Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery （VATS） for the management of primary spontaneous pneumothorax ...Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery （VATS） for the management of primary spontaneous pneumothorax （PSP）. Methods： From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. Results： The average time of surgery was 49.0 rain （range, 33-65 rain）. No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients （93.75%） and moderate for two patients （6.25%）. No recurrences ofpneumothorax were observed at follow-up. Conclusions： The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.展开更多
Objective： The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery （VATS） radical treatment for patients with stage ⅢA lung cancer, with the primary endpoint...Objective： The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery （VATS） radical treatment for patients with stage ⅢA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. Methods： A total of 51 patients with radiologically or mediastinoscopically confirmed stage ⅢA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/ complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. Results： A total of 51 patients with non-small cell lung cancer （NSCLC） were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 （80.4%） had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 （98%） received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage （〉1,000 mL）, and the postoperative recovery was satisfactory. Up to 45 patients （88.2%） did not suffer from any perioperative complication, and 6 （11.8%） experienced one or more complications. Conclusions： VATS radical treatment is a safe and feasible treatment for stage ⅢA lung cancer.展开更多
Background： Video-assisted thoracic surgery （VATS） has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer （NSCLC）. However, popularization of this relativ...Background： Video-assisted thoracic surgery （VATS） has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer （NSCLC）. However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. Methods： Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. Results： Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients （69%）. The median 5-year overall survival for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. Conclusions： VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectableNSCLC展开更多
A first-order question in the studies of the Solar System is how its outer zone known as the Kuiper belt was created and evolved.Two end-member models, involving coagulation vs. streaming instability, make different p...A first-order question in the studies of the Solar System is how its outer zone known as the Kuiper belt was created and evolved.Two end-member models, involving coagulation vs. streaming instability, make different predictions-testable by the cratering history of Kuiper Belt Objects(KBOs)-about the cumulative size-frequency distribution(SFD) of the KBOs. Among all of the imaged KBOs, Pluto’s largest icy moon, Charon, appears to preserve the largest size range of seemingly undisturbed craters, their diameters(D) on Charon ranging from < 1 km to > 220 km. Current work shows that Charon’s craters with D < 10-20 km are fewer than those expected by the coagulation mechanism, but whether this is an artifact of post-cratering modification of smaller craters is unknown. We address this issue by conducting systematic photogeological mapping and performing detailed landform analysis using the highest resolution images obtained by the New Horizons spacecraft, which reveal a range of differentiable terrains on Charon. The most important findings of our work include(1) truncation and obliteration of large craters(diameters > 30-40 km) and their crater rim ridges along the eastern edges of several north-trending, eastward-convex, arcuate ranges in Oz Terra of the northern encountered hemisphere,(2) lobate ridges, lobate knob trains, and lobate aprons resembling glacial moraine landforms on Earth,(3) dendritic channel systems containing hanging valleys,and(4) locally striated surfaces defined by parallel ridges, knob trains, and grooves that are > 40-50 km in length. The above observations and the topographic dichotomy of Charon’s encountered hemisphere can be explained by a landscape-evolution model that involves(i)a giant impact that created the Vulcan Planitia basin and the extensional fault zone along its northern rim,(ii) a transient atmosphere capable of driving N2-ice glacial erosion of the water-ice bedrock and transporting water-ice debris to sedimentary basins,(iii) regional glacial erosion and transport of earlier emplaced impact ejecta deposits from the highlands of Oz Terra into the lowland basin of Vulcan Planitia,(iv) syn-glaciation north-trending thrusting, interpreted to have been induced by Charon’s despinning, and(v) the development of a water-ice debris cover layer over subsurface N2 ice below Vulcan Planitia during global deglaciation. The infilling of the Vulcan Planitia could have been accompanied by cryovolcanism. The extensive modification of impact craters means that the size-frequency distributions of Charon’s craters should serve only as a lower bound when used to test formation mechanisms proposed for Kuiper belt objects.展开更多
Langerhans cell histiocytosis(LCH)is an idiopathic group of reactive proliferative diseases linked to aberrant immunity,pathologically characterized by clonal proliferation of Langerhans cells.LCH rarely involves the ...Langerhans cell histiocytosis(LCH)is an idiopathic group of reactive proliferative diseases linked to aberrant immunity,pathologically characterized by clonal proliferation of Langerhans cells.LCH rarely involves the thymus.We report a case of thymic LCH with diabetes insipidus as the first presentation,without evidence of myasthenia gravis and without evidenced involvement of the skin,liver,spleen,bones,lungs and superficial lymph nodes.This present case may have important clinical implications.In screening for LCH lesions,attention should be attached to rarely involved sites in addition to commonly involved organs.Follow-up and imageological examination are very important to a final diagnosis.展开更多
文摘Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal video-assisted thoracoscopic surgery （VATS） for the management of primary spontaneous pneumothorax （PSP）. Methods： From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. Results： The average time of surgery was 49.0 rain （range, 33-65 rain）. No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients （93.75%） and moderate for two patients （6.25%）. No recurrences ofpneumothorax were observed at follow-up. Conclusions： The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.
文摘Objective： The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery （VATS） radical treatment for patients with stage ⅢA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. Methods： A total of 51 patients with radiologically or mediastinoscopically confirmed stage ⅢA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/ complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. Results： A total of 51 patients with non-small cell lung cancer （NSCLC） were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 （80.4%） had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 （98%） received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage （〉1,000 mL）, and the postoperative recovery was satisfactory. Up to 45 patients （88.2%） did not suffer from any perioperative complication, and 6 （11.8%） experienced one or more complications. Conclusions： VATS radical treatment is a safe and feasible treatment for stage ⅢA lung cancer.
文摘Background： Video-assisted thoracic surgery （VATS） has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer （NSCLC）. However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. Methods： Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. Results： Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients （69%）. The median 5-year overall survival for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. Conclusions： VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectableNSCLC
文摘A first-order question in the studies of the Solar System is how its outer zone known as the Kuiper belt was created and evolved.Two end-member models, involving coagulation vs. streaming instability, make different predictions-testable by the cratering history of Kuiper Belt Objects(KBOs)-about the cumulative size-frequency distribution(SFD) of the KBOs. Among all of the imaged KBOs, Pluto’s largest icy moon, Charon, appears to preserve the largest size range of seemingly undisturbed craters, their diameters(D) on Charon ranging from < 1 km to > 220 km. Current work shows that Charon’s craters with D < 10-20 km are fewer than those expected by the coagulation mechanism, but whether this is an artifact of post-cratering modification of smaller craters is unknown. We address this issue by conducting systematic photogeological mapping and performing detailed landform analysis using the highest resolution images obtained by the New Horizons spacecraft, which reveal a range of differentiable terrains on Charon. The most important findings of our work include(1) truncation and obliteration of large craters(diameters > 30-40 km) and their crater rim ridges along the eastern edges of several north-trending, eastward-convex, arcuate ranges in Oz Terra of the northern encountered hemisphere,(2) lobate ridges, lobate knob trains, and lobate aprons resembling glacial moraine landforms on Earth,(3) dendritic channel systems containing hanging valleys,and(4) locally striated surfaces defined by parallel ridges, knob trains, and grooves that are > 40-50 km in length. The above observations and the topographic dichotomy of Charon’s encountered hemisphere can be explained by a landscape-evolution model that involves(i)a giant impact that created the Vulcan Planitia basin and the extensional fault zone along its northern rim,(ii) a transient atmosphere capable of driving N2-ice glacial erosion of the water-ice bedrock and transporting water-ice debris to sedimentary basins,(iii) regional glacial erosion and transport of earlier emplaced impact ejecta deposits from the highlands of Oz Terra into the lowland basin of Vulcan Planitia,(iv) syn-glaciation north-trending thrusting, interpreted to have been induced by Charon’s despinning, and(v) the development of a water-ice debris cover layer over subsurface N2 ice below Vulcan Planitia during global deglaciation. The infilling of the Vulcan Planitia could have been accompanied by cryovolcanism. The extensive modification of impact craters means that the size-frequency distributions of Charon’s craters should serve only as a lower bound when used to test formation mechanisms proposed for Kuiper belt objects.
文摘Langerhans cell histiocytosis(LCH)is an idiopathic group of reactive proliferative diseases linked to aberrant immunity,pathologically characterized by clonal proliferation of Langerhans cells.LCH rarely involves the thymus.We report a case of thymic LCH with diabetes insipidus as the first presentation,without evidence of myasthenia gravis and without evidenced involvement of the skin,liver,spleen,bones,lungs and superficial lymph nodes.This present case may have important clinical implications.In screening for LCH lesions,attention should be attached to rarely involved sites in addition to commonly involved organs.Follow-up and imageological examination are very important to a final diagnosis.
