Search

Background The perioperative outcomes of the use of stapling devices versus electrocautery to dissect intersegmental planes in patients undergoing segmentectomy for small pulmonary lesions is still unclear. The aim of this randomized controlled trial was to compare the perioperative outcomes of these two methods. Methods A single-center, prospective, participant-blinded, randomized controlled trial (NCT03192904) was conducted with a preplanned sample size of 136. The primary outcome was the incidence of postoperative complications. Secondary outcomes included duration of operation, blood loss during operation, first-day drainage volume, duration of drainage, postoperative hospital stay, loss of lung function, and medical costs. Results The trial was stopped early as a result of a marked difference in the primary outcome between groups at a scheduled interim check of the data after recruiting 70 patients. The incidence of postoperative complications (eg, air leakage) was higher in the electrocautery group than in the stapler device group (11/32, 34.4% vs 2/33, 6.1%, P = .004). There were no differences in duration of operation, blood loss during operation, first-day drainage volume, duration of drainage, postoperative hospital stays, loss of lung function, or total medical cost, although the per-patient cost of medical materials was higher in the stapler device group (US$4214.6 ± 1185.4 vs $3260.1 ± 852.6, P Conclusions Among patients undergoing segmentectomy, the use of stapler devices to divide intersegmental planes decreased postoperative complications without further compromising lung function or increasing economic burden.

In recent years, with the popularity of computed tomography (CT) scanning, early lung cancer has been found in a large number of patients, and segmentectomy has been widely used in clinical practice. The development of intersegmental plane is the most critical step in segmentectomy. At present, there are many methods to identify the intersegmental plane. Also, dissection of the intersegmental plane has been a challenge for thoracic surgeons for decades because of the complicated anatomic variations. This study focuses on the safety and efficacy of relevant methods in both identification and dissection of the intersegmental plane in segmentectomy.

BACKGROUND: Radiological manifestations of coronavirus disease 2019 (COVID-19) featured ground-glass opacities (GGOs), especially in the early stage, which might create confusion in differential diagnosis with early lung cancer. We aimed to specify the radiological characteristics of COVID-19 and early lung cancer and to unveil the discrepancy between them. METHODS: One hundred and fifty-seven COVID-19 patients and 374 early lung cancer patients from four hospitals in China were retrospectively enrolled. Epidemiological, clinical, radiological, and pathological characteristics were compared between the two groups using propensity score-matched (PSM) analysis. RESULTS: COVID-19 patients had more distinct symptoms, tended to be younger (P

BackgroundFew of the previous studies of clinical high risk of psychosis (CHR) have explored whether outcomes other than conversion, such as poor functioning or treatment responses, are better predicted when using risk calculators. To answer this question, we compared the predictive accuracy between the outcome of conversion and poor functioning by using the NAPLS-2 risk calculator.MethodsThree hundred CHR individuals were identified using the Chinese version of the Structured Interview for Prodromal Symptoms. Of these, 228 (76.0%) completed neurocognitive assessments at baseline and 199 (66.3%) had at least a 1-year follow-up assessment. The latter group was used in the NAPLS-2 risk calculator.ResultsWe divided the sample into two broad categories based on different outcome definitions, conversion (n = 46) v. non-conversion (n = 153) or recovery (n = 138) v. poor functioning (n = 61). Interestingly, the NAPLS-2 risk calculator showed moderate discrimination of subsequent conversion to psychosis in this sample with an area under the receiver operating characteristic curve (AUC) of 0.631 (p = 0.007). However, for discriminating poor functioning, the AUC of the model increased to 0.754 (p < 0.001).ConclusionsOur results suggest that the current risk calculator was a better fit for predicting a poor functional outcome and treatment response than it was in the prediction of conversion to psychosis.

Minimally invasive techniques are increasingly being used in pulmonary segmentectomy and combined subsegmentectomy. However, there are no reports as yet on robotic combined anatomic subsegmentectomy (CAS). In this report, we describe related clinical data and operative techniques and present our early results.Clinical data of patients undergoing robotic CAS were retrospectively reviewed. A combined subsegmentectomy was defined as the resection of 2 or more subsegments that involved 2 or more adjacent segments. The study enrolled patients who underwent completely portal robotic CAS.Between May 2015 and January 2018, a single surgeon performed completely portal robotic CAS for 16 patients. In the CAS-treated patients, 75% of the lesions were located in the right upper lobe, and none required conversion to thoracotomy. Median operative time was 175 minutes (range, 75 to 294 minutes), and mean postoperative hospital stay was 4 days (range, 2 to 11 days). Although 1 patient experienced a prolonged air leak, the other 15 recovered uneventfully. Within a median follow-up period of 15 months, there were no deaths or tumor recurrences.Completely portal robotic CAS is a safe and effective procedure in a select subset of patients, proving quite suitable for smaller (2 cm) multisegment lung cancers, particularly lesions of the right upper lobe. A robotics approach facilitates complex and challenging CAS, the disadvantage being lengthy operative times during early acquisition of skills.

Evidence shows that BDNF may regulate activity-dependent forms of synaptic plasticity underlying learning and memory. Previous studies reported low BDNF levels and cognitive impairment in the early stage of schizophrenia. Our current study aimed to explore the association between serum BDNF and cognitive functions in first-episode drug-naïve (FEDN) patients with schizophrenia, which has been under-investigated. We recruited 80 FEDN patients and 80 healthy controls and examined the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and serum BDNF in both groups. Patient psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). BDNF levels were significantly lower in patients compared to controls (p 0.001). The RBANS total score and nearly all indexes (all p 0.001) except for visuospatial/constructional index (p 0.05) were significantly lower in patients than controls. No significant correlation was found between BDNF and any index or total scores of RBANS in either patients or healthy controls (all p 0.05). However, the PANSS negative subscale score were negatively associated with both the immediate memory and language indexes (both p 0.005). Our findings suggest that excessive cognitive impairments are present in the early stage of schizophrenia. Low BDNF may contribute to the pathogenesis of schizophrenia, but maybe not to its cognitive impairments.

Agricultural soil pollution is a serious problem that can endanger ecology, food safety, and human health. The study evaluated the accumulation and distribution of major and trace elements in the agricultural soil of the Gannan area in the northwest Songnen-Plain, a very important base of grain production in northeastern China. To identify the concentrations and sources of pollutants and also to assess the soil environmental quality, a total of 2400 topsoil (0–20 cm) samples and 10 subsoil (180–200 cm) samples were collected. Then 6 major elements (CaO, Fe2O3, K2O, MgO, Na2O, SiO2), 18 trace elements (As, B, Cd, Co, Cr, Cu, F, Hg, I, Mo, Mn, N, Ni, P, Pb, Se, S, and Zn), pH, and Corg (organic carbon) were analyzed. The accumulation of Cd, Cu, Pb, Zn, Hg, and F was apparent in the agricultural soils. Correlation coefficient analysis showed that most major and trace elements, as well as pH and Corg, were significantly positive correlated in agricultural soil. Principal component analysis (PCA) indicated two main anthropogenic sources for trace elements in agricultural topsoil. The first component including B, Cr, Cu, Mg, Ni, and Zn, represented a mixture of atmospheric deposition and livestock manures; whereas the second component, relating to Ca, F, Cd, Hg, Se, and P, suggested the inorganic fertilizers and lime, as well as agrochemicals. Spatial distribution patterns using GIS contour maps and an integrated soil pollution index were established for the selected metal concentrations. In general, the range of RI (the potential ecological risk index) was from 43.6 to 556, with a mean value of 106, indicating low ecological risk in this study area. This study indicated that more attention should be paid to metal pollution of agricultural soil in the rural area to safeguard both soil and food safety.

Objectives Both robotic-assisted thoracic surgery (RATS) and uniportal video-assisted thoracic surgery (UVATS) are minimally invasive surgical techniques used for treatment of lung cancer. However, no research studies comparing early outcomes between RATS and UVATS have been reported. Methods Non-small-cell lung cancer patients treated with RATS or UVATS at our institution from January 2015 to September 2016 were enrolled. Early outcomes were compared after propensity score-matched analysis using 4 factors: age, gender, tumour size and operative procedure. Results A total of 153 patients were included in this study: 76 patients underwent RATS and 77 patients underwent UVATS. After propensity score-matched analysis, each group included 69 cases. The comparison of the 2 groups showed that there were no significant differences in operative time, postoperative hospital stay, chest tube duration, analgesic usage, complications or the number of resected lymph nodes. However, RATS caused less intraoperative blood loss (P = 0.037) and more dissected lymph node stations (P = 0.014). Conclusions Judging from the short-term outcomes, both RATS and UVATS are safe and feasible for non-small-cell lung cancer treatment. In particular, RATS is better able to reduce bleeding and complete lymphadenectomy than UVATS.

To investigate the relationship between the variations of event-related potentials (ERP) and clinical symptoms and treatment in first episode schizophrenia patients.The ERP (P50, color map of N400 and prepulse inhibition of the startle reflex (PPI) ) were tested in 85 first episode schizophrenia (FES) patients and 78 normal controls (NC), and followed-up at 1, 2 and 3 years after treatment in FES. Positive and negative symptom scale (PANSS) was used to evaluate the psychotic symptoms of patients.(1) Compared with NC, FES showed decreased PPI% (41% ± 37% vs 68% ± 42%, P0.001), increased P50 S2/S1(87 ± 41 vs 51 ± 47, P0.001), prolonged N400 latency and decreased N400 amplitudes (P0.05 - 0.01 ). ( 2) Significant correlations were found between variations of color map of N400 latencies and general scores of PANSS (r = 0.321, P = 0.042), N400 amplitude and positive symptom scores (r = -0.437, P = 0.008) and total scores of PANSS (r = -0.392, P = 0.023), but the variations of PPI and P50 latencies and amplitudes did not show significant correlation with the positive symptom scores and total scores of PANSS. (3) The color map of N400 latencies and amplitudes in FES group showed significant difference (P0.05) but the major indexes of PPI and P50 did not show significant difference (P0.05) among the 1, 2 and 3 years' follow-up after treatment.This follow-up study suggests that the variations of PPI and P50 is probably a trait marker of FES, and the variations of color map of N400 might be a status marker of FES.

We appreciate the thoughtful and constructive comments by Dr. Wael C. Hanna from Canada (1) and Dr. Abbas E. Abbas from America (2) on our article “ Robotic Assisted Right Middle Lobectomy ”. In this article, we described our experience with robotic assisted right middle lobectomy through a specific case (3). As both Dr. Hanna and Dr. Abbas mentioned in their insightful comments, they preferred to line up all of the robotic ports in the same intercostal space (8 th intercostal space) to minimize postoperative pain. In robot-assisted thoracic surgery, the incision positions are flexible and their placement primarily depends on the practice and preference of the surgeon. Many surgeons place the ports in multiple locations in the intercostal space (4-6). Another important factor that we could not ignore is racial difference. Caucasians have wider chests than Chinese; the Chinese chest surface is 93% of the chest surface of Caucasians (7).

Anomalies in β-waves have been found to be associated with mental depression. However, little is known about the causality of cortical inter- and intrahemispheric dependence of depressed patients in various cognitive states. This study investigates the possibility of β-wave interdependence in depressed patients subjected to mental arithmetic tasks following relaxation. The EEGs of 12 depressed patients (age = 37.2 ± 11.8 years from 15 to 74 years, male/female = 7/5) and 12 healthy volunteers (age = 37.5 ± 11.7 years from 22 to 58 years, male/female = 6/6) were analyzed using a causality measure, partial directed coherence (PDC). The depressed patients showed lower frontal cortical interdependence in both the resting and mental arithmetic task states, confirming the histopathological evidence which shows that supra- and infragranular layers of the dorsolateral prefrontal cortex of depressed patients decrease both in density and in the size of neurons and glial cells. On the other hand, the mental arithmetic task was found to enhance inter- and intrahemispheric interactions in both groups, and such hemispheric hyperactivation is consistent with findings from functional imaging. The results presented here indicate that PDC can be a useful tool for evaluating changes in cortical interdependence in different psychotic or mental states and might well be used for diagnosis and therapeutic assessment in affective disorders.

To evaluate the characteristics of sensory gating inhibition and variation of schizophrenia with both prepulse inhibition (PPI) and P50.The PPI of startle reflex and P50 were tested by an event-related potential (ERP) recorder in 82 first episode schizophrenics (FES) recruited from September 2007 to February 2014 at Shanghai Mental Health Hospital and 78 healthy controls (NC) from hospital staffs and local residents for the same period. All patients fulfilled the evaluation of PPI with strong stimulus alone and strong + weak stimulus paradigm, P50 with conditioning (S1)-testing (S2) paradigm. The psychotic symptoms were assessed with Positive and Negative Syndrome Scale (PANSS).(1) Compared with control group, schizophrenia group had increased P(L) (NC: (89 ± 14) ms, FES: (97 ± 17) ms, P0.05) and PPL, decreased amplitude (NC: (92 ± 21) ms, (24 ± 14) µV, FSZ: (96 ± 20) ms, (41 ± 29) µV, P0.05, 0.01), lower PPI inhibition ratio (NC: (67 ± 32)%, FSZ: (41 ± 37)%, P0.05). (2) Compared with NC group, there were increased S2 amplitude [NC: (3 ± 2) µV vs FES: (5 ± 3) µV, P0.05] and ratio of S2/S1 amplitude [(43 ± 22) % vs (82 ± 41)%, P0.05] in schizophrenia group. And P50 inhibition decreased significantly.Schizophrenics have both PPI and P50 impairments. And a combination of PPI inhibition ratio and S2/S1 (P50) may be a better electrocerebrophysiological index for schizophrenia.

Nicotine may improve schizophrenia patient's cognitive deficit symptoms. This study was to explore the chronic effects of smoking on prepulse inhibition of the startle reflex (PPI) and P50 in the patients with first-episode schizophrenia (FES).The event-related potentials (ERP) recording and analysis instrument made by Brain Products, Germany, was used to detect PPI and P50 in 49 male FES patients (FES group, n = 21 for smokers and n = 28 for non-smokers) and 43 normal male controls (control group, n = 19 for smokers and n = 24 for non-smokers).Compared with normal controls, the FES group had prolonged PPI latency when elicited by single stronger stimulus (P0.05); the FES group had prolonged PPI latency and increased PPI amplitude (P0.05, 0.01) when elicited by weak and strong stimuli. The FES group had lower PPI inhibition rate than normal controls (P0.05). Compared with normal controls, the FES group had increased P50-S2 amplitude and increased amplitude ratio S2/S1 (both P0.05). In the control group, the smokers had a tendency of increase in P50-S2 amplitude (P0.05) and shorter P50-S2 latency (P0.05) than the non-smokers. The smokers had higher PPI amplitude than the non-smokers (P0.05). In the FES group, the smokers had higher P50-S1 amplitude, shorter P50-S2 latency, and higher amplitude ratio S2/S1 than the non-smokers (P0.05, 0.01). The smokers had higher PPI amplitude than the non-smokers (P0.05).There is obvious PPI and P50 deficits in schizophrenic patients. However, these deficits are relatively preserved in the smokers compared with the non-smokers, which suggests that long-term smoking might partially improve the sensory gating in schizophrenic patients. Whether this conclusion can be deduced to female patients requires further follow-ups.

We are going to share the experience of robotic-assisted thoracoscopic segmentectomy. A 55-year-old patient underwent robotic-assisted thoracic surgery for a nodule in the right segment 6. The patient was discharged on postoperative day 3 without any perioperative complications. This case showed the robotic-assisted technique is a safe approach for lung segmentectomy.

Robotic-assisted surgery is now widely used in the field of thoracic surgery. We are going to share the experience of robotic surgery for left upper lobectomy. A 63-year-old patient underwent robotic-assisted thoracic surgery for a primary non-small cell lung cancer. The patient was discharged on postoperative day 3 without any perioperative complications. The pathological stage was T1aN0M0 (stage IA).

Routine surgical instruments: #7 knife handles, surgical scissors, forceps, needle holders, clamps (Snap, Kelly, Allis), Langenbeck, retractors, sponge-holding forceps, disinfection plates, and medicine bowls.

We are going to share the experience of robotic surgery for mediastinal mass. A 40-year-old patient underwent robotic-assisted thoracic surgery for a posterior superior mediastinal mass. The patient was discharged on postoperative day 2 without any perioperative complications. The pathological diagnosis was mediastinal neurofibroma. Our result showed the robotic thoracic surgery of the posterior superior mediastinal mass was efficient and reliable.

With the widely application of da Vinci Surgical System in thoracic surgery, which has advantages such as less trauma, less bleeding, and quick recovery, the delivery of specialized nursing care has come to the forefront. However, there were few studies about the postoperative nursing for robot surgery. Therefore, we summarized our experience on enhanced recovery after robotic-assisted thoracic surgery.

Robotic-assisted surgery is now well established and has been introduced into the field of thoracic surgery. We are going to share the experience of robotic surgery for right inferior lobectomy. A 61-year-old patient underwent robotic-assisted thoracic surgery for a primary lung adenocarcinoma. The patient was discharged on postoperative day 6 without any perioperative complications. The pathological stage was T1aN0M0 (stage IA). Our result showed the robotic-assisted thoracoscopic surgery was a safe and feasible surgical approach for non-small cell lung cancer (NSCLC).

When patients are hospitalized, they are usually unhappy. Furthermore, patients in the thoracic surgery ward usually have malignant tumors. Therefore, in addition to dealing with a monotonous and unfamiliar environment, patients often feel depressed. Before the operation, most patients have some degree of anxiety, because they lack comprehensive knowledge about the operation, such as tissue trauma and postoperative conditions. If patients have any questions or worries, they can ask the physician or nurses. The doctors should answer these questions patiently and help patients feel positive about the operation.

We are going to share the experience of robotic surgery for esophageal leiomyoma. A 46-year-old patient underwent robotic-assisted enucleation of esophageal leiomyoma in our center. The patient was discharged on postoperative day 5 without any perioperative complications. Our result showed the robotic-assisted surgery has some advantages particularly in performing suture and knot tying.

Robotic-assisted surgery is now well established and has been introduced into the field of thoracic surgery. We are going to share the experience of robotic surgery for left inferior lobectomy. A 44-year-old patient was underwent robotic-assisted thoracic surgery for a pulmonary nodule. The patient was discharged on postoperative day 3 without any perioperative complications. The pathological stage was T1aN0M0 (stage IA). Our result showed the robotic-assisted thoracoscopic surgery was a safe and feasible surgical approach for lobectomy.

A patient with a history of dysphagia for 3 months was diagnosed as upper esophageal cancer by gastroscopy. After sufficient preoperative preparation, the patient underwent esophagectomy of McKeown procedure by Robotic-assisted approach. The five-port method was used in both thoracic and abdominal part. A jejunostomy tube was placed for enteral nutrition. At last, a cervical esophagogastric anastomosis was performed. No complications occurred during the 6-day postoperative hospitalization. The TNM stage was T3N0M0, stage IIA.

We are going to share the experience of robotic-assisted thoracoscopic thymectomy. A 68-year-old patient underwent robotic-assisted thoracic surgery for a primary thymoma. The patient was discharged on postoperative day 3 without any perioperative complications. This case showed the robotic-assisted thoracoscopic thymectomy is a technically sound and safe approach for anterior mediastinal mass.

Robotic-assisted thoracic segmentectomy is a minimally invasive option for the treatment of the resectable lung cancer. Its advantages over conventional video-assisted thoracic surgery include a clear and magnified three-dimensional operative field and the flexible multi-joint arms. This technical article presents a case from our center to share some surgical techniques for this procedure.

We are going to share the experience of robotic surgery for lung segmentectomy. A 50-year-old patient underwent robotic-assisted thoracoscopic surgery for a ground glass opacity (GGO) in the S 1+2 segment of left upper lobe. The patient was discharged on postoperative day 3 without any perioperative complications. The pathological stage was T1aN0M0 (stage IA). Our result showed the robotic approach was feasible and reliable for lung segmentectomy.

We are going to share the experience of robotic surgery for right upper lobectomy. A 71-year-old patient underwent robotic-assisted thoracoscopic surgery for a primary lung adenocarcinoma. The patient was discharged on postoperative day 3 without any perioperative complications. The pathological stage was T1aN0M0 (stage IA). Our result showed the robotic-assisted thoracoscopic surgery was a feasible and reliable surgical approach for non-small cell lung cancer (NSCLC).

To investigate the variations of sensory evoked potentials (SEPs) in patients with affective disorders accompanying suicidal behavior.39 depressive patients, 22 manic patients and 33 normal controls were included in the study. Visual, auditory and somatosensory evoked potentials (VEP, AEPSSEP) were recorded from every subject using a Nicolet Spirit Instrument.Both the depressive and manic groups presented prolonged latencies and decreased amplitudes of major components of SEPs as compared to that of normal controls. Depressive patients with suicidal behavior had decreased P(3) amplitude of VEP (P0.05), while maniacs with suicidal behavior had decreased P(2) amplitudes of VEPAEP (P0.05 or 0.01). Compared with patients without suicidal behavior, patients with suicidal behavior had significantly decreased P(3) amplitudes of VEPSSEP.The variations of SEPs in patients with affective disorders is closely associated with a history of suicidal behavior. Their clinical significance and biological correlates with suicidal behavior need further study.