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Depression and quality of Life before and after diagnosis of lung cancer

Hao WANG ; Chunbo LI ; Peng ZHANG ; Hui NING ; Nan SONG ; Gening JIANG

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(6):389-392. doi:10.3760/cma.j.issn.1001-4497.2010.06.010

Objective The aim of the present study was to assess the frequency of depression and quality of life(QoL)in lung cancer patients before and after diagnosis , and to investigate the potential related factors. Methods The subjects consisted of 115 consecutive adult patients newly diagnosed for lung cancer in Shanghai Pulmonary Hospital between April 2008 and October 2008. Depression and QoL were evaluated before the diagnosis for baseline; the same evaluation was repeated after surgery. The median interval was 34.6 days (ranged 28-44 days). Patients' biomedical characteristics were noted from patients' medical records, while the demographic factors were obtained during the interview at the out-patients department. Statistical analysis was used to identify the significant predictors. Results The overall incidence of depression before final diagnosis and after surgery was 22.6% and 17.4 %, respectively. No significant change in the prevalence of depression was found in our study. Education, cost of hospitalization, and smoking status were associated with an increased risk of depression before final diagnosis. Age, having confidant, performance status, and type of surgery were found related with postoperative depression. Patients' QoL had a decrease in every subscale after surgery. Changes in role, social functioning scales and fatigue, pain symptom scales were found significantly. In QoL subsc ales, preoperative dyspnea, postoperative role functioning, fatigue , and pain were associated with changes of depression. Conclusion Depression may be present prior to final diagnosis in lung cancer patients and it does not seem to decrease significantly after surgery, indicating the need for psychological screening and appropriate intervention during theperioperative period. A poorer QoL was detected after surgery, which maybe partly contributed to depression symptoms.

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Utilization of edge-to-edge valve plastic technique to correct severe tricuspid regurgitation in patients with congenital heart disease

Keye LIU ; Yongqiang LAI ; Zhiqiang LUO ; Yi LUO ; Zhe HAN ; Fulin LIU ; Yiwu LIANG

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(6):371-373. doi:10.3760/cma.j.issn.1001-4497.2010.06.004

Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe tricuspid regurgitation in patients with congenital heart disease. Methods From April 2001 to Mar. 2010, severe tricuspid regurgitation was corrected with a flexible band anuloplasty and edge-to-edge valve plasty technique in 14 patients with congenital heart disease. The age ranged from 7 years to 62 years [average (31.2 ± 16.1 ) years]. Congenital cardiac anomalies include: atrioventricular canal in 5 cases, secundum atrial septal defect in 6 cases, secundum atrial septal defect with mitral valve regurgitation in 2 cases and cor triatriatum in 1 case. Results No hospital death or postoperative morbidity occurred. No or trivial tricuspid regurgitation was present in 11 cases and mild tricuspid regurgitation in 3 cases at discharge. The follow-up ranged from 3 month to 97 months [average (51.6 ± 26.8 ) months]. No tricuspid stenosis was found. No or trivial tricuspid regurgitation was present in 5 cases. Mild tricuspid regurgitation was present in 8 cases, and moderate tricuspid regurgitation in 1 case at the latest followup. Conclusion Edge-to-edge valve plasty is an easy, effective and important procedure to correct severe tricuspid regurgitation in patients with congenital heart disease.

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Treatment of patients with bosentan in post-operation of congenital heart disease with pulmonary arterial hypertension: a double-blind, randomized controlled trial

Yajuan ZHANG ; Shangshou HU ; Shoujun LI ; Zhe ZHENG ; Yongqing LI ; Xu WANG ; Yang WANG

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(6):380-384. doi:10.3760/cma.j.issn.1001-4497.2010.06.007

Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin-1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associated with congenital heart disease, and the concentrations of endothelin-1 was correlated with severity degree of pulmonary arterial disease.Endothelin exerting vasoconstrictor and mitogenic effects by binding to two distinct receptor isoforms in the pulmonary vascular smooth muscle cells: endothelin A and B receptors. Bosentan is an orally active dual ( A and B) endothelin receptor antagonist that has been shown to improve exercise capacity, haemodynamics, and clinical worsening in many clinical trials, but have no experience in post-operation of congenital heart disease with PAH. In our country, there are lots of elder patients of congenital heart disease accompany with pulmonary arterial hypertension. And they have poor prognosis after operation because pulmonary arterial hypertension leads to right ventricular failure and sudden death. So we hope bosentan can improve clinical outcome of these patients. This time we present the results of the bosentan trial in post-operative patients still with pulmonary arterial hypertension, a randomized controlled trial designed to assess the efficacy and safety of the dual endothelin receptor antagonist bosentan in post-operative pulmonary arterial hypertension, and present the first experience of bosentan for these patients.Methods This study was a prospective clinical trial. The objects were 30 patients ( age:4 months - 6.8years,weight:5 - 15 kg) who still had pulmonary artery hypertension at one week after cardiac defects repaired. They were randomized to controlled ( n = 15 ) or to bosentan ( n = 15 ). Dosage regimen: 10 - 20 kg patients, 31. 25 mg qd ( 4 weeks ) ,31.25 mg bid ( 8 weeks);5 - 10 kg patients, 15.6 mg qd ( 4 weeks), 15.6 mg bid ( 8 weeks). Evaluate the efficacy and safety of Bosentan through the amelioration of pulmonary arterial systolic pressure, WHO functional class, and clinical worsening. Results We monitored pulmonary arterial systolic pressure after operation by echocardiogram 2 times, baseline ( 1 week after operation) and at 12 weeks later. The pulmonary arterial systolic pressure decreased 19.5 mm Hg in Bosentan group( P =0. 000), and decreased 10.3 mm Hg in control group(P =0. 164), with the mean treatment effect of 9.2 mm Hg (P=0.049,95%CI:0. 1 -18.3). The effct of bosentan on haemodynamics is also reflected in the reduction plasma ET-1 concentration in bosentan group. Plasma ET-1 in control group increased (0. 15 ±0.1 )fmol/ml(P =0.77), however, decreased (2.01 ±0.3)fmol/ml (P=0. 03) in bosentan group; Bosentan prevented post-operation PAH. Bosentan treatment was associated with lower incidence of worsening NYHA functional class compared with controlled(0 in the bosentan group vs 13% in the placebo group) There was a delay in time to clinical worsening with bosentan compared wih controlled group. Abnormal liver function occurred in 2 cases in bosentan group but resolved after discontinuation of bosentan treatment, no other side effects. Bosentan produced hemodynamic improvement and was well tolerated in infant. Conclusion Bosentan administration in patients with postoperative PAH is safe and efficient. Bosentan is a new effective approach to therapy for postoperative pulmonary arterial hypertension in children.

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Clinical study of prosthesis-patient mismatch after aortic valve replacement

Zhong WU ; Dongjin WANG ; Jie LI ; Bugao SUN

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(6):374-376. doi:10.3760/cma.j.issn.1001-4497.2010.06.005

Objective The prosthesis used for aortic valve replacement (AVR) may be too small in relation to the body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. The aim of this study was to evaluate the prevalence of PPM and the impact of PPM on hemodynamic and early mortality after AVR. Methods A total of 292 patients ( 167 males, 125 females; mean age of ( 52.8 ± 14.6 ) years, with ranging 22 - 82 years) who underwent AVR between January 2007 and December 2009 were retrospectively evaluated. Etiologies were: rheumatic in 243 cases, degenerative in 36, congenitally bicuspid aortic valve in 8, and infective endocarditis in 5. Combined operations with AVR including mitral valve replacement ( 172 cases), mitral valve repair (56 cases), tricuspid valve repair (238 cases), and coronary artery bypass grafting (32 cases). The aortic valve prosthesis effective valve orifice area (EOA) was divided by the body surface area (BSA) to obtain the EOA index (EOAI). PPM was then defined as none or mild if EOAI was ＞0.85 cm2/m2, as moderate for 0.65 -0.85 cm2/m2 and as severe for ＜0.65 cm2/m2. The mean flow rate through aortic prostheses and mean transvalvular pressure gradients were measured by color Doppler after AVR. The prevalence of PPM was compared between the different type ( mechanical or bioprosthetic valve) and the different size ( ＞21 mm or ≤21 mm) of aortic valve prostheses. The effect of PPM on hemodynamic and early mortality after AVR was also studied. Results 219 patients received mechanical AVR and 73 bioprosthetic AVR. Moderate PPM occurs more frequently with bioprosthetic AVR (6.25% versus 48.22%, P ＜0. 01 ). Bigger than 21mm prostheses were used in 191 patients and ≤21 mm prostheses in 101 patients. The prevalence of PPM was 13.61% and 33.66% respectively ( P ＜ 0. 05 ). According to the EOAI of the aortic valve prostheses,all the 219 patients were divided into two group, PPM group and non-PPM group. The mean flow rate of aortic prostheses and mean transvalvular pressure gradients in PPM group was significantly higher than those in non-PPM group [(2.66 ± 0.87 ) m/s versus ( 1. 58 ± 0.47 ) m/s, ( 26.50 ± 6.25 ) mm Hg versus ( 16.75 ± 3.46 ) mm Hg, P ＜ 0. 01]. There were 9 deaths during early period of operation, and the total 30-day operative mortality was 3.08%. The postoperative early mortality of PPM group and non-PPM group was 6.67% and 2.16% respectively, and there were significantly difference between the two group ( P ＜ 0. 05 ). Conclusion Prosthesis-patient mismatch is common present after AVR, especially in patients with bioprostheses and small size valve prostheses. PPM has a negative impact on postoperative hemodynamic and early mortality. PPM results in higher transvalvular pressure gradients and higher early mortality.

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Effects of 3,3' ,4' ,5,7-pentamethylquercetin on intimal hyperplasia of vein grafts

Zhangfan MAO ; Xiaohui XUN ; Zongquan SUN ; Jie HUANG ; Ganjun KANG ; Xiaojian WU

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(6):405-408. doi:10.3760/cma.j.issn.1001-4497.2010.06.015

Objective Pentamethylquercetin (PMQ) has a role in cardiovascular protection. We investigate the effects of 3,3' ,4' ,5,7-pentamethylquercetin, a derivative of PMQ, on intimal hyperplasia of the vein grafts in rats both in vivo and in vitro. Methods The proliferation of vascular smooth muscle cells ( VSMC ) was induced with Ang Ⅱ (0. 1μmol/L, 24 h)while PMQ was administrated at six different dosages (0. 1, 0.3, 1,3, 10 and 30 μmoL/L). Cell viability was identified with MTT; ROS was measured with DCFH-DA; and the expression of NADPH oxidase subunits Nox1, p47phox, and p22phox mRNA were measured with real-time PCR. For the experiment in vivo, 24 SD rats were randomly assigned to control group and PMQ groups, the latter was further divided into three different dosage groups. In the control group, solvent was administrated daily via gavage. In PMQ groups, PMQ ( 12.5 mg/kg, 25 mg/kg, 50 mg/kg) was administrated daily respectively in the same way.All SD rats received operation performed by one person. Reversed external jugular vein was implanted into the external carotid of the same side with interrupted suture. 4 weeks after operation, all vein grafts were harvested. Status of the vein grafts was observed and tissue sections were analyzed with HE staining. The intimal hyperplasia ( intima/media area index and intima/media thickness index) of the vein grafts was assessed. Results Cell viability and ROS of VSMC induced by Ang Ⅱ were suppressed by PMQ. Cell viability and ROS of VSMC were increased substantially when treated with Ang Ⅱ. The therapeutic effects of PMQ could be initially identified at dose of0. 3 μmol/L, with a peak at 3 μmol/L. The effects decreased from 30μmol/L to 10 μmol/L. PMQ at dose of 0.1 μmol/L had no effect on cell viability and ROS of VSMC induced by Ang Ⅱ. PMQ also downregulated the mRNA expression of NADPH oxidase subunits Nox1, p47phox and p22phox induced by Ang Ⅱ. A peak effect was observed at 3μmoL/L and decreased at 30 μmol/L. PMQ at o. 1 μmol/L had no effect on mRNA expression of NADPH oxidase subunits induced by Ang Ⅱ. As compared with control group, PMQ decreased intima/media area index ( 1. 64 ±0.20 in control, 0. 74 ±0.18 at 12.5 mg/kg, 1.09 ±0.17 at 25 mg/kg, 1.21 ± 0. 21 at 50 mg/kg) and intima/media thickness index ( 1.34 ± 0. 24 in control, 0.67 ± 0. 17 at 12.5 mg/kg, 0. 74 ± 0.14 at 25 mg/kg, 0.93 ± 0. 18 at 50mg/kg) at three dosages after implantation. Conclusion PMQ may suppress the proliferation of VSMC and inhibit neointima hyperplasia of vein grafts in rats. The effects may be attributed to the anti-oxidative activity and the downregulation of mRNA expression of NADPH oxidase subunits Noxl, p47phox and p22phox.

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The application of CT scan in Nuss procedure for pectus excavatum

Yun PENG ; Qi ZENG ; Na ZHANG ; Chenghao CHEN ; Jihang SUN

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(6):396-399. doi:10.3760/cma.j.issn.1001-4497.2010.06.012

Objective To study the application CT scans in Nuss procedure for pectus excavatum. Metlhods 648 children with pectus excavatum underwent Nuss procedure from July 2002 to September 2008 The preoperative CT scan was carried out for evaluation of the deformity degree and morphology classification of chest wall malformation, the deformity in relation with adjacent tissue and associated different disorder. Results Nuss procedure was successfully performed in all 648 patients. The preoperative CT scan showed medium deformity of the pectus excavatum in 73 cases ( 11.27% ) and severe deformity in 575 cases (88.73%). Morphologic classification of the pectus excavatum were symmetric type in 407cases (62.81% ) , eccentric type in 83( 12.81% ) ,and unbalanced type in 158( 24.38% ). 116 cases with pectus excavatum were associated with other different disorders, among them 55 cases ( 17.9% )were diagnosed by CT scan. 28 cases received stimultanously operation for their abnormalities. Conclusion CT scan is a useful tool for evaluation the deformity degree and morphology classification, direct the operation, reduce the complications and find other different disorders. It should be a routine examination before Nuss procedure.

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Thoracic endovascular aortic repair of chronic type B aortic dissection in 84 patients

Sheng YANG ; Fangjiong HUANG ; Zhanming FAN ; Zhizhong LI ; Jiahui DU ; Zhaoguang ZHANG ; Shangdong XU

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(6):385-388. doi:10.3760/cma.j.issn.1001-4497.2010.06.008

Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection. Methods Methods From June 2001 to September 2007, 84 patients with chronic type B aortic dissection received TEVAR. The time between onset of dissection and TEVAR was (13.9 ± 22.0) months (ranged 1 - 120 months). All patients were followed for 6 - 86 months [mean (33.2 ± 19.2) months]. Results The entry tear was completely sealed in 77 cases ( 91.7% ) during TEVAR. The incidence of incomplete seal was 8.3%. One-month mortality was 1. 2%. One patient had retrograde type A dissection 1 month after operation. Four patients received a second TEVAR during follow-up :3 for endoleaking and 1 for newly formed intima tear. Seven patients (8.3%) died during follow-up: 3 thoracic aorta rupture due to endoleaking, 1 abdominal aorta rupture caused by continuous dilation of the abdominal aorta, unrelated to aortic dissection deaths in 2 and 1 died of unknown cause. The Kaplan Meier actuarial survival curve showed a 7-year survival rate of 84.4%. Conclusion Early and mid-term results showed that TEVAR was effective in treating chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increasing of physician's experience and refinement of the stent-graft, results are likely to improve in the future.

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Investigation of the expression of MTA1 protein and its relationship to the prognosis in squamous cell carcinoma of the esophagus after esophagectomy

Liang SONG ; Zhou WANG ; Xiangyan LIU ; Gang CHEN ; Fanying LIU

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(5):343-346. doi:10.3760/cma.j.issn.1001-4497.2010.05.018

Objective To investigate the expression of MTA1 protein and its relationship to the prognosis in esophageal cancer after esophagectomy. Methods One hundred and sixty-five patients with middle third squamous cell carcinoma of the esophagus were enrolled in this study. All patients underwent operation in Provincial Hospital Affiliated to Shandong University between January 2002 and January 2004. The expression of MTA1 protein was detected by immunohistochemistry. All statistic analyses were performed with SPSS 10.0 statistical software. According to the clinicopathologic factors, the difference of MTA1 protein expression was compared by x2 test. Kaplan-meier method was performed to calculate the survival rate, Cox regression multivariate analysis was performed to determine independent prognostic factors. Results The 5-year survival rate in Ⅰ stage,Ⅱ stage and Ⅲstage was separately 100.0% 、38.3% and 22.4%, and the MTA1 protein expression rate in Ⅰ stage, Ⅱ stage and Ⅲ stage was separately 25.0% 、30.9% and 57.9%, the difference of MTA1 protein expression between Ⅱ stage and Ⅲ stage was statistically significant ( x2 = 11.6, P = 0. 00). The MTA1 protein expression rate in T1 stage, T2 stage and T3 stage was separately 42.9% 、13.3% and 50%. MTA1 protein expression rate in T2 stage patients and T3 stage patients was separately 13.3% and 50%, the difference of MTA1 protein expression between them was statistically significant (x2 = 13.2, P =0.00). The positive expression of MTA1 protein in patients with lymph node metastasis was significantly higher than those without metastasis ( x2 = 8.2, P = 0.04). The 5-year survival rate in patients with MTA1 protein positive expression was significantly lower than those without MTA1 protein positive expression (P =0.00 ), and the 5-year survival rate in T3 stage patients with MTA1 protein positive expression was significantly lower than those without MTA1 protein positive expression ( P =0.01 ), and the 5-year survival rate in N0 stage patients with MTA1 protein positive expression was significantly lower than those without MTA1 protein positive expression (P = 0.03 ), and the 5-year survival rate in N1 stage patients with MTA1 protein positive expression was significantly lower than those without MTA1 protein positive expression ( P =0.04). However, the 5-year survival rate in T2 stage patients with MTA1 protein positive expression was not significantly lower than those without MTA1 protein positive expression (P =0.20). The result of Cox analysis demonstrated that N stage and MTA1 protein positive expression were independent prognostic factors. Conclusion MTA1 protein overexpression was detected in esophageal squamous cell carcinoma and was found to be significantly associated with T stage and lymph node metastasis. The patients with MTA1 protein overexpression was significantly lower the 5-year survival rate than without MTA1 protein expression. Lymph node metastasis and MTA1 protein overexpression were independent prognostic factors.

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Endovascular interventional treatment of bronchial artery aneurysm: case report and review of literature

Wei CHEN ; Xiaoyun HU ; Xuan WANG ; Jiasheng HUANG ; Chuanxian HU

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(5):340-342. doi:10.3760/cma.j.issn.1001-4497.2010.05.017

Objective To present one case of bronchial artery aneurysm successfully treated with endovascular interventional procedure and review literature. Methods A 67-year-old man was diagnosed with mediastinal bronchial artery aneurysm accompanied with tuberculous pleurisy by chest imaging. The aneurysm was treated via transcatheter bronchial artery embolization combined with endovascular stent-graft placement in the thoracic aorta under DSA guidance. Results Postprocedural angiography showed satisfactory exclusion of the aneurysm and no endolead. Conclusion Interventional therapeutic management of bronchial artery aneurysm is feasible and accurate.

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Mid- and long-term follow-up for the graft patency after coronary artery bypass graft surgery

Wei CHENG ; Wenjun ZHEN ; Yujian MA ; Xiaokang OUYANG ; Hongfeng TONG ; Yaoguang SUN ; Yongzhong WANG ; Wen HUANG

Chinese Journal of Thoracic and Cardiovascular Surgery.2010;26(5):325-328. doi:10.3760/cma.j.issn.1001-4497.2010.05.012

Objective To analyze the mid- and long-term results after coronary artery bypass graft surgery (CABG), to evaluate the accuracy of multi-detector CT coronary angiography (MDCT) on the graft patency status and to compare the patency for different grafts. Methods One hundred and one cases underwent CABG from June 1992 to March 2008 were followed up by searching the database of MDCT (42 cases) and selective coronary angiography (SCA, 59 cases). The mean following up period was (66.79 ±44.27) months. Three hundreds and 10 grafts including 115 arterial and 195 venous were analyzed.A comparison of the patency rate between the arterial and venous grafts was also carried out. At the mean time, 2 groups were divided according to the paft lesions( patency of not). Uunivariate analysis and Logistic regression analysis were made for statistics. Results At the follow-up of (53.93 ± 36.80) months, the patent rate of LIMA, RA, SV and CV examined by MDCT was 94.7%, 92.0%, 85.9% and 60.0%, respectively. The patent rate for MDCT patients with angina was 83.5%, and 95.2% for angina-free group ( P = 0.046). At the follow-up of (75.95 ±47.09) months, the patent rate of LIMA, RA, SV and CV examined by SCA was 87.1%, 81.0%, 53.6% and 57. 1%, respectively. In SCA patients the patent rate was 62.0% for angina group and 100% for angina-free group ( P = 0.025 ). According to logistic regression analysis, only the postoperative period was statistically related to the graft lesion. Conclusion MDCT could find out the occlusions and obvious stenoses of the grafts after CABG. It might be served as a noninvasive method to evaluate the grafts patency postoperatively. The mid- and long-term patency of arterial grafts is better than venous grafts. Graft lesion is an important factor leading to postoperative recurrent angina pectoris. The severity of the graft lesion has a close relation to the lenth of postoperative period.

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