Great progress has been made in immunotherapy for esophageal squamous cell carcinoma in recent years. However, for thoracic surgeons, immunotherapy is still a new thing and they lack enough experience. Therefore, this paper attempts to discuss some hot issues of immunotherapy, including the indications, side effects, clinical efficacy and evaluation of efficacy. The author hopes that this article will help and attract the attention of thoracic surgeons.
Organ preservation after neoadjuvant therapy for esophageal cancer has gained significant attention. While the CROSS trial established neoadjuvant chemoradiotherapy (nCRT) followed by surgery as standard care, approximately 30% of patients achieve pathological complete response (pCR), prompting exploration of active surveillance (AS). The landmark SANO phase Ⅲ trial (2025) demonstrated non-inferior 2-year overall survival (74% AS vs. 71% surgery), with 31% of patients avoiding surgery. Multimodal assessment (endoscopic deep biopsy+EUS+PET-CT) reduced residual disease misdiagnosis to 10%. The Asian-led NEEDS trial is evaluating definitive chemoradiotherapy with salvage surgery. Although immunotherapy boosts pCR rates to 40%-55%, challenges persist, including 8%-12% false-negative cCR assessments, limited long-term data, and East-West histological disparities. The 2024 NCCN guidelines conditionally recommend AS (Category 2B, prioritized for squamous cell carcinoma), emphasizing centralized implementation. Future directions involve ctDNA and radiomics for risk stratification to advance precision organ-preserving strategies.
Patients with thoracic malignancy have a high incidence of perioperative venous thromboembolism (VTE), but its onset is insidious, often asymptomatic or atypical, and is easily overlooked. Early identification and standardized prevention of VTE can effectively reduce the risk of VTE. "Guideline for the prevention and management of perioperative venous thromboembolism in thoracic malignancies in China (2022 version)" has been officially released recently. This article closely follows the context, significance, core implications, and the impact of future VTE prevention in thoracic surgery. It is hoped that through our joint efforts, we can reduce the incidence of perioperative VTE and mortality of thoracic surgery, and strive to improve the long-term survival of patients with lung cancer and esophageal cancer.
Objective To study the role of ultracision harmonic scalpel and skin flap in axillary fossa external fixation in operation of breast cancer. Methods One hundred and sixty-six patients with breast cancer were included in this study between May 2009 and November 2009. Combined group (n=51) applied ultracision harmonic scalpel combined with skin flap external fixation. External fixation group （n=52） used the skill of skin flap external fixation. Routine group included 63 patients. Operative time, accidental injury during operation， volume of bleed and drainage, time of drainage, detection amount of lymph node, and complications such like subcutaneous fluidity were observed and recorded. Results The operative time and detection amount of lymph node were not different among three groups （Pgt;0.05）. The volume of bleed in combined group was less than that in other groups （Plt;0.05）. The volume of drainage and the time of drainage were decreased or shorten by turns from routine group, external fixation group to combined group （Plt;0.05）. The incidence rate of subcutaneous fluidity in combined group was lower than that in routine group （Plt;0.05）. Conclusions Using ultracision harmonic scalpel in operation of breast cancer can remarkably reduce the volume of bleed and drain postoperatively. Ultracision harmonic scalpel combined with skin flap external fixation is safety and can reduce the incidence rate of subcutaneous fluidity, thus can be applied widely in breast cancer operation.
Objective To explore the shortterm clinical effects of complex transplantation among the acellular dermal matrix(ADM) of heterogenic or heterocatal and autogenic split on the burnt wound as to find out a permanent substitution for the treatment on full skin thickness defect without scar. Methods Two kinds of ADM were used on the 18 patients with full thicknessburn wound through complex transplantation with autogenic splits. The patients with medialthickness autograft was used as control group. Survival rate was obtained 2 weeks after operation; contraction rate and the scores of Vancouver burn scale were obtained 8 weeks after operation. Results No significant difference was observed in survival rate among the three groups 2 weeks after operation(P＞0.05); no significant difference was observed in contraction rate of autografts and scores of Vancouver burn scale among the three groups 8 weeks after operation(P＞0.05). Conclusion ADM of heterogenic and ADM of heterocatal have similar effect on the reconstruction of skin, so the piglet ADM made in this way could be used as a substitution.
目的 建立犬開放性氣胸海水浸泡的實驗模型 ,探討實驗動物早期死亡原因。 方法 2 0條健康成年雜種犬隨機分為兩組。對照組 :實驗動物受傷后直接觀察 ;實驗組 :動物受傷后置入人工配制的海水中。監測血流動力學、呼吸、血液滲透壓、血液電解質、動脈血氣變化以及肺部病理改變。 結果 實驗組死亡率明顯高于對照組 ,平均生存時間為 45分鐘。實驗組經海水浸泡后有急性呼吸和循環功能衰竭、嚴重電解質平衡紊亂、高滲血癥、重度肺損傷以及嚴重代謝性和呼吸性酸中毒。 結論 開放性氣胸后海水浸泡可引起一系列嚴重的病理生理變化 ,其結果是導致實驗動物早期死亡的重要原因。
ObjectiveTo investigate the predictive value of preoperative plasma fibrinogen and serum albumin score (FA score) for postoperative survival of hepatocellular carcinoma (HCC) after hepatectomy.MethodWe retrospectively analyzed the clinicopathological data and follow-up information of 275 patients with HCC who underwent hepatectomy in West China Hospital of Sichuan University from March 2009 to December 2013.ResultsThere’s no statistically significant difference in gender, ALT, total bilirubin, hepatitis B virus surface antigens, AFP, cirrhosis, macrovascular invasion, tumor differentiation, TNM stage, and postoperative adjuvant transarterial chemoembolization of HCC patients between FA score of 0 group and FA score of 1 and 2 group (P>0.05). There’s statistically significant difference in age, AST, tumor size, tumor number, microvascular invasion, and BCLC stage (P<0.05). Multivariate Cox proportional hazard regression analyses revealed that FA score (1 and 2) was an independent risk factor for HCC patients’ overall survival rate [HR=1.632, 95%CI was (1.141, 2.335), P=0.007] and early recurrence-free survival rate [HR=1.678, 95%CI was (1.083, 2.598), P=0.021], the overall survival rate and early recurrence free survival rate of HCC patients with FA score of 0 group were better than those of patients with FA score of 1 and2 group.ConclusionsThe preoperative FA score has a good prognostic value for survival of HCC patients who underwent hepatectomy. Preoperative FA score of 1 and 2 is an independent risk factor for overall survival rate and early recurrence free survival rate of HCC patients after hepatectomy.
Objective To investigate the changes in osteoprotegerin (OPG) / receptor activator of nuclear factor-κB ligand (RANKL) ratio in sepsis-associated acute lung injury (SA-ALI) and the role of regulation of this ratio on the inflammatory response in SA-ALI. Methods Eighteen C57BL/6 male mice were randomly divided into sham operation group, cecal ligation and perforation (CLP) group and RANKL group, with 6 mice in each group. Before the experiment, the RANKL group was intraperitoneally injected with 5 μg (0.2 mL) of recombinant RANKL antibody, whereas both the sham operation group and the CLP group were intraperitoneally injected with a volume-matched normal saline. One hour later, the sham operation group underwent only abdominal exploration and repositioning, while the other groups underwent the CLP surgery to induce the SA-ALI model. After 24 h of modelling, all mice were sacrificed and samples were collected. Pathological evaluation of lung tissues was performed by haematoxylin-eosin staining; enzyme-linked immunosorbent assay was used to detect serum concentrations of interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β; while the mRNA and protein expression of OPG and RANKL, along with their ratio values, were detected by real-time polymerase chain reaction for quantitative analysis and protein immunoblotting. Results The SA-ALI mouse model was successfully established. Compared with the sham operation group, mice in the CLP group showed disturbed alveolar structure, obvious alveolar and interstitial haemorrhage and inflammatory cell infiltration, elevated serum levels of IL-6, TNF-α and IL-1β (P<0.05), significantly increased mRNA and protein expression of OPG and elevated OPG/RANKL ratio in lung tissue (P<0.05), whereas RANKL mRNA and protein expression was significantly decreased (P<0.05). Compared with the CLP group, the pathological damage of lung tissue in the RANKL group was reduced, the infiltration of alveolar and interstitial inflammatory cells was significantly improved, and the alveolar structure and morphology were more regular, with lower serum levels of IL-6, TNF-α and IL-1β (P<0.05), significantly lower mRNA and protein expression of OPG and OPG/RANKL ratio in lung tissue (P<0.05), and significantly higher mRNA and protein expression of RANKL in lung tissue (P<0.05). Conclusion The alteration of OPG/RANKL ratio may be related to the pathophysiological process of SA-ALI, and the decrease in its level may reflect the attenuation of the inflammatory response in SA-ALI.
目的 評價國內干擾素（INF）治療多發性骨髓瘤（MM）的療效與安全性。 方法 計算機檢索中國期刊全文數據庫（1989年－2011年）、中國生物醫學文獻數據庫（1989年-2011年）和中文科技期刊全文數據庫（1989年－2011年），并手工檢索所有納入文獻的參考文獻，納入INF治療MM的隨機對照試驗（RCT）。評價納入研究的方法學質量并進行資料提取后，采用RevMan 5.0軟件進行Meta分析。 結果 共納入10個RCT，包括366例患者。Meta分析顯示，INF聯合美法侖+潑尼松（MP） 方案與單用MP方案比較，其總有效率差異有統計學意義[OR=4.52，95% CI（1.84，11.10），P=0.001]；INF聯合長春新堿+多柔比星+地塞米松/潑尼松[VAD（P）]與單用VAD（P）方案比較，其總有效率[OR=4.13，95% CI（1.53，11.14），P=0.005]和完全緩解率[OR=3.88，95% CI （1.49，10.16），P=0.006]差異也均有統計學意義；INF+其他化療方案與單用化療方案比較，其總有效率[OR=2.57，95%CI（1.11，5.96），P=0.03]和完全緩解率[OR=3.17，95% CI（1.21，8.27），P=0.02]，差異均有統計學意義。 結論 目前國內研究結果表明，INF與化療聯合運用能增加MM治療的總有效率和緩解率，但由于納入研究樣本量小且質量較低，上述結論尚需要高質量、大樣本的隨機與雙盲對照試驗加以分析。
Objective To evaluate the efficacy of asarone injection in treating respiratory disease. Methods All the randomized controlled trials (RCTs) about treating respiratory disease with asarone injection were collected by searching MEDLINE (1990 to 2010), EMbase (1990 to 2010), CSJD (1989 to January 2010) and CNKI (1979 to December 2009). The assessment of methodological quality and data extraction of the included studies were performed independently by two reviewers, and Meta-analysis was conducted with RevMan 5.0 software. Results A total of 29 studies involving 3 931 patients met the inclusion criteria. The results of Meta-analysis showed that: a) Asarone injection was effective in treating respiratory diseases including bronchiolitis, chronic obstructive pulmonary diseases (COPD) and AECOPD, bronchitis and pneumonia; b) In treating bronchiolitis, asarone injection was superior to aminophylline, heartleaf houttuynia herb and virazole in total effective rate, and was similar to andrographolide in curative effect; c) In treating COPD and AECOPD, asarone injection was superior to symptomatic treatment and bromhexine in total effective rate, was similar to benzylpenicillin sodium and tablete glycyrrhiza in curative effect, and was inferior to aminophylline in total effective rate without significant difference; d) In treating bronchitis, asarone injection was superior to aminophylline and symptomatic treatment in total effective rate, and was similar to mucosolvin in curative effect; and e) In treating pneumonia, asarone injection was superior to antibiotic, ribavirin and aminophylline in total effective rate. Conclusion Asarone injection is effective in treating respiratory disease. Because of the lower methodological quality and publication bias of the included trials, it is necessary to perform more high-quality and large-scale randomized controlled trials to make the conclusion more reliable.