Objective To explore the feasibility of a novel technique of anvil placement in combined use of laparoscopic and thoracoscopic Ivor Lewis esophagectomy. Methods From June 2011 to October 2012, we performed a novel technique of minimally invasive Ivor Lewis esophagogastrectomy in 20 patients with midthoracic esophageal cancer.The anvil was placed to connection with the esophageal stump under thoracoscopic vision, and an apical pleural stomach esophagus anastomosis was performed by using normal stapling. Results The mean operation time lasted for 200 minutes (150-300 minutes) with a mean blood loss of 180 ml (150-250 ml) without blood transfusion.The mean number of lymph nodes resected was 18 (12-44).No additional incision was required. There were no complications at post-operation and no anastomic leakage.The patient’s hospital stay lasted a mean of 10 days (8-12 days) .Follow-up reviews were conducted for 6 months and no recurrence was found in all the 20 patients. Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy with novel technique of anvil placement for the treatment of esophageal carcinoma ensures the feasibility and safety.

AIM　To study the effects of verapamil on end-plate potentials(EPPs) in isolated non-uniform stretched muscle preparation(INSMP) of rat diaphragms pretreated with neostigmine or 3,4-diaminopyridine(3,4-DAP). METHODS　Using conventional intracellular microelectrode recording technique. RESULTS A sustained depolarization could be induced at the end-plate area pre-incubated with 0.2－5.0 μmol·L-1 neostigmine or 1.0－4.0 mmol·L-1 3,4-DAP. In normal Tyrode solution, verapamil at a concentration of 1, 5, 10 or 20 μmol·L-1 had no significant effect on evoked endplate potentials and miniature endplate potentials. However, the sustained depolarization due to neostigmine or 3,4-DAP could be antagonized by verapamil at 5－20 μmol·L-1 and the duration of the depolarization was shortened in a concentration-dependent manner. CONCLUSIONL-type calcium ion channels can be activated by accumulated acetylcholine in the synaptic cleft and may be involved in producing sustained depolarization, while they play no role in transmitter release under normal physiological conditions.

Sepsis is one of the serious illnesses leading to high mortality in ICU.Some animal experiments and clinical trails show that target temperature management has a protective effect on target organ function in sepsis,but the optimal timing,length of targeted temperature managment continued,intervention measures,and optimal target temperature obtained in sepsis remains in the great controversy.Whether the patients with sepsis would be truly benefited from the body temperature management is still worthy issue for further study.The aim of this article reviews is to trace the recent research progress on the body temperature management in sepsis.

Objective To discuss the relationship age and pathologic type, tumor size (≥4 cm) and pelvic lymph metastasis in cervical cancer, and the relative factors of cervical cancer with metastasis of pelvic lymphaden and the possibility of ovarian conservation. Methods 166 cases of cervical cancer accepted radical hysterectomy and pelvic lymphadenectomy in our hospital from June 2002 to June 2007, and were analyzed retrospectively. 166 cases of cervical cancer were divided into two groups, the age in group A was less than 35, while in group B was more than 35. Results The possibility of adenocarcinoma, the tumor size (≥4 cm) and the metastasis of pelvic lymphaden were higher in group A than in group B. The higher the clinical stage, the higher the pathological type and grade were. The greater the tumor size were ,the higher the rate of pelvic lymphatic metastasis (P <0.01). The more tissue infiltrate were, the higher the rate of pelvic lymphatic metastasis (P <0.01). Conclusion The possibility of adenocarcinoma carcinoma, the tumor size (≥ 4 cm) and the metastasis of pelvic were more higher in young women. The rate of pelvic metastasis is closely related to clinical stage, pathological type and grade, tumor size, and tissue infitration.

Objective To observe the synergetic action of Zhenqi Fuzheng granule in prevention and treatment of critically ill patients with severe infection. Methods A retrospective study was conducted. 154 cases with critical illness were enrolled in the First People's Hospital of Baiyin in Gansu Province from January 2009 to December 2013. The control group consisted of 76 cases and only basic treatments were given;in the treatment group, there were 78 cases,besides the basic treatments,they also taken nasal feeding of Zhenqi Fuzheng granule 5 g twice a day,7 days constituting for 1 therapeutic course,a total of 1-3 courses. The incidences of pulmonary infection, urinary tract infection,deep venous catheter-related infections,rate of using antibiotics,fatality rate,infection relapse rate,disease course,pathogen flora distribution were observed in the two groups. Results Compared with the control group,the rates of lung infection,urethral infection,deep vein catheter-related infection,the rate of using antibiotics, fatality rate,infection relapse rate,the discovery rates of drug resistant Acinetobacter baumannii,Pseudomonas aeruginosa,Stenotrophomonas maltophilia,Staphylococcus aureus,and Blastomyces albicans were obviously reduced in treatment group〔lung infection:15.38%(12 cases)vs. 47.37%(36 cases),urethral infection:7.69%(6 cases) vs. 23.68%(18 cases),deep vein catheter infection:5.13%(4 cases)vs. 18.42%(14 cases),antibacterial drug using rate:48.72%(38 cases)vs. 77.63%(59 cases),fatality rate:10.26%(8 cases)vs. 18.42%(14 cases),infection relapse rate:28.21%(22 cases)vs. 48.68%(37 cases),the discovery rate of Acinetobacter baumannii:3.85%(3 cases) vs. 11.84%(9 cases), of Pseudomonas aeruginosa:2.56%(2 cases) vs. 9.21%(7 cases), of Stenotrophomonas maltophilia:5.13%(4 cases)vs. 13.16%(10 cases),of Staphylococcus aureus:5.13%(4 cases) vs. 6.58%(5 cases),of Blastomyces albicans:6.41%(5 cases)vs. 10.52%(8 cases),all P<0.05〕;the therapeutic course was obviously shortened(day:5.79±1.89 vs. 13.65±2.73,P<0.05). Conclusion In critically ill patients with severe infection,treatment of Zhenqi Fuzheng granule can reduce the incidences of severe lung infection, urinary tract infection,deep venous catheter-related infection,the 5-year relapse rate,fatality rate,and shorten the therapeutic course,lower the usage of antibiotics and detection rate of drug-resistant bacteria,therefore,clinically it is effective in such patients.

Therapeutic hypothermia used for clinical purposes has had a long history. With the continuous development in the intensive care and surface cooling techniques, it has made various large hypothermia clinical trials possible. Studies have found that moderate hypothermia (28～35℃) has significant protective effects on important organs such as heart and brain, and it does not have obvious side effects. Recently, mild hypothermia (32～35℃) has been widely used for cardio-pulmonary-cerebral resuscitation, and its effect is satisfactory.

Objective:To investigate the amplification of the telomerase RNA component (TERC) gene in cervical cancer and cervical intraepithelial neoplasia (CIN) using dual-color interphase fluorescence in situ hybridization (FISH) and its significance in screening of cervical lesion. Methods:Cervical cast-off cell specimens were screened from 120 outpatients with cervical lesion, including normal cell from liquid based cytology (20 cases), CIN Ⅰ , Ⅱ , Ⅲ and cervical cancer cell from liquid based cytology (each of 25 cases). The amplification of TERC gene in cervical cast-off cells was detected by dual-color interphase FISH. The results of normal samples were used to set up the threshold. Results:①The percentages of abnormal cells in CIN Ⅰ , Ⅱ , Ⅲ and cervical cancer were significantly higher than threshold value ( P<0.05), and the percentage of abnormal cells was increased with the serious degree of pathological grade (P<0.01) ; ②The percentagesof 2:3,2:4,2:5 and great than or equal to 4:4 types in CIN Ⅰ , Ⅱ , Ⅲ and cervical cancer were significantdifferences (all P<0.01). The percentages of 2:4,2:5 and great than or equal to 4:4 types in cervical cancer were significant higher than that in CIN Ⅰ (P<0.001) while the percentage of 2:3 type was significant lower than that in it (P<0.001);③The percentage of abnormal cells was increased with the serious degree of cytological grade (P<0.01) in different cytological grades. The percentages of 2:3,2:5 and great than or equal to 4:4 types in atypical squamous cell of undetermined significance (ASCUS), low-grade squamous intraepithe-lial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) were significant differences (all P <0.01), and the percentages of 2:5 and great than or equal to 4:4 types in HSIL were significant higher than that in ASCUS( P <0.01) while the percentage of 2:3 type was significant lower than that in it ( P <0.01);④The detection rates of LSIL and HSIL with cytological examination in low grade and high grade CIN were 40% (10/25) and 62% (31/50) respectively, which were significant lower than the detection rates of FISH which was 100%(P<0.05).Conclusions:There is an abnormal amplification of TERC gene in CIN Ⅰ , Ⅱ , Ⅲ and cervical cancer, and its copy numbers are increased with the serious degree of pathological and cytological grades. Detection of amplification of TERC gene in cervical cast-off cells with FISH has a certain value for screening cervival lesion and prediction of lesion progression.

Environmental arsenic exposure is a worldwide public health problem. Long-term exposure to inorganic arsenic is closely related to diseases such as cardiovascular disease, diabetes and malignant tumors. Different dietary structure and intake of certain specific nutrients may have important effects on the pathogenic effect of arsenic. This article summarizes the effects of dietary nutrients on arsenic toxicity, providing reference for the follow-up arsenic toxicity research and reducing the risk of arsenic-related diseases through nutritional intervention.

Objective To explore 24-hour ambulatory blood pressure of patients with cervical spinal cord injury. Methods 42 patients with cervical spinal cord injury and 45 patients with thoracic-lumbar spinal cord injury were included. Their 24-hour ambulatory blood pressures were monitored. Their day systolic blood pressure (dSBP) and day diastolic blood pressure (dDBP) when seating and standing, night SBP and DBP, and SBP descending rate at night were compared. Results There were significant differences in dSBP and dDBP when standing, and SBP descending rate at night between 2 groups (P<0.01). There was significant difference in dSBP between seating and standing position in patients with cervical spinal cord injury (P<0.01). Conclusion There is orthostatic hypotension in cervical spinal cord injury patients and their SBP descending rate at night is upside down.

Objective To explore the effects of music games thematic curricula on preschool children with intellectual disabilities. Methods 30 children with intellectual disabilities accepted music games thematic curricula (experiment group, n=15) or routine thematic curricula (control group, n=15) respectively. They were assessed with the Scales of Learning Attitude, Scales of Emotive Behavior, Scales of Communicational Ability, and Scales of Social Skill before and after 20 weeks of curricula. Results The experiment group performed better in learning attitude, emotive behavior, communicational ability, and social skill than the control group (P<0.001). Conclusion Using music games in thematic curricula can not only improve the mood and behavior of the preschool children with intellectual disabilities apparently, but also inspire their learning interest, develop their communicational and social abilities.