Objective To investigate the risk factors of vagus nerve invasion of advanced adenocarcinoma of esophagogastric junction (AEG).Methods The specimens from 98 patients with advanced AEG who underwent radical total gastrectomy and esophagogastric Roux-en-Y anastomosis from January 2011 to August 2012 at the First Affiliated Hospital of Anhui Medical University were collected.Serial section cutting was done and the upper and bottom incisional edges of every section were marked.The specimens were stained by hematoxylin-eosin solution,S-100 and CK immunohistochemistry.Vagus nerve invasion could be affirmed if cancer cells were observed in the peripheral space of vagus nerve and vagus nerve parenchyma or cancer cells infiltrated along the peripheral space of vagus nerve.Relationship between nerve invasion and clinicopathological factors was analyzed using chi-square test or Fisher exact probability.Factors related to vagus nerve invasion were analyzed using one-way analysis of variance and multi-factor logistic regression analysis.Results The incidence of vagus nerve invasion was 28.6％ (28/98),and the tumor only invaded the vagus nerve which had the same altitude as the upper incisional edge.The results of one-way analysis of variance showed that Siewert classification,intravascular cancer emboli,lymph node metastasis,the degree of lymph node metastasis,clinical staging,the degree of tumor differentiation were correlated with the vagus nerve invasion (x2 =14.156,14.552,5.454,10.706,6.919,14.767,P ＜ 0.05).The results of multi-factor logistic regression analysis showed that Siewert classification,intravascular cancer emboli and degree of tumor differentiation were the independent influencing factors of vague nerve invasion (OR =3.667,10.368,0.249,P ＜ 0.05).Conclusion Vagus nerve invasion is correlated with Siewert classification,intravascular cancer emboli and degree of tumor differentiation.The range of vagus nerve invasion is restricted under the upper incisional edge of tumor section.

Regulatory T cells (Tregs) are a subpopulation of CD4 +T cells highly expressing CD25 and Foxp3. Treg not only involves in autoimmune disease, infection and transplantation tolerance, but also plays a pivotal role in the suppression of anti-tumor immunity during tumor development. Current researches suggest the frequency of Treg is increased in tumor tissues and peripheral blood of patients with HCC, which is associated with HCC development, and affect survival rate and prognosis of HCC patients. Depletion of Treg together with surgical resection of the tumor could be a new approach for HCC, which can enhance tumorspecific T cell memory to remove latent metastasis and protect against recurrence for improvement of HCC therapeutic effect. This review presents the role of Treg in HCC development, the relationship between Treg and prognosis and its clinical practice.

Reflux is a common post-gastrectomy complication due to the destruction of physiological antireflux mechanism,which affects patients' post-surgery life quality greatly.It's one of the basic requirements of digestive tract reconstruction to reduce the incidence of post-surgery reflux,and nowadays there are many kinds of anti-reflux surgical methods,which are also hot topics both at home and abroad.The non-surgical anti-reflux treatments are mainly focused on gastrointestinal motility promotion,mucosa protection,acid suppression,and so on.There are still some controversies concerned with which surgical or non-surgical way to choose.It's of great significance to have a deep insight into the associated mechanisms and make a wise decision on the surgical management with proper non-surgical assistance.

Despite the gradual improvement in surgical treatment techniques and surgical instruments, the complications and mortality of gastric cancer patients after gastrectomy remain high because of an increased proportion of advanced age and incidence of preoperative morbidity in these patients. Therefore, reducing the peri-operative adverse outcomes in gastrectomy is highly significant. According to published literature, the risk factors of morbidity and mortality may include age, TNM stage, ASA score, POSSUM score, complication, surgeon workload, hospital operation volume, lymphadenectomy scope, combined multiple organ resection, and gastrecto-my type. This review summarizes the recent progress in the risk factors for the mortality and morbidity of gastrectomy.

Clinical data of 23 locally recurrent rectal cancer patients underwent radical anterior resection and 69 controls matched by age and gender was retrospectively analyzed to find out the risk factors related to local recur-rence after radical anterior resection of rectal carcinoma. Univariate analysis showed that tumor size, number of positive lymph nodes, distance between tumor and the anal verge and T stage were risk factors for locally recurrent rectal cancer after radical anterior resection. The results of logistic regression analysis showed that T stage ( T4 stage) was an independent risk factor correlated with the tumor recurrence after radical anterior resection and loca-tion of tumor( distance of tumor from the anal verge being less than 5 cm) seemed to be an independent risk factor correlated with the tumor recurrence.

Objective To investigate the changes and significance of the contents of cholecystokinin (CCK) acceptors and nitric oxide synthase (NOS) in sphincter of Oddi and the contents of CCK and nitric oxide (NO) in the blood of the patients with calculus of bile duct. Methods The contents of CCK acceptors and NOS in sphincter of Oddi and the contents of CCK and NO in the blood were determined in 41 patients with gallstone and 6 controls. Results The contents of CCK and NO in the blood of patients with gallstone were significantly higher than that in control [ ( 38.91±4.85 ) pmol/L vs ( 30.67±1.81 ) pmol/L; (40.84±4.74 ) pmol/L vs ( 32.81±1.11) pmol/L] ;The contents of CCK acceptors and NOS in sphincter of Oddi in the patients with gallstone were signifi-cantly lower than in the controls [ (67.59±5.87 ) ng/L vs ( 78.99±1.71 ) ng/L; ( 457.52±45.40 ) ng/L vs ( 519.61±11.38 ) ng/L] ;The contents of CCK and NO in the blood in the different groups with calculus of bile duct were significantly different from those in the controls. Conieusion The degree of the decrease of the contents CCK acceptors and NOS in sphincter of Oddi leads to the decrease of Oddi sphincter function,resuting in cholestasis and promoting the formation of bile duct stone.

Bile duct stone is the common and frequently-occurring disease, its incidence upwards trend. In recent years, people realize that Oddi sphincter movement disorders play an important role in the inci-dence of bile duct stones. NO, CCK, VIP and theie interactian have effects on sphincter function and dis-charged from the regulation of bile. These factors are necessary to conduct an in-depth study to investigate the cause of bile duct stone and its treatment.

Objective To explore the changes of the pressure of sphincter of Oddi(SO)in postoperative patients with cholangiolithiasis.Methods Sixty cases with multiple biliary calculi operation (recurrent cholangiolithiasis group),80 cases with biliary calculi operation at first time(cholangiolithiasis group)and 9 cases with external injuries of pancreas or liver(control group),who were examined in order to identify common bile duct pressure(CBDP),SO basal pressure(SOBP),amplitude of SO contractions (SOCA),frequency of SO contractions(SOF),then comparing the difference of statistics among the three groups.Results CBDP,SOBP,SOCA,SOF in recurrent cholangiolithiasis group and cholangiolithiasis group were significantly higher than those in control group[(13.78 ±9.91),(12.65 ±7.64)mm Hg(1mm Hg =0.133 kPa)vs.(12.54 ± 2.35)mm Hg,(15.27 ± 9.15),(14.89 ± 7.87)mm Hg vs.(13.63 ± 3.27)mm Hg,(106.30 ± 54.70),(98.39 ±38.29)mm Hg vs.(87.65 ±56.38)mm Hg,(6.91 ± 1.92),(6.25 ±2.17)times/min vs.(5.26 ± 2.11)times/min](P ＜ 0.05),but there was no significant difference between recurrent cholangiolithiasis group and cholangiolithiasis group(P ＞ 0.05).Conclusion SO dysfunction resides in the postoperative patients with cholangiolithiasis,and it is possible related with the formation and/or recurrence of cholangiolithiasis.

Objective To explore the relationship between cholelithiasis and the function of sphincter of Oddi (SO). Methods To identify the existence of calculi, choledochoscopy was performed in patients 6 weeks after exploration of the common bile duct (CBD) and T tube drainage, in which 71 were patients with stones in gall bladder, CBD or intra-hepatic bile duct, and 9 with trauma of pancreas or liver.Biliary manometry was performed after choledochoscopy, and an additional manometry was applied after calculus removal if calculi were detected. The indices measured included SO basal pressure ( SOBP), amplitude of SO contractions (SOCA), frequency of SO contractions (SOF) and CBD pressure (CBDP). The patients with cholelithiasis were classified into cholecystolithiasis group, choledocholithiasis group, and hepatolithiasis group according to the position of calculi. Patients with trauma were assigned as the control group.Results All variables in 50 patients with choledocholithiasis were similar before and after the procedure.The variables in patients with cholecystolithiasis and choledocholithiasis had no difference from those of the control (P ＞ 0. 05 ). The SOBP and SOCA of patients in hepatolithiasis group were lower than those of the control group ( P ＜ 0. 05 ), while no difference in SOF was detected (P ＞ 0. 05 ). Conclusion The function of SO in patients with hepatolithiasis is abnormal ( decrease in SOBP and SOCA). Biliary manometry cannot be the reliable evidence for the existence of calculi in bile duct.

Objective To investigate the prognostic factors and influencing factors of lymph node ratio (LNR) in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods The retrospective case-control study was conducted.The clinicopathological data of 444 patients with Siewert Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2011 were collected.All the 444 patients underwent radical D2 lymph node dissection,extent of lymph node dissection was inferior mediastinum,around the esophageal hiatus and celiac lymph node.Follow-up usingtelephone interview and outpatient examination was performed to detect patients' prognosis once every 3 months within 2 years postoperatively,once every 6 months from 2 vears to 5 years postoperatively and once every 12 months after 5 years up to October 2016.Observation indicators:(1) follow-up and survival situations;(2) univariate and multivariate factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ[AEG;(3) univariate and multivariate factors analysis affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG.The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method.The univariate analysis and multivariate analysis were respectively done using the Log-rank test and the COX regression model.Results (1) Follow-up and survival situations:all the 444 patients were followed up for 1-81 months,with a median time of 52 months.The 1-,3-,5-year overall survival rates of 444 patients were respectively 93.2％,60.3％ and 45.7％.(2) Factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG:results of univariate analysis showed that tumor diameter,tumor differentiation,invasion depth of tumor,pN staging and staging of LNR were related factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG,with statistically significant differences (x2 =12.332,5.898,36.045,38.847,46.464,P＜0.05).Results of multivariate analysis showed that invasion depth of tumor and staging of LNR were independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG [RR =1.393,1.411,95％ confidence interval (CI):1.137-1.708,1.106-1.801,P＜0.05].(3) Factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG:results of univariate analysis showed that tumor diameter,tumor differentiation and invasion depth of tumor were related factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG,with statistically significant differences (x2=20.077,12.618,36.586,P＜0.05).Results of multivariate analysis showed that tumor diameter,tumor differentiation and invasion depth of tumor were independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG (OR=0.684,0.688,0.788,95％ CI:0.485-0.965,0.505-0.936,0.687-0.903,P＜0.05).Conclusions The invasion depth of tunor and staging of LNR are independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG.Tumor diameter,tumor differentiation and invasion depth of tumor are independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG.