Purpose:To improve the methads of approach in s urgery of esophageal cancer ,increase resection rate of esophagectomy, decrease the remnant cancer in margin and mortality after operation, enhance the postoper ative effect. Methods:From Jan.1999 to Dec. 2002,we adopted different surgica l approach as in esophagectomy in 297cases with esophageal cancer, such as left posterior thoracotomy(group I), left posterior thoracotomy with cervical incisi on (group Ⅱ),right anterior thoracotomy (group Ⅲ), right posterior thoracotomy (group Ⅳ). Results:The rate of operative resection was 98.7%(293/297)an d for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ they were 98.2%(86/87)、98.1%(52/53)、98.5%(133/135) 、100%(22/22) respectively;operation-related mortality was 1.7%(5/297) and fo r groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 2.3%(2/87)、1.9%(1/53)、0.75%(1/135)、4.5%(1/22) respectively;the occurrence of remnant cancer was 3.8%(11/293) and for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 4.7%(4/86)、3.8%(2/52)、2.6%(3/133)、9.1%(2/22) respective ly;the rate of postoperative complication was 12.8%(38/297) and for groups Ⅰ, Ⅱ, Ⅲ, Ⅳ it was 17.2%(15/87)、9.4%(5/53)、11.1%(15/135)、13.6%(3/22) respectiv ely. In the number of lymph node resected , there was statistical difference bet ween groups Ⅲ, Ⅳ and Ⅰ, Ⅱ(P0.05).Conclusions:Right anterior thoracotomy, right posterior thoraco tomy were more satisfactory operative approaches in radical total thoracic esop hagectomy of esophageal carcinoma. Through these two approaches,we not only can resect mediastinal and abdominal lymph nodes radically, but can also decrease t he cancer of at the margin and mortality after operation.

Objective To elevate accuracy of CT T4 staging diagnosis of esophageal carcinoma, we analysed relativity between CT diagnosis and postoperational pathology for the tracheal, bronchial, carinate early invasion. Methods From 1996 to 2002, 49 patients with cervical and middle-upper segment esophageal carcinoma proved by esophagectomy and pathology, whom were taken cervical or thoracic CT scaning before operation. Comparison was studied between postoperational pathology and CT diagnosis of tumor early invasion of the trachea, bronchus and carina. Results Of 49 patients with esophageal carcinoma, 21 lesions were in the cervical esophagus, out of 18 cases with tracheal early invasion performed by CT scaning, 14 cases comfirmed by postoperational pathology; 28 lesions in the middle-upper segment of thoracic esophagus, out of 17 cases with tracheal, bronchial or carinate early invasion diagnosed by CT scaning, 14 cases testified by postoperational pathology. Tracheal, bronchial and carinate early invasion of esophageal carcinoma proved by CT did not accord with postoperational pathology completely. The sensitivity, specificity, and accuracy of CT diagnosis for the tracheal, bronchial and carinate early invasion of esophageal carcinoma were 93.3 %, 33.3 %, 76.2 % in cervical esophageal and 82.4 %, 72.7 %, 78.6 % in thoracic esophageal respectively. The contingency coefficients of preoperational CT scaning comparison with postoperational pathology are 0.52, 0.77 respectively. Conclusion Early invasion to the trachea, bronchus and carina identified by conventional CT procedure for patients with esophageal cancer was more accurate and specific in thoracic than that in cervical. Esophageal tumor early invasion to the trachea, bronchus and carina performed with CT corresponded to postoperational pathology in some measure. Operatablity did not completely depend on the invasion of the trachea, bronchus and carina of esophageal carcinoma performed with CT.

10.3969/j.issn.2095-4344.2013.23.015

The discovery of microRNA (miRNA) has opened up a new train of thought for the diagnosis and treatment of esophagus cancer.let-7 is one of the most widely research of miRNA.In a variety of tumors,the expression of let-7 is down-regulated.let-7 can play the role of tumor suppressor gene by targeting to high mobility group A2 (HMGA2) and inhibit the cell proliferation.Recent studies have shown that the lower the degree of differentiation of cells,let-7 expression level is lower.It is expected as a symbol of poorly differentiated tumors.In addition,let-7 and esophagus cancer's radiation and chemotherapy sensitivity are closely related.

BACKGROUND:Old femoral neck fractures with senile osteoporosis have more surgical difficulties.There are a lot of intraoperative and postoperative complications and long-term effects are poor.OBJECTIVE:To explore the clinical outcomes of hip arthroplasty in patients with old femoral neck fractures with senile osteoporosis.METHODS:From October 2012 to July 2014,20 patients with old femoral neck fractures and senile osteoporosis were enroled in this study.Posterolateral approach was used to perform hip arthroplasty.Of them,14 patients received primary total hip arthroplasty with biological prosthesis,and 6 patients were subjected to semi-hip arthroplasty with straight shank cylindrical renovated biological prosthesis.RESULTS AND CONCLUSION: The patients were folowed up for 3 to 24 months.Harris score was apparently increased after arthroplasty in patients with old femoral neck fractures and senile osteoporosis compared with pre-arthroplasty.Postoperative radiographs revealed that femoral stem biological fixation was good.Bone fixation was visible in radiographs at 3 months after arthroplasty.These findings suggested that old femoral neck fractures and senile osteoporosis could be treated with hip arthroplasty.To select the type of prosthesis and surgical methods according to the femoral calcar-medulary cavity ratio in patients with old femoral neck fractures and senile osteoporosis can effectively restore the function of hip joint.

Objective To explore the impacts of enriched environment(EE),which has different initiation time points and intensity,on the neural and ethological prognosis and contents of myelin basic protein(MBP)of neo-natal rats with hypoxic - ischemic brain damage(HIBD). Methods HIBD rat models were established. Rats were divided into the early,the intermediate and the late intervention groups,which experienced EE from 7,14 and 21 days after HIBD for 14 days. The early and intermediate intervention groups were then divided into 6 - h and 24 - h groups, which experienced EE intervention for 6 hours or 24 hours respectively each day. Trapeze tests and water maze tests were carried out to detect the neural and ethological prognosis. Immunohistochemical method was used to detect MBP of the brain white matter,and the percentages of positive cells with MBP were detected by an image analyzer. The con-tents of MBP were measured. Results The trapeze test scores of the early and intermediate sham operation group,HI group,early 6 - h and 24 - h EE groups and the intermediate 6 - h and 24 - h EE groups,the late sham operation group,the late HI and late EE intervention group were(4. 05 ± 0. 88)scores,(2. 35 ± 1. 02)scores,(3. 67 ± 1. 12) scores,(3. 50 ± 1. 41)scores,(3. 50 ± 0. 93)scores,(3. 56 ± 1. 13)scores,(4. 00 ± 0. 89)scores,(2. 17 ± 1. 17)scores,(3. 50 ± 0. 92)scores,respectively. The trapeze test scores of early,intermediate and late EE groups were higher than those of the HI groups in the same period. There was no significant difference between the early,the intermediate 6 - h EE groups and 24 - h EE groups. Scores of water maze of each corresponding group were(40. 68 ± 23. 77)seconds,(56. 66 ± 10. 96)seconds,(46. 49 ± 19. 27)seconds,(51. 72 ± 20. 46)seconds,(38. 20 ± 18. 36)seconds,(47. 96 ± 20. 65)seconds,(38. 63 ± 20. 44)seconds,(59. 66 ± 13. 81)seconds and(45. 93 ± 22. 45)seconds,respectively. The water maze scores of the early,the intermediate 6 - h EE group and the late 24 -h EE groups were higher than those of the HI groups in the same period. There was no significant difference between the early,the intermediate 6 - h EE groups and the 24 - h EE groups. The relative abundance of MBP of the early and intermediate and the late HI groups were 6. 32 ± 1. 63 and 6. 74 ± 2. 19,and significantly less than that of the sham groups in the same periods,which were 9. 09 ± 1. 69 and 9. 37 ± 2. 46. The relative abundance of MBP of early 6 - h and 24 - h groups,the intermediate 6 - h and 24 - h groups and the late EE group was 7. 84 ± 2. 51,8. 05 ± 1. 86, 8. 89 ± 2. 29,8. 48 ± 2. 67 and 7. 98 ± 2. 09,respectively,which was significantly higher than that of the HI groups in the same periods. It showed that the neural and ethological prognosis of neonatal rats with HIBD could be improved,no matter the intervention began in the early,the intermediate or the late periods,or the intervention time was 6 hours or 24 hours each day. And relative abundance of MBP in the white matter increased with EE. Conclusions EE interven-tion has a long window stage for young rats. EE intervention could improve the neural and ethological prognosis of rats with HIBD. EE intervention could elevate the contents of MBP in the white matter,which could be one of the mecha-nisms for EE to improve the neural and ethological prognosis of rats with HIBD.

Objective To investigate clinicopathological features of scalp angiosarcoma, and to analyze the relationship of tumor stage and treatment with prognosis. Methods Clinical and follow-up data were collected from 16 patients with non-metastatic primary scalp angiosarcoma treated in the Department of Plastic and Reconstructive Surgery of Zhongda Hospital, Southeast University from September 2002 to June 2013. According to the seventh edition American Joint Committee on Cancer (AJCC)TNM staging system for soft tissue sarcomas (2010), staging of scalp angiosarcoma was performed for the 16 patients. Statistical analysis was carried out by the Kaplan-Meier method for survival rates and by the Log-rank test for survival curve. The Cox regression model was used for multivariate regression analysis. Results Of the 16 patients, 4 had stageⅠangiosarcoma, 4 stage Ⅱangiosarcoma, and 8 stage Ⅲ angiosarcoma. The tumor usually began as ecchymosis-like lesions on the head or face in early stage, and progressed into dark red infiltrative plaques, nodules and ulcers which easily ruptured and bled in later stage. Histopathological examination showed generalized vascular proliferation and infiltration with high histological morphological diversity. Cytologic atypia was commonly seen. The median time to recurrence was 15 months, and local recurrence occurred in 7 patients. The median time to metastasis was 20.5 months, and distant metastasis was observed in 8 cases, including 4 cases of pulmonary metastasis, 2 lymph node metastasis, 1 liver metastasis and 1 bone metastasis. The survival time was 33.0 ± 4.4 months (median, 32 months)in 4 patients with stage Ⅰangiosarcoma, 24.0 ± 7.9 months(median, 15 months)in 4 patients with stage Ⅱangiosarcoma, and 23.9 ± 3.9 months (median, 24 months)in 8 patients with stage Ⅲ angiosarcoma. Additionally, the survival time was 23.4 ± 5.2 months(median, 21 months), 24.4 ± 5.7 months(median, 24 months)and 35.8 ± 9.7 months(median, 26 months) in 5 patients receiving surgical treatment alone, 7 patients receiving surgical treatment and radiotherapy, and 4 patients receiving surgical treatment, radiotherapy and immunotherapy, respectively. Conclusions Surgical treatment combined with radiotherapy and immunotherapy may serve as the first-choice treatment for scalp angiosarcoma. Tumor size and treatment regimens are main factors influencing prognosis of scalp angiosarcoma.

Objective To explore the curative effect of ursodeoxycholi acid on retinopathy of prematurity (ROP) caused by high concentration of oxygen in newborn rats. Methods The model of ROP was established. Neonatal rats were divided into normal control group, ROP model group, low dose ursodeoxycholi acid treatment group (10mg/kg) and high dose ursodeoxycholi acid treatment group (40mg/kg). Rats were sacrificed at days 17. The new retinal vessels were observed and counted under lfuorescence microscope. Results The new retinal vessels in ROP rats were hyperplastic, twisted and unevenly distributed. There was signiifcant difference in the number of new retinal vessels among different groups (P=0.000). The number of new retinal vessels of rats in ROP group, low-dose group and high-dose group was signiifcantly more than that in control group (P=0.000). The number of new retinal vessels in low-dose group and high-dose group was significantly less than that in ROP group (P<0.05). The number of new retinal vessels in high-dose group was less than that in low-dose group (P>0.05). Conclusions Ursodeoxycholi acid could inhibit the angiogenesis of retina and could have curative effect on ROP.

Objective:To evaluate the levels of interleukin 18(IL-18) mRNA in peripheral blood mononuclear cells(PBMCs),livers and spleens in monkey endotoxic shock models.Methods:Cynomolgus monkeys were injected i.v. with lipopolysaccharide(LPS) (2.8 mg/kg) to prepare the endotoxic shock models. The mRNA levels of IL-18 in PBMCs,livers and spleens were tested by fluorescence semi-quantitative realtime reverse transcription(RT)-PCR and compared with that of TNF-? and IL-1?.Results:IL-18 mRNA expression in PBMCs remarkably increased at 120 min after LPS administration, so did in livers and in spleens at the same time. mRNA levels of TNF-? in PBMCs peaked at 60 min after LPS injection, and also increased markedly at 120 min in livers and spleens. IL-1? mRNA levels peaked at 60 min in PBMCs, and did not change so much in livers and in spleens.Conclusion:IL-18 mRNA expression in PBMCs can be up-regulated by LPS, but changed latterly than TNF-? and IL-1? in endotoxic shock cynomolgus monkeys. It is presumed that IL-18 can be produced by PBMCs and liver Kupffer cells(maybe splenic macrophages),and TNF-? is produced by a variety of cells, but IL-1? in bloodstream mainly come from PBMCs after LPS challenge.

AIM: To investigate the effects of testosterone on endothelial function and intimal proliferation after balloon injury in male rabbit abdominal aorta. METHODS: 24 male New Zealand white rabbits were divided randomly into three groups: control group ( n =8, sham castration), hypotestosteronemia group ( n =8,castration) and testosterone replacement group (n =8,castration +testosterone undecanoate intramuscular injection,14 mg/kg). Abdominal aorta was injured with 3 mm PTCA balloon after testosterone undecanoate had been injected for three days. Two weeks later, blood samples were obtained for detection of plasma testosterone, lipids, metabolic product of nitric oxide (NO - 2/NO - 3), superoxide dismutase(SOD) and malondialdehyde (MDA),and all the abdominal aorta were excised to be analyzed by computer. RESULTS: The intimal area of hypotestosteronemia group were significantly larger than that of other two groups( P