Nuss procedure is not suitable for pectus excavatum patients with low age. In order to get these patients treated satisfactorily, we have designed a novel technique with a new concept. We placed a metal bar above the chest wall depression. After lifting with steel wires, the depression is fixed in the middle of the bar, and the deformed chest wall can be well treated. Our experiences show that this method is suitable for the younger pectus excavatum children.After Nuss procedure was reported in 1998, most of the pectus excavatum patients received such operation. However, due to the higher recurrence rate and other disadvantages, the procedure is considered unsuitable for low age patients [1,2]. Since most of the children are found to have pectus excavatum shortly after birth, and their families want to complete the operation as soon as possible, it is necessary to design a new procedure to get these children treated. * TechniqueThe patient is located in the supine position. Skin incision is made in the lower part of the anterior chest wall, just in front of the xiphoid process, with a length of about 2 cm. The soft tissues and muscles are separated to the bottom of the depression just above the surface of the bone structure, then the separation range is enlarged and two tunnels for metal bar are made on both sides of the chest wall. The xiphoid process is exposed and split in the midline longitudinally. After proper traction, the posterior structures behind the sternum are dissociated, and the connection between the diaphragm and the bottom of the sternum is cut off. Three steel wires were sutured through the deformed part of depression, two passing through the costal arches, and one passing through the lower end of the sternum, with the deformed chest wall being completely lifted (Figures 1 and 2). A metal bar is prepared, and its length is about 2 to 3 cm longer than the distance between the highest points on both sides of the depression. The bar is shaped in accordance with the radian of the normal thoracic wall, so that the shape of the bar is equivalent to the patient's chest. Put one end of the bar into the tunnel on one side of the chest wall at first, and then, after reasonable traction, put another end into the opposite tunnel. When
MiR-145 has been reported to be downregulated in multiple tumors. It acts as a tumor suppressor in lung cancer. In this study, we investigated the potential effects of miR-145 on invasion and metastasis and the molecular mechanism in non-small cell lung cancer. MiR-145 was downregulated in the NSCLC specimens and significantly correlated with advanced clinical stage and lymph node metastasis. In addition, AEG-1/MTDH was a direct target of miR-145, and the expression of AEG-1/MTDH was inversely correlated with miR-145 expression in NSCLC tissues. Ectopic expression of miR-145 suppressed cell invasion and metastasis in NSCLC cells. AEG-1/MTDH overexpression partially reversed the suppressive effect of miR-145. These findings provide novel insights with potential therapeutic applications for the treatment of NSCLC.
Pectus excavatum is a common thoracic deformity, and Nuss procedure is considered as the standard operation for the treatment of this deformity. However, there are often cases of Nuss procedure failure in the clinic. Once such a situation occurs, it often needs to be operated again. Since Nuss procedure can cause adhesions behind the sternum and in the bilateral thoracic cavities, if Nuss procedure is still used in the reoperation, it is not only very difficult, but also possible to cause heart and lung injuries. Therefore, Nuss procedure is not an ideal choice for reoperation. Wang procedure is a new method to treat the deformity of depressed chest wall. Since this operation is mainly performed outside the chest wall and rarely involves the structures in thoracic cavity, it is suitable for reoperation after the failure of Nuss procedure. This article reports a 12-year-old boy who had a failed Nuss procedure. We used Wang procedure for treatment and achieved satisfactory results.
Thoracic deformity can be roughly divided into two categories, one is depression deformity the other is protrusion deformity. In general, depression deformity is called pectus excavatum. In the era of open surgery, there is no big problem with this nomenclature. However, in the era of minimally invasive surgery, because the general minimally invasive surgery cannot be used to treat some depression deformities, it is necessary to further classify these deformities. After a long time observations, we found that there was a type of deformity with distinct characteristics, which was the transverse groove in the anterior chest wall, and was significantly different from the hollow of the typical pectus excavatum. This deformity cannot be corrected with standard Nuss procedure. In order to better understand and treat this special deformity, we named it groove chest. We also made a special design for its operation, and finally designed an effective surgical method. Our experience shows that the surgery we designed is an effective technique, which also proves the necessity of treating groove chest as an independent deformity.
Pectus carinatum is a common thoracic deformity, and its treatment has a long history. The early operation was open operation. With the emergence of the concept of minimally invasive surgery in clinical practice, minimally invasive surgery of pectus carinatum has gradually become the mainstream in its treatment. The earliest minimally invasive operation was Abramson procedure. This kind of operation has certain effect, but it also has many disadvantages. In order to eliminate its disadvantages, we designed a new operation, Wenlin procedure. In essence, this operation is a template plastic surgery. Because of the special design, it has obvious advantages. So far, this operation has been widely used in China. Clinical experience shows that this operation is safe, simple and practical. However, like all other operations, this operation also has defects. In the future use process, its defects need to be continuously discovered and improved.
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