Objective To investigate the value of narrow band imaging (NBI) and lugol chromo-endoscopy (LCE) in the diagnosis of advanced esophageal carcinoma.Methods The clinical data of 162 patients with advanced esophageal carcinoma who received NBI and LCE at the Cancer Hospital of Peking University from November 2010 to May 2012 were retrospectively analyzed.Esophageal mucosa was first examined using white light imaging (WLI),and then followed by NBI and LCE,and the lengths of the lesions were recorded.Biopsy histology was obtained in all abnormal mucosa which were detected by NBI or LCE.Difference in the length of lesions detected by the NBI/LCE and WLI was calculated.Surgical approach and method of anastomosis were recorded for patients who received surgical treatment,and the final treatment method was recorded for patients who did not receive surgical treatment.Difference in the treatment methods was compared before and after endoscopy.Results The length of the lesions detected by the 3 methods was identical in 121 patients,different in 41 patients.The difference ranged between 1 and 3 cm was observed in 22 patients,＞3 cm and ≤5 cm in 8 patients,＞5 cm and ≤10 cm in 7 patients,＞ 10 cm in 4 patients.Of the patients in the above mentioned 4 categories,there were 1,2,2,4 patients in each category received neo-adjuvant therapy,and the rest patients received operation.Superficial cancer contiguous to the primary lesion was found in 41 patients,including squamous cell carcinoma in 31 patients,carcinoma-in-situ in 3 patients and severe dysplasia in 7 patients.Of the 153 patients who received surgery,the surgical plan for 12 patients was modified.Intrathoracic anastomosis was changed to cervical anastomosis in 2 patients,anastomosis under the aortic arch was changed to anastomosis above the aortic arch in 3 patients,trans-abdominal operation was changed to thoraco-abdominal operation in 7 patients.Conclusions The combination of NBI and LCE is more accurate to evaluate the extent of lesions of advanced esophageal carcinoma,and is useful to decide the treatment protocol.Pathological examination of the adjacent abnormal mucosa should be carried out for patients whose lesion length was inconsistent under different observation methods.

Objective To evaluate the accuracy and influencing factors of mini-probe endoscopic ultrasonography (EUS) in determining the T stage for early gastric cancer (EGC).Methods The clinical data of 103 patients with EGC who were admitted to the Peking University Cancer Hospital from March 2011 to June 2014 were retrospectively analyzed.The diagnosis results of mini-probe EUS were compared with postoperative pathological findings,of which the differences in the accuracy of mini-probe EUS in determining the T stage of EGC were analyzed according to tumor location,diameter,differentiated types,with or without ulceration and Lauren classification.The rate comparison and univariate analysis were done by the chi-square test,and multivariate analysis was done using the Logistic regression model.Results Among 107 lesions,75 lesions were detected in uT1a stage by mini-probe EUS and 32 lesions in uT1b stage.The results of pathological examination showed that 61 lesions were detected in T1 a stage,40 lesions in T1 b stage and 6 lesions in T2 stage.The accuracy of mini-probe EUS in the T1 stage of EGC was 66.4％ (71/107),including 70.7％ (53/75) in the uT1 a stage and 56.3 ％ (18/32) in the uT1b stage of EGC.There were significant differences in the accuracy of mini-probe EUS for determining the T stage of EGC among the patients with different tumor diameters,different differentiated types and with or without ulceration (x2=7.834,7.432,6.461,P ＜0.05).The results of multivariate analysis showed that tumor diameter more than 30 mm and undifferentiated types of tumors were independent risk factors affecting the accuracy of miniprobe EUS in determining the T stage of EGC (OR =0.340,0.332,95％ confidence interval:0.563-0.932,0.582-1.022,P ＜ 0.05).Conclusions The clinical value of mini-probe EUS in the T stage of EGC is relatively high.The accuracy of mini-probe EUS detecting in the T1 a stage of EGC is higher than the T1 b stage of EGC,and the factors affecting the accuracy of mini-probe EUS in determining preoperative stage of EGC include tumor diameter more than 30 mm and undifferentiated type of tumors.

Objective Acute respiratory dysfunction (ARD) can occur after aortic surgery with the use of cardiopulmonary bypass and deep hypothermic circulation arrest, but relatively little is known about acute respiratory dysfunction in the patients with type A aortic dissection. This study aims to analyze the independent risk factors of acute respiratory dysfunction after A type aortic dissection surgery and to assess possible prevention and treatment option in the future. Methods Clinical data of the 252 patients including 193 male patients and 59 female patients who underwent type A aortic dissection surgery from February 2009 to October 2010 were collected. The mean age was 47 years. Postoperative acute respiratory dysfunction was defined as oxygenation impairment (PaO2/FiO2 ＜ 150) that occurred within 72 h of surgery except pleural effusion, cardiogenic pulmonary edema, pneumonia, pulmonary embolism and haemato-/ pneumothorax. There were 187 acute A type aortic dissection patients and 65 chronic type A aortic dissection patients. Clinical characteristics including age, gender, weight, height, history of hypertension, history of smoking, preoperative complications such as preoperative shock and acute renal failure, pericardial effusion, previous cardiac surgery, time from event to surgery, malperfusion syndrome, cardiopulmonary time, cross-clamp time,deep hypothermia circulation arrest time, surgical procedure, duration of intensive care unit stay and postoperative complications including tracheotomy, dialysis dependent renal failure and hospital mortality were gathered. Arterial blood analysis, chest X ray, ventilator parameters, number of blood transfusion and flood balance were assayed after operation. All the factors were evaluated by means of univariate and multivariate logistic regression analysis to identify relative risk factors of ARD. Results Acute respiratory dysfunction occurred in 32 (12.7% ) patients. The in-hospital mortality was significant difference between acute respiratory dysfunction group and non- acute respiratory dysfunction group (P ＜ 0.05). The value of BMI, incidence of acute aortic dissection, preoperative SBP level, cardio-pulmonary bypass time, aortic clamp time and total arch replacement in acute respiratory dysfunction group were significantly higher than the values in non- acute respiratory dysfunction group. Multivariate Logistic regression analysis showed blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes were independent risk factors of early stage acute respiratory dysfunction after type A aortic dissection surgery.Conclusion Acute respiratory dysfunction after type A aortic dissection was a severe early stage postoperative complication and was associated with in-hospital mortality. The patients in acute aortic dissection were prone to have acute respiratory dysfunction. The independent risk factors of acute respiratory dysfunction included blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes.

Objective To investigate the effect of malignant tumor on neuromuscular block of cisatracurium. Methods Sixty ASA Ⅰ or Ⅱ patients with head and neck neoplasms (15 cases with benign tumor, 45 with malignant tumor), aged 18-64 yr, were randomly divided into 4 groups ( n = 15 each): Ⅰ benign tumor group (group B,3 × ED95 ); Ⅱ -Ⅳ different dose cisatracurium group (group C1 (2 × ED95 ), C2 (3 × ED95 ) and C3 (4 ×ED95)). Neuromuscular block was assessed with accelerograph F (TOF-watch SX). Single stimulation of ulnar nerve was used. Anesthesia was induced with TCI of propofol (target plasma concentration 3 μg/ml) and remifentanil (target effect-site concentration 3 ng/ml). Tracheal intubation was facilitated with cisatracurium 0.15 mg/kg in group B, and with cisatracurium 0.10, 0.15 and 0.20 mg/kg in group C1, C2 and C3 respectively. The onset time, clinical duration, time for recovery of T/Tc to 75 % and recovery index were recorded. Results The clinical duration, time for recovery of T/Tc to 75 % and recovery index were significantly longer in group C2 than in group B (P ＜ 0.05). The onset time was significantly shorter, while the clinical duration and time for recovery of T/Tc to 75% were significantly longer in group C2 and C3 than in group C1 , and in group C3 than in group C2 ( P ＜0.05) .Conclusion The duration of action and recovery times of cisatracurium were prolonged in patients with malignant tumor.

Objective To explore the effect of predepositautotransfusion in hematopoietic stem cell donors.Methods 127donors of hematopoietic stem cell wereretrospectively analyzed from 2013 to 2016,whenhematopoietic stem cells collection and autologous blood transfusion.Results Collection autologous blood 70 550 mL by 127 donors,and 2 cases had mild blood donation reaction,at a rate of 1.6％ (2/127).Collectionbone marrow stem hematopoietic stem cell 100 159 mL.The detection results were WBC (27.02±8.21) × 1010/L、Plt(213.19±62.42) × 109/L、RBC(4.31±0.44) × 1012/L、Hb(131.53 t14.53)g/L,from 117 donors beforespinal cord extraction.The detection results were WBC (35.8519.08)× 1010/L、Plt (188.34±50.24) × 109/L、RBC (4.02± 0.41) × 1012/L、Hb (122.60 ± 13.48) g/L,from 117 donorsafter autologous blood transfusion in one day.Compared with donors after autologous blood transfusion in one day,WBC was higher before spinal cord extraction(P＜0.05),Plt RBC and Hb was significantly decree (P＜0.05).Conclusion Preoperative autologous blood donation can save blood and prevent blood-borne infectious disease,which can used in Hematopoietic stem cell donor.

Objective To increase the quality of blood transfusion medical record and strengthen the management of clinical blood transfusion by establishing a management system for clinical blood transfusion.Methods The management system of clinical blood transfusion was developed by using Sybase PowerBuilder 10.5 program and Oracle 8/8i database,through the function module's development of blood application and evaluation by using C/S structure.Results The management system of clinical blood transfusion realized the exchange of the internal data information with the blood information management system and LIS database,and implemented online audit of transfusion application and evaluation,which improved the work efficiency and reduced the human error.Conclusion The management system of clinical blood transfusion can improve the quality of blood transfusion medical record and realize real-time regulation of clinical blood transfusion to ensure the safety of transfusion.

Objective To investigate the feasibility, safety and efficacy of endovascular implantation of 125I seeds under the dual-guidance of ultrasound and digital subtraction angiography (DSA) for the treatment of hepatocellular carcinoma (HCC) associated with portal vein tumor thrombus. Methods A total of 30 patients with primary HCC complicated by portal vein tumor thrombus underwent implantation of 125I seeds via portal vein. Guided by ultrasound, percutaneous transhepatic puncturing of portal vein was performed first, then, catheter was inserted, which was followed by transcatheter 125I seeds implantation into the affected portal vein under DSA guidance. The technical success rate, postoperative complications, routine blood tests, liver function, the suppression of portal vein tumor thrombus and survival time were analyzed. Results Successful implantation of 125I seeds was achieved in all patients, no serious procedure-related complications occurred. All patients were followed up for 3-36 months, the portal vein tumor thrombus showed a significant shrinkage in all patients. The median survival time was about seven months. Conclusion For the treatment of hepatocellular carcinoma associated with portal vein tumor thrombus, endovascular implantation of 125I seeds under the dual-guidance of ultrasound and digital subtraction angiography is clinically safe and feasible. This treatment has satisfactory effect on the portal vein tumor thrombus.

Objective:To study the expression of caspase-3 and free radical injury in hypoxic-ischemic brain damage ( HIBD) of neonatal rats.Methods:All seven-day-old Wistar rats were randomly divided into HIBD group and sham operation group.Brains was obtained at time of 6 h,12 h,24 h,48 h,72 h,96 h after HIBD.Neuronal cell apoptosis was detected by terminal deoxynucleotidyl transferase mediated dUTP-biotin nick end labeling ( TUNEL).The expression level of caspase-3 protein was detected by immunohisto-chemistry.The level of malondialdehyde ( MDA) and supemxide dismutase ( SOD) were measured by thiobarbitic acid colorimetry and xanthin oxidase,respectively.Results:The number of neuronal cell apoptosis and the expression of caspase-3 protein began to increase at 6 h and reached the peak at 48 h in HIBD group,they were both significantly higher than those in the sham operation group at each time point (P<0.05).The level of MDA began to increase at 6 h and reached the peak at 24 h in HIBD group,it was significantly higher than the sham operation group at each time point (P<0.05).The level of SOD began to decrease at 6 h and reached the lowest level at 24 h in HIBD group,it was significantly lower than the sham operation group at each time point ( P<0.05 ) .The number of neuronal cell apoptosis and the expression of caspase-3 protein were positively correlated with the level of MDA, but they were negatively correlated with the level of SOD.Conclusion: Free radical injury promotes the expression of caspase-3 and neuronal cell apoptosis in HIBD.

OBJECTIVE To investigate the protective effect of velvet antler polypeptides(VAP)on hydrogen peroxide( H2 O2 )-induced injury in vascular endothelial cells and the possible mechanism.METHODS The EVC-304 cells cultured invitrowere incubated with H2 O2 for another 12 h after pretreat-ment with VAP 20,40 and 80 mg·L-1 for 24 h. Cell viability was determined by MTT assay, Hoechst333258 staining was used to observe cell morphology,the activity of superoxide dismutase (SOD)and the level of malondialdehyde( MDA)were detected with kits and the expression of heat shock protein(HSP70)and caspase 3 was detected by Western blotting. RESULTS Compared with the normal control group,the cell survival rate was decreased significantly in H2 O2 injury group( P ﹤0.01),cell shrinkage,chromatin condensation,and nuclear fragmentation were seen,the intracellular SOD activity decreased while MDA content increased(P﹤0.01),and caspase 3 and HSP70 expression increased(P﹤0.01). Compared with H2 O2 group,the cell survival rate in VAP 20,40 and 80 mg·L-1 pre-treatment groups increased significantly(P﹤0.01),the apoptosis ratio declined from(25.3±1.0)% to (15.2±1.2)%,(10.3±0.9)% and(7.9±1.4)%(P﹤0.01),the SOD activity increased to 19.2±0.5,22.3± 1.7 and(24.9±0.6)kU·g-1 protein(P﹤0.01),MDA concentration decreased to 1.51±0.2,1.48±0.3 and (1.02±0.1)μmol·g-1 protein(P﹤0.01),and the expression of caspase 3 and HSP70 declined significant-ly(P﹤0.01). CONCLUSION VAP has exert protective effect on H2 O2-induced injury in vascular endothe-lial cells. The possible mechanism might be related to improvement of intracellular oxidative stress level.

Objective The incidence of post-operative hyperbilimbinemia, which is associated with poor outcomes in patients, was reported to be increased in recent years though it has been a rare complication for cardiac operations. Post-opera-tive impairment of liver function is highlighted. We evaluated the incidence and prognosis of post-operative hyperbiliruhinemia in adult patients who underwent cardiotomy with extracorporeal membrane oxygenation (ECMO) support. Methods Sixty-five adult patients who had received ECMO support after cardiac surgery from 2004 to 2008 were enrolled and evaluated retrospec-tively. Post-oporative hypethilirubinemia was defined as the serum level of the total bilirubin more than 51.3 μmol/L during postoperative period. Demographic and clinical data included gender, age, types of surgery, perioperative hemodynamic param-eters, biochemical variables, duration of the ventilation support, ICU stay and outcomes. Results The mean age of the pa-tients was (50.1 ± 13.9) years, forty-six patients(70.8%) were male. The main cardiac procedures were heart transplanta-tion for 9 patients, coronary artery bypass grafting and/or valve operations for 47 patients, congenital heart disease correction for 4 patients and other operations for 5 patients. Among all patients, fifty-one patients(78.5%) were weaned from ECMO succeas-fully and thirty-thrce patients were discharged from hospital. The overall mortality rate was 49.2%. Overall incidence of post-operative hyperbilirubinemia was 55.4%. In patients with postoperative hyperbilirubinemia, the mean peak value for serum to-tal bilirubin was 104.8 (68.5-156.7) μmol/l. The hospital mortality in the hyperbilirubinemia group was significantly higher than that in the non-hyperbilirubinemia group(66.7% vs. 27.6%, P <0.01). Moreover, postoperative hypethilirubinemia (adds ratio = 3. 895, 95% confidence interval, 1.088 - 13.947 ; P = 0.037) and SOFA score (odds ratio = 1.214, 95% confidence interval, 0.987 - 1.494, P = 0.047) and APACHE Ⅲ score (odds ratio = 1.096, 95% confidence interval, 1.028 - 1.169 ; P = 0.004) were associated with hospital mortality after adjusting for preoperative levels of the total bilirubin, direct bilirubin, gender and age. Conclusion Postoperative hyperbilirubinemia is one of the complications in adult patients who undergo cardiotomy with ECMO support, and is associated with increased hospital mortality.