This paper reviewed the clinical application of video-assisted mediastinoscopy(VAMS),Including:(1)The methods of VAMS;(2)The diagnosis of thoracic disease by VAMS,such as stages of lung cancer,the diagnosis of occupying lesion in anterior or superior mediastinum;and the therapy which includes of resection of occupying lesion in mediastinum and esophageal carcinoma;primary palmar hyperhidrosis;malig-pleural effusion,drainage of mediastinat abscess;(3)The incidence of complication is low.

Objective To investigate the methods of isolation,culture,identification and labeling of mesenchymal stem cells(MSCs) in vitro and lay a foundation for further study on intervention of MSCs on immunologic rejection of organ transplantation. Methods MSCs were isolated and cultivated by adherent methods . The expressions of CD90 and CD45 of cells were analyzed by using flow cytometry in order to identify MSCs.The third generation of MSCs were labeled by DAPI,the labeling efficiency was detected.Results Primary cultured MSCs adhered to plastic surface within 48 h and reached 90% confluence within 7-10 d .Flow cytometry showed that the positive rates of CD90 and CD45 of MSCs at third generation were 99.8% and 6.8%. MSCs expressed CD90 but no CD45.All of the MSCs after labeling by DAPI showed blue fluorescence by immunofluoroscope. DAPI labeling was sensitive and highly efficient to MSCs.Conclusion Adherent method is simple and easy to isolate and cultivate MSCs and it can serve as a routine method.DAPI labeling can be used as a efficient method to label MSCs.

Objective To investigate the effects of inhaled low dose nitric oxide(NO)on lung ischemia-reperfusion injury during flush and delayed 10 min after reperfusion.Methods Sixty health a- dult male Sprague-Dawley rats were randomly allocated to the control and the NO group.Before the donor lung was harvested,the right hilus was clipped for 5 min(clipping test),then blood sample was collected from carotid artery for arterial blood gas analysis as baseline.Lung transplantation was per- formed in a“cuff-like”vessel anastomosis technique.Dynamic compliance(Cdyn)and resistance of airway(Raw)were monitored before operation(baseline)and after 2-h reperfusion.The graft's gas exchange and oxygenation were assessed by“clipping test”after 2-h reperfusion.The lung graft was harvested for measuring wet/dry weight ratio(W/D),the activity of myeloperoxidase(MPO)and in- ducible nitric oxide synthase(iNOS),the content of malonyldialdehyde(MDA),and the expression of iNOS gene and protein.Results After 2-h reperfusion,compared to the control group,PaO_2/FiO_2, OI,and Qs/Qt were improved significantly in the NO group(277?91 vs.157?47,P＜0.01;2.67?0.89 vs.4.72?1.48,P＜0.01;21.1?4.57 vs.27.1?2.37,P＜0.01,respectively).The activi- ties of MPO were significantly reduced in NO group(1.80?0.46 vs 3.08?0.65 U/g tissue,P＜0.01).The content of MDA in the lung tissue of NO group was significantly higher than that of the control group(34.8?7.9 vs.20.0?11.2 nmol/mg protein,P＜0.05).Inflammatory cell infiltration was also significantly reduced(P＜0.05).The expression of iNOS gene and protein in the lung tissue of NO group was significantly lower than that of the control group.The activities of iNOS were also significantly reduced in NO group(10.6?10.2 vs 97.8?82.2 nmol?g~(-1)?min~(-1),P＜0.05).The im- munohistochemical positive staining of iNOS was localized in the alveolar epithelial cells and the in- flammatory cells infiltrated in the alveolar spaces and mesenchymal tissue.But there were no signifi- cant differences between two groups in Cdyn,Raw and W/D ratio.Conclusion Inhaled low dose NO might mitigate the intrapulmonary shunt,prevent neutrophil sequestration,inhibit the expression of iNOS gene and protein in isograft,thereby ameliorate ischemia-reperfusion injury and improve the ox- ygenation of the graft.

OBJECTIVETo study the mechanism of delayed emptying indigestible solids in thoracic stomach after the resection of esophageal cancer by monitoring the variety of antropyloroduodenal migrating motor complex (MMC) during interdigestion.

METHODSEsophagectomy and gastroesophagostomy in the neck was performed in 5 men with esophageal cancer. An eight-lumen manometric sleeve assembly was passed through a nostril into the duodenum during operation. The sleeve was astride the pylorus. Antropyloroduodenal manometry was performed for at least 300 min with a polygraphic system (PC POLYGRAF HR) 7 - 11 days after operation.

RESULTSTwenty-eight MMCs were recorded in the pylorus and duodenum, 12 MMC(s) in the antrum, and 33% (4/12) of the motility frequency of antral phases III started after that of pyloroduodenal phases III. The number of MMC in the antrum was lower than that in the duodenum after the operation. The mean duration of MMC of the antrum, pylorus and duodenum was (49.2 +/- 10.5) min, (46.5 +/- 10.4) min and (45.9 +/- 10.0) min respectively. The mean duration of phases III was respectively (6.7 +/- 3.5) min in the antrum, (10.0 +/- 3.5) min in pylorus, and (8.0 +/- 3.9) min in duodenum. The mean wave amplitude of phases III was respectively (83 +/- 30) mm Hg in the antrum, (60 +/- 12) mm Hg in pylorus, and (55 +/- 4) mm Hg in duodenum. The mean duration of MMC of the antrum and duodenum was shorter in patients than that in healthy volunteers, and the mean wave amplitude of phases III of the antrum was lower in patients than that in healthy volunteers.

CONCLUSIONSDiminution of the number of MMC and the mean wave amplitude of phases III in the antrum, incoordination of the antropyloroduodenal phases III should be the most important one of the mechanisms of delayed emptying of indigestible solids in thoracic stomach after the resection of esophageal cancer.

Duodenum ; Esophageal Neoplasms ; Gastric Emptying ; Gastrointestinal Motility ; Humans ; Manometry ; Pylorus

OBJECTIVETo compare the perioperative complications between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy and gastric tube reconstruction for the treatment of middle and lower thoracic esophageal cancer.

METHODSRetrospective analysis of clinical data was performed on 288 patients with middle and lower thoracic esophageal cancer who underwent completely minimally invasive esophagectomy by one surgical team in Fujian Medical University Union Hospital from December 2010 to March 2014. Among the 288 patients, 103 patients underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis using a transoral anvil(Orvil)(Ivor-Lewis group, 2-incision) and 185 patients underwent combined laparoscopic and thoracoscopic esophagectomy and cervical anastomosis(McKeown group, 3-incision). Patients were stratified by surgical approach and perioperative outcomes were compared between the two groups.

RESULTSThere were no statistical differences between two groups in intra-operative blood loss, conversion to open, extubation time, time to resume oral intake, postoperative hospital stay, the median number of lymph nodes resected. The operation time of Ivor-Lewis group was significantly shorter than that of McKeown group [(283.4±32.0) min vs. (303.6±43.7) min, P=0.003). The hospital cost of Ivor-Lewis group was significantly higher than that of McKeown group [(76 492±18 553) yuan vs. (68 923±17 331) yuan, P<0.01]. There were no statistical differences between two groups in chylothorax, delayed gastric emptying, atrial fibrillation, postoperative bleeding, admission to ICU, short-term postoperative mortality (P>0.05). The total postoperative complication morbidity of Ivor-Lewis group was significantly lower than that of McKeown group(16.5% vs. 31.4%, P<0.01). Ivor-Lewis group had lower pulmonary complication(8.7% vs. 25.9%, P<0.01), anastomotic leakage(1.9% vs. 13.0%, P<0.01), anastomotic stricture (0% vs. 4.9%, P<0.05), recurrent laryngeal nerve injury(1.0% vs. 7.0%, P<0.05).

CONCLUSIONIvor-Lewis approach is associated with less postoperative complications, but higher cost as compared to McKeown approach in the treatment of middle and lower thoracic esophageal cancer.

Anastomosis, Surgical ; Anastomotic Leak ; Blood Loss, Surgical ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; methods ; Operative Time ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies