Objective To compare the accuracy of jugular venous oxygen saturation (SjvO2),somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) in estimation of the occurrence of intraoperative cerebral ischemia in patients undergoing clipping of intracranial aneurysm.Methods Forty-three ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with a body mass index of 20-25 kg/m2,undergoing clipping of intracranial aneurysm,were studied.Anesthesia was induced with sufentanil,rocuronium and propofol.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remifentanil and propofol.Blood samples were taken from the jugular bulb for detection of SjvO2 before aneurysm clipping or temporary occlusion of parent artery and at 1,3,10,20 and 30 min after clipping aneurysm or temporary occlusion of parent artery.The amplitude and latency of SSEPs and MEPs were recorded simultaneously.The occurrence of cerebral ischemia estimated by SjvO2,SSEPs and MEPs was recorded.The condition of nerve defect was recorded within 3 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of nerve defect.Results Among 43 patients,14 cases were diagnosed as having brain ischemia.The sensitivity and specificity of SjvO2 in estimation of the occurrence of intraoperative brain ischemia were 71％ and 93％,respectively (P ＜ 0.01).The sensitivity and specificity of SSEPs in estimation of the occurrence of intraoperative brain ischemia were 71％ and 62％,respectively (P ＜ 0.05).When the diagnostic criterion of cerebral ischemia was defincd as a decrease in the amplitude of MEPs or prolongation of the latency MEPs,the sensitivity and specificity of MEPs in estimation of the occurrence of intraoperative brain ischemia were 79 ％ and 52 ％,respectively (P ＞ 0.05).When the diagnostic criterion of cerebral ischemia was defined as a loss of the amplitude of MEPs,the sensitivity and specificity of MEPs in estimation of the occurrence of intraoperative brain ischemia were 57％ and 93％,respectively (P ＜0.05).Conclusion The sensitivity of SjvO2 and SSEPs in estimation of the occurrence of intraoperative brain ischemia is higher,however,the specificity of SjvO2 and MEPs is higher,indicating that SjvO2 is a reliable criteria for estimation of the occurrence of intraoperative brain ischemia in patients undergoing clipping of intracranial aneurysm.

Objective:This study aims to investigate the correlation between the number of resected lymph nodes (LNs) and the prognosis of patients with node-negative non-small cell lung cancer (NSCLC). Methods:A retrospective review of 305 patients with NSCLC, who received curative resection between January 2004 and December 2009, was conducted. All patients were proved without lymph node involvement histopathologically. The prognostic impact of the number of negative LNs and the clinicopathologic factors were analyzed. Results:The overall median survival time and the 1-, 3-, and 5-year overall survival rates were 60.0 months, 76.1%, 59.3%, and 47.1%, respectively. Survival analysis confirmed that the number of negative LNs, T staging and the stations of the mediasti-nal lymph nodes dissected were showed to be independent prognostic factors. Patients with a high number of negative LNs had better overall survival than patients with a low number of negative LNs (P<0.05). The patients with dissected LNs counts of more than 11 for cases with pTl~2 tumor (P<0.05) and more than 16 for cases with pT3 tumor (P<0.05) had better long-term survival outcomes. The post-operative complication rate was 12.1%, which was not significantly correlated with the number of dissected lymph nodes (P>0.05). Conclusion:The number of negative lymph nodes is an independent prognostic predicting factor for node-negative NSCLC. Sufficient dissection of LNs is recommended to improve the survival of the patients with node-negative NSCLC.

Objective: To explore the status of lymph node metastasis of middle third thoracic esophageal squamous cell carcinoma and its influence on the prognosis and to seek the reasonable range of lymphade-nectomy. Methods: A total of 129 patients who underwent curative esophagectomy with modern two-field lymphadenectomy of middle third thoracic esophageal squamous cell carcinoma were reviewed. Results: The lymph node metastasis rate was 56.6% and the upper mediastinal lymph node metastasis rate was 43.4%. The lymph node metastasis ratio (positive nodes/total dissected nodes, LMR) was 11.3%. Paraesophageal lymph nodes, lymph nodes near the right recurrent nerve, the left gastric and infracadnal lymph nodes were most commonly involved when the tumor was located in the middle thoracic esophagus. Tumor differentiation, the depth of tumor invasion and the length of tumor were influencing factors for lymph node metastasis. The 5-year survival of N_0, N_1 (LMR≤20%) and N_1 (LMR>20%) patients were 50.4%, 31.0% and 6.8%, respective-ly, with a significant difference among the three groups (P=0.000). Conclusion: LMR was one of the key fac-tors affecting the prognosis, of esophageal cancer. Patients with middle third thoracic esophageal carcinoma should be treated with radical surgery with modern two-field lymphadenectomy.

Objective To evaluate the feasibility of low-tube-voltage, low injection rate, low contrast agent dosage in combination with iterative model reconstruction ( IMR) algorithm in CT angiography ( CTA) of the head-and-neck vessels .Methods Sixty patients who underwent CT angiography of the head-and-neck vessels were randomly divided into groups A and B with 30 cases in each group .Patients in group A received a conventional scan with 120 kVp and filterback projected ( FBP) reconstruction .Patients in group B received a low-dose scan with 80 kVp, and image reconstruction with FBP ( group B1) and IMR (group B2)algorithm.The contrast agent protocol were as follows: the injection time in all patients was 10s, the injection rate was 4.5-5.5 ml/s in group A while 3.5-4.0 ml/s in group B.The CT values of artery, image noise, signal to noise ratio ( SNR) and contrast to noise ratio ( CNR) were measured and compared among three groups with One-way ANOVA analysis . Image quality was evaluated by two radiologists with five scale method , and compared with Kruskal-Wallis test .The CT dose index volume (CTDIvol) and dose length product ( DLP) were recorded and compared between groups with two independent samples t-test.Results The image quality scores of groups A , B1and B2 were 3-5, 2-4 and 3 -5, respectively .Image quality of twelve patients in group B 1 couldn′t meet the diagnostic requirements but none in group A and B 2.The objective image parameters SNR and CNR for group B 2 were equal to group A ( P >0.05), while those for group B1 were lower than group A (t=13.39, 9.45, P<0.05) and group B2 (t=-12.14, -9.96,P<0.05).CTDIvol and DLP for group B were separately 80.9%, 81.3%lower than those of group A(t=39.1, 32.2,P<0.05).The injection rate and contrast agent volume for group B were separately 22.0%, 22.1% lower than those of group A ( t=20.8, 20.8, P<0.01) .Conclusions It is feasible in CT angiography of the head-and-neck vessels with lower tube-voltage, lower injection rate, lower contrast agent dose and combining with iterative model reconstruction algorithm.This protocol can reduce the radiation dose by 81.3% while maintaining image quality .Trial registration Chinese clinical trial registry ,ChiCTR-BOC-16010060.

Objective: To analyze the learning curve of uniportal video-assisted thoracoscopic surgery (VATS) lobectomy for the treatment of resectable lung cancer. Methods: The clinical data of 160 patients with resectable lung cancer who underwent uniportal VATS lobectomy by a single surgical team between May 2016 and April 2017 at Department of Thoracic Surgery, the First Affiliated Hospital of the University of Science and Technology of China were analyzed retrospectively. The study group consisted of 90 male and 70 female patients with age of 28 to 84 years (median: 62 years). The patients were divided into four groups from group A to D according to chronological order. The operation time, incision length, intraoperative blood loss, number of dissected lymph nodes and nodal stations, the proportion of changes in operation mode, postoperative complications, chest drainage duration and hospitalization time were individually compared among the four groups by variance analysis and χ² test. Results: The 4 groups were similar in terms of incision length, chest drainage duration, number of dissected lymph nodes and nodal stations and postoperative hospitalization time (P>0.05). The difference of the operation time ((185.9±17.9) minutes vs. (139.9±10.7) minutes vs.(128.7±7.8) minutes vs.(124.0±9.3) minutes, F=219.605, P=0.000), intraoperative blood loss ((233.9±135.8) ml vs. (126.8±18.1) ml vs. (116.4±22.6) ml vs.(112.8±25.3) ml, F=26.942, P=0.000), the proportion of changes in operation mode (17.5% vs.7.5% vs. 5.0% vs. 5.0%, χ²=8.300, P=0.040), and the incidence of postoperative complications (27.5% vs. 10.0% vs. 10.0% vs. 7.5%, χ²=8.643, P=0.034) among the 4 groups was statistically significant. Conclusions Uniportal VATS lobectomy can be safely and feasibly performed for resectable lung cancer, learning curve for uniportal VATS lobectomy is approximately 40 cases. Operation time, intraoperative blood loss, postoperative complications and the proportion of changes in operation mode can be used as the main measures during surgery.

Ethanol is one of the major risk factors for esophageal cancer.The main mechanisms of ethanol induced esophageal cancer include the direct carcinogenesis of acetaldehyde,the genetic polymorphism of enzymes related to alcohol metabolism,the carcinogenic effect of reactive oxygen species,the disorder of nutrient metabolism induced by ethanol,and the synergistic effect of ethanol and tobacco.

Objective To compare the accuracy of somatosensory evoked potentials(SSEPs), motor evoked potentials(MEPs), regional cerebral oxygen saturation(rSO2)and multimodal monitoring in monitoring cerebral ischemia in patients undergoing carotid endarterectomy(CEA). Methods Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 46-76 yr, scheduled for elective CEA, were enrolled in the study. SSEPs, MEPs and rSO2were monitored during CEA. The event of intraoperative cerebral ischemia was defined as:(1)SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%;(2)disappearance of MEP amplitude;(3)decrease in rSO2>20% of the baseline value;(4)When multimodal monitoring was applied, the event of intraopera-tive cerebral ischemia could be defined as long as one variable previously described met the condition. The gold standard of perioperative cerebral ischemia was defined as:(1)the National Institutes of Health Stroke Scale score≥4 at 1, 3 and 5 days after operation than before operation was considered as neurologi-cal dysfunction;(2)cranial CT showed a new ipsilateral cerebral focal ischemia, and postoperative in-tracranial hemorrhage diseases were excluded. Results Five cases developed cerebral ischemia after opera-tion. The sensitivity and specificity of SSEPs in predicting cerebral ischemia were 80% and 83%, respec-tively;MEPs 80% and 80%, respectively; SSEPs+MEPs 100% and 79%, respectively; rSO260% and 93%, respectively;SSEPs+MEPs+rSO2100% and 7%, respectively. Decrease in rSO2> 20% of the base-line value was consistent with SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%in diagnosis of cerebral ischemia(Kappa value 0.67, P<0.01); decrease in rSO2>20% of the baseline value was consistent with disappearance of MEP amplitude in diagnosis of cerebral ischemia(Kappa value 0.54, P<0.01). Conclusion rSO2has a good agreement with SSEPs and MEPs in diagnosis of cerebral ischemia during CEA; combination of SSEPs and MEPs produces better accuracy in monitoring cerebral is-chemia.

Objective To discribe the technique for uniportal video-assisted thoracoscopic pneumonectomy and lymphadenectomy,and to evaluate the feasibility,safety and the short-term clinical outcomes of this approach.Methods The clinical data of 283 patients with resectable non-small cell lung cancer who received uniportal or three-port video-assisted thoracoscopic pneumonectomy between January 2015 and December 2016 was analyzed retrospectively.Of those 283 patients,151 underwent uniportal video-assisted thoracoscopic pneumonectomy and 132 underwent three-port video-assisted thoracoscopic pneumonectomy.The clinicopathologic factors,operatinal factors,postoperative complications,the number of total lymph nodes dissected or the stations of the total lymph nodes dissected,and conversive rate of the two groups were compared by t test and x2 test.Results The two groups were similar in terms of clinicopathologic data,postoperative complications,length of opertion and conversive rate(P ＞ 0.05).The approach of uniportal video-assisted thoracoscopic pneumonectomy was associated with a significant decrease in surgical blood loss [(126.12 ± 212.13) ml vs.(178.61 ± 173.17) ml,P =0.02],volume of 3 days of post operative chest drainage [(505.25 ± 109.60) ml vs.(566.67 ± 233.35) ml,P =0.004],chest tube duration [(4.31 ±3.12)dvs.(6.93 ±3.10)d,P＜0.001] and postoperative stay [(5.49 ± 4.77) d vs.(7.23±4.24)d,P=0.001].There was no significant difference between the two groups in the number of total lymph nodes dissected or the stations of the total lymph nodes dissected (P ＞ 0.05).The stations of 4L and 5-13 in left lymphadenectomy and the stations of 2 R,3,4R and 7-13 in the right lymphadenectomy did not differ between the two groups(P ＞ 0.05).Conclusion Our uniportal video-assisted thoracoscopic pneumonectomy can be safety and effectively performed for resectabte non-small cell lung cance with favorable early outcomes.

Objective To explore the effectiveness of virtual autopsy-based postmortem computed tomography(PMCT)liver three dimensional slicer(3D slicer)artificial intelligence(AI)volume reconstruction to assist forensic practice.Methods Twenty cases of the deceased who underwent both virtual autopsy and traditional autopsy in our center were selected and subjected to liver volume segmentation by 3D slicer method,Tada's formula method and literature method,and the data obtained from the traditional autopsy were compared and analyzed to obtain the accuracy rate.Results The 3D slicer method yielded higher consistency(95%confidence interval),lower volumetric variability(standard deviation),and a smaller region(variance)of uncertainty than the Tada formula method and the methods mentioned in the literature.Conclusion 3D slicer AI reconstruction based on virtual autopsy can visualize virtual anatomy,help increase the diagnostic accuracy of traditional autopsy,assist in pathological diagnosis,and provide new directions and tools for the development of imaging histology of virtual autopsy.

Metformin, as a first-line drug in the treatment of type 2 diabetes, has been proved to be safe and effective. In recent years, epidemiological studies have found that metformin can inhibit the proliferation and metastasis of lung cancer cells, and is expected to become a new anti-lung cancer drug. Lung cancer is a disease that seriously endangers human health, its morbidity and mortality have been ranked first among all malignant tumors, and the prognosis is poor. In recent years, a great deal of evidence shows that metformin can reduce the risk and mortality of tumors such as lung cancer. Its mechanisms mainly include activating adenosine monophosphate-activated protein kinase pathway, improving hyperinsulinemia and insulin resistance, promoting lung cancer cell apoptosis and inhibiting related inflammatory response. The aim of this article is to reviews the study of metformin on lung cancer.