Objective To explore the feasibility and safety of Mckeown-type minimally invasive esophagectomy in para-recurrent laryngeal nerve lymphadenectomy. Methods A total of 163 cases underwent minimally invasive McKeown resection for esophageal carcinoma in the Affiliated Tumor Hospital of Xinjiang Medical University were retrospectively analyzed. Patients were divided into routine treatment group (n=63), right recurrent nerve lymph node dissection group (right group, n=53) and bilateral recurrent laryngeal nerve lymph node dissection group (bilateral group, n=47) according to the operation modes. The postoperative pathology, operation time, intraoperative bleeding volume, postoperative hospitalization time, number of lymph nodes and pneumonia, anastomotic fistula, laryngeal nerve injury and other complications were compared between three groups of patients. Pathological conditions were consisted of the location of tumor, the degree of differentiation, T stage and pathological stage. Postoperative complications were followed up for 6 months. Results There were no significant differences in tumor location, pathological differentiation degree, T stage and pathologic stage between three groups. The amount of bleeding was more in the routine group than that of the right group and the bilateral group (P<0.05). There was no significant difference in the amount of bleeding between the right group and the bilateral group. The total lymph nodes and thoracic lymph nodes were increased in order in routine group, the right group and the bilateral group, and there was significant difference between three groups(P<0.05). There were no significant differences in other operation data and complications between three groups. Conclusion McKeown-type minimally invasive esophagectomy shows good feasibility and safety for para-recurrent laryngeal nerve lymphadenectomy .

Objective To investigate the clinical efficacy of fractionated ultrapulse carbon dioxide laser combined with microneedle for depressed acne scars.Methods Totally 86 patients with depressed acne scar were randomly divided into 2 groups:the treatment group received fractionated ultrapulse carbon dioxide laser combined with microneedle technology and the control group only received fractionated ultrapulse carbon dioxide laser.The treatment interval was 1 to 3 months,and the whole course was 2-8 times.The total effective rate and the adverse reaction were analyzed in the facial acne scar.Results The surface of depressed acne scars was significantly improved.ECCA score of all patients declined obviously after treatment,the score of the treatment group declined from 61± 11 to 45± 15,and the control group declined from 57± 14 to 40± 16.There were significantly statistical differences in the results of each group (P＜0.05).More treatment times resulted in better surface improvement.The total effective rate were 81.8％ (18/22) and 100％ (24/24) in the treatment group,and 80.0％ (16/20) and 100％ (20/22) in the control group.The course was 6.8± 1.6 months in the treatment group and 20.8±4.6 months in the control group (P＜0.05) to get a similar satisfied result.There were no obvious adverse reactions except two cases of erythema and pigmentation in the treatment group and 5 cases in the control group.The former was with less adverse reactions.Conclusions Ultrapulse carbon dioxide laser combined with microneedle technique is effective for facial acne scars,with less complications and shorten treatment course.

Objective To investigate the clinical efficacy of Q-switch 1064 nm wavelength laser combining with microneedle technology for the treatment of melasma.Methods 70 melasma patients were selected in the Out-patient Department of Wuhan General Hospital of Guangzhou Military Command from July 2012 to Sept.2013.The patients were randomly divided into 3 groups:the combining therapy group (patients in this group received Q-switch 1064 nm wavelength laser combining with microneedles technology,the treatment interval was 2 or 3 weeks,and the whole course was 2-6 months);the microneedle group and the Q-switch 1064 nm wavelength laser group.The effect and the adverse reaction were observed and recorded during the treatment,and the reduced area of the pigment patch was also measured to judge the total efficacy after the course.Results The total effective rate was 78.6％ (22/28) in the combining therapy group and 40.0％ (8/20) in the microneedle group,45.5％ (10/22) in the Q-switch 1064 nm wavelength laser group.There were statistically significant differences between the combining therapy group and the other groups (P1 ＜0.05,P2 ＜0.05),without obvious adverse reaction.Conclusions It is significantly better to use American Medlite C6 Q-switch 1064 nm wavelength laser combining with microneedles technology than that of the single use of Q-switch 1064 nm wavelength laser or microneedles in the treatment for the patients with melasma.The method is also simple to handle and suitable for clinical application.

Objective To analyze the management of clinical pathways ( CP) in China. Methods Cross-sectional questionnaire surveys of 51 public hospitals with CPs in place in Shanghai, Hubei province and Gansu province were conducted from March to May of 2015. Results Among the 51 public hospitals with CPs, 48 ( 94. 1%) of them organized training on CPs, 48 ( 94. 1%) of them monitored CPs′implementation, and 40 (78. 4%) applied incentives for CPs′ implementation. But there were some issues and difficulties encountered in CPs′ implementation. Conclusions Comprehensive measures are necessary to improve the management of CPs at public hospitals of China.

Objective To analyze the implementation of clinical pathways ( CP) at public hospitals at different levels and in different regions in China. Methods The status of CPs′ implementation at 54 public hospitals in Shanghai, Hubei province and Gansu province was surveyed by questionnaires from March to May of 2015. Results 51 (94. 4%) of the surveyed public hospitals put in place clinical pathway(s), where the average CPs implemented were 45 and the average percentage of the cases using CPs was 52. 7%. There were great variations among these hospitals. In addition, the common diseases with definite diagnostic and treatment options were found with the highest implementation rates of CPs at such hospitals. Conclusions CPs are implemented widely at public hospitals of China, yet enhanced implementation strategies are expected to further CPs′adoption.

Objective:To establish a liquid chromatography tandem mass spectrometry ( LC-MS/MS) method for the determination of 5-fluorouracil (5-Fu) in patient’s plasma and apply it in clinics patients validation. Methods:5-Fu was analyzed on an Agela Inno-val NH2 (2. 1 mm × 50 mm, 5 μm) column. Methanol:ultra pure water (2 ∶98) was used as the mobile phase with isocratic elution. The flow rate was 0. 3 ml ·min-1 and the column temperature was set at 40℃. The ion transitions with electrospray ionization negative model were m/z 128. 8→42. 1 and m/z 188. 6→42. 1 for 5-Fu and 5-bromouracil (the internal standard), respectively. The LC-MS/MS method was verified according to the guideline of quantitative analysis validation of biological samples ( Chinese Pharmacopoeia, 2015 edition, the fourth part) . Results:The calibration curve of 5-Fu was linear within the range of 10-1 000 ng · ml-1 . The lower limit of quantification was 10 ng · ml-1 . The precision, accuracy, matrix effect and stability within the linear range were all in line with the requirements of method validation. Conclusion:The LC-MS/MS method developed in the study for the determination of 5-Fu is simple, rapid, accurate and reproducible, which can be used for the plasma concentration detection of 5-Fu in patients.

Aim To determine the function of nuclear factor-κB ( NF-κB ) in immunological liver injury of rat model and its effect on CYP2E1 expression, content and metabolic activity. Methods The immunological liver injury rat model was prepared by injection of Ba-cillus Calmette Guérin ( BCG,125 mg · kg-1 ) for 14 days. The hepatic tissue injury was revealed by hema-toxylin and eosin ( HE ) method and serum concentra-tion of alanine aminotransferase( ALT) , aspartate ami-notransferase ( AST ) respectively. CYP450 total con-tent in hepatic homogenate was determined by spectro-photography. The expression of CYP2E1 protein was detected by Western blot analysis. The enzyme kinetics of CYP2 E1 probe drug chlorzoxazone was evaluated by high-performance liquid chromatography ( HPLC ) as-say. Results The results showed that BCG-pretreat-ment ( 125 mg · kg-1 ) significantly increased the weight of liver and spleen, serum levels of ALT and AST(P<0. 01) , and decreased CYP2E1 expression, content and metabolic activity ( P <0. 05 ) . Adminis-tration of ammonium pyrrolidine dithiocarbamate (PDTC) (50, 100, 200 mg·kg-1) reversed the a-bove hepatic injury stimulated by BCG in vivo. Moreo-ver, PDTC dose-dependently inhibited the down regu-lation of CYP2 E1 ( P<0. 05 ) . Conclusion Passiva-tion of NF-κB can inhibit the down regulation of CYP2 E1 in liver tissue of immunological liver injury rats;NF-κB may be involved in CYP2 E1 down-regula-tion.

Objective To investigate whether IL-17 could stimulate the vascular endothelial growth factor (VEGF) production on HaCaT cells alone. We also investigated whether shikonin could inhibited the proinflamation effects of interleukin-17(IL-17) acting on HaCaT cells. MethodsWe examined the expression of VEGF by double antibody sandwich enzyme-linked immunosorbent assay ( ELISA ) and realtime polymerase chain reaction(RT-PCR) in HaCaT cells and the cell supernatant. The viability of HaCaT cells in the drug group was detected by the Cell Counting Kit-8 (CCK-8). ResultsThe expression of VEGF in different time IL-17-stimulated groups on HaCaT cells and the cell supernatant were higher than the control group( P＜0.001 ). The expression of VEGF in different drug treatment groups on HaCaT cells and the cell supematant were lower than the stimulated group by IL-17 ( P＜0. 001 ). The cell viability of different drug treatment groups have no significant difference( P＞0.05 ). ConclusionWe show that IL-17 specifically and time-dependently augmented and induced VEGF expression on HaCaT cells and the cell supernatantThen shikonin markedly inhibited the increase tengency of IL-17 effection on HaCaT cells and the cell supematant level.

Objective To analyze infarcts distribution and vascular malformation in patients with multiple infarcts in the posterior circulation and to investigate their correlation with the disease prognosis.Methods Thirty-four patients who had more than one infarct in the posterior circulation as shown on MRI were enrolled in the study.The digital subtraction angiography (DSA) of aortic arch and whole brain were performed on all patients and the images were analyzed and re-evaluated by two senior clinicians respectively.All the patients were assessed using Modified Rankin Scale (MRS) at discharge and correlation of infarcts distribution and vascular malformation with prognosis was evaluated.Results Infarct lesions most often involved pons (22 patients) and the middle (pons and anterior inferior cerebellum) plus distal territories (rostral brainstem, superior cerebellum and occipital and temporal lobes, 12 patients).Vascular abnormality was found in 76.5% (26/34) of the patients.The common vascular lesions involved vertebral artery (14 patients), intracranial vertebral artery (13 patients) and basilar artery (7 patients).The incidence of poor prognosis was 20.6% with 17.6% the severe disability rate and 2.9% the mortality rate.Patients with multiple lesions in proximal, middle and distal territories or basilar artery were likely to have poor prognosis.Conclusion Vascular abnormality is the main etiological factor for multiple infarcts in the posterior circulation.Infarcts distribution and the location of vascular lesions were key factors in predicting prognosis.

Objective To treat radial head fractures with open reduction and internal fixation, removal of the radial head and artificial joint replacement based on different fracture types to discuss the outcome of these methods and summarize optimal strategy for treatment of radial head fractures. Meth-ods A retrospective study was done on data of 47 patients with 48 radial head fractures treated in our de-partment from November 1999 to May 2008. Among them, nine patients were treated conservatively (all type Mason Ⅰ fractures), 28 treated with open reduction and internal fixation (one patient with type Ma-son Ⅰ fracture, 14 with type Mason Ⅱ and 13 with type Mason Ⅲ), eight with removal of radial head (three patients with type Mason Ⅲ fractures and five with type Ⅳ) and three with artificial joint replace-ment (all type Mason Ⅳ fractures). Results All patients were followed up for average 2.8 years (1-4.4 years). Two patients treated with artificial joint replacement were followed up for six months and three months respectively. According to the Mayo Elbow Performance Index, the excellence rate was 8/9 in conservative treatment, 82% (23/28) in open reduction and internal fixation, 6/8 in removal of the radial head and 3/3 in artificial joint replacement respectively. Conclusions The radial head fracture should be given anatomical reduction for early functional exercise. Conservative treatment can be used for type Mason Ⅰ fractures, open reduction and internal fixation for type Mason Ⅱ , type Mason Ⅲ fractures and part of type Mason Ⅳ fractures. The removal of radial head or mental prosthesis replacement are al-ternative for parte of type Mason Ⅳ fractures that can not attain stable fixation through open reduction and internal fixation.