Thoracoscopic anatomic pulmonary segmentectomy and subsegmentectomy have become sophisticated surgical solutions for complex pulmonary diseases. The rapid development of three-dimensional computed ...tomographic angiography (3DCTA) has made it possible to provide more refined individualized anatomic details and has consequently enabled subsubsegmentectomy (SSS). In this study, we report two successful thoracoscopic anatomic SSSs of the left S1+2 aii and S3 aii under the guidance of 3DCTA reconstructed images. To the best of our knowledge, these are the first two cases of SSSs ever detailed reported. The nomenclature of subsubsegments is adopted according to the Japanese Committee on the Nomenclature for Bronchial Branching.
Abstract Background Large cohort studies provide conflicting evidence regarding the potential for oral macrolide antibiotics to increase the risk of serious cardiac events. Objectives This study ...performed a meta-analysis to examine the link between macrolides and risk of sudden cardiac death (SCD) or ventricular tachyarrhythmias (VTA), cardiovascular death, and death from any cause. Methods We performed a search of published reports by using MEDLINE (January 1, 1966, to April 30, 2015) and EMBASE (January 1, 1980, to April 30, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Results Thirty-three studies involving 20,779,963 participants were identified. Patients taking macrolides, compared with those who took no macrolides, experienced an increased risk of developing SCD or VTA (RR: 2.42; 95% CI: 1.61 to 3.63), SCD (RR: 2.52; 95% CI: 1.91 to 3.31), and cardiovascular death (RR: 1.31; 95% CI: 1.06 to 1.62). No association was found between macrolides use and all-cause death or any cardiovascular events. The RRs associated with SCD or VTA were 3.40 for azithromycin, 2.16 for clarithromycin, and 3.61 for erythromycin, respectively. RRs for cardiovascular death were 1.54 for azithromycin and 1.48 for clarithromycin. No association was noted between roxithromycin and adverse cardiac outcomes. Treatment with macrolides is associated with an absolute risk increase of 118.1 additional SCDs or VTA, and 38.2 additional cardiovascular deaths per 1 million treatment courses. Conclusions Administration of macrolide antibiotics is associated with increased risk for SCD or VTA and cardiovascular death but not increased all-cause mortality.
Summary Background Homoharringtonine-based induction regimens have been widely used in China for patients with acute myeloid leukaemia. However, their efficacy has not been tested in a multicentre ...randomised controlled trial in a large population. We assessed the efficacy and safety of homoharringtonine-based induction treatment for management of newly diagnosed acute myeloid leukaemia. Methods This open-label, randomised, controlled, phase 3 study was done in 17 institutions in China between September, 2007, and July, 2011. Untreated patients aged 14–59 years with acute myeloid leukaemia were randomly assigned (by a computer-generated allocation schedule without stratification) to receive one of three induction regimens in a 1:1:1 ratio: homoharringtonine 2 mg/m2 per day on days 1–7, cytarabine 100 mg/m2 per day on days 1–7, and aclarubicin 20 mg/day on days 1–7 (HAA); homoharringtonine 2 mg/m2 per day on days 1–7, cytarabine 100 mg/m2 per day on days 1–7, and daunorubicin 40 mg/m2 per day on days 1–3 (HAD); or daunorubicin 40–45 mg/m2 per day on days 1–3 and cytarabine 100 mg/m2 per day on days 1–7 (DA). Patients in complete remission were offered two cycles of intermediate-dose cytarabine (2 g/m2 every 12 h on days 1–3). The primary endpoints were the proportion of patients who achieved complete remission after two cycles of induction treatment and event-free survival in the intention-to-treat population. The trial is registered in the Chinese Clinical Trial Register, number ChiCTR-TRC-06000054. Findings We enrolled 620 patients, of whom 609 were included in the intention-to-treat analysis. 150 of 206 patients (73%) in the HAA group achieved complete remission versus 125 of 205 (61%) in the DA group (p=0·0108); 3-year event-free survival was 35·4% (95% CI 28·6–42·2) versus 23·1% (95% CI 17·4–29·3; p=0·0023). 133 of 198 patients (67%) in the HAD group had complete remission ( vs DA, p=0·20) and 3-year event-free survival was 32·7% (95% CI 26·1–39·5; vs DA, p=0·08). Adverse events were much the same in all groups, except that more patients in the HAA (12 of 206 5·8%) and HAD (13 of 198 6·6%) groups died within 30 days than in the DA group (two of 205 1%; p=0·0067 vs HAA; p=0·0030 vs HAD). Interpretation A regimen of homoharringtonine, cytarabine, and aclarubicin is a treatment option for young, newly diagnosed patients with acute myeloid leukaemia. Funding Chinese National High Tech Programme, Key Special Research Foundation of the Ministry of Science and Technology of China, National Nature Science Foundation of China, National Clinical Key Specialty Construction Project.
Background This meta-analysis aimed to provide a pooled analysis of clinical studies correlating postoperative radiotherapy (PORT) with survival in patients with completely resected thymoma. Methods ...According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. An electronic search was conducted using online databases. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used in this meta-analysis and were calculated from published survival data. A meta-analysis was conducted to assess the impact of PORT in completely resected thymoma on overall survival (OS), disease-free survival (DFS). and disease-specific survival (DSS). We also performed a subgroup analysis for OS of patients with stage II and stage III thymoma. Results Fourteen studies, which included 3,823 patients (2,096 patients who received PORT and 1,727 patients who did not receive PORT), met the selection criteria. From the available data, the thymoma patients with PORT who did not undergo resection did not have significantly improved OS (HR 0.99; 95% CI 0.87 to 1.13; p = 0.87), DFS (HR 1.21; 95% CI 0.97 to 1.51; p = 0.09), or DSS (HR 0.66; 95% CI 0.39 to 1.13; p = 0.13) compared with the patients who did not undergo PORT. However, our subgroup analysis showed a significant difference in OS in patients with stage II thymoma (HR 0.57; 95% CI 0.41 to 0.80; p = 0.001) and patients with stage III thymoma (HR 0.73; 95% CI 0.59 to 0.90; p = 0.004). Conclusion Our results showed that for completely resected thymoma, PORT had no advantage in the overall group of patients but increased OS in the patients with stage II and III thymoma after a complete resection. On the basis of this study, PORT is beneficial in patients with stage II and III patients after a complete resection.
Abstract As transcatheter aortic valve replacement (TAVR) has become an alternative treatment for patients at high risk for surgical aortic valve replacement (SAVR), bicuspid aortic valve (BAV) draw ...our attention again. The reported frequency of BAV was between 0.5% to 2% in western population. However, there was no such epidemiologic study in Chinese population. Our study sought to investigate the prevalence and complications of BAV in China by echocardiographic database. A total of 668 cases who were confirmed with bicuspid aortic valve, identified from 195,708 echocardiographic records of 157,039 patients in the echocardiographic database of West China Hospital (between June 2008 and June 2012), were analyzed retrospectively. The incidence of BAV was 0.43% in the cohort, and 579 (86.68%) patients were complicated by various degree of aortic valve stenosis or aortic valve regurgitation. The incidence of infective endocarditis and aortic dissection was 0.68% episodes per patient-years with mean age of 42.96 ± 11.25 years old and 0.18% episodes per patient-years with mean age of 43.00 ± 5.14 years old, respectively. In conclusion, our study demonstrated that the prevalence of bicuspid aortic valve and complications in Chinese were similar to that in the western population.
A 39-year-old woman was admitted to our hospital for a pure ground-glass opacity that had been detected in the right lung during a regular examination. A computed tomography scan showed a pure ...ground-glass opacity beneath the pleura of the right upper lobe of the lung that had enlarged over time. As a consequence, a lung adenocarcinoma was suspected. Meanwhile, three-dimensional computed tomography scans revealed a tracheal bronchus originating directly from the lateral wall of the trachea. The patient consequently underwent posterior segmental resection and mediastinal lymph node sampling by video-assisted thoracic surgery. During surgery, in addition to the tracheal bronchus, a variable central vein was found entering the left atrium dorsal to the right pulmonary artery trunk. We submit that, to the best of our knowledge, this is the first case of its kind ever reported.
Abstract Background It was previously reported that propofol, an intravenously administered hypnotic and anesthetic agent, protects organs from ischemia–reperfusion (I/R) injury. However, the ...underlying mechanisms are largely unknown. Glycogen synthase kinase 3β (GSK-3β) is known to play an important role in the oxidative stress–induced apoptosis. In this study, we investigated the role of GSK-3β and mitochondrial permeability transition pore (MPTP) in the protective effects of propofol against hepatic I/R injury. Materials and methods The left and median hepatic artery and the portal vein branches were blocked by no-damage artery clips to create the model of partial ischemia (70%), and liver lobes were subjected to warm ischemia for 30, 60, 90 min, respectively. Reperfusion of 120 min was then initiated by the removal of clamp. The MPTP opening was assessed by measuring mitochondrial large amplitude swelling and mitochondrial membrane potential. Results Pretreatment with propofol in conditions of hepatic I/R inhibits the apoptosis of hepatocytes as evidenced by decreased terminal deoxynucleotidyl transferase dUTP nick end labeling–positive cells. Importantly, propofol suppressed the mitochondrial GSK-3β by promoting or preserving its phosphorylation at Ser9, thus restraining the opening of MPTP and preventing the mitochondrial swell and mitochondrial membrane potential collapse. Conclusions Propofol protects liver from I/R injury by sustaining the mitochondrial function, which is possibly involved with the modulation of MPTP and GSK-3β.
Objective To evaluate the clinicopathologic features, prognostic factors, and management of patients in the North Chinese population with head and neck squamous cell carcinoma (HNSCC) who developed a ...second primary malignancy (SPM). Methods This was a retrospective study including 1818 eligible patients between June 1999 and April 2011. Results A total of 188 HNSCC patients developed SPM. Multiple oral dysplastic lesions (MODLs) ( P < .001) were among the risk factors for occurrence of SPM. However, MODLs were closely associated with many mild pathologic features, such as early T stage ( P < .001), early N stage ( P = .036), good pathologic differentiation ( P < .001), and mild growth pattern ( P < .001). Interestingly, multivariate survival analysis showed that SPM patients had a better prognosis if they had the characteristics of MODLs ( P = .020). Conclusions MODLs were a crucial risk factor leading to the occurrence of oral SPM after an index HNSCC in patients in Northern China. However, SPM patients with the characteristics of MODLs had a better prognosis.
PDF
