Objective To investigate the role of heat shock protein 70 (HSP70) in liver flbrosis in infants with biliary atresia (BA) and its impact on prognosis. Methods Fourty-six (46) cases of infants with BA undergoing elective Kasai surgery were selected. In the same period, 30 cases of children with choledochal cyst and 17 cases of children with portal vein cavernous transformation were selected. The expressions of HSP70 in liver tissues were detected using immunohistochemical staining. The liver flbrosis in children with BA was detected using Sirius red-saturated picric acid staining. The expressions of HSP70 proteins in different flbrotic liver tissues were detected by using double staining. All postoperative BA infants were followed up and ended at June 30, 2016.Results The proportion of high expression of HSP 70 proteins in BA infants were signiflcantly higher than that in children with choledochal cyst and vein cavernous transformation (P<0.05). Rank correlation analysis showed that the expressions of HSP70 in liver tissues were positively correlated with the degree of liver flbrosis (r=0.861,P<0.05). 15 patients died among 46 cases of BA infants. The survival rate in BA children with mild liver flbrosis was 82.4%, which was signiflcantly higher than 58.6% in the severe group (P<0.05). The survival rate in HSP70 protein low expression group was 85.0%, while in HSP70 protein high expression group was 53.8%. Kaplan-meier survival analysis showed that the median survival time in the HSP70 protein low expression group was (34.0±2.6) months, while in the HSP70 protein high expression group was (18.3±2.2) months, the difference was statistically signiflcant (χx2=4.765,P=0.029).Conclusions The expressions of HSP70 proteins in liver tissues in infants with BA were high and were positively correlated with the degree of hepatic flbrosis. It suggested the possible involvement of HSP70 in the process of liver fibrosis. The upregulated expressions of HSP70 often indicated poor prognosis in children. It could be used as determining biomarker for prognosis.

Objective:To evaluate the feasibility and safety of laparoscopic jejunostomy with central venous catheterization set (CVC, Arrow International Inc., USA) during the operation of totally minimally invasive Ivor-Lewis esophagectomy (MIIE). Methods:The clinical data of 88 patients with esophageal squamous cell carcinoma who were admitted to the Fudan University Cancer Hospital from February 2013 to April 2014 were retrospectively analyzed. Among them, 48 patients with early mid-lower esophageal cancer un-derwent laparoscopic jejunostomy with CVC, and 40 patients accepted nasogastric tube nutrition. Short-term clinical outcomes were collected. Results:No significant difference in nutrition index was found between the two groups, but the rate of unplanned extubation in the laparoscopic jejunostomy with CVC group was less than that in the nasogastric tube nutrition group. Conclusion:Laparoscopic jejunostomy with CVC set is a safe and feasible technique. It is potentially accepted as an optional approach in MIIE for post-operative nutrition support.

Objective Totally MIIE with per-oral placement of anvil has been reported elsewhere,but MIIE with manual pursestring and per-thoracic port placement of anvil has been seldomly reported.The feasibility of the latter technique was proved in this study.Methods Patients with mid-lower thoracic esophageal cancer were prospectively treated with totally MIIE at Shanghai Cancer Center of Fudan University from Feberay 28,2013 to August 31,2013.Laproscopic intracorporeal construction of the gastric conduit and needle catheter J-tube were performed in the first stage of MIIE.In the second stage a hand sewn pursestring was made with endostitch system and the anvil of EEA stapler was inserted via the tenth inter costal port prior to the intrathoracic anastamosis.Short-term clinicopathologic outcomes were collected.Results 39 cases were treated with totally MIIE,media age 61 years,ranged 48-69 years,10 females and 29 males.There was 1 conversion to open surgery.The median duration of operation was 245 minutes.The median intraoperative blood loss was 210 ml.All the patients were margin negative and staged from pT1N0M0 to pT3N2M0.The average lymph node yields were 16.5 per patient.The median postoperative hospital stay was 7 days.There was no mortality.Perioperative morbidity occurred in 4 patients (10％).2 patients were complicated with late stage gastric paralysis which began 2 or 3 days after oral feeding and both recovered in 1 month.1 patient was with minor anastamotic leakage which was endoscopically demonstrated on the 14th day postoperatively and the patient recovered in 1 month post leakage.1 patient was complicated with severe pneumonitus and ARDS; the ICU stay of that case was 19 days and the recovered patient was discharged 27 days postoperatively.Conclusion MIIE with regular EEA stapler and intrathoracic anastamosis is feasible in patients with thoracic esophageal cancer.Prospective randomized clinical trials could be conducted to compare the open procedure and totally MIIE with regular EEA stapler.

Objective To explore the association between X-ray repair cross complementing group 1 (XRCC1)gene rs25487 locus polymorphisms and nonobstructive azoospermia in Hui minority ethic population of Shaanxi Province.Methods We used polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)method for genotyping at XRCC1 gene rs25487 locus in 79 patients with nonobstructive azoospermia and 82 healthy male controls in Hui minority ethic population of Shaanxi Province.Then we analyzed the association be-tween XRCC1 gene rs25487 locus and nonobstructive azoospermia.Results Compared with GG genotype,GA, AA and GA + AA genotypes demonstrated a significantly increased risk for nonobstructive azoospermia (OR =2.286,95% CI 1.1 5 1-4.539;OR =2.202,95% CI 0.753-6.439;OR =2.271,95% CI 1.1 71-4.403),respec-tively.Meanwhile,the A allele frequency was significantly higher in azoospermic patients than in controls (OR =1.582,95% CI 1.005-2.492,P =0.047).Conclusion G→A in XRCC1 gene rs25487 locus is correlated with nonobstructive azoospermia in Hui minority ethic population of Shaanxi province.

Objective To evaluate the safety,efficiency of retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic tumors,and summarize the surgical experience.Methods From Jan 2015 to Jan 2016,5 patients with completely endophytic tumors,who underwent retroperitoneal laparoscopic partial nephrectomy were recruited.one patient underwent 3D printing kidney model,and another 4 patients underwent 3Dimensional CT and locating four projection positions of the tumor on the surface,in order to guide the tumor resection in laparoscopic partial nephrectomy.Perioperative,operative,and postoperative,as well as oncological outcomes were analyzed.Results In all 5patients,preoperative four points location in 3D model or 3Dimensional CT for completely endophytic tumors is feasible and accurate in term of locating the tumor.The mean operative time was(129.0 ± 19.5) min,mean warm ischaemia time was (19.6 ± 5.4) min and mean estimated blood loss was(100 ± 83) ml.Pathological examination showed cell renal cell carcinoma.All the patients had a negative surgical margin,and no tumor recurrence or metastasis during 6-18months of follow up.Conclusions In experienced institutes,retroperitoneal laparoscopic partial nephrectomy combined with four points location in 3D model or 3Dimensional CT for completely endophytic tumors is a feasible and safe procedure in terms of accurate locations,low complication rates,reasonable functional and oncologic outcomes after an intermediate-term follow-up

Objective To evaluate the prognostic significance of MMP-2 , MMP-9 and Cathepsin-D expression in lymph node-negative human breast carcinoma. Methods Specimens from the primary breast tumors of 270 axillary lymph node negative breast cancer patients were studied for MMP-2 , MMP-9 and Cathepsin-D protein expression by immunohistochemical staining. Results The positive expression of MMP-2, MMP-9 and Cathepsin-D was 56.7%(153/270),59.6%(161/270) and 55.6%(150/270), respectively. In univariate analysis, MMP-2, MMP-9 and the co-expression of MMP-2 and MMP-9 were significantly associated with tumor free survival. In multivariate analysis, co-expression of MMP-2 and MMP-9 was unfavorablely related with tumor free survival(RR=2.487; P

Objective To analyze the metastatic rule of common hepatic artery lymph node of thoracic esophageal squamous cell carcinoma,and to investigate the strategies of common hepatic artery lymph node dissection.Methods The clinical data of 682 patients with esophageal squamous cell carcinoma who were admitted to the Cancer Hospital of Fudan University from May 2005 to December 2010 were retrospectively analyzed.The locoregional lymph node metastasis of thoracic esophageal squamous cell carcinoma,relationship between metastatic rates of common hepatic artery lymph node and clinicopathological factors and the postoperative complications were analyzed.The enumeration data were analyzed using the chi-square test.Results A total of 18 277 lymph nodes were dissected (27 lymph nodes per patient).The lymph node metastatic rate was 55.87％ (381/682),and the metastatic lymph node ratio was 7.87％ (1438/18 277).Lymph nodes adjacent to the cardia of stomach,laryngeal nerve,lesser curvature of stomach,cervical esophagus,left gastric artery had a higher metastatic rate,while common hepatic artery lymph node had a lower metastatic rate.All the common hepatic artery lymph node metastasis was accompanied with locoregional metastasis.A total of 1480 common hepatic artery lymph nodes were dissected (2 common hepatic artery lymph nodes per patient).Twenty-four patients had common hepatic artery lymph node metastasis,with the metastatic rate of 3.52％ (24/682) and the lymph node ratio of 2.16％ (32/1480).The common hepatic artery lymph node metastatic rates of upper,middle and lower esophageal squamous cell carcinoma were 2.33％ (1/43),3.76％ (16/425) and 3.27％ (7/217),with no significant difference (x2 =0.295,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients in T1,T2 and T3 stages were 2.35％ (2/85),5.46％ (10/183) and 2.90％ (12/414),with no significant difference (x2 =2.850,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with high,moderate and poor differentiated esophageal squamous cell carcinoma were 0(0/63),3.50％ (16/457) and 4.94％ (8/162),with no significant difference (x2=3.259,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with diameter of tumor under 3 cm,3-5 cm and above 5 cm were 2.59％ (6/232),3.02％ (11/364) and 8.14％ (7/86),with significant difference (x2 =6.267,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in N0,N1,N2,N3 stages were 0(0/301),2.53％ (5/198),5.65％ (7/124) and 20.34％ (12/56),with significant difference (x2 =62.368,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 0(0/62),1.78％ (6/337),5.06％ (13/257) and 19.23％ (5/26),with significant difference (x2=25.959,P ＜0.05).Two hundred and twenty-eight patients had postoperative complications with the complication rate of 33.43％ (228/682).The incidence of anastomotic fistula was the highest,which was 11.58％(79/682).Conclusions The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is the lowest.For patients suffered from esophageal cancer in stage I or the tumor diameter under 5 cm,the dissection of common hepatic lymph node can be ommitted in surgery.

Background and purpose:Endoscopic treatment is a promising therapeutic option for superifcial lesions throughout the gastrointestinal tract, this study was aimed to evaluate the efficacy of endoscopic resection (ER) using the new Duette multiband mucosectomy kit (DT-6) on treating esophageal disease. Methods:Since Jun. 2011, ER using DT-6 has been performed on 100 patients in a tertiary medical center. Data from those who have been followed up for over 6 months was analyzed. ER and esophagectomy were compared on treating high grade dysplasia (HGD) lesions and early esophageal cancer. Results:From Jun. 2011 to Jan. 2012, a total of 32 patients with esophageal lesions underwent 34 ER using DT-6 (22 male and 10 female, mean age 59.0 years, range 25 to 83 years). There were (3.4±1.0) specimen resected per operation, and the average greatest diameter was (11.8±2.7)mm. Intraoperative blood loss was (5.45±1.47)mL. The median follow-up period was 8.2 months with a 100%half-year-follow-up rate. Except one pneumothorax occurred during one endoscopic submucosal dissection (ESD), no other complications happened. When Comparing ER and esophagectomy on treating HGD and early esophageal cancer, ER showed advantages in terms of operation time, intraoperative blood loss, hospital stay and complications. Conclusion:ER using DT-6 is safe, simple, minimally invasive and effective for esophageal disease. Prospective study and long follow-up are needed to compare endoscopic resection and esophagectomy for HGD and early esophagus cancer.

Acute Pain ; etiology ; prevention & control ; Chronic Pain ; etiology ; prevention & control ; Humans ; Lung Neoplasms ; surgery ; Pneumonectomy ; adverse effects ; methods ; Thoracic Surgery, Video-Assisted

Objective:To investigate the effects of navigation bronchoscopy and artificial intelligence in the standardized training of residents on basic bronchoscopy skills, with the goal of enhancing their practical abilities.Methods:We selected 26 trainees (14 on standardized training of residents and 12 on standardized training of specialists) who participated in the basic navigational bronchoscopy skills and technique training (NBSTAT) at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from September 2023 to January 2024. The training was structured around a modular curriculum with navigation as the core design concept, consisting of five modules: lesion identification, precise localization, route planning, navigation operation, and real-time error correction. Theoretical teaching and skill practice were combined. The skill proficiency of the trainees was assessed using the Ruijin Hospital bronchoscopy simulation training system and the electromagnetic navigation bronchoscopy system. SPSS 26.0 was used to perform the t-test and Wilcoxon rank-sum test for comparisons. Results:After the training, the trainees as a whole showed significant improvements in practicing the skills, with the simulated operation time was reduced from (125.08±48.16) seconds to (77.69±24.75) seconds, the number of errors decreased from 1 to 0, the total score increased from (60.77±15.01) to (75.19±17.63), and the navigation operation time was reduced from 3 (3, 4) minutes to 2 (2, 3) minutes (all P<0.05). There were no significant differences in these assessment items between resident trainees and specialist trainees. The satisfaction rate of the trainees with the training reached 100.00%. Conclusions:The curriculum is effective in basic bronchoscopy skill training, remarkably enhancing the bronchoscopy skills of resident and specialist physicians, which is a useful approach for physicians to cope with the continuous development of diagnostic and therapeutic techniques for pulmonary diseases.