The definition,staging and optimal treatment of adenocarcinoma of esophagogastric junction (AEG) have long been in controversy.Surgery is still the primary treatment for resectable AEG,and surgical procedures depend on its classifications.However,the efficacy of surgery alone is barely satisfactory.Neoadjuvant chemoradiotherapy and perioperative chemotherapy can improve the survival of patients.Simplified 2 cm principle is presented in the 8th edition of American Joint Committee on Cancer for TNM staging system of esophageal cancer.In addition,the new edition provides clinical staging and pathologic staging after neoadjuvant therapy,improving the clinical practicability of new staging system.

Objective To investigate the prognostic significance of the angiolymphatic invasion(ALI) in patients with esophageal squamous cancer(ESCC) who received radical resection.Methods A retrospective review was performed on 355 patients who underwent radical resection for ESCC in our hospital between June 2005 and December 2008.Clinicopathological features and overall survival rate were surveyed.Results Of all the patients included, these 46 ESCC patients with angiolymphatic(ALI group) invasion accounted for 13.3％.The 5-year overall survival rate was 20.3％ in patients of ALI group and 40.2％ in those of non-ALI group(P =0.001).The histological differentiation was poorer in the ALI group (P =0.008) as compared with non-ALI group.Univariate analysis showed that body mass index(BMI), ALI, T stage, N stage, and differentiation were associated with survival(P ＜ 0.05 for all).Multivariate analysis revealed that ALI, N stage, T stage and BMI were independent risk factors of prognosis.Conclusion This study highlights that ALI may facilitate the stratification of patients with a poor prognosis after radical resection for ESCC.

Objective To investigate the clinical outcome of modified large decompressive craniectomy in treatment of severe traumatic brain injury combined with acute subdural hematoma. Methods A retrospective analysis was carried out to compare the clinical outcome of large decompressive craniectomy (treatment group) for 81 patients with severe traumatic brain injury combined with acute subdural hematoma from July 2007 to June 2010 and that of standard large trauma decompressive craniectomy (control group) for 65 patients with same injuries from July 2004 to June 2007. Results According to the Glasgow outcome scale at the end of month 6 after injury, there were 21 patients (GCS 5 points) with good recovery, 19 (GCS4 points) with moderate deficit, 24 (GCS 3 points) with severe deficit, five (GCS 2 points) under persistent vegetative status and 12 (GCS 1 points) deaths in the treatment group,with good prognosis rate (good recovery and moderate deficit) of 49% (P ＜ 0.05) and poor prognosis rate of 51%. However, only 21 patients got favorable outcome, including 12 patients (GCS 5 points)with good recovery and nine (GCS 4 points) with moderate deficit; 44 patients got unfavorable outcome (68%), including 22 patients (GCS 3 points) with severe deficit, three (GCS 2 points) under persistent vegetative status and 19 (GCS 1 points) deaths in the control group (P ＜0.05). Furthermore, the incidences of delayed intracranial hematomas and subdural collection of fluid in the treatment group were significantly lower than those in the control group (P ＜ 0.05). Conclusion Modified large decompressive craniectomy can significantly improve the outcome and reduce complications of patients with severe traumatic brain injury combined with acute subdural hematoma.

Objective To explore the role of improved cranioplasty plus ventriculoperitoneal shunt in early treatment of hydrocephalus secondary to decompressive craniectomy for patients with severe craniocerebral injury. Methods A retrospective study was performed on 45 patients complicated by hydrocephalus after decompressive craniectomy for severe craniocerebral injury treated with early stage improved cranioplasty plus ventriculoperitoneal shunt from January 2006 to December 2010.Then,the clinical data,complications and outcomes were summarized. Results All operations were carried out 38-80 days after injury.The postoperative complications were distal obstruction of ventriculoperitoneal shunt in two patients and intracranial infection in one.The clinical symptoms were obviously improved in 36 patients (80％) and the cerebral ventricle was diminished in 34 (76％) one month postoperatively.The Glasgow Outcome Scale (GOS) at discharge was good in eight patients,moderate disability in 19,severe disability in 13 and prolonged coma in five,where better recovery (good recovery and moderate disability) in 27 patients (60％) showed significant improvement compared with preoperation ( x2 =23.47,P ＜0.01 ). Conclusion Early cranioplasty plus ventriculoperitoneal shunt is an effective and safe method for treatment of the complicated hydrocephalus after decompressive craniectomy for severe craniocerebral injury.

Objective:To evaluate the clinical value of radioactive nuclide strontium chloride (89SrCl2) combined with 99Tc-MDP in treating patients with breast cancer and osseous metastasis. Methods:A total of 80 patients with breast cancer and experiencing bone pain from osseous metastasis were randomly categorized into three groups. 22 patients were treated with 99Tc-MDP (99Tc-MDP group), 30 were treated with 89SrCl2 (89SrCl2 group), and 28 were treated with the combination therapy of 89SrCl2 and 99Tc-MDP (combination group). The analgesic effect, remission of bone metastases, and quality of life of patients in the three groups were observed before and after treatment. Side effect was also monitored. Results:In the combination group, the overall pain relief rate and the increase rate of life quality score were 92.9%(26/28) and 78.6%(22/28), respectively. The combination group was statistically significantly different from the two single-treatment groups (P<0.05). The effective rate of metastatic lesions was 46.4%(13/28) in the combination group, which was significantly higher than that in the 99Tc-MDP group (18.2%, 4/22;P<0.05). The effective rate of metastatic lesions was not significantly different between the combination and 89SrCl2 groups (33.3%, 10/30) (P>0.05). Conclusion:The treatment of 89SrCl2 com-bined with 99Tc-MDP can increase the analgesic effect and significantly improve the curative effect without overt side effects in patients with breast cancer and bone metastasis.

Objective To investigate the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFA) supplementation on neuron apoptosis,brain edema,activation of microglia,inflammatory response and neural function after traumatic brain injury (TBI) in rats,so as to understand the protection of ω-3 PUFA in rats following TBI and its mechanism.Methods TBI model was established using Feeney's method.Ninety SD rats were randomly divided into 5 groups:sham operation group (sham group),TBI group,TBI + selective activator of c-Jun N-terminal kinase (JNK) anisomycin group (TBI + Aniso group),TBI + ω-3 PUFA supplementation group (TBI + ω-3 group),and TBI + ω-3 PUFA supplementation + JNK activation group (TBI + ω-3 + Aniso group).We measured rat behavioral outcomes by modified neurological severity score (mNSS) on day 1,3,and 7 after TBI.Brain water content was measured with wet-dry weight method.The neuron apoptosis and microglial activation (identified by specific marker IBA-1) in TBI cerebral cortex were determined by TUNEL staining and immunofluorescence.Inflammatory cytokines [tumor necrosis factor-α (TNF-α),interleukin (IL)-1α,IL-1β,and IL-6] and the JNK signaling pathway (JNK,pJNK) were tested with reverse transcription-polymerase chain reaction and Western blot,respectively.Results Compared with the sham group,the levels of brain cell apoptosis,brain edema,neuron apoptosis,and inflammatory-relatived factors (TNF-α,IL-1 α,IL-1β,and IL-6) were significantly increased in the other four groups (P ＜ 0.05).Compared with the TBl group,ω-3 PUFA supplementation reduced brain water content following TBI,especially on day 3 after TBI [(78.14 ± 0.57) ％ vs.(82.31 ± 0.81) ％,P ＜ 0.01],and improved neurological function score (P ＜ 0.05).Meanwhile,ω-3 PUFA supplementation suppressed neuron apoptosis,the activation of microglia,and the mRNA and protein expressions of inflammatory cytokines (TNF-α,IL-1α,IL-1 β,IL-6).The activation of JNK signaling pathway was also inhibited by ω-3 PUFA.Conclusion ω-3 PUFA supplementation may markedly reduce brain edema,suppress neuron apoptosis,and improve neurological outcomes after TBI in rats,possibly mediated by inhibiting JNK signaling pathway and microglial activation,reducing microglia-induced cerebral inflammatory responses,demonstrated as down-regulated expression of TNF-α,IL-1α,IL-1β,and IL-6.

Objective To investigate the effects of glutamine (Gln) supplementation on neurologica severity score,brain edema,neuron apoptosis,and endoplasmic reticulum stress (ERS) response after traumatic brain injury (TBI) in rats.Methods TBI rat models were established using modified Feeney's method.Eighty Sprague-Dawley rats were divided into 4 groups with a random number table:sham operation group (Sham group),TBI group,Gln supplementation group (TBI + Gln group) and ERS inducer 2-deoxy-D-glucose group (TBI +Gln + 2-DG group).We measured the rats' neurobehavioral outcomes by modified neurologic severity score (mNSS) on day 1,3,7 and 14 after TBI.Neuron apoptosis was detected using TUNEL staining.Brain water content was measured with wet-dry weight method.The apoptosis-related protein (caspase-12,caspase3,and Bcl-2) and ERS-related cytokines [inositol-requiring enzyme 1 (IRE-1),C/EBP homologous protein (CHOP)] expressions in TBI cerebral cortex were determined by immunohistochemistry staining and Western blot.Results Compared with the Sham group,the levels of brain edema,mNSS,apoptosis-related protein (caspase-12,caspase-3,Bcl-2) and ERS-related proteins (IRE-1,CHOP) were significantly increased in the other three groups (all P =0.00).Compared with the TB1 group,the TBI +Gln group showed significant lower brain water content [3 d:(81.39±0.59)％ vs.(83.54±0.52)％,P=0.04;7 d:(74.86±0.38)％ vs.(77.32±0.66)％,P=0.03],improved mNSS (8.63 ±0.22 vs.10.37±0.29,P=0.03),suppressed expressions of apoptosis-and ERS-related proteins (caspase-12,caspase-3,IRE-1,and CHOP)(P =0.01,P ＜ 0.01),and increased expression of anti-apoptotic protein Bcl-2 (P =0.02).Compared withthe TBI + Gln group,the expression of ERS-related factors (IRE-1 and CHOP),brain edema level,and neurological severity were increased in the TBI + Glu + 2-DG group.Conclusion Glutamine supplementation may have neuroprotection function,demonstrated as reducing brain edema and neuron apoptosis,and improving neurobehaviroal outcomes after TBI,possibly mediated by inhibiting TBI-induced ERS response.

Objective To investigate the effect of human interferon-beta (IFN-β) gene engineered human mesenchymal stem cells (hMSC) in the treatment of human prostate cancer xenograft in nude mice.Methods An adenovirus vector containing human IFN-β gene was constructed and transfected into hMSC in vitro.IFN-β-expressing mesenchymal stem cells (IFN-β-hMSC) were labeled with 4,6-diamidino-2-phenylindole (DAPI).The human prostate cancer cell line PC-3 were injected into the flank or axillary of severe combined immunodeficiency (SCID) mice subcutaneously to establish human prostate cancer xenograft models.IFN-β-hMSC were injected into the tail vein of mice bearing human prostate cancer xenografts.The tumors,livers,lungs,spleens and kidneys were harvested.Frozen sections and paraffin sections were used to observe the distribution of IFN-β-hMSC in vivo by fluorescence microscope.Mice were divided into seven groups of six animals randomly,IFN-β-hMSC (2 × 106,2 × 105 ) as treatment group,Ad-hMSC,unmodified hMSC,Ad-IFN-β,Recombinant IFN-β,and NS as control group.The weight of the tumor and the survival time of mice were observed to evaluate the experimental efficacies of IFN-β-hMSC in the treatment of prostate cancer. Results IFN-β-hMSC with blue nuclei were distributed extensively in the tumors,but no blue nucleus was seen in the livers,lungs,spleens and kidneys.After treating,the weights of the tumour masses from mice were (1.35 ±0.28) g,(1.43±0.41) g,(3.49 ±0.25)g,(3.58±0.30)g,(3.30 ±0.24) g,(3.32 ±0.25) g,(3.32 ±0.47) g in the IFN-β-hMSC (2 ×106),IFN-β-hMSC (2 ×105),Ad-hMSC,unmodified hMSC,Ad-IFN-β,Recombinant IFN-β,and NS group,the median survival time from mice were 91 d,87 d,57 d,59 d,62 d,61 d,61 d in the IFN-β-hMSC (2 × 106),IFN-β-hMSC (2 × 105),Ad-hMSC,unmodified hMSCs,Ad-IFN-β,Recombinant IFN-β,and NS group,respectively.Injection of IFN-β-MSC can significantly reduce tumor weight and increase animal survival compared with controls ( P ＜ 0.05 ). Conclusion IFN-β-hMSC can migrate to prostate cancer microenviroment in vivo,and injection of IFN-β-MSC can significantly reduce tumor weight and increase animal survival.

Objective To investigate the clinical effect of human neural stem cells transplantation on severe visual disability infants after cerebral palsy. Methods Cells obtained from the forebrain of an 11-week-old abortive fetus were cultured and expanded for 15 days, then injected into cerebral ventricle of 7 patients. Results Their vision of 4 patients improved, as well as changes of flash visual evoked potential and functional magnetic resonance imaging in a few days after transplantation. Conclusion Neural stem cells transplantation may benefit in some CP children with severe visual disability.

Esophagectomy is one of the most complex interventions in thoracic surgery.Traditional open esophagectomy requires large incision and is associated with many complications.Video-assisted thoracoscopic surgery (VATS) contributes to less complications and hospital stay,and uniportal VATS has more minimal advantages over multi-portal VATS.Due to the technical complexity of esophagectomy,uniportal VATS is highly difficult.Surgeons from Taiwan reported uniportal VATS esophagectomy for the first time in 2015,and this uniportal technique was also reported by surgeons from other institutions.Nowadays,uniportal VATS esophagectomy is still in its initial stage,skills are immature,and long-term,large sample,controlled studies are demanded.Here,authors reviewed the development,skills,short-term outcomes,current practice in West China Hospital,the advantages and challenges for unipotrtal VATS esophagectomy.