Objective To evaluate initial results of Ivor Lewis minimally invasive esophagectomy (MIE) for esophageal carcinoma using a diamond-shaped anastomosis with 45 mm linear-stapler.Methods Clinical data of 12 patients diagnosed middle to distal esophageal carcinoma and undergoing Ivor Lewis minimally invasive esophagetomy using a diamond-shaped anastomosis technique during Dec.2015 and Nov.2016 in Peking Union Medical College Hospital were collected and analyzed retrospectively.Results The mean operation time was (378 ± 56) min,the mean blood loss was (280 ± 120) ml,and the mean postoperative hospital stay was (12.2 ± 2.0) days.No positive margin,no peri-operative death occurred.Postoperative complication included atelectasis and pulmonary infection in 1 patient,paresis of left recurrent laryngeal nerve in 1 patient.No anastomotic leak or constriction occurred.Median follow up was 7 months,11 patients had no evidence of disease progress,1 patient had subcutanecous metastasis and was reoperated.Conclusion The diamond anastomosis technique utilizing in Ivor Lewis MIE for esophageal carcinoma is feasible,easy to manipulate,safe and reliable.

Objective To imitate the development process of new drugs with rutin as the model and to do multidiscipli-nary experiments of preparation and pharmacodynamics of rutin tablets .Methods Thin-layer chromatography was used to i-dentify rutin in Pagodatree flower bud .High-performance liquid chromatography was used for quantitative determination of ru-tin in Pagodatree flower bud and rutin products .The vasodilatation effect of rutin was investigated .The preparation of rutin tablets was completed .Results and Conclusion We completed the identification of Pagodatree flower bud ,extraction and puri-fication of rutin from Pagodatree flower bud ,the assay of rutin ,the pharmaco-dynamics study and the formulation of rutin tab-lets .The experiments helped the postgraduates to be familiar with the research process of new drugs and to improve their ex-perimental operation skills .

Objective To analysis the clinicopathological features of skip N2 metastasis in NSCLC in our clinical center,therefore guide for clinical decision making for NSCLC patients.Methods A total of 120 NSCLC patients with N2 metastasis treated by surgery were enrolled from January 2017 to May 2018,of which 55 were males and 65 were females.The mean age of them were (58.36 ± 11.34) years old.36 patients had skip N2 metastasis,accounting for 30％ of patients with N2 metastasis.48 patients had a history of smoking or a definitive history of second-hand smoke exposure,compared with other 72 patients.Collected pre-and post-operation clinical data of those patients,and carried out relevant statistical analysis.Results Among the NSCLC with skip N2 metastasis,it occulted more frequently in right lower lobe and peripheral lung cancer.The main pathological type was adenocarcinoma with acinar subtype.The most cases of skip N2 metastasis were characterized by single N2 station metastasis.Age of patients showed a significant difference between the two groups(P =0.049).Gender,smoking history,T staging of lung cancer,pathological type and involvement of pulmonary membrane showed no statistic difference between the two groups(P ＞ 0.05).Conclusion Patient with skip N2 metastasis seemed to be elder,and the lesions of those patients were more likely to be lung adenocarcinoma in the right lower lobe and peripheral lung cancer,often involved single N2 station.The lung cancer in right upper lobe often skipped to level R2 + R4,which in right middle lobe often skipped to levels R2 + R4 and 7,in right and left lower lobes skipped to level 7,in the left upper lobe often skipped to level 5.

Small cell lung cancer carries the worst prognosis among lung cancer. The current guidelines only recommend surgical treatment for patients in the Ⅰ-ⅡA stage, but surgical treatment is often in a neglected position in clinical practice. More and more recent studies have focused on this aspect. This article reviews the recent research literatures and reviews the progress of surgery in the multidisciplinary treatment of small cell lung cancer.

Objective:To analyze clinical features of aortoesphageal fistula (AEF) patients with massive upper gastrointestinal hemorrhage.Methods:Five AEF patients with massive upper gastrointestinal hemorrhage admitted in Peking Union Medical College Hospital from 2016 January 1st to 2019 December 31st. The clinical data, endoscopic findings, radiological manifestations, treatment and clinical outcomes were retrospectively analyzed.Results:Among 5 patients, 4 were males, 1 was female with an average age of (58±8) years old. The underlying conditions were atherosclerosis ( n=4), hypertension ( n=3), hyperlipidemia ( n=1); 2 cases had aortic aneurysm stent implantation and 1 case of rheumatic heart disease had valve replacement. All 5 patients were complicated with hematemesis and hypovolemic shock, and 4 cases had sentinel hemorrhage. Contrast-enhanced CT or CT angiography of the aorta showed thicken esophageal wall, local esophageal discontinuity, aortic aneurysm, gas around the aortic stent and contrast agent spilling over. The gastroscopy showed esophageal depression lesions, deep ulcers, mucosal erosion with bleeding. Conservative therapy and endoscopic hemostasis failed, 2 patients died without surgical intervention; 3 patients underwent emergency surgeries, 2 survived and 1 died perioperatively. Conclusions:Aortoesophageal fistula is in lack of specific clinical manifestations but is highly in mortality. Therefore CT and gastrocopic examination should be performed for suspected patients, early diagnosis and surgical treatment are the key to save patients′ lives.

Objective     To evaluate the influence of resection status, pathological type, pathological stage and postoperative adjuvant therapy on prognosis of surgically treated thymic carcinoma. Methods     In this retrospective study, 56 patients with surgically treated thymic carcinoma in the Department of Thoracic Surgery, Peking Union Medical College Hospital from January 2005 to December 2015 were enrolled. There were 30 males and 26 females aged 52.1±11.5 years ranging from 22 to 81 years. The survival curve was performed by Kaplan-Meier method. The prognostic factors affecting overall survival (OS) and disease-free survival (DFS) were analyzed by one-way analysis of variance (ANOVA). Results     R0 resection was performed in 37 patients (67.9%), and other resections in 19 (32.1%); 13 patients suffered thymic carcinoma with Masaoka stage Ⅰ-Ⅱ, 26 Ⅲ, and 17 Ⅳ. Low-grade thymic carcinoma was found in 42 patients, and high-grade in 14. Postoperative radiotherapy, chemotherapy and chemoradiotherapy were performed on 17, 12 and 18 patients respectively and 9 patients were untreated. Forty-one patients was followed up for 1 to 10 years, and the follow-up rate was 73%. The 1-, 3- and 5-year OS rates were 93%, 74% and 61%, respectively. Resection status and pathological stage affected OS. Postoperative radiotherapy after R0 resection affected DFS, but did not affect OS. Conclusion     Most patients with thymic carcinoma after surgery can survive for a long period, and R0 resection is the most important prognostic factor of thymic carcinoma. Postoperative radiotherapy after R0 resection in patients with Masaoka stage Ⅱ-Ⅲ is recommended.

Objective To investigate the feasibility of Multi-dimensional Visual Hand Function Rehabilitation Quantitative Assessment System in the assessment of hand function for stroke patients. Methods From November, 2017 to July, 2018, 17 stroke inpatients were assessed with Fugl-Meyer Assessment-upper extremities (FMA-UE) and the Multi-dimensional Assessment System. Results The results of Multi-dimensional Assessment System positively correlated with the score of FMA-UE (r = 0.609, P = 0.010). Conclusion The Multi-dimensional Visual Hand Function Rehabilitation Quantitative Assessment System can be used to assess the hand function for stroke patients quantitatively.

Melanoma is the most aggressive cutaneous tumor. Neuropilin and tolloid-like 2 (NETO2) is closely related to tumorigenesis. However, the functional significance of NETO2 in melanoma progression remains unclear. Herein, we found that NETO2 expression was augmented in melanoma clinical tissues and associated with poor prognosis in melanoma patients. Disrupting NETO2 expression markedly inhibited melanoma proliferation, malignant growth, migration, and invasion by downregulating the levels of calcium ions (Ca²⁺) and the expression of key genes involved in the calcium signaling pathway. By contrast, NETO2 overexpression had the opposite effects. Importantly, pharmacological inhibition of CaMKII/CREB activity with the CaMKII inhibitor KN93 suppressed NETO2-induced proliferation and melanoma metastasis. Overall, this study uncovered the crucial role of NETO2-mediated regulation in melanoma progression, indicating that targeting NETO2 may effectively improve melanoma treatment.
Humans ; Calcium-Calmodulin-Dependent Protein Kinase Type 2/metabolism* ; Cell Line, Tumor ; Cell Proliferation ; Melanoma/genetics* ; Membrane Proteins/genetics* ; Phosphorylation ; Signal Transduction

Objective    To investigate the clinical characteristics and treatment of primary mediastinal yolk sac tumor (PMYST). Methods    We collected the clinical data of PMYST patients who were admitted to the Department of Thoracic Surgery of Peking Union Medical College Hospital from September 2000 to September 2020. The clinical and pathological characteristics, treatment and prognosis of PMYST patients were retrospectively analyzed. Results     Finally 18 patients were enrolled, including 17 males and 1 female with a median age of 22.0 (16.6, 26.2) years. Patients had increased level of alpha fetoprotein (AFP). The pathological type can be single yolk sac tumor or combined with other mediastinal germ cell tumors. Chemotherapy and radical surgery were the main treatment methods. Extensive resection was feasible for patients with tumor invasion of other organs. Seven patients developed lung or pleural metastasis after operation, and 3 of them had extrapleural metastasis. One patient recurred within 1 year after surgery. All patients were followed up by telephone or outpatient department. At the last follow-up, 5 patients survived, 9 died, and 4 were lost to follow up, with a median survival of 16.8 months. The median disease-free survival was 14.9 months. The survival rates at 1, 3 and 5 years were 73.3%, 28.6% and 11.8%, respectively. Conclusion    PMYST often occurs in young-middle aged male patients. Preoperative puncture can provide an effective diagnostic basis. R0 resection, AFP returning to normal after treatment and no metastasis may be potential indicators of good prognosis. The overall prognosis of PMYST is poor, and some patients can achieve long-term survival after treatment.

Objective To investigate the clinical features, diagnosis, treatment and prognosis of ectopic adrenocorticotropic hormone (ACTH) syndrome caused by bronchopulmonary carcinoid. Methods Twenty patients (13 males and 7 females) with ectopic ACTH syndrome caused by bronchopulmonary carcinoid confirmed by surgical pathology were selected from March 2007 to May 2016 in our hospital. We collected and arranged the important clinical data of 20 patients and analyzed carefully. Results The mean age of 20 patients including 14 patients of typical carcinoid and 6 patients of atypical carcinoid was 38.85±15.31 years ranged 13-70 years. All patients had the typical clinical manifestation of Cushing's syndrome. All the thoracic lesions were located by thoracic computed tomography (CT) eventually. The concentration of serum cortisol and ACTH significantly decreased after surgery. Postoperative complications in 3 patients (15.00%) were severe pulmonary infection. Eighteen patients including 13 patients of typical carcinoid and 5 patients of atypical carcinoid were followed up. The median time of follow-up was 31.5 (12-122) months. There were 7 patients of stage Ⅰa, 1 patient of stage Ⅰb, 2 patients of stage Ⅱa and 8 patients of stage Ⅲa in the patients followed up. One patient underwent postoperative radiotherapy, and 4 patients with postoperative chemotherapy. During the follow-up period, one patient relapsed and there was no death. Conclusion Ectopic ACTH syndrome caused by bronchopulmonary carcinoid is a very rare disease. It is every difficult for clinicians to make early diagnosis and draw up plans of treatment without multidisciplinary collaboration. Chest CT is an important method of finding lesions and assessing the viability of surgery. Surgical treatment in early stage will be effective for this disease. And almost all of patients can achieve long-term survival after complete resection of tumors early.