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Shanghai, China

Xing Q.,Heart Center | Pan S.,Heart Center | An Q.,University of Sichuan | Zhang Z.,Zhejiang University | And 4 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2010

Objective: To summarize the clinical experiences and mid-term follow-up results of perventricular closure of perimembranous ventricular septal defect without cardiopulmonary bypass under transesophageal echocardiography guidance. Methods: A total of 408 patients with perimembranous ventricular septal defects, aged 5 months to 15 years (3.1 ± 1.7 years) with a body weight of 4.5 to 26 kg (13.6 ± 5.5 kg), underwent perventricular device closure. The procedure was performed via a small lower sternal incision. A guidewire was inserted through the ventricular septal defect to the left ventricle under transesophageal echocardiography guidance after a pursestring suture was placed on the right ventricular free wall. A modified delivery sheath was introduced over the guidewire to establish the delivery pathway. Proper devices were delivered and then deployed if no atrioventricular or aortic valvular disturbance, or residual shunt was detected by transesophageal echocardiography. Patients were followed up with a standard protocol, which is once every month in the first 3 postoperative months and then once every 3 months with echocardiography, electrocardiography, and chest radiography in each follow-up. Results: A total of 393 patients in this group underwent successful closure (96.3%), and the procedure was converted to conventional open repair in 15 patients (3.7%). A total of 213 symmetric devices (54.2%) and 180 asymmetric devices (45.8%) were implanted. Only 6 of the 393 patients (3.5%) received transfusion of blood products. New trivial or mild tricuspid regurgitation was found in 13 patients (3.3%), and there was no worsening of regurgitation in those patients with existing tricuspid regurgitation before operation. Eleven patients (2.8%) had incomplete right bundle branch block. Most of the patients were discharged 3 to 5 days after the operation. Follow-up in all patients ranged from 3 months to 2 years (14.6 ± 6.2 months) and revealed no residual shunt, new or aggravating aortic regurgitation, obstruction of left or right ventricular outflow tract, or device dislocation. Conclusion: Minimally invasive perventricular device closure of ventricular septal defect without cardiopulmonary bypass is a simple, effective, and relatively safe intervention under guidance of transesophageal echocardiography. This method should be considered for patients with ventricular septal defect. Long-term follow-up is necessary. © 2010 The American Association for Thoracic Surgery. Source

Wang C.,Changhai Hospital | Yao F.,Shanghai Chest Hospital | Han L.,Changhai Hospital | Zhu J.,Changhai Hospital | Xu Z.-Y.,Changhai Hospital
Journal of Heart Valve Disease | Year: 2010

Background and aim of the study: The study aim was to assess the performance of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in Chinese patients undergoing heart valve surgery. Methods: Between January 2003 and December 2007, the data from a total of 1,726 consecutive patients who underwent heart valve surgery at the authors' center were-collected and scored according to the additive arid logistic EuroSCORE models. The patients were allocated to three risk subgroups, and the entire cohort and each risk subgroup analyzed. Calibration of the EuroSCORE model was assessed by the Hosmer-Lemeshow (H-L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. Results: Completed data from all 1,726 patients were analyzed. There were significant differences in the prevalence of risk factors between the study sample and European cardiac surgery populations. The observed mortality was 4.46% overall, compared to 3.51% (additive) and 2.85% (logistic). The additive EuroSCORE model showed good calibration in predicting in-hospital mortality (H-L; p = 0.204), but the logistic EuroSCORE model underpredicted observed mortality (H-L; p = 0.038) in the entire cohort. Both, the additive and logistic EuroSCORE models showed good calibration in predicting in-hospital mortality in the medium- and high-risk subgroups, but overpredicted observed mortality in the low-risk subgroup. The discriminative power of both models for the entire cohort was poor (areas under the ROC curve of 0.644 and 0.647 for the additive and logistic models, respectively). Conclusion: The additive and logistic EuroSCORE models gave an imprecise prediction for individual operative risk in heart valve surgery patients at the authors' center; thus, use of the EuroSCORE models for risk evaluation at this center may be unsuitable in the future. It will be necessary to re-examine the performance of the EuroSCORE model for predicting operative mortality in heart valve surgery on a multicenter database in China. © Copyright by ICR Publishers 2010. Source

Wang Z.X.,Shanghai Chest Hospital
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery | Year: 2013

Most patients with esophageal cancer have advanced disease at presentation. The efficacy of surgical resection alone is often unsatisfactory in patients with stage III or more advanced cancer according to the seventh edition of UICC staging system for esophageal cancer. The systematic multidisciplinary treatment is important. Mounting evidence indicates that preoperative concurrent chemoradiotherapy is the most effective induction therapy to down-stage tumor and increase radical resection rate. For the esophageal squamous cell carcinoma patients with multi-stations and multi-fields lymph node metastasis, preoperative induction chemotherapy would be a viable option. For locally advanced cancers which have been surgically resected, postoperative adjuvant radiotherapy maybe helpful to improve local control for the insufficient surgical dissection. The role of adjuvant chemotherapy also needs further studies. Thoracic esophageal squamous cell carcinoma and lower esophageal adenocarcinoma which is common in western countries are different. We need more prospective clinical studies to establish our treatment modalities for esophageal cancer. Source

Liu Q.,Fudan University | Fu X.-L.,Fudan University | Yu W.,Shanghai Chest Hospital | Zhu Z.-F.,Fudan University | Zhang Y.-J.,Fudan University
Nuclear Medicine Communications | Year: 2015

Objectives: The aim of the study was to evaluate the predictive value of fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) pretreatment on local control (LC) and survival after radical radiotherapy or chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma (SCC) and to discuss its potential value for establishing optimal radiation treatment plans. Methods: Fifty-eight patients with pathologically proven esophageal SCC who underwent 18F-FDG PET/CT pretreatment in our center were retrospectively reviewed. We examined the correlation between the PET parameters of primary tumors and LC and overall survival. The coefficient of variation was used to estimate the 18F-FDG uptake in heterogeneity. Results: The mean duration of follow-up for surviving patients was 38 months, and 36 patients died because of tumor recurrence or other diseases. The rates of 3-year overall survival and LC were 40.4 and 50.4%, respectively. Multivariate analysis of LC revealed that metabolic tumor volume (MTV) greater than 16.08ml was the only predictor of outcome, with a lower 3-year LC (P = 0.017, hazard ratio: 1.608, 95% confidence interval: 1.090-2.371). The coefficient of variations of their primary lesion were higher compared with those of patients who had smaller MTVs. Conclusion: In this study, MTV assessed by PET/CT might be an adverse factor for predicting LC in esophageal SCC. For those with higher MTVs, higher intratumor heterogeneity suggests that irradiation may need to be boosted in stable high-uptake regions to improve LC. These results need to be prospectively validated in larger cohorts. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Zhang L.,Sun Yat Sen University | Ma S.,Zhejiang Cancer Hospital | Song X.,Guangxi Zhuang Autonomous Region Tumour Hospital | Han B.,Shanghai Chest Hospital | And 11 more authors.
The Lancet Oncology | Year: 2012

Background: Maintenance treatment of patients with advanced non-small-cell lung cancer (NSCLC) without disease progression after first-line chemotherapy is a subject of ongoing research. The aim of the randomised, double-blind, placebo-controlled, INFORM study was to investigate the efficacy, safety, and tolerability of the EGFR-tyrosine-kinase inhibitor gefitinib in the maintenance setting. Methods: Patients were aged 18 years or older, were of east Asian ethnic origin, had a life expectancy of more than 12 weeks, histologically or cytologically confirmed stage IIIb or IV NSCLC, a WHO performance status of 0-2, and had completed four cycles of first-line platinum-based doublet chemotherapy without disease progression or unacceptable toxic effects. Between Sept 28, 2008 and Aug 11, 2009, 296 patients were randomly assigned 1:1 to receive either gefitinib (250 mg per day orally) or placebo (orally) within 3-6 weeks after chemotherapy until progression or unacceptable toxic effects. Randomisation was done via an interactive web response system with computer-generated randomisation codes. Our primary endpoint was progression-free survival assessed in the intention-to-treat population. This completed study is registered with Clinicaltrials.gov, number NCT00770588. Findings: Progression-free survival was significantly longer with gefitinib (n=148) than with placebo (148) (median progression-free survival 4·8 months [95% CI 3·2-8·5] vs 2·6 months [1·6-2·8]; hazard ratio [HR] 0·42, 95% CI 0·33-0·55; p<0·0001). Adverse events occurred more frequently with gefitinib than with placebo; the most common adverse events of any grade were rash (73 [50%] of 147 in the gefitinib group vs 14 [9%] of 148 in the placebo group), diarrhoea (37 [25%] vs 13 [9%]), and alanine aminotransferase increase (31 [21%] vs 12 [8%]). The most commonly reported grade 3 or 4 adverse event was alanine aminotransferase increase (3 [2%] of 147 in the gefitinib group, none of 148 in the placebo group). Ten of 147 (7%) patients given gefitinib and five of 148 (3%) patients given placebo had serious adverse events. Three deaths were thought to be related to treatment with gefitinib: one from interstitial lung disease; one from lung infection; and one from pneumonia. Interpretation: Maintenance treatment with gefitinib significantly prolonged progression-free survival compared with placebo in patients from east Asia with advanced NSCLC who achieved disease control after first-line chemotherapy. Clinicians should consider these data when making decisions about maintenance treatment in such patients. Funding: AstraZeneca. © 2012 Elsevier Ltd. Source

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