Extended lymph node dissection helps increase the radical resection rate,the accuracy of surgical-pathological staging,and the distant prognosis of thoracic esophageal carcinoma.However,it is also associated with significantly increased surgical morbidity and has noticeable negative effects on the quality of life after surgery.Selective lymph node dissection based on clinical evidences is helpful in reducing surgical risks while assuring the completeness of resection.

Objective The influence of myasthenia gravias(MG) upon the long term survival of thoma patients varied in the retrospective studies as reported,including the positive,negative impact and irrelevant influence.The recent study from the Chinese Alliance for Research on Thynic Diseses(ChART) indicated that in different stages of thymoma,MG influenced the prognosis in different ways.It's the author's conclusion that the complicated influences of MG on the prognosis of thymoma include a direct one which is negative resulting from MG related complications and an indirect positive one due to its beneficial pathologic and staging patterns.Inprovement of the prognosis for patients with thymoma complicating MG will be expected with advancement in MG therapeutics.

Objective To investigate risk factors for feeding intolerance of preterm infants under the reactive scope model guidance, and provided empirical evidence for effective prevention and treatment of feeding intolerance in preterm infants. Methods Checked the cases of 242 preterm infants been treated in the neonatal department from August 2014 to January 2015 according to the order of admission. Through literature reviewing and expert consultation, the clinical observation table was designed based on the reactive scope model, and risk factors for feeding intolerance of preterm infants were investigated by single factor analysis and logistic regression analysis from the feeding intolerance (FI) group and non-FI group. Results The incidence of feeding intolerance in preterm infants was 33.8%(70/207), feeding intolerance in preterm infants often occurred during the period of being fed within 72 hours, and the clinical manifestations were gastric retention, abdominal distension and emesis. Single factor analysis showed that gestational age, birth weight, fetal distress, aminophylline application, intrauterine infection, breast milk feeding and twice stool interval were the related factors to the feeding intolerance. Logistic regression analysis showed that gestational age and birth weight were the protective factors of FI. Fetal distress, aminophylline application, twice stool interval >3 d were the risk factors of FI. Conclusions Gestational age and birth weight were the protective factors of FI. Fetal distress, aminophylline application, twice stool interval>3 d were the risk factors of FI.

Objective To increase the radical resection rate and decrease local-regional relapse rate in thoracic esophageal carcinoma. Methods One-hundred and four patients were prospectively randomized to receive esophagectomy with thoraco-abdominal 2-field lymphadenectomy (48 cases) or with lymph node sampling (56 cases). In 101 patients who survived after surgery, 29 received adjuvant chemotherapy with cisplatin and fluorouracil (FP). Results Comparing with lymph node sampling, the operation time for lymphadenectomy was prolonged. However, there was no increase in blood loss, surgical morbidity, or mortality. Mean stations of lymph node dissected (10.5 stations vs. 3.2 stations,P

Objective To study the respiratory and circulatory changes in elderly patients, and their relationship with pulmonary complications after thoracotomy. Methods 58 elderly patients either aged over 75 years, with major organ dysfunction or underwent highly invasive procedures (group 1). Respiratory and circulatory status, including arterial blood gas under room air, water balance, urine gravity, and hemodynamics monitoring through pulmonary artery catheter were documented. The results were compared with those from 56 young patient controls receiving thoracotomy in the same period (group 2). Results All 12 patients having pulmonary complications were from group 1 (group 1A). Ten of them presented on the 2nd or 3rd postoperative day with hypoxemia. The other 2 died of type II respiratory failure after severe infection. Preoperative pulmonary co-morbidity (P=0.026, Exp(B)=5.4) and obesity (P=0.043, Exp(B)=4.9) were identified as independent risk factors for pulmonary complications after thoracotomy in elderly patients. During the first 3 postoperative days, PaO_2 of group 1A was significantly lower than group 2 as well as the other elderly patients who did not develop pulmonary complications after surgery (Group 1B). PaCO_2 of group 1A and 1B were significantly lower than group 2. There were also significant differences between the three groups in water balance on the first postoperative day (group 1A +832ml, P=0.006 vs. group 1B +109ml, P=0.004 vs. group 2 -243ml ). Urine gravity in group 1A was also significantly higher than in group 2 in the first 3 postoperative days. Pulmonary artery catheter monitoring revealed increased cardiac output and decreased systemic vascular resistance, showing a hyperdynamic status, in elderly patients after surgery. Pulmonary vascular resistance was elevated in the same time. Conclusion Pulmonary co-morbidities commonly seen in elderly patients are responsible for pulmonary complications, the major cause of surgical mortality after thoracotomy. Hypoxemia in the early postoperative period is mainlycaused by relative volume overloading from trauma induced interstitial edema. Close monitoring of arterial blood gas under room air, water balance, and urine gravity after thoracotomy may identify elderly patients at risk of developing pulmonary complication and prompt timely intervention.

Objective:To summarize the major risk factors of infection in the process of cleaning and disinfection of endoscopy center in our hospital,and formulate the corresponding prevention measures to reduce the incidence of endoscopic infection so as to ensure medical safety of patients.Methods:The specialist check the cleaning disinfection process,statistics of each link in the risk factors of infection.600 endoscopes were taken at random after disinfection,endoscopic inner cavity and the outer surface samples are collected,the cleaning and disinfection of the test results for evaluating quality indicators.Results:Testing 600 samples of qualified 584,and the percent of pass is 97.3％,gastroscopy,colonoscopy,duodenum mirror,bronchoscope,endoscopic ultrasonography qualified rate was 98.6％,96.8％,95.6％,96.0％,97.2％,respectively.28 strains of pathogenic bacteria were detected in 16 cases of unqualified samples,including 13 strains of helicobacter pylori,7 strains of escherichia coli,4 strains of pseudomonas aeruginosa,2 strains of pseudomonas aeruginosa,1 strains of staphylococcus aureus,1 strains of Klebsiella pneumoniae;16 cases to detect unqualified reason analysis,scrub incomplete accounted for 37.5％,Not according to the instructions required to use multi-enzyme and disinfectant accounted for 18.75％,special infected patients did not do special treatment of endoscopy accounted for 12.5％,endoscopic insufficient drying and the staffhand hygiene is not up to standard accounted for 12.5％,respectively.Conclusion:Endoscopic cleaning and disinfection aspects of infection caused by many factors,infection control education should be strengthened for all personal in the endoscopy center,regular professional training of cleaning and sanitation personal,cleaning and disinfection process should be standardized management,establish traceability registration system,control the quality of the endoscope cleaning and disinfection from each link.It is the main measure to prevent digestive endoscopy center in infection.

Objective The aim of this study is to evaluate the effects of drug,electric cardiovertion,radiofrepuency ablation and implantable anti-atrial-fibrillation pacemaker on patients with persistent idiopathic atrial fibrillation.Methods 58 patients with persistent idiopathic atrial fibrillation were treated with drug or electric cardjovertion,radiofrequence ablation and anti-atrial-fibrillation pacemaker.Results There were 30 patients successfully converted to sinus rhythm by drug.The mean conversion time of drug was 8?5 days.22 patients were converted by electric cardioversion.10% of cases(6 of 58)failed to convert by both methods.In follow-up period,12 cases of patients were healed,19 cases got significant improvement,14 cases got moderate improvement,8 cases had no improvement.The total efficiency rate was 76%.18 cases in successful cardioversion patients were healed,5 cases got significant improvement,5 cases got moderate improvement,4 cases had no improvement.The total efficiency rate was 75%(14 of 18).2 cases got improvement by anti-atrial-fibrillation pacemaker.Conclusion Combined treatment of drug,electric cardioversion,radiofreqency ablation and anti-atrial-fibrillation pacemaker can imrove cure rate of persistent idiopathic atrial fibrillation.

Objective To investigated the clinicopathological findings and prognosis of 60 patients with pleomorphic carcinoma.Methods 60 cases of pleomorphic pulmonary carcinoma were collected and studied clinicopathologically between 1999 and 2011.All patients underwent pulmonary resections.Results There was no in-hospital death.1 had haemothorax that required reoperation,1 patient had a late cicatricial bronchial stenosis after sleeve lobectomy of the upper right lobe,and treated successfully by the resection of the right two lobes.The 3,5-year survival rates of all patients were 47.2％ and 25.6％ respectively.For N0 and N1-N2 patients,3-,5-year survival rates were 57.3％,32.5 ％ and 25.4％,17.1％,respectively.Overall survivals were of significant difference between radical resection and uncomplete resection.Multivariate Cox regression analyses of overall survival of all 60 patients indicated that radical resection (P =0.041) and nodal status (P =0.029) were significant independent prognostic factors.Conclusion Pleomorphic carcinoma is a rare type of lung cancer.Pleomorphic carcinoma of the lung was often found as a large mass peripherally located and was associated with poor prognosis.Radical resection and nodal status were significant independent prognostic factors.

In the present study, a finite element model of L4-5 lumbar motion segment was established based on the CT images and a combination with image processing software, and the analysis of lumbar biomechanical characteristics was conducted on the proposed model according to different cases of flexion, extension, lateral bending and axial rotation. Firstly, the CT images of lumbar segment L4 to L5 from a healthy volunteer were selected for a three dimensional model establishment which was consisted of cortical bone, cancellous bone, posterior structure, annulus, nucleus pulposus, cartilage endplate, ligament and facet joint. The biomechanical analysis was then conducted according to different cases of flexion, extension, lateral bending and axial rotation. The results showed that the established finite element model of L4-5 lumbar segment was realistic and effective. The axial displacement of the proposed model was 0.23, 0.47, 0.76 and 1.02 mm, respectively under the pressure of 500, 1 000, 1 500 and 2 000 N, which was similar to the previous studies in vitro experiments and finite element analysis of other people under the same condition. The stress distribution of the lumbar spine and intervertebral disc accorded with the biomechanical properties of the lumbar spine under various conditions. The established finite element model has been proved to be effective in simulating the biomechanical properties of lumbar spine, and therefore laid a good foundation for the research of the implants of biomechanical properties of lumbar spine.
Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Intervertebral Disc ; anatomy & histology ; Lumbar Vertebrae ; anatomy & histology ; Models, Anatomic ; Pressure ; Prostheses and Implants ; Range of Motion, Articular ; Rotation

Objective To explore the subcellular localization of Galectin-9 and its effect on allogeneic immune response.Methods The plasmid pEGFP-N1 was inserted with Galectin-9 fragment which was amplified from pBKCMV-Galectin-9 by PCR.The recombinant plagmid wag then transfected into CHO cells using JetPEI in vitro.The cells were cultured in G418 selecting mediam to obtain the stably-transfected cells.The transcription and expression of Galectin-9 gene were verified by immunohistochemical staining and RT-PCR.The solid-phase transgenic CHO cells or freshly-cultured supernatant wag added into the mixed lymphocyte response system to detect the inhibitory effect of Galectin-9.Galectin-9 protein wag administered intraperitoneally for 7d consecutively.Results The expression of Galectin-9 wag localized in the cytosol of CHO.The allogeneic mix lymphocyte proliferation was dose-dependently inhibited by the freshly-cultured supernatant from stably-transfected CHO cells.Furthermore,the supernatant from stably-transfected CHO cells dose-dependently inhibited the level of IL-2.The inhibitory effect could be reversed by Tim-3-Fc blocking.Administration of Galectin-9 significantly prolonged the survival of allogeneic cardiac transplants[(22.7±1.2)d vs(7.2±0.4)d)].Conclusion Galectin-9 may be secreted in physical situation to exert its immunomodulatory function on allogeneic immune response.Furthermore.Galectin-9 may be a novel therapeutic drug in transplant medicine.