Objective To investigate the effect of great omentum combined with medical obturation glue on preventing thoracic cavity anastomotic leakage.Methods From August 2008 to September 2012,560 patients with esophageal gastric cardial carcinoma were enrolled and divided into two groups:the regular group (n =280) and the experimental group (n =280).In the regular group,anastomosis was reinforced with interrupted mattress sutures after esophageal gastric anastomosis was stapled.In the experimental group,anastomosis was covered with great omentum and medical obturation glue was sprayed to conglutinate after reinforced with interrupted mattress sutures.After that,gastric corpus was fixed upon the thoracic aorta and posterior chest wall.The clinical effects of the two groups were compared.Results Intrathoracic anastomotic leakage occurred in 8 cases (2.86％(8/280)) of the regular group,including 7 cases with symptomatic leakage and 1 case with asymptomatic loculate leakage.Seven patients were cured with conservative treatment and 1 patient with severe infection left hospital without cure.Average length of hospital stay was (55.6 ± 30.5) days postoperatively.Anastomotic stenosis occurred in 11 patients (3.93％,11/280).In the experimental group,one patient (0.36％,1/280) with asymptomatic loculate leakage was hospitalized for 20 days,and finally cured and discharged.8 cases with anastomotic stenosis occurred in the experimental group (2.86％,8/280).There was statistic difference in the rate of intrathoracic anastomotic leakage between the two groups (P =0.044),but there was no statistic difference in anastomotic stenosis between the two groups (P =0.484).Conclusion The technique of great omentum combined with medical obturation glue for preventing thoracic cavity anastomotic leakage,which is easy to perform,can obviously decrease the occurrence and attenuate the symptom of intrathoracic anastomotic leakage,and anastomotic stenosis increases unobviously.It also can shorten the length of hospital stay and is worthy of clinical promotion.

Objective To investigate the various occasions of invasive mechanical ventilation in patients with acute left heart failure. Methods Thirty-two patients with acute severe left heart failure were divided into two groups:17 patients were treated with non-invasive mechanical ventilation (non-invasive mechanical ventilation group) and 15 patients were treated with invasive mechanical ventilation (invasive mechanical ventilation group). The respiratory rate (RR), arterial oxy-gen partial pressure p(O2), heart rate (HR) and mean arterial pressure (MAP) were observed after treatment for 0.5 h,1 h and 3 h in two groups of patients. The in-hospital mortality was compared between two groups. Results Ten patients of non-in-vasive mechanical ventilation group were in remission after 0.5 h, 7 cases without remission switched to endotracheal intuba-tion for invasive mechanical. And 3 of them were in remission in 0.5~1 h, 4 of them dead. Fourteen patients in invasive me-chanical ventilation group were in remission after 0.5 h, one case was in remission after 0.5~1 h and no dead in this group. There were more patients in remission after 0.5 h in invasive mechanical ventilation group than those of non-invasive me-chanical ventilation group (P=0.041). There were no significant differences in the number of patients in clinical remission af-ter 0.5~1 h and mortality between two groups. The values of RR and HR were decreased with the increasing treatment time in two groups. The values of p(O2) and MAP were increased with the increasing treatment time in two groups. There was a sig-nificantly lower RR at 0.5 h and 1 h in invasive mechanical ventilation group than that of non-invasive mechanical ventila-tion group (P ＜ 0.05). The values of p(O2) and MAP were significantly higher at 0.5 h in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group (P＜0.05). The levels of HR at 0.5 h and 3 h were significant-ly lower in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group ( P＜0.05). Con-clusion Invasive mechanical ventilation should be used as soon as possible if non-invasive mechanical ventilation can not alleviate the symptoms in patients more than 0.5 hours.

The prognosis of hepatocellular carcinoma (HCC) is closely associated microvascular invasion (MVI), and in recent years, more and more clinical studies have been conducted on MVI, but there are few articles on the development of basic pathology and related controversies. As the basis of clinical research, it is of great significance to understand the definition of MVI and the controversy over pathological grading. With reference to related articles, this article reviews the development history of the definition of MVI, analyzes the current status of the research on the criteria for pathological grading of MVI, and assesses the value of different criteria in predicting postoperative recurrence of HCC, so as to provide a reference for the clinical research on MVI.

Objective To evaluate the feasibility,safety and clinical value of CT-guided localization with a Hook-wire system for nodular pulmonary lesions before video-assisted thoracoscopic resection (VATS). Methods The records of all patients undergoing VATS resection for solitary pulmonary nodules preoperatively localized by CT-guided a Hook-wire system were assessed with respect to failure to localize the lesion by the Hook-wire system, conversion thoracotomy rate, duration of operation, postoperative complications, and histology of nodular pulmonary lesions. Results Sixty-eight patients with seventy four nodules underwent VATS resections. Preoperative CT-guided Hook-wire localization succeeded in all patients ( 100. 0% ). Conversion thoracotomy was necessary in 2 patients. The average operative time was ( 15 ±6)min. Asymptomatic complication rate was 70.6% (48/68), asymptomatic pneumothorax rate, asymptomatic hemorrhage rate and simultaneous pneumothorax and bleeding rate were 45.6% (31/68),25.0% ( 17/68 ) and 4. 4% ( 3/68 ), respectively. The mean hospitalization was ( 15 ± 6 ) days.Histological assessment revealed primary lung cancer (NSCLC) in 30, metastasis in 18, and nonmalignant disease in 26 nodules. Conclusions Video-assisted thoracoscopic resection of nodular pulmonary lesions previously localized by a CT-guided Hook-wire system is related to a low conversion thoracotomy rate, short operation time, and high safety. It for differential diagnosis and treatment.

This study aims to prepare altrenogest extended-release tablets,evaluate their quality and establish a content determination method.The hydrophilic gel skeleton type,dosage and core thick-ness of altrenogest extended-release tablets were used as the investigating factors,and the release degree of the tablets was used as the investigating index,the prescription process of altrenogest ex-tended-release tablets was optimized by one-factor screening and central combinatorial design re-sponse surface method,and quality evaluation was carried out,the in vitro release model was es-tablished,and a high-performance liquid chromatography(HPLC)assay method was set up for the determination of altrenogest extended-release tablets.The results showed that the optimal pre-scription of altrenogest extended-release tablets was 2％as the main drug,70％as the solubilizer,0.5％as the lubricant,19.1％as the filler,8.4％as the hydrophilic gel skeleton material,and the thickness of the tablets was 3.8 mm.The in vitro drug release conformed to the Higuchi model,and the altrenogest showed a good linear relationship with the R2=0.999 98 in the range of 10-80 mg/L.The optimized process for the extended-release tablets was stable and had a good quality.The extended-release tablets were stable and had significant slow-release effect.The HPLC method is accurate and reliable and can be used for the determination of altrenogest in extended-release tablets.