Background and purpose: Three-incision esophagectomy for patients with esophageal cancer has been increasingly used, but the incidence of either postoperative anastomotic leak or stricture is higher than that in intrathoracic gastroesophageal anastomosis. The purpose of this study was to investigate the clinical effects of the side-to-side stapled cervical gastroesophageal anastomosis in preventing anastomotic leak and stricture after three-incision esophagectomy. Methods: One hundred and twenty-seven patients undergoing three-incision esophagectomy for esophageal cancer with gastric replacement were reviewed. A side-to-side stapled cervical gastroesophageal anastomosis was performed in 71 cases and manually sewn anastomosis in 56 cases. The incidence of postoperative anastomotic leak and stricture was compared between these two groups and the results were statistically analyzed using SPSS11.0 soft.Results: Anastomotic leakage was noted in seven patients (9.9%) in the stapler group and fourteen patients (25.0%) in the manually sewn group (P=0.04). After the operation two patients (2.8%) in the stapler group and nine patients (16.1%) in the manually sewn group developed a benign esophageal stricture (P=0.02).The incidence of either postoperative anastomotic leak or stricture in cases of the stapler group was significantly lower than that in the manually sewn group (P<0.05). Conclusion: Construction of the cervical esophagogastric anastomosis with a side-to-side stapled technique provides a larger luminal diameter which significantly reduces the incidence of postoperative anastomotic strictures. The surgery also greatly reduces the incidence of anastomotic leaks and strictures, so it could be used as an alternative strategy for cervical esophagogastric anastomosis after esophagectomy for esophageal cancer

Objective To summarize the experiences of Nuss procedure for complicated pectus excavatum.Methods From August 2006 to July 2011,443 patients with pectus excavatum received Nuss operation.Among them,95 patients with complicated pectus excavatum (CT Haller index ＞ 6) received modified technique of Nuss procedure,including multi-bar technique,oblique placed bar,double arc bar technique; fix with wire ; osteotomies ; auxiliary small incision; thoracoscopy placed by different lateral.Results All operations were successfully accomplished without severe complications.The mean operative time was (90.13 ± 39.12 ) minutes and the mean volume of blood loss was (45.41 ± 19.23 )ml.The mean hospital stay was (7.21 ± 2.87 ) days.All patients have been satisfied with their surgical correction.Therapeutic results evaluation was excellent in 75.8％ of patients,good in 16.8％.Conclusion Multi modified technique of Nuss procedure can lead to a satisfactory outcome for complicated pectus excavatum patients.

Objective The Nuss procedure is a minimally invasive pectus repair.The aim of this study was to explore the changes in quality of life in patients who underwent a Nuss procedure.Methods 96 patients,who underwent a Nuss procedure in our institution,were interviewed at preoperation,1 year after operation with the bar in place,and before the planned bar removal.The Nuss Questionnaire modified by George Krasopoulos et al,which evaluates psychosocial and physical well-being,was independently used by patients.Results Most of the scoring of the individual questions and the total score of individual patients revealed a significant improvement,both in preoperation vs.1 year after operation and 1 year after operation vs.before the planned bar removal.Conclusion The Nuss procedure has been shown to improve the quality of life in patients with pectus excavatum deformity in the short term.

Objective To study the influence of the minimal invasive Nuss procedure on the pulmonary function of post-operative pectus excavatum patients. Methods Conduct retrospective analysis on the data from 676 pectus excavatum patients who were treated by the minimal invasive Nuss procedure from August 2006 to November 2014. Wherein 182 cases have com-plete preoperative and postoperative pulmonary-function data of one year, three years. These cases were divided into 3 groups according to the age, namely, children group( from 6 to 12 years old, 34 cases) , adolescents group( from 13 to 18 years old, 80 cases) , adults group( above 18 years old, 68 cases) , among which there were 71 cases with pulmonary function data of 1 year after removal of steel plate, they were divided into 3 groups in the same way,namely, children group(20 cases), adoles-cents group(22 cases), adults group(29 cases) . To compare and analyze the pulmonary function indicatrix of patients with dif-ferent ages in preoperative stage, 1 year, 3 years postoperative stages and 1 year after dismantling the steel plate stage, and to investigate the influence of the minimal invasive Nuss procedure on the postoperative lung function. Results The pulmonary function indicatrix in preoperative stage, 1 year, 3 years postoperative stages of the children group did not have significant difference(P>0. 05); the FVC, FEV1 indicatrix of adolescents and adults groups declined after operation in 1 year and 3 years compared with the preoperative stage(P<0. 05), FEF 25％ -75％, FEF 50％, FEF75％ were improved after operation in 1 year and 3 years compared with the preoperative stage(P<0. 05);the pulmonary function indicatrix of three age groups in the 1 year after dismantling the steel plate stage had all improved, in which the pulmonary function indicatrix of the children group improves most significantly(P<0. 05). Conclusion After the minimal invasive Nuss procedure before the plate dis-mantling process, the pulmonary function of children patients remains to be similar. Partial ventilatory function was damaged in the adolescents and adults patients. After the plate dismantling process, the pulmonary function indicatrix of each age group hasimproved in different degrees. Improvement effect is the most significant in patients below the age of 12.

Objective To analyze and assess the postoperative motor function in children with spastic cerebral palsy (SCP) by surface electromyography (sEMG) and joint angle. Methods Sixteen children with SCP were involved in this study. The sEMG of rectus femoris, biceps femoris, semitendinosus, tibialis anterior, lateral gastrocnemius and medial gastrocnemius muscles and joint angles of the hip, knee and ankle during straight walking were collected preoperatively and postoperatively. In every gait phase, the mean values of joint angles, root mean square and integrated electromyography of sEMG were calculated, to evaluate muscle strength and muscular tension quantitatively. Results The muscle tension of lower limbs was significantly decreased (P<0.05). The muscle strength of rectus femoris and biceps femoris was decreased in the swing phase. At the midswing and terminal swing phase, the strength of tibialis anterior increased significantly (P<0.05). The flexion angle of hip and knee decreased significantly (P<0.05). The dorsiflexion angle of ankle increased significantly (P<0.05), and the varus angle decreased significantly (P<0.05). Conclusions After operation, the crouching gait and clubfoot were improved positively. Therefore, the motor function of children was improved. Combining sEMG and joint angle can evaluate the muscle function of patients quantitatively, and it also can provide references for clinical diagnosis.

Objective: To investigate the clinical effect and safety of long-acting pegylated interferon-α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 μg/week) in the treatment of HBeAg-positive chronic hepatitis B (CHB) patients, with standard-dose Peg-IFN-α-2a as positive control. Methods: This study was a multicenter, randomized, open-label, and positive-controlled phase III clinical trial. Eligible HBeAg-positive CHB patients were screened out and randomized to Peg-IFN-α-2b (Y shape, 40 kD) trial group and Peg-IFN-α-2a control group at a ratio of 2:1. The course of treatment was 48 weeks and the patients were followed up for 24 weeks after drug withdrawal. Plasma samples were collected at screening, baseline, and 12, 24, 36, 48, 60, and 72 weeks for centralized detection. COBAS® Ampliprep/COBAS® TaqMan® HBV Test was used to measure HBV DNA level by quantitative real-time PCR. Electrochemiluminescence immunoassay with Elecsys kit was used to measure HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe). Adverse events were recorded in detail. The primary outcome measure was HBeAg seroconversion rate after the 24-week follow-up, and non-inferiority was also tested. The difference in HBeAg seroconversion rate after treatment between the trial group and the control group and two-sided confidence interval (CI) were calculated, and non-inferiority was demonstrated if the lower limit of 95% CI was > -10%. The t-test, chi-square test, or rank sum test was used according to the types and features of data. Results: A total of 855 HBeAg-positive CHB patients were enrolled and 820 of them received treatment (538 in the trial group and 282 in the control group). The data of the full analysis set showed that HBeAg seroconversion rate at week 72 was 27.32% in the trial group and 22.70% in the control group with a rate difference of 4.63% (95% CI -1.54% to 10.80%, P = 0.1493). The data of the per-protocol set showed that HBeAg seroconversion rate at week 72 was 30.75% in the trial group and 27.14% in the control group with a rate difference of 3.61% (95% CI -3.87% to 11.09%, P = 0.3436). 95% CI met the non-inferiority criteria, and the trial group was non-inferior to the control group. The two groups had similar incidence rates of adverse events, serious adverse events, and common adverse events. Conclusion In Peg-IFN-α regimen for HBeAg-positive CHB patients, the new drug Peg-IFN-α-2b (Y shape, 40 kD) has comparable effect and safety to the control drug Peg-IFN-α-2a.