship between the clinical onset of cerebral infarction in anterior cycle and properties of carotid atheromatous plaque.Methods A retrospective analysis was carried out on clinical data of 624 cases of cerebral infarction in anterior cycle from December 2010 to December 2013 in our hospital.The carotid artery plaque Crouse score,index,and intima-media thickness (IMT) were used to evaluate carotid atherosclerosis and plaque lesions.The National Institute of Health stroke scale (NIHSS) questionnaire was used to evaluate neural function defect.Results Compared to the non-lesion side,the lesion side carotid artery plaque Crouse score was decreased and IMT was increased (P ＜ 0.05) ; the lesion carotid artery plaque Crouse was lower,the higher NIHSS scores (r =-0.546,P =0.004) ; IMT score was higher,higher NIHSS score; carotid artery atheromatous plaque Crouse was negatively related to NIHSS score; IMT score was positively related to NIHSS score (r =0.672,P =0.003).Conclusions The clinical onset of cerebral infarction in anterior cycle was correlated with the carotid sclerosis degree.The Crouse score and IMT of the lesion have certain significance in predicting prognosis of cerebral infarction in anterior cycle.

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Measurement of fetal optic tract diameters with three-dimensional ultrasound

Yingchun LUO ; Aijun TIAN ; Wei ZHANG ; Qichang ZHOU

Journal of Chinese Physician.2015;17(2):212-214,220. doi:10.3760/cma.j.issn.1008-1372.2015.02.016

Objectives To construct reference range of fetal optic tract mean diameter and to report the measured optic tract mean diameter in fetuses with agenesis of the septum pellucidum (SP).Methods Three-dimensional volumes of the optic chiasm were acquired in 254 normal fetuses during routine sonographic examination at 21 ～ 40 weeks' gestation and the diameters of posterior left and right optic tracts were measured offline.A polynomial regression approach was used to calculate reference charts for the fetal optic tract mean diameter.In addition,16 three-dimensional volumes were acquired in fetuses with SP agenesis for offline measurement of optic tract diameter.The complete follow-up data were obtained in 7 of these 16 cases.Results In normal fetuses,the optic tract diameter increased linearly throughout gestation.Normal charts and equations were constructed.Among 7 fetuses with SP agenesis and complete follow-up,one had postnatal normal vision,two had hypoplastic optic tract,and four underwent termination of pregnancy.Three cases of normal childbirth were tested after the baby was born as a bundle of apparent dysplasia,including 1 case of neonatal characterized by lack of vision at the one year old and 2 cases of impaired vision.Four cases of termination of pregnancy included 1 case with tracking pathological confirmation of optic nerve hypoplasia,and the other 3 cases without tracking the pathological results.Conclusions We present new reference charts for fetal optic tract mean diameter.In fetuses with agenesis of the SP,sonography of the optic tract might be a useful tool to assess its development and may help prenatal counseling.

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Difference of the treatment response of the different clinical COPD phenotypes to inhaled salmeterol and fluticasone

Li DONG ; Xufang SHANG ; Xiujuan WEI

Journal of Chinese Physician.2015;17(2):236-238,242. doi:10.3760/cma.j.issn.1008-1372.2015.02.022

Objective To compare the treatment responses of the inhaled salmeterol and fluticasone (50/500 μg) for three months in the different clinical phenotypes of chronic obstructive pulmonary diseases (COPD) which were chronic bronchitis phenotype and emphysema phenotype and to explore the difference of the treatment responses.Methods To enroll and follow up the stable COPD patients from outpatient department who received the treatment of inhaled salmeterol and fluticasone (50/500 μg).Patients with low attenuation area (LAA,the density on CT scan ＜-950 HU) ≥15％ of the while lung area％ (LAA％) were defined as emphysema group,while patients with LAA％＜ 15％ were defined as chronic bronchitis group.All the subjects received lung function test before and after three-month treatment.Results Totally,84 patients (49 male and 35 female patients) with stable COPD were enrolled with an average age (61.04 ±9.23) years old,30 patients in emphysema group and 54 patients in chronic bronchitis group.Before treatment,forced expiratory volume in one second (FEV1) ％ predicted value and residual volume (RV) ％ predicted value in emphysema group were lower than those of chronic bronchitis group (P =0.04 and P =0.01),while inspiratory capacity (IC)％ predicted value was higher than that of chronic bronchitis group (P =0.02).After three-month salmeterol and fluticasone inhalation treatment,FEV1 and RV were improved in both groups,but FEV1 and RV in chronic bronchitis group were improved more significantly than those of emphysema group (P =0.02 and P =0.03).Conclusions The treatment responses of different clinical phenotypes of COPD to inhalation of combination of salmeterol and fluticasone were different,chronic bronchitis phenotype had better treatment response compared to emphysema phenotype.

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Effect of Yixintai granule on myocardial remodeling in rabbits with chronic heart failure

Zhihua GUO ; Ya LI ; Gangqiang WU ; Yun TANG ; Xiangping MAO ; Yueai WANG ; Tao SUN

Journal of Chinese Physician.2015;(3):340-342,346. doi:10.3760/cma.j.issn.1008-1372.2015.03.006

Objective To explore the effect of Yixintai granule on myocardial remodeling in rabbits with chronic heart failure ( CHF) .Methods The rabbit model of CHF with adriamycin was established. These successful CHF models of rabbits were divided into model group, high,middle, and low dose of Yix-intai groups, losartan potassium group, and normal control group.Echocardiographic indexes and myocardi-al remodeling indexes were measured after 4 weeks of medication.Results Compared to the model group, the left ventricular posterior wall (LVPW), left ventricular internal diameter at end-systole (LVIDs), left ventricular internal diameter at end-diastole ( LVIDd) , cardiac index ( CI) , and left ventricular mass index (LVWI) of the treatment groups were decreased ( P <0.05 or P <0.01), and the interventricular septum ( IVS) of the middle and high Yixintai groups was decreased significantly ( P <0.01 ) .Compared to the low dose of Yixintai group, the IVS, LVPW, CI, and LVWI of the middle and high Yixintai groups were decreased ( P <0.05 or P <0.01) , and the LVIDs and LVIDd of the high Yixintai group were decreased ( P <0.05 ) .Conclusions Yixintai granule can improve myocardial remodeling in rabbits with CHF. Meanwhile, the curative effect of medial and high groups of Yixintai is better than the low dose group.

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Effect of dexmedetomidine combined with video laryngoscopy during orotracheal intubation for pa-tients with spontaneous breathing

Lei LYU ; Juping HE

Journal of Chinese Physician.2015;(3):395-397,402. doi:10.3760/cma.j.issn.1008-1372.2015.03.021

Objective To investigate the effectiveness of different dose dexmedetomidine ( DEX) combined with video laryngoscopy during orotracheal Intubation for patients with spontaneous breathing. Methods A total of 87 emergency or intensive care unit ( ICU) patients with spontaneous breathing was in-cluded (age range:18 to 75 years).The patients were randomly divided into three groups with 29 cases each:midazolam combined with fentanyl group ( A) , low dose DEX group ( B) , and high dose DEX group (C).Mean arterial pressure (MAP),heart rate (HR), and SpO2 were detected before injecting different dosage drugs (T0), during intubation (T1),after intubation immediately (T2), at 3 min after intubation ( T3 ) .The amount of intubation time and side effects in each group were assessed.Results Compared to A group, the changes of hemodynamics in group B and C were more stable after injecting drugs.The doctors spend less time for intubation in group B and C.The rate of significant bradycardia in group C was higher than other groups.Conclusions If you can assess indications, doses and timings strictly, it was safety and availability to control intubation response in the patients with spontaneous breathing by injected of DEX.

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The analysis of measurement results of adult myopia biological optical parameters

Ying WANG ; Yunchun ZOU ; Shuang XU ; Yang YANG

Journal of Chinese Physician.2015;(3):328-330,336. doi:10.3760/cma.j.issn.1008-1372.2015.03.003

Objective To investigate the correlations between the ocular biometric optical parame-ters and refractive dioptres in adults, assess the influence of the biometric optical parameters on the develop-ment of myopia, and provide a reference of prevention and treatment for myopia.Methods A total of 188 adults (376 eyes) aged 18 to 40 years old was enrolled in this study.Dioptres were measured with phorop-ter, A-mode ultrasound was used to measure the vitreous length and lens thickness, the axis length, anterior corneal surface semidiameter anterior chamber depth were measured with intraocular len-master ( IOL-mas-ter) .SPSS 17.0 software was used to analyze the date.Results ⑴Of the 376 eyes, the results showed a statistically significant difference between myopia and emetropia in the axis length, vitreous depth, anterior corneal surface semidiameter, anterior chamber depth and lens thickness( P <0.01).⑵The partial corre-lation analysis indicated a significant positive correlation between the refraction dioptres and axial length, vitreous length ( r =-0.90, -0.88, respectively, P <0.01);and significant strong correlation was also found between dioptres and anterior corneal surface horizontal and vertical semidiameter ( r =0.81, 0.84, respectively, P <0.01);But correlations between dioptres and lens thickness and anterior chamber depth were very weak ( r =-0.11, 0.12, respectively, P <0.01);the correlation between axial length and vit-reous depth was very high ( r =0.95, P <0.01).and the data indicated that the anterior corneal surface horizontal and vertical semidiameter were high positive correlation( r =0.91, P <0.01);the same high positive correlation between the axial length and the anterior corneal surface semidiameter ( horizontal/verti-cal) was also found ( r =0.78,0.81, P <0.01).Conclusions Two chief factors (corneal surface semi-diameter and ocular axial length) influencing the level of dioptres were high positive correlation, seeking the mutual coordination factors which promote corneal curvature change and axial growth and finding out the feedback mechanism of promoting the cornea sphericity might be conducive to further explore how to control the occurrence and development of myopia.

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