Objective To investigate the clinical efficacy of re-modified Sugiura procedure for the treatment of portal hypertension.Methods The retrospective cohort study was adopted.The clinical data of 119 patients with portal hypertension who were admitted to Second People's Hospital of Yichang from June 2006 to October 2014 were collected.Seventy-two patients who underwent pericardial devascularization were allocated into the Hassab group,and the other 47 patients who underwent the re-modified Sugiura procedure were allocated into the R-M Sugiura group.All the patients firstly underwent splenectomy.The patients of the Hassab group received the classical surgery of pericardial devascularization,and the operation in the R-M Sugiura group was improved on the modified Sugiura procedure in several aspects:(1) the cardia was transected obliquely.(2) Paraesophageal vessels were preserved by selective pericardial devascularization.(3) The pedicled omentum covered the anterior anastomosis and was sutured to the posterior abdominal wall.Observed indices included (1) intraoperative and postoperative situations:operation time,volume of intraoperative blood loss,postoperative anal exhaust time and duration of postoperative hospital stay.(2) Postoperative complications:postoperative pleural effusion,perioperative digestive tract re-bleeding,difficult swallowing,portal vein thrombosis and gastric dynamic dysfunction.(3) Situation of follow-up.The follow-up was performed by telephone interview and outpatient examination to observe the grading of the esophageal varices at postoperative month 6 and 18 using gastroscope till February 2016.Measurement data with normal distribution were presented as x ± s,and comparison between groups was done by the t test.Count data were analyzed by the chi-square test.Ranked data were analyzed by Wilcoxon rank test.Results (1) Intraoperative and postoperative situations:operation time of the Hassab group and the R-M Sugiura group was (201 ± 27) minutes and (255 ± 32) minutes,respectively,with a statistically significant difference between the 2 groups (t =9.67,P ＜ 0.05).The volume of intraoperative blood loss,postoperative anal exhaust time and duration of postoperative hospital stay were (380 ± 86) mL,(2.7 ± 0.7) days,(14.2 ± 2.4) days in the Hassab group and (401 ± 72) mL,(3.0 ± 1.7) days,(15.1 ± 2.7) days in the R-M Sugiura group,respectively,showing no statistically significant difference (t =1.35,1.26,1.86,P ＞ 0.05).(2) Postoperative complications:dysphagia was detected in 3 patients of the Hassab group and in 10 patients of the R-M Sugiura group at the postoperative day 10,with a statistically significant difference between the 2 groups (x2 =0.86,P ＜ 0.05).However,dysphagia was detected in 1 patient of the Hassab group and in 4 patients of the R-M Sugiura group at the postoperative day 20,showing no statistically significant difference between the 2 groups (x2 =2.03,P ＞ 0.05).The number of postoperative pleural effusion,perioperative digestive tract rebleeding,portal vein thrombosis and gastric dynamic dysfunction of the Hassab group and the R-M Sugiura group were 23,6,10,8 cases and 20,1,6,6 cases,respectively,showing no statistically significant difference (x2=1.39,1.02,0.03,0.08,P ＞ 0.05).(3) Situation of follow-up:all the patients were reexamined using gastroscope to observe the grading of esophageal varices.There were 0,7,56,9 patients of G0,G Ⅰ,G Ⅱ,G Ⅲ grading of varices in the Hassab group and 35,12,0,0 patients in the R-M Sugiura group at postoperative month 6,showing a statistically significant difference between the 2 groups (Z =-9.64,P ＜ 0.05).There were 0,0,48,24 patients of G0,G Ⅰ,G Ⅱ,G Ⅲ grading of varices in the Hassab group and 24,20,3,0 patients in the R-M Sugiura group at postoperative month 18,showing a statistically significant difference between the 2 groups (Z =-9.28,P ＜ 0.05).Conclusion The re-modified Sugiura procedure is more effective than the Hassab operation in curing portal hypertension,and it could also reduce the rate of rehemorrhage and improve the short-term and long-term prognosis.

Objective To investigate the changes of thyroid function and carotid atherosclerosis in patients on maintenance hemodialysis (MHD).Methods A total of 110 stable MHD patients undergoing hemodialysis for at least three months were enrolled in the study.Serum free-T3 (FT3), free-T4 (FT4) and thyroid stimulating hormone (TSH) concentrations were measured by electrochemiluminescence.Plasma levels of homocysteine (Hcy) and C-reactive protein (CRP) were detected.Clinical data and biochemical indicators were collected.These patients were divided into thyroid dysfunction group and euthyroidism group.Prevalence of atherosclerosis was detected by carotid ultrasonography.The associations between the changes of thyroid function and carotid atherosclerosis were analyzed by Logistic regression model.Results Among these 110 patients, 42 (38.18％) patients had thyroid dysfunction.Hcy and CRP concentrations were significantly higher in thyroid dysfunction group than those in euthyroidism group (P ＜ 0.05).The intima-media thickness, number of plague and arteriostenosis of carotid were higher in thyroid dysfunction group than those in euthyroidism group (P ＜ 0.05).Multivariate logistic regression analysis showed that increased Hcy and CRP, decreased serum FT3 were independent risk factors for carotid atherosclerosis.Conclusions Thyroid dysfunction with low serum FT3 is frequently found in MHD patients.In MHD patients, FT3 is closely correlated to carotid atherosclerosis.

A plasmids of continuous expressing shRNAs targeting the NDV NA-1 Phosphoprotein (P) gene was designed.Virus titration,Real Time RT-PCR,CPE indicated that P-specific siRNA could inhibit virus replication at 36 h post-virus infection.In future studies,a combination of siRNAs targeting the NP and L gene may be used as a tool to study NDV replication and antiviral therapy.

Objective To investigate the correlation between the number of resected lymph nodes(LNs) and the prognosis of patients with node-negative esophageal carcinoma.Methods A retrospective review of 429 patients receiving esophagectomy with morden two-field lymphadenectomy for cancer between January 1998 and December 2008 was performed.All patients were proved without lymph node involvement histopathologically.The prognostic impact of the number of negative LNs and the clinicopathologic factors were analyzed.Results The overall median survival time was 63.0 months,and the 1-,3-,and 5-year overall survival rates were 78.5％,64.0％ and 51.2％,respectively.Survival analysis confirmed that the number of negative LNs and the depth of tumor invasion were showed to be independent prognostic factors.Patients with a high number of negative LNs had better overall survival than patients with a low number of negative LNs(P ＜ 0.05).The patients had better long-term survival outcomes with dissected LNs counts of more than 15 for cases with pT1 tumor(P ＜ 0.05),and more than 20 for cases with pT2-3 tumor(P ＜ 0.05).Conclusion The number of negative lymph nodes is an independent prognostic predicting factor for node-negative esophageal carcinoma.Sufficient dissection of LNs is recommended to improve the survival of patients with node-negative esophageal carcinoma.

Objective:The aim of our study was to compare the short-term and long-term outcomes between minimally invaisive Ivor-Lewis esophagectomy(MIILE)and minimally invasive McKeown esophagectomy(MIME) for squamous cell carcinoma of middle and lower esophagus.Methods:The data of 268 patients diagnosed with middle and lower esophageal spuamous cell carcinoma who had received MIILE or MIME between August 2010 and March 2014 at department of thoracic surgery, The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), was analyzed retrospectively. We divided the subjects into two groups according to the mode of the operation, each group was identified 81 patients after propensity score matching. We were using t test, χ2 test, Kaplan- Meier curve and Log- rank test to compare preoperative data and overall survival of the two groups. Results:Compared with MIME, MIILE had lower complication in pulmonary infection and anastomotic fistula, also had less operating time, whereas MIME had an advantage in the number of lymph nodes dissection adjacent to recurrent laryngeal nerve( P<0.05). The 1-year、3-year、5-year survival rate of MIILE were 87.7%、59.2%、45.9%, and the 1-year、3-year、5-year survival rate of MIME were 86.4%、58.7%、42.8%.There were no significant difference between two groups in 5-year survival rate. Conclusion:For squamous cell carcinoma of middle and lower esophagus, minimally invasive Ivor-Lewis esophagectomy and minimally invasive McKeown have no significant difference in long-term survival, but minimally invasive Ivor-Lewis esophagectomy has advantages in reduce the operating time, decrease pulmonary infection and anastomotic fistula during perioperative period.Nevertheless minimally invasive McKeown has an advantage in dissection of the lymph nodes adjacent to recurrent laryngeal nerve.

OBJECTIVETo compare the effect of minimally invasive Ivor-Lewis esophagectomy with traditional Ivor-Lewis esophagectomy on the quality of life in patients with middle thoracic esophageal carcinoma.

METHODSRetrospective analysis was performed on 121 patients with middle thoracic esophageal carcinoma, of whom sixty patients underwent minimally invasive Ivor-Lewis esophagectomy(endoscopic group) and sixty-one patients underwent traditional Ivor-Lewis esophagectomy (open group). All the items of EORTC questionnaire QLQ-C30, seven items of QLQ-OES18 and two additional items(right upper limbs activity obstacle and numbness of right chest wall) were used to evaluate the quality of life.

RESULTSThe scores of global quality of life, physical functioning, role functioning, social functioning, fatigue, pain, dyspnea and troublesome coughing were more favourable in endoscopy group than those in open group at 4-week and 12-week after operation(P<0.05). However, the advantage of endoscopy group only sustained in global quality of life, physical functioning and fatigue at 24-week after operation(P<0.05). Furthermore, the scores of pain, right upper limbs activity obstacle and numbness of right chest wall were less in endoscopy group than those in open group at 4-week, 12-week and 24-week after operation.

CONCLUSIONMinimally invasive Ivor-Lewis esophagectomy is associated with less trauma, shorter time of recovery and better postoperative quality of life.

Carcinoma ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Postoperative Period ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires

OBJECTIVETo apply the membrane separation process in the concentration process of Chuanxiong Chatiao granules and to lay the foundation for its industrialized application.

METHODThe type of membrane, the optimal pressure, the optimal temperature and the optimal detergent were selected by the single factor method. A comparative study was conducted between qualities of extracts from Chuanxiong Chatiao granules by new and traditional processes.

RESULTThe type of membrane was determined to be SMN-130A2350054. The optimal pressure was 1.7 MPa. The optimal temperature was 36 degrees C and the optimal detergent was 1% sodium polyphosphate. The qualities of extracts from Chuanxiong Chatiao granules by new and traditional processes showed no difference.

CONCLUSIONThe selected membrane separation process can effectively achieve concentration and save energy. The extracts from Chuanxiong Chatiao granules by the new process show no difference with traditional processes. Therefore, it provides basis for the industrialized application of Chuanxiong Chatiao granules.

Drugs, Chinese Herbal ; chemistry ; Technology, Pharmaceutical ; methods

Objectives: To evaluate the diagnostic value of CT for lymph node metastasis of thoracic esophageal carcinoma with a diameter of more than 1 cm, and to find the optimal diagnostic index by comparing relevant CT indexes. Methods: Totally 80 patients with pathologically proved thoracic esophageal cancer with preoperative CT examination revealed lymph node diameter greater than 1 cm admitted at Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China from January 2016 to January 2018 were enrolled in this study. There were 70 males and 10 females, aging of (60±14) years (range: 40-85 years). According to the pathological result of lymph nodes, all the patients and lymph nodes were divided into two groups (N+group: 47 patients, 62 lymph nodes; N-group: 33 patients, 39 lymph nodes). The average number of dissected lymph nodes were 21±4 and 101 lymph nodes′ diameter were greater than 1 cm. The clinicopathologic factors, postoperative complications, lymph node dissection and relevant CT indexes like the minimum diameter of lymph nodes (Min D), the maximum diameter of lymph node (Max D), lymph node axial ratio(LAR), the enhancement of lymph node (ELN) and the boundary of lymph node (BLN) were compared. The clinicopathological data, lymph node dessection and CT parameters of the two groups were compared by t test, χ² test or Wilcoxon rank sum test. Receiver operating characteristic (ROC) curve analysis was used to compare the ability to predict lymph node metastasis between Min D, Max D, LAR, ELN and BLN. Multiple Logistic regression analysis were performed to determine the independent variables for prediction of lymph node metastasis. Results: The difference of tumor segmentation, pN stage, pTNM stage, total number of metastatic lymph nodes, total number of abdominal lymph node metastases, Min D, Max D, ELN and BLN between the two groups were statistically significant. The results of univariate and multivariate analyses showed that gender (OR=0.128, 95%CI: 0.019 to 0.858, P=0.034), pTNM stage (OR=1.514, 95%CI: 1.020 to 2.247, P=0.039), Min D (OR=0.102, 95%CI: 0.010 to 0.995, P=0.050) and LAR (OR=0.195, 95%CI: 0.052 to 0.731, P=0.015) were the independent relative factors. The area under the curve of ROC curve analysis of Min D, Max D, LAR, ELN and BLN were 0.679, 0.666, 0.561, 0.650 and 0.820, respectively. BLN was the best CT index to diagnosis lymph node metastasis, while the accuracy of dignosis of lymph node metastasis of BLN was 97.0%. The Youden index of Min D, Max D and LAR were 1.25 cm, 1.64 cm and 0.77, respectively. Combining the BLN and ELN had a higher diagnostic rate (97.0%) of lymph node metastasis. Conclusions CT has high diagnostic value for lymph node metastasis in thoracic esophagel cancer when the lymph node diameter is greater than 1 cm. BLN is the best diagnostic index for lymph node metastasis.

Inflammatory bowel disease(IBD),including ulcerative colitis and Crohn's disease,was often associated with malnutrition in the course of disease development. Enteral nutrition ( EN ) can improve the nutritional status of IBD patients, relieve the illness, and promote the recovery of the disease. Therefore, we should pay attention to the significance of EN in the IBD treatment,and strengthen the implementation of EN in IBD patients.

To investigate the feasibility, safety and short-term efficacy of modified inflatable video-mediastinoscopy in patients with early esophageal cancer. Methods The study retrospectively evaluated 54 patients with cT1N0M0 esophageal carcinoma who received minimally invasive esophagectomy in the First Affiliated Hospital of University of Science and Technology of China between July 2017 and June 2018. Of those patients, 23 patients underwent modified inflatable video-assisted mediastinoscopic transhiatal esophagectomy(MIVMTS) and 31 underwent minimally invasive McKeown esophagectomy (MIME). The clinicopathologic factors, operational factors, postoperative complications and lymph node dissection of patients were compared. Results There was no significant difference in clinicopathological data between the MIVMTS group and MIME group. The incidence of total minor postoperative complications, pulmonary infection of minior postoperative complications, total postoperative complications and total pulmonary complications in MIME group were higher than MIVMTS group. The incidence of recurrent laryngeal nerve injury, arrhythmia and air leaks in minior and pulmonary infection, chylothorax, anastomotic fistula in major postoprative complications were no different in the two groups with P >0. 05. The intraoperative blood loss, duration of surgery and postoperative thoracic drainage fluid volume of MIVMTS group were less than MIME group, the difference was statistically significant. The postoperative hospitalization of the two groups have no statistics significance(P >0. 05). There were no significant difference in the lymph node dessection of the left laryngeal recurrent nerve lymph nodes, paraesophageal lymph nodes, subcarinal lymph nodes and superior phrenic lymph node of the two groups. However, when compared with MIVMTS group, the MIME group have advantage in the right laryngeal recurrent para-nerve lymph node dissection. Conclusion MIVMTS can be safely and effectively performed for early esophageal cancer with favorable short-term efficacy.