1 病例资料 1. 1 病例1 患者32岁,孕1产0.因孕34周,突然胸痛、憋喘1h于2011年12月20日来诊.既往有自发性气胸的类似发病史.1h前用力排便时突然出现右侧胸痛、憋喘.入院检查:T 36. 3℃,P 91 次/min,R 22 次/min,BP 106/60mmHg (1mmHg=0. 133kPa).口唇轻度紫绀,气管轻度右移,左胸呼吸动度减弱,叩呈鼓音,呼吸音消失,右肺及心脏无异常.腹部膨隆,宫底高度30cm,胎位为左枕前位,胎心144/min,无产兆.心电图示:正常心电图;未行X线胸片示检查.诊断为:妊娠并发自发性气胸.来院后立即于胸腔闭式引流(10F),患者呼吸困难明显减轻.同月25日上午患者自觉引流管处疼痛难忍且呼吸困难,请产科医生会诊.会诊认为患者胸腔引流管置管处疼痛明显,妊娠已足35周,为防止出现胎儿缺氧意外,建议行剖宫产术.遂于12月25日下午剖宫产,产1健康男婴(阿氏评分10分) ,同期行胸腔镜肺大疱破裂修补手术.治疗后胸部 CT检查,右肺已完全复张,痊愈出院.

目的 探讨青蒿素对大鼠自体移植静脉桥内膜增生的影响.方法 将雄性Sprague-Dawley(SD)大鼠32只建立自体静脉移植模型,随机分为两组:实验组(16只)和对照组(16只).实验组于造模前1 d给予青蒿素100 mg/(kg·d)灌胃直至取材,对照组相同时间给予等体积生理盐水灌胃.两组动物分别于造模后2周和4周取材备检,每个时间点8只.应用图像分析仪计算新生内膜厚度,免疫组织化学方法检测平滑肌22α(SM22α)的表达变化及Western bolt检测SM22α蛋白表达变化情况.结果 实验组术后2周、4周静脉桥新生内膜厚度与同期对照组比较明显减少[(20.79±1.88)μm vs.(35.23±2.66)μm,P<0.01;(37.06±2.22)μm vs.(46.23±2.54)μm,P<0.01].SM22α在静脉桥平滑肌细胞有表达,实验组SM22α蛋白表达阳性率在术后2、4周较同期明显抑制下降[(59.20±5.76)vs.(26.12±3.72),P<0.01;(35.63±4.36)vs.(10.38±2.98),P<0.01].实验组SM22α蛋白含量(SM22α/β-Actin)在术后2、4周较同期明显抑制下调[(0.58±0.1)vs.(0.39±0.06),P<0.01;(0.42±0.06)vs.(0.21±0.05),P<0.01].结论 青蒿素可明显抑制静脉桥内膜增生,原因可能与其抑制血管SM22α的表达下调,从而抑制平滑肌细胞增殖有关.

目的 探讨单侧自发性气胸合并双侧肺大疱的理想处理方式.方法 总结16例单侧自发性气胸患者接受胸腔镜手术处理两侧肺大疱的经验.结果 患者于术后3～7d均顺利出院,手术时间为(119.44±6.77)min,术中出血量为(58.85±9.63)mL,术后胸腔引流量为(163.82±97.65) mL,引流时间为(1.96 ±0.48)d,住院时间为(6.06±1.78)d,住院费用为(3.83±1.50)万元.术后出现进行性出血1例.随访1～ 84个月,出现气胸复发1例.结论 在胸腔镜下同期处理两侧肺大疱可以降低患者对侧气胸的发生率,从而避免患者再次手术的痛苦,减少住院费用.

目的 探讨按摩水泉穴对缓解心力衰竭患者口渴感的效果.方法 选取2016年1月—2018年6月在本院胸心血管外科进行治疗的60例心力衰竭患者作为研究对象,将其随机分为对照组与观察组,每组各30例.对照组采用棉签蘸水湿润患者口唇,观察组在对照组的基础上采用按摩水泉穴的方法.比较两组的口渴感缓解效果.结果 观察组的口渴感缓解总有效率高于对照组(P<0.05).结论 按摩水泉穴不仅可以有效改善心力衰竭患者口渴感的不适症状,还能大大减轻护理工作量,值得临床推广.

AIM The study aimed to unveil the effect of TK1 expression on the clinicopathological significance and prognosis in patients with lung cancer. Results & methodology: Studies for meta-analysis were selected according to a thorough literature search in databases (PubMed, EMBASE and Chinese databases). Ten studies containing 1393 lung cancer patients were investigated in our analysis. The TK1 overexpression was associated with poorer overall survival(OS) in lung cancer patients (hazard ratio = 1.881; 95% CI:1.318-2.684, Z = 3.48; p = 0.001). Furthermore, The TK1 expression is associated with the clinicopathological features of lung cancer patients (tumor type, age, lymph node metastasis, distant metastasis and tumor, node, metastasis [TNM] stages).  Discussion & conclusion: The TK1 expression might have a supportive implication in assessing biological behavior and prognosis of lung cancer patients.

Background: The impact of miR-10b expression on the survival outcome of patients with cancers is still controversial. Method and materials: A systematic review and meta-analysis was performed to determine its implication on the survival of cancer patients. We carried out an electrical literature search to identify the eligible studies published in PubMed, Web of Science and Embase together with the Chinese databases. Result In total, 28 studies of 23 articles enrolling 3134 patients were included for this meta-analysis, of which 25 studies reported overall survival (OS), 4 studies evaluated recurrence-free survival (RFS) and 3 studies were related to disease-free survival (DFS). As a result, this meta-analysis revealed that up-regulation of miR-10b could confer an unfavorable factor for OS (HR = 1.853, 95% CIs: 1.521-2.258, P < 0.01) but not DFS (HR = 1.309, 95% CIs: 0.699-2.453, P = 0.4) or RFS (HR = 2.692, 95% CIs: 0.877-8.265, P = 0.084). Additionally, further analysis also suggested that overexpression of miR-10b predicted the shorter OS for the patient with different types of cancers, which contained lung cancer, breast cancer, glioma, colorectal cancer and gastric carcinoma. Subgroup analyses were also conducted according the region, sample size, system and miR-10b detection assay and statistical method. Conclusion: This study shows that augmented expression of miR-10b strongly predicts poor prognosis for patients with cancers.

Background: Diabetes is a risk factor for vein graft failure after bypass surgery with coronary artery disease (CAD). We first developed a vein grafting model in rats with a type 2 diabetes mellitus-like (T2DM) condition to provide animal models for relevant clinical research. Methods: Sixty male Sprague-Dawley rats were fed high-fat (T2DM group) or normal food (CON group) for one month and then injected (T2DM group) with streptozotocin (35 mg/kg) to induce T2DM. Insulin or glucose tolerance tests were performed to verify the T2DM models. All rats subsequently underwent surgical vein grafting, and the morphology of their grafts at 0, 14, and 28 days was analyzed under microscope. Results: The T2DM group exhibited significantly increased glucose, insulin, free fatty acids, and cholesterol levels (all, P < 0.05), and also exhibited significant hyperglycemic and hyperinsulinemic responses to an intraperitoneal glucose tolerance test compared to that in the CON group. Furthermore, the insulin sensitivity of the T2DM group was significantly reduced as the CON group gained little change according to an insulin tolerance test (P < 0.05). Additionally, the number of cell nuclei of the intima and media on the 14th and 28th day in the T2DM group approximately doubled as compared to that in the CON group (both, P < 0.05). Conclusion: We successfully developed a model of surgical vein grafting in type 2 diabetic rats. This novel rat model may facilitate in vivo mechanistic studies of the increased neointimal formation in type 2 diabetes mellitus-related vein graft failure.

Objective Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Here, we introduced a method of video-assisted thoracic surgery with no disposable consumables. Methods Between Oct. 2011 and Feb. 2016, a series of 84 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad. Results Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage ( P > 0. 05 ), postoperative stay, and recurrence between the two groups [( 16 747. 30 ±2 586.41) yuan vs (21 088.54±6 005.68)yuan,P<0.05] . Conclusions Biportal thoracoscopic bleb ligation for primary spontaneous pneumothorax is a safe, low-cost, simple and reliable procedure.

Objective To study the effect of Pioglitazone(PIO) on intimal hyperplasia after vein graft and its potential mechanism.Methods 32 male Sprague-Dawley rats were randomly divieded into two groups,one admisnistrated with PIO(3 mg· kg-1 · d-1) and the other with saline.A week later,the right common carotid arteries were reconstructed using homolateral external jugular veins in rats.The drugs treatment was continued after surgery for 2 or 4 weeks until grafted veins were harvested.The neointima thickness was measured by Computer image analysis software.To observe the activation of ERK1/2 pathway,the western blot were performed.In vitro,human great saphenous vein smooth muscle cells were co-cultured with PIO,and cells proliferation was detected by the CCK-8 assay.The TUNEL staining was performed to determine apoptosis.Results PIO treatment significantly attenuated intimal thickening compared with the the control group both at second [(8.56 ± 1.64) μm vs (25.44 ± 0.89) μm,P ＜ 0.01] and fourth week [(10.51 ± 1.47) μm vs (35.69 ± 1.07) μm,P ＜ 0.01)] after veins graft.Also PIO inhibited the ERK1/2 activation in grafted veins.In vitro,PIO significantly reduced PDGF-induced cells proliferation and increased cells apoptosis.Conclusion PIO effectively improved intimal hyperplasia in grafted veins perhaps associated with its ability to suppress vascular smooth muscle cells proliferation and enhance cell apoptosis,and might be related to the down regulation of ERK1/2 activity.

Objective To explore the expression change of girders of actin filaments( Girdin) in autologous vein graft of rat and its relationship with intimal hyperplasia.Methods A total of 28 male Sprague-Dawley(SD) rats were randomly divided into four groups,and the external jugular vein-to-common carotid artery transplant model was established.The vein graft samples were harvested 3,7,14 and 28 days after operation,respectively,and contralateral veins were collected as control.Intima was observed under the optical microscope and neointima thickness was calculated using the computer image analysis system.The expression changes of Girdin and proliferating cell nuclear antigen( PCNA) in the vessel wall of grafted veins and contralateral veins were detected by both immunohistochemistry and Western Blot.Results In the grafted veins,intima was significantly thicker on the 7th day after operation (P<0.01),and this change was more significant on the 14th day,then culminated on the 28th day.The result of immunohistochemistry showed that both Girdin and PCNA expressions increased obviously on the third day after operation (P<0.01),peaked on the 14th(Girdin) or 7th(PCNA) day,and then decreased gradually after that.A positive correlation existed between Girdin and PCNA expressions postoperatively(r=0.938,P<0.01).A little expression of Girdin and little expression of PCNA were found in the contralateral veins.Conclusion Girdin expression increases after vein grafting,and is closely related to the proliferation of media smooth muscle cells in grafted veins,which might play an important role in the process of intimal hyperplasia after vein grafting.

Diabetes mellitus (DM) is an important risk factor for increased vein graft failure after bypass surgery. The neuregulin-1 (NRG-1)/ErbB signaling system plays a critical role in neointimal formation after vascular injury as well as the proliferation and migration of mitogen-induced vascular smooth muscle cells; however, changes in NRG-1/ErbB signaling leading to vein grafts attrition in DM remain largely unexplored. Therefore, the aim of this study was to investigate changes in NRG-1/ErbB signaling in vein grafts in diabetic rats. To do this, a rat model of DM was established by streptozotocin injection followed by engraftment of autologous jugular veins to carotid arteries to induce intimal hyperplasia. After vein graft harvest, a pathohistological examination was performed; changes in NRG-1 and ErbB expression were also assessed. NRG-1 and ErbB expression localized to endothelial cells and vascular smooth muscle cells, which is consistent with the arterialization of vein grafts. NRG-1, ErbB2, and ErbB4 expression significantly decreased in vein grafts over time. Our findings show that NRG-1/ErbB signaling is impaired in vein grafts of diabetic rats, suggesting an important role for this pathway in the pathogenesis of intimal hyperplastic lesions in vein grafts of patients with DM.

目的:探讨SSR128129E(SSR)对大鼠自体移植静脉桥内膜增生的影响.方法:将28只雄性SD大鼠建立自体静脉移植模型并随机分为实验组和对照组,实验组给予SSR 50 mg/(kg·d)胃灌注,而对照组给予生理盐水胃灌注,于术后2、4周取材备检.应用图像分析仪计算新生内膜厚度,免疫组化检测FGFR2的表达部位及western bolt检测FGFR2蛋白表达变化情况.结果:术后2、4周,相比于对照组静脉桥,实验组新生内膜厚度明显减少[(17.59±4.33) μm vs.(30.47±6.99) μm,P＜0.05;(27.92±7.55) μm vs (53.95±8.90) μm,P＜0.01].FGFR2蛋白在内皮及平滑肌细胞中均有表达,且明显下降.结论:SSR可明显抑制静脉桥内膜增生,原因可能与其降低FGFR2的表达,进而抑制平滑肌细胞增殖有关.

Background Muscle-sparing thoracotomy (MST) has recently been developed in an attempt to minimize tissue injuries during thoracic operation and postoperative sequelae. However, its potential advantages over traditional posterolateral thoracotomy (PLT) remain to be determined. Here, we performed a meta-analysis on all available studies that compare the pros and cons between the two approaches. Methods A total of 11 relevant studies were found to satisfy our inclusive criteria from three electronic databases. End points included postoperative pain, pulmonary function, postoperative mortality, and perioperative complications. Results Data from seven randomized controlled trials and four observational studies were included (n = 408 and 564, respectively). Compared with PLT group, MST group had a significantly reduced postoperative visual analog scale score on day 1 (weighted mean difference [WMD], -0.79; 95% confidence interval [CI], -1.10 to -0.48), week 1 (WMD, -0.60; 95% CI, -0.98 to -0.22), and month 1 (WMD, -0.73; 95% CI, -1.30 to -0.16). However, no difference between the two approaches was found on postoperative forced vital capacity and forced expiratory volume in 1 second (week 1: standardized mean difference [SMD], 0.44; 95% CI, -0.18 to 1.07 versus SMD, 0.53; 95% CI, -0.13 to 1.18; month 1: SMD 0.26; 95% CI, -0.26 to 0.78 versus SMD, 0.38; 95% CI, -0.25 to 1.00), mortality (odds ratio [OR], 1.23; 95% CI, 0.49 to 3.09), and complications (OR, 0.86; 95% CI, 0.60 to 1.23). Conclusions MST may improve postoperative pain, but shows less effect on other perioperative parameters.

Objective To study the effect of HTK solution and perfadex solution on the function of pulmonary artery endothelium. Methods Fifty-four porcine pulmonary rings (2 mm long) were randomly divided into three groups, including control group (n =18) incubated in Krebs-Henseleit (KH) at 4 ℃ for 4 hours, group A (n =18) incubated in HTK solution and group B (n =18) incubated in perfadex solution at 4 ℃ for 4 hours. The vasoconstriction responses induced by indomethacin (7 μmol/L), N-nitro-L-arginine(300 μmol/L), oxyhemoglobin (20 μmol/L) and prostaglandin F2α (1×10 -7.5 mol/L) were detected. The vasodilator responses induced by bradykinin and non-receptor-mediated calcium ionophore were also detected in three groups. Results The maximum contraction of the vascular ring was caused by prostaglandin F2α. The maximum relaxtion responses of the vascular ring were caused by bradykinin and non-receptor-mediated calcium ionophore. There were no significant differences between three groups (P > 0.05). Conclusion There was no significant difference in endothelium-derived hyperpolarizing factor (EDHF)-mediated relaxation of porcine pulmonary artery between HTK,perfadex and KH solutions.

Abstract Background Muscle-sparing thoracotomy (MST) has recently been developed in an attempt to minimize tissue injuries during thoracic operation and postoperative sequelae. However, its potential advantages over traditional posterolateral thoracotomy (PLT) remain to be determined. Here, we performed a meta-analysis on all available studies that compare the pros and cons between the two approaches. Methods A total of 11 relevant studies were found to satisfy our inclusive criteria from three electronic databases. End points included postoperative pain, pulmonary function, postoperative mortality, and perioperative complications. Results Data from seven randomized controlled trials and four observational studies were included (n = 408 and 564, respectively). Compared with PLT group, MST group had a significantly reduced postoperative visual analog scale score on day 1 (weighted mean difference [WMD], −0.79; 95% confidence interval [CI], −1.10 to −0.48), week 1 (WMD, −0.60; 95% CI, −0.98 to −0.22), and month 1 (WMD, −0.73; 95% CI, −1.30 to −0.16). However, no difference between the two approaches was found on postoperative forced vital capacity and forced expiratory volume in 1 second (week 1: standardized mean difference [SMD], 0.44; 95% CI, −0.18 to 1.07 versus SMD, 0.53; 95% CI, −0.13 to 1.18; month 1: SMD 0.26; 95% CI, −0.26 to 0.78 versus SMD, 0.38; 95% CI, −0.25 to 1.00), mortality (odds ratio [OR], 1.23; 95% CI, 0.49 to 3.09), and complications (OR, 0.86; 95% CI, 0.60 to 1.23). Conclusions MST may improve postoperative pain, but shows less effect on other perioperative parameters.

Objective To study the effect of Perfadex and Wisconsin Unviersity solution on the function of pulmonary artery endothelium.Methods Small lobe pulmonary arteries were dissected from nine porcine lungs.The artery from each lung was cut into six rings in 2mm.Two of them were randomly incubated in Krebs,Perfadex or Wisconsin Unviersity solution (UW solution) at 4℃ for 4 hours.Endothelium-derived hyperpolarizing factor (EDHF)-mediated relaxation (percentage of-7.5 logM U46619 precontraction) induced by bradykinin or calcium ionophone A23187 in the present of indomethacin,L-NNA and oxyhemoglobin were measured at 37 ℃ in the organ chambers.Results Vasoconstriction induced by U46619 is no significant difference among three groups (P＞ 0.05).Compared with Krebs group,the relaxation induced by bradykinin or A23187 was significantly decreased in Perfadex group (P＜0.01),while there is no significant difference in UW group (P＞0.05).Conclusion Endothelium-derived hyperpolarizing factor (EDHF) plays an important role in endothelium-mediated relaxation of porcine pulmonary artery.EDHF-mediated relaxation is impaired when the lung preserved with Wisconsin Unviersity solution,wheras its function is not affected by Perfadex solution.