Background: Diaphragm plication is an effective and safe procedure for patients with symptomatic, acquired diaphragm paralysis. Improvements in dyspnea scores, ventilation perfusions and exercise capacity has been reported. Unfortunately, no continuous measurements of lung functions at 3 to 5 years’ follow-up have been recorded. This study was designed to assess the long-term effects and potential mechanism of diaphragm plication for non-malignant diaphragmatic paralysis patients, especially in relation to patients’ subjective and objective improvement. Methods: This study retrospectively reviewed the medical records of 36 adult patients with diaphragmatic paralysis treated with diaphragm plication by thoracotomy at the Tianjin Chest Hospital from 1992 to 2016. The adult patients were carefully selected based on etiology and a combination of clinical manifestation, pulmonary function testing, and chest imaging characteristics. Patients’ preoperative pulmonary functions, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in the supine and sitting positions were recorded. Survival information was obtained at follow-ups continuously conducted with 8 patients for 4 years after surgery. Results: The main symptoms were lifestyle-limiting dyspnea and orthopnea, and a few patients also had digestive symptoms. The mean body mass index of patients was 26.02±2.19. The etiology was trauma in 3 patients, and surgery in 5 patients. The operated diaphragm was found to be lower than the contralateral diaphragm in the first 3 months after surgery; however, from the 4th month, both sides of the diaphragm were basically at the same level. Additionally, 31 patients (86.11%) showed an improvement in subjective symptoms, especially digestive symptoms preoperatively. The averages of FVC and FEV1 increased by 26.8% and 24.3%, respectively, in patients 6 months after diaphragmatic plication, and from the 18th month, lung function declined gradually, returning to preoperative levels in the 4th year. Conclusions: Diaphragmatic plication can obviously improve the lung function and subjective symptoms of patients in the short term, but from the 18th month, lung function declined gradually to preoperative levels in the 4th year indicated that its long-term effect on lung function is poor. The major purpose of diaphragmatic plication is to balance the position of the heart and abdominal organs, and thus to improve patients’ symptoms to a certain extent.

Background: The histologic classification of lung adenocarcinoma (LUAD) was mainly divided into three pathological subtype groups: the low-grade predominant subtype group (lepidic), the intermediate-grade predominant subtype group (papillary and acinar), and the high-grade predominant subtype group (micropapillary and solid). Previous studies have focused on the prognostic impact of predominant subtypes of lung adenocarcinoma. In this investigation, we investigated the effect of the second predominant subtype on prognosis. Methods: The data of LUAD postoperative patients were retrospectively collected. Exclusion criteria included cases in which the pathologic results revealed a single characteristic, the presence of invasive mucinous LUAD, or if the first predominant and the second predominant groups could not be distinguished. Categorical variables were compared with the two-tailed Pearson χ2 test and continuous variables with the Student’s t-test. Follow-up was conducted by telephone and other methods. Independent prognostic factors of the second major subtype were determined by the Kaplan-Meier method and log-rank test. The Cox proportional risk regression model was used to analyze the possible prognostic factors. Results: Among 293 patients, the mean age was 61.9 years and 47.1% were male. The results revealed that when the predominant group was the low-grade group, the second predominant groups had no significant influence on overall survival (OS) (P=0.15) but significantly influenced disease free survival (DFS) (P=0.037). Subsequently, when the predominant group was the intermediate-grade group, the second predominant groups significantly influenced OS (P=0.024) but had no significant influence on DFS (P=0.3). Moreover, when the predominant group was the high-grade group, the second predominant groups significantly influenced OS (P=0.033) but had no significant influence on DFS (P=0.31). Conclusions: The independent prognostic effect of the second predominant group was not identified for OS and DFS of lung adenocarcinoma. The effects of the second predominant subtype groups on OS and DFS were not evenly distributed among different predominant subtype groups, and the low-grade second predominant subtype exhibited some protective effects on the middle-grade predominant subtypes.

Background: This study aims to report the experience of a single center using thoracic endovascular aortic repair (TEVAR) to treat retrograde type A intramural hematoma (IMH) with focal intimal disruption (FID) in descending aorta. Methods: A total of 24 consecutive patients with retrograde type A IMH and complicated with FID in descending aorta underwent TEVAR in our center from 2015 to 2020. Their clinical data, imaging manifestation and follow-up results were retrospectively reviewed and analyzed. Results: The median age of patients was 57.9 years (range, 42–80 years) and 18 were men (75%). As the preoperative CT angiography showed, the 24 patients developed IMH complicated with different kinds of FIDs in descending aorta [5 had intramural blood pool (IBP), 15 had ulcer-like projection (ULP), 2 had penetrating atherosclerotic ulcer (PAU), and 5 had localized dissection]. Successful deployment of aortic stent graft was achieved in all patients. There was no endoleak, stent graft migration, spinal cord ischemia, stroke, or 30-day mortality observed after TEVAR. The median duration of follow-up was 30.0 months (range, 3–60 months). As the last follow-up CT angiography showed, most of the patients (23 in 24, 96%) had favorable aortic remodeling. The maximum hematoma thicknesses and maximum diameters of both ascending and descending aorta were significantly decreased. During follow-up, 1 patient developed retrograde type A aortic dissection (RAAD) and underwent open surgery 3 months after TEVAR. 1 patient died of lung cancer 2 years later. There was no aorta-related death observed. Conclusions: TEVAR provides a safe and effective treatment strategy for selected patients with retrograde type A IMH, and FID developed in descending aorta could be the possible treatment target. However, RAAD remains one of the most serious postoperative complications of concern.

Background: This study aims to report the experience of a single center using thoracic endovascular aortic repair (TEVAR) to treat retrograde type A intramural hematoma (IMH) with focal intimal disruption (FID) in descending aorta.Methods: A total of 24 consecutive patients with retrograde type A IMH and complicated with FID in descending aorta underwent TEVAR in our center from 2015 to 2020. Their clinical data, imaging manifestation and follow-up results were retrospectively reviewed and analyzed.Results: The median age of patients was 57.9 years (range, 42–80 years) and 18 were men (75%). As the preoperative CT angiography showed, the 24 patients developed IMH complicated with different kinds of FIDs in descending aorta [5 had intramural blood pool (IBP), 15 had ulcer-like projection (ULP), 2 had penetrating atherosclerotic ulcer (PAU), and 5 had localized dissection]. Successful deployment of aortic stent graft was achieved in all patients. There was no endoleak, stent graft migration, spinal cord ischemia, stroke, or 30-day mortality observed after TEVAR. The median duration of follow-up was 30.0 months (range, 3–60 months). As the last follow-up CT angiography showed, most of the patients (23 in 24, 96%) had favorable aortic remodeling. The maximum hematoma thicknesses and maximum diameters of both ascending and descending aorta were significantly decreased. During follow-up, 1 patient developed retrograde type A aortic dissection (RAAD) and underwent open surgery 3 months after TEVAR. 1 patient died of lung cancer 2 years later. There was no aorta-related death observed.Conclusions: TEVAR provides a safe and effective treatment strategy for selected patients with retrograde type A IMH, and FID developed in descending aorta could be the possible treatment target. However, RAAD remains one of the most serious postoperative complications of concern.