Chong Zhang

Electric-bicycle-related injury: a rising traffic injury burden in China.

Objective To examine the rising casualty rate related to electric bicycle usage. Design Analysis of the Hangzhou Police Bureaus data on electric-bicycle-related injuries and deaths. Setting Hangzhou, China, 2004–2008. Patients or subjects Electric-bicycle riders. Main outcome measure Electric-bicycle-related casualty rates in Hangzhou from 2004 to 2008. Results There was a significant average annual increase in electric-bicycle-related casualty rates of 2.7 per 100u2009000 population (95% CI 1.5 to 3.9, p=0.005). At the same time, overall road traffic and manual-bicycle-related deaths and injuries decreased. Conclusion As it is difficult to ban the use of electric bicycles in China, laws, rules and regulations need to be reinforced and strengthened. New regulations should be created for the safety of electric bicycle riders and others on the road, and mandatory helmet use should be considered.

Kimura's Disease Presenting as the Middle Mediastinal Mass

Kimuras disease usually located in the periauricular area most frequently; however, we believe that there have been no reports about kimuras disease presenting as middle mediastinal mass. we describe the diagnosis and treatment of kimuras disease in the middle mediastinum.

Primary pulmonary artery sarcoma

Primary pulmonary artery sarcoma is an uncommon tumor. We report a case of a 73-year-old male patient with a two-week history of palpitations and shortness of breath, aggravated for two days and was believed to be pulmonary hypertension. Emergency heart ultrasound after admission presented a massive pulmonary embolism in the pulmonary artery. The patients condition was successfully managed with urgent pulmonary artery embolectomy. The patient demonstrated improvement in hemodynamics after the operation. Histologic and immunohistochemical assays were performed and a diagnosis was made as primary pulmonary artery sarcoma arising from the left pulmonary artery. Resection of the tumor is recommended for the treatment of this rare malignant tumor. The corresponding chemotherapy, follow-up and prognosis are described as well in this case report.

Time-to-Progression of NSCLC from Early to Advanced Stages: An Analysis of data from SEER Registry and a Single Institute.

The average time required for cancers to progress through stages can be reflected in the average age of the patients diagnosed at each stage of disease. To estimate the time it takes for non-small-cell lung cancer (NSCLC) to progress through different tumor, node and metastasis (TNM) stages and sizes, we compared the mean adjusted age of 45904 NSCLC patients with different stages and tumor sizes from Surveillance, Epidemiology and End Results (SEER) cancer registry database and our institute. Multiple-linear-regression models for age were generated adjusting for various factors. Caucasian, African-American and Asian patients with stage IA cancers were on average 0.8, 1.0 and 1.38 adjusted years younger, respectively, than those with stage IIIB cancers (pu2009<u20090.001). And these with T1a cancers were on average 0.84, 0.92 and 1.21 adjusted years younger, respectively, than patients with T3 cancers (pu2009<u20090.001). Patients with tumors measuring larger than 8 cm in diameter were on average 0.85 adjusted years older than these with tumors smaller than 1 cm (pu2009<u20090.001), with Caucasian demonstrating the shortest age span (0.79 years, Pu2009<u20090.001). In conclusion, the time-to-progression of NSCLC from early to advanced stages varied among ethnicities, Caucasian patients demonstrating a more rapid progression nature of tumor than their African-American and Asian counterparts.

Surgical resection of resectable thoracic metastatic hepatocellular carcinoma after liver transplantation.

Although the role of orthotopic liver transplantation (OLT) in the treatment of hepatocellular carcinoma (HCC) has improved over the years, tumor recurrence is still a major imitation of long-term survival even after radical transplantation treatment. Thoracic metastasis is the most common site of extrahepatic spreads. The role of surgery for thoracic metastasis is not known, and until now there have been few reports about surgical resection for thoracic HCC metastasis after liver transplantation. We evaluate the surgical efficacy in the treatment of thoracic HCC recurrence after OLT.

The role of epithelial-mesenchymal transition in the post-lung transplantation bronchiolitis obliterans

BackgroundMany patients who receive lung transplantation (LT) operations develop varying degrees of bronchiolitis obliterans (BO) after the surgeries. Epithelial-mesenchymal transition (EMT) is considered to be related to the process of bronchiolitis obliterans. In this study we simulated the pathological process of post-lung transplantation bronchiolitis obliterans, and explored the correlation between BO and EMT of small airway epithelial cells.MethodsWe transplanted the left lungs of F344 rats to Lewis rats by the Tri-cuff anastomosis and established the allogeneic rat left lung orthotopic transplantation model. Cyclosporine and lipopolysaccharide were administrated appropriately after the surgery. The histological structure and the expression levels of the EMT markers was observed with the methods of HE staining, Masson staining and immunohistochemistry. The analysis of enumeration data was performed using Fisher’s Exact test and Spearman’s rank correlation was used for the correlation analysis.ResultsInflammatory cell infiltration, fibroplasia of bronchiole walls and significant lumen stenosis were found in the pulmonary mesenchyme of the transplanted lungs. The positive expression rate of E-cadherin in the transplanted lungs was 38.50% (5/13), significantly lower than that in the normal lung tissues [87.50% (7/8)] (Pu2009<u20090.05), while the positive expression rate of Vimentin was 76.92% (10/13) which is significantly higher than that in the normal lung tissues [25.00% (2/8)] (Pu2009<u20090.05). And a negative correlation existed between the expression levels of E-cadherin and Vimentin (ru2009=u2009−0.750, Pu2009<u20090.01).ConclusionsIn the disease model we established in this study, we found pathological changes that met BO characteristics happened in the transplanted lungs. Meanwhile, the small airway epithelial cells of transplanted lungs underwent an epithelial-mesenchymal transition, which indicated a role of EMT in the BO airway remodeling.

The treatment of recurrent aortic prosthetic detachment with modified Bentall procedure: Results of two cases

Recurrent prosthetic valve detachment after aortic valve replacement (AVR) for aortic regurgitation is a most serious complication. Endocarditis, aortitis, or other factors are the common causes. AVR or repair of the detachment are usually difficult to manage and still have a high detachment rate. We report 2 cases of successful surgical management with the translocated Bentall procedure for recurrent aortic valve detachment resulting from indefinite causes.

Sublobar Resection for Pulmonary Aspergilloma: A Safe Alternative to Lobectomy

BACKGROUNDnThis study was performed to evaluate the effectiveness of sublobar resection for the treatment of pulmonary aspergilloma compared with lobectomy.nnnMETHODSnPatients with pulmonary aspergilloma who underwent lobectomy or sublobar resection in our department between March 2007 and December 2015 were retrospectively reviewed. Data were collected for patient demographic characteristics, medical history, preoperative investigations, perioperative findings, postoperative conditions, and recurrence status. Propensity-matched comparative analyses were performed to adjust for potential differences of patients baseline characteristics between the groups.nnnRESULTSnA total of 96 patients underwent lobectomy, 46 patients underwent attempted sublobar resection. The median follow-up time is 53 months. No recurrence was found in either group. Three patients (3.1%) in the lobectomy group required reoperation for bleeding. The patients who underwent sublobar resection had less underlying lung disease (pxa0= 0.031), smaller lesions (pxa0= 0.033), and were more likely to have been treated with video-assisted thoracic surgery (p < 0.001). These differences were eliminated by propensity score matching (46 pairs were successfully matched). Comparative analyses in matched groups demonstrate that there was no marked difference in the volume and duration of chest drainage or the length of postoperative hospital stay. However, the patients with sublobar resection had shorter operation time (pxa0= 0.004), less blood loss (pxa0=xa00.042), and less postoperative complication (pxa0= 0.048).nnnCONCLUSIONSnSublobar resection performed for small simple pulmonary aspergilloma and selected complex pulmonary aspergilloma has a low recurrence rate andxa0confers perioperative advantages compared with lobectomy.

Initial experience of Da Vinci robotic thoracic surgery at the First Affiliated Hospital of Zhejiang University

Robot-assisted thoracic surgery (RATS) is a relatively new but rapidly adopted technique, pioneered by the urological and gynecological departments. The primary objective of this study is to present the current status, a series of improvement and innovation of Da Vinci robotic surgery in the Department of Thoracic Surgery at First Affiliated Hospital of Zhejiang University. In addition, we discuss the prospect of robotic surgical technology.