Objective To discuss the indication, the prevention and treatment of complications of the esophagectomy through left thoracic and neck approach. Methods 2?058 cases of esophageal carcinoma were analyzed retrospectively. Results The success rate of this procedure was 98.40%, and 33 cases died postoperatively, the mortality was 1.60%(33/2?058). Lymph node metastases were presenting 895 cases. The gross rate of lymph node metastasis was 43.49%(895/2?058), the rates of 1ymph nodes metastasis in neck, chest and abdomen were 5.12%(107/2?058), 42.50%(875/2?058) and 21.19%(436/2?058), respective1y. The occurrence rate of residual carcinoma was 1.51%(31/2?058). The complication rate was 15.74%(324/2?058). 1?870 cases were followed-up (90.86%). The overall 3-, 5-year survival rates were 61.22%(895/1?462) and 36.45%(384/1?053), respectively. Conclusion The advantages of this approach were relatively radical resection, 1ow incidence of residual carcinoma, less severe complications.

1. The blood supply of the tensor fascia lata myocutaneous free flap comes chiefly from the ascending branch of the lateral circumflex artery (76.74％) or its ascending and the transverse branches (23.26％). In most cases the ascending branch may be served as the vascular pedicle of myocutaneous free flap in transplatation. In a few cases the transverse branch my be used instead of the ascending one.2. The projection of the origin of the lateral circumflx artery on the body surface is at a point averaging 96.5mm below, and 49.2mm medial to the anterior superior iliac spine. This point is the surface landmark of the lateral circumflex artery. 3. The branches of the lateral circumflex artery may be classified into four types. Type 1—32 cases, 74.42％; Type Ⅱ—3 cases, 6.98％; Type Ⅲ—7 cases, 16.28％; Type Ⅳ—1 cases, 2.33％.4. The tensor fascia lata is chiefly supplied by the ascending branch of the lateral circumflex artery, it divides into a short superior and a long inferior twigs. Both twigs enter the muscle and form abundant anastomoses in the subcutaneus tissues. In order to reduce the thick ness of the free flap for the use in plastics, the superior twig with its supplying muscle is cut away and the inferior one's left to supply myocutaneus flap.5. The angle between the ascending branch and the inner surface of the tensor fasca lata varies between 44? to 120?, with an average of 66.5?. The original angle must be kept in transplantation, which favours the survival of the myocutaneus free flap.

Objective To study the relationship between obstructive sleep apnea syndrome(OSAS) in the elderly and the occurrence and development of arrhythmia. Methods A total of 120 OSAS patients and 40 normal controls were selected and their polysomnography(PSG) or dynamic blood oxygen and analyzed holter were monitored. Results The total number of the reduction in apnta hypopnea index (AHI) and arterial orygen saturation (SaO 2) over 0.04 and the lasted period during SaO 20.05), while the incidences of the intermediate and serious groups significantly increased(P

Objective To investigate the differences and significance of blood levels of T helper 17 (Th17) cell and interleukin17 (IL-17) between peripheral and culprit vessels in patients with acute coronary syndrome.Methods A total of 76 patients recruited in 2012 were divided into three groups according to the coronary angiography and clinical manifestations:acute coronary syndrome,stable angina and control groups.The blood samples were taken from cubital vein and culprit coronary artery after coronary angiography.The percentage of Th17s among CD4+ T cells was detected by flow cytometric analysis and the IL-t7 levels were measured by enzyme-linked immunosorbent assay.Results There was no significant difference in the percentages of Th17 cells between peripheral blood and culprit artery blood [(3.18 ± 0.29) ％ vs.(3.17 ±0.30)％,(P =0.919)];but the perecentages of Th17 in peripheral blood were found to be significantly higher in patients with acute coronary syndrome (3.18 ± 0.29)％ than those with stable angina (1.32 ± 0.31) ％ and those without coronary heart disease (1.28 ± 0.33) ％,(P ＜ 0.01).There was no significant difference in the level of IL-17 between peripheral blood and culprit artery blood [(81.23 ± 18.63) vs.(82.37 ±20.51) pg/mL,P =0.573];but the level of IL-17 in peripheral blood was also significantly higher in patients with acute coronary syndrome than those with stable angina and those without coronary heart disease [(81.23 ± 18.63) vs.(25.96 ± 14.58) pg/mL or (23.75 ± 13.64) pg/mL,P ＜0.01].Conclution There were no significant differences in percentage of Th17 cell among CD4 + T cells and levels of IL-17 in blood between peripheral and culprit vessels in patients with acute coronary syndrome.The percentage of Th17 among CD4 + T cells and the levels of IL-17 in blood increase in patients with acute coronary syndrome suggesting a potential role of Th17 and IL-17 in the development and instability of the atheroma.

Objective To investigate the molecular mechanisms of effect of glycogen synthase kinase -3beta( GSK3β) on proliferation of human osteosarcoma cells .Methods Normal osteoblast hFO and osteosarcoma cell lines were examined for GSK 3βexpression and activity by Western blot and in vitro kinase assay ( NIRKA) . The effects of small molecule GSK3βinhibitors on cell proliferation and apoptosis were examined .Depletion of en-dogenous GSK3βby GSK 3βsiRNA detected the expression and phosphorylation of p 27 and its downstream cy-clinD1-CDK-Rb pathway factor by Western blot .Human osteosarcoma cell xenografts ,in athymic mice model , were treated with DMSO as control or with GSK 3βinhibitor SB-216763 or AR-A014418 by intraperitoneal in-jection,3 times a week.The tumor growth and body weight were observed in nude mice .Results Osteosarcoma cell lines showed increased GSK 3βexpression and decreased serine 9 phosphorylation compared with normal oste-oblast cells.Inhibition of GSK3βresulted in attenuated cell proliferation and increased apoptosis in most osteosar-coma cell lines in vitro and in vivo in MG 63 xenografts in rodents but not in hFOB cells .We decreased endoge-nous GSK3b activity,tumor growth was inhibited in SB216763,AR -A014418 group compared with control group.There was statistical significance(P<0.05).GSK3βinhibition in osteosarcoma cells was associated with decreased p27 expression, Rb expression and phosphorylation level of decline , CDK2, 4, 6 protein level de-creased,the upregulation of cyclin D1 expression but the phosphorylation level of no effect .Conclusion In this research,we demonstrate that deregulated GSK 3βsustains osteosarcoma cells survival through modulation of p27and cyclinD1-CDK-Rb pathway.The result will open up a potential target for clinical treatment of osteosar -coma.

The arterial source of the flap,the anastomoses of cutaneous arteries in theskin and subcutaneous tissue and nervous distribution in the flap were observed andsurveyed in 42 upper limbs of adult cadavers.1.The arterial source of the flap comes mainly from the cutaneous branches ofprofund brachial artery,radial collateral artery,lateral humeral cutaneous artery andcutaneous branches of the posterior circumflex humeral artery.In most cases theprofund brachial artery and radial collateral artery may be served as the vascularpedicle of the flap of lateral brachium in transplantation.2.The cutaneous arteries in this flap anastomose each other to from a networkin the skin and subcutaneous tissue.Cutaneous arteries arising from the medial brac-hial region and the upper part of forearm also participate in the formation of thisvascular network.3.The veins of the flap contain both superficial and deep groups:The superfi-cial group is the cephalic vein of brachium which goes upward along the lateralsulcus of m.biceps brachii and its outer caliber is somewhat wider;the deep groupfollows the profund brachial artery or radial collateral artery as their venae comit-antes.Both groups may be sutured together or separately with veins of the recipientin skin grafting.4.The lateral brachial cutaneous nerve and posterior antebrachial cutaneousnerve pierce through the lateral intermuscular septum at various levels,and innervateover the skin in lateral brachial and posterior forearm regions.Since the posteriorbrachial cutaneous nerve is accompanied closely by the radial collateral artery,muchattention should be paid to it in cutting skin flap.5.The extent of cutting a skin flap in lateral brachial region can be enlargeddue to free anastomoses with arteries of adjacent regions which was demonstrated byperfusing red ink into profund brachial artery.The flap of lateral brachium maybe subdivided into following three parts:the upper,middle and lower,the vascularpedicle of which are the cutaneous branch of posterior circumflex humeral artery,lateral humeral cutaneous artery and profund brachial artery(or radial collateralartery)respectively.

Brain ; abnormalities ; diagnostic imaging ; Humans ; Infant ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Twins, Conjoined

The cutaneous arteries of the forearm and their anastomoses in skin and subcutaneous tissue were invetigated on 35 upper limbs.1. The average length of the radial artery is 215.3 mm. This artery can be divided into a covered part and a exposed part. Their lengths are 117.7 mm. and 101.4 mm. respectively. The calibers of the upper end, the intermediate point, and the lower end of the radial artery are 2.7mm, 2.3 mm and 2.4 mm respectively.2. The exposed part of the radial artery sends out more cutaneous branches (9.6 branches) than the covered part (4.2 branches), While their muscular branches are nearly equal in number. The calibers of the cutaneous and muscular branches of the radial artery varies from 0.3～0.5 mm.The fine anastomoses of the cutaneous branches exist between the radial and ulnar arteries and between the radial and ulnar arteries and the dorsal interosseus artery and they form an arterial networks in the subcutaneous tissue of the whole forearm. For blood supply a skin flap may be cut from the whole forearm from the standpoint of morphology.4. The calibers of the radial and cephalic veins at the level of middle part of the forearm are 1.3 mm and 2.8 mm respectively. As the vasular pedicle both the veins should be anastomosed during transplant operation in order to increase the volume of the draining blood.5. The skin flap of forearm blongs to a type of blood supply of arterial trunk network, which have been distinguished with that of some other skin and myocutaneous flaps according to the anatomical characteristics of the radial artery.