Objective To compare the effect of thoracoscopy combined with laparoscopy Mckeown and tradi-tional three incision surgery in radical resection of esophageal carcinoma.Methods 300 patients with esophageal cancer who confirmed diagnosis by gastroscopy and pathology,were randomly divided into the observation group and the control group,150 patients in each group.The observation group was treated by thoracoscopy combined with lapa-roscopy Mckeown esophagectomy,and the control group was treated by traditional three incision surgery.The operation time,intraoperative blood loss,number of lymph node dissection,length of chest tube drainage,postoperative complica-tions,and length of postoperative hospital stay of the two groups were compared.Results There were no significant differences between the two groups in operating time[(282 ±62)min vs.(273 ±64)min,P >0.05],and number of lymph node dissection[(23.2 ±6.6)vs.(21.6 ±6.4),P >0.05],and there were significant differences in intraop-erative blood loss[(262.3 ±44.7)mL vs.(315.2 ±72.6)mL,P <0.05],length of chest tube drainage[(7.6 ± 1.6)d vs.(9.4 ±2.4)d,P <0.05],postoperative complications[16.7% vs.30.0%,P <0.05],and length of hos-pital stay[(10.5 ±2.5)d vs.(14.0 ±2.0)d,P <0.05].Conclusion Thoracoscopy combined with laparoscopy Mckeown esophagectomy can achieve the same efficacy compared with the traditional approach,and it is worth popu-larizing in clinic for reducing intraoperative blood loss,length of chest tube drainage,postoperative complications,and length of hospital stay.

Objective To evaluate the efficacy of transarterial interventional therapy (TAIT) in treating patients with metastatic liver cancer, and to investigate the factors influencing the prognosis of patients. Methods From January 1997 to June 2000, 470 patients with metastatic liver cancer had undergone TAIT 1231 times in the Cancer Hospital of the Chinese Academy of Medical Sciences. The clinical data of the patients were retrospectively analyzed. The short-term and long-term efficacy and the side effect of TAIT were assessed. The potential factors influencing the prognosis of the patients were determined by Cox regression analysis. Results Complete remission was observed in 94 patients, and partial remission in 143. The total effective rate was 50.4% (237/470). The median survival time was 13.5 months. The O. 5-, 1-, 2-, 3-, 5-year survival rates were 86.4%, 66. 8%, 35.6%, 16.9%, 7.3%, respectively. No severe complication occurred. The factors influencing the prognosis of the patients were: the resection of the primary tumor, blood supply of the tumor, multiple metastases of liver cancer, thrombus in the portal vein, adjuvant chemotherapy after TAIT, tumor originated from breast cancer, tumors invading multiple lobes, concurrent metastasis in other sites (X2= 17. 322, 12. 593, 8.721, 8.573, 8.492, 7. 838, 5. 623, 5. 463, P < 0.05). Conclusions TAIT is an effective palliative therapy for metastatic liver cancer which cannot be resected. The factors mentioned above influence the prognosis of patients after TAIT.

Objective To determine the effect of high dose albumin on permeability of blood brain barrier (BBB) in brain of rats after ischemic-reperfusion (IR) in order to explore its possible mechanism.Methods Establishment of brain ischemic reperfusion rat model by using middle cerebral artery occlusion (MCAO).Medicine treatment was given by caudal vein injection after 2 hours of MCAO.Thirty-six healthy male SD rats were then randomly (random number) divided into 6 groups (n =6 in each):6 h and 24 h sham-operation groups (Group Sham:operation without ischemia),6 h and 24 h normal saline groups (Group NS:NS injection 5 ml/kg) and 6 h and 24 h albumin group (Group Alb:25 ％ Alb injection 1.25 g/kg).Six hours and 24 hours after the end of reperfusion,rats were measured by Zea-Longa score (neural function deficit) separately.Serum concentration of S100B was examined by the ELISA kit and Evans blue in brain tissue was detected by spectrophotometer.The level of AQP4 was examined by Western blot and immunohistochemistry.All data were analyzed by one-way analysis of variance (ANOVA),The intergroup comparisons were analyzed by the least-significant-difference (LSD) test by using SPSS version 17.0 software.Differences were considered statistically significant if P ＜ 0.05.Results Zea-Longa score significantly increased in both group NS and group Alb at 6 h and 24 h (P =0.000).However,there was no significant difference in ZEA-LONGA score of 6 h and 24 h between group Alb and group NS (P =1.000).The serum concentration of S100B in group NS 6 h was significantly lower than that in group Alb at 6h (196.67±20.11 vs 160.04±14.00,P=0.000),and at24h (2.45±0.07 vs.2.23±0.07,P=0.000).Furthermore,concentration of Evans blue in brain tissue in group Alb was significantly higher than that in group NS at both 6 h (0.97 ± 0.08 vs.0.74 ± 0.06,P =0.000) and 24 h (2.45 ± 0.07 vs.2.23 ± 0.07,P =0.000).The expression of AQP4 in brain tissue was higher in group Alb than that in group NS at both 6 h (0.72 ±.0.11 vs.0.57 ± 0.06,P ＜ 0.01) and 24 h (0.80 ± 0.03 vs 0.61 ± 0.02,P ＜0.01).Conclusions High dose albumin contribute slightly in improvement of neural deficit in rats after IR.On the contrary,it can also aggravate the IR injury,which increases brain edema then increase the permeability of BBB.The mechanism may be associated with over-expression of AQP4 in brain tissue.

Objective To investigate effects and its mechanisms of hypertonic saline hydroxyethyl starch 200/0.5 solution on intracranial pressure and brain water content in rats with ischemic cerebral edema.Methods All experiments were conducted in the animal experimental center of Sun Yat-sen University.The 28 male Sprague-Dawle (SD) rats were randomly (random number) divided into hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group,control group and sham operation group,each n =7.Ischemic cerebral edema model was reproduced by middle cerebral artery occlusion (MCAO),followed by reperfusion after ischemia for 2 hours (If the moldel was not successful,other rats were operated to fill the missing models).Then reperfusion after ischemia 2 hours and received hypertonic saline hydroxyethyl starch and hydroxyethyl starch via tail vein at the beginning of reperfusion.The colloidal osmotic pressure (COP) and intracranial pressure (ICP) were evaluated on 0,2,6,12,18,24 hours after the surgery.The water content of the right hemisphere was measured on 24 h after the surgery.Results The ICP of hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group and control group were significantly higher than that of sham operation group on 2,6,12,18,24 h after the surgery.The ICP of hypertonic saline hydroxyethyl starch group was significantly lower than those of hydroxyethyl starch group and control group on 2,6,12,18 and 24 h.But there was no significant difference in ICP of the hydroxyethyl starch group compared with that of control group at all time points.The COP of hypertonic saline hydroxyethyl starch group and hydroxyethyl starch group were significantly higher than the control group and sham operation group at each time point; There was no significant difference in COP (mmHg) of the hydroxyethyl starch group compared with that of hypertonic saline hydroxyethyl starch group at all time points.The brain water content (BWC) of hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group and control group were significantly higher than that of sham operation group on 24 hours after the surgery [(81.24±0.36)％,(83.04±0.10)％,(83.14±0.41)％ vs.(78.37±0.37)％,all P=0.000],BWC of hypertonic saline hydroxyethyl starch group lower than these of hydroxyethyl starch group [(81.24±0.36)％ vs.(83.04 ±0.10) ％,P =0.000] and control group [(81.24 ±0.36)％ vs.(83.14 ±0.41) ％,P =0.000].There was no significant difference in BWC of the hydroxyethyl starch group compared with that of control group [(83.04 ± 0.10) ％ vs.(83.14 ± 0.41) ％,P =0.578].Conclusion Hypertonic saline hydroxyethyl starch solution could significantly ameliorate ischemic cerebral edema and reduce ICP,but the relationship between its elevated COP and reduced ICP has not been confirmed.

Objective To discuss the safety of using etomidate combined with remifentanil by target controlled infusion ( TCI) for painless bronchofibroscopy. Methods Sixty patients were divided into two groups: painless bronchoscopy group (treatment group, 24 patients) and the routine bronchoscopy group (control group, 36 patients). Treatment group received TCI of remifentanil and intravenous injection of etomidate fat emulsion. Control group was subjected to surface anesthesia with 2%lidocaine. SpO2 , blood pressure, heart rate and breath changes during examination and complete awakening were continuously monitored. Bronchofiberscopy time, body movement during examination, bucking and satisfaction degree after examination were also recorded. Results Treatment group patients felt senseless and painless during bronchoscopy, without memory of bronchoscopy and pain. Patients in control group had discomfort, body movement and acute bucking, and most of them had painful memory. There were significant differences between the two groups (P<0. 01). In treatment group, after examination, blood pressure, respiratory frequency, heart rate and SpO2 were significantly decreased (P<0. 01). During examination, the blood pressure, respiratory frequency and heart rate were increased, and SpO2 decreased in control group compared to the baseline (P<0. 01). There was no significant difference in SpO2 between treatment group and control group during examination (P>0. 05). Conclusion TCI etomidate combined with remifentanil during bronchoscopy achieved satisfying anesthetic effect.

Objective To study Joint Mobilization on shoulder pain after stroke. Methods Hemiplegic patients with shoulder pain after stroke were treated with joint mobilization. The effects were determined by the simple McGill Questionnaires and Fugal-Meyer upper extremity functional score before and 30 days after treatment.Results The pain scores of the treatment group were significantly lower than that of the control group (P<0.01), the upper extremity functional scores of the treatment group were significantly higher than that of the control group (P<0.01).Conclusion Joint mobilization for hemiplegic patients with shoulder pain after stroke can significantly reduce shoulder pain and effectively improve upper extremity function.

ObjectiveTo investigate whether esmolol could improve clinical outcome and tissue oxygen metabolism by controlling heart rate (HR) in patients with septic shock.Methods A single-center double-blinded randomized controlled trial was conducted. The patients suffering from septic shock received 6-hour early goal directed therapy (EGDT) with pulmonary artery wedge pressure≥ 12 mmHg (1 mmHg = 0.133 kPa) or central venous pressure (CVP)≥ 12 mmHg requiring norepinephrine to maintain mean arterial pressure (MAP)≥ 65 mmHg and HR≥95 bpm admitted to intensive care unit (ICU) of Guangdong General Hospital from September 2013 to September 2014 were enrolled. They were randomly divided into esmolol group and control group by computer-based random number generator. All patients received conventional basic treatment, while those in the esmolol group received in addition persistent esmolol infusion by micro pump with dosage of 0.05 mg·kg-1·min-1 with the dosage adjusted to maintain HR lower than 100 bpm within 24 hours. The patients in control group did not receive drug intervention for HR. The primary end-points consisted of length of stay in ICU and 28-day mortality. The secondary end-points included hemodynamic parameters [HR, MAP, CVP, cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI)] and tissue oxygen metabolism parameters [central venous oxygen saturation (ScvO2), lactate level (Lac)]before and 24, 48, 72 hours after the treatment.Results A total of 48 patients with septic shock were enrolled with 24 patients in esmolol group and 24 in control group.① The primary end-points: compared with control group, the length of stay in the ICU in the esmolol group was significantly shortened (days: 13.75±8.68 vs. 21.70±6.06,t = 3.680, P = 0.001), and 28-day mortality was significantly lowered [25.0% (6/24) vs. 62.5% (15/24),χ2 = 6.857,P = 0.009].② The secondary end-points: there were no significant difference in the hemodynamic and tissue metabolism parameters before treatment between two groups. No significant difference was found between before and after treatment of all above parameters in control group. HR and Lac in the esmolol group were obviously declined, SVI, SVRI, ScvO2 were gradually increased, but no significant difference in MAP, CVP, and CI was found. Compared with the control group, HR in the esomolol group was significantly lowered (bpm: 84.4±3.5 vs. 111.2±7.2,P< 0.01), SVRI and ScvO2 were significantly increased from 24 hours [SVRI (kPa·s·L-1·m-2): 137.9±1.6 vs. 126.9±1.3, ScvO2: 0.652±0.017 vs. 0.620±0.017, bothP< 0.01]; SVI was significantly increased (mL/m2: 39.9±2.2 vs. 36.8±1.7,P< 0.01) and Lac level significantly declined from 48 hours (mmol/L: 2.8±0.3 vs. 3.4±0.3,P< 0.01).Conclusion The results demonstrate that HR controlled by a titrated esmolol infusion given to septic shock patients was associated with an improvement in tissue metabolism, reduction in the length of ICU stay and lowering of 28-day mortality.

Objective To evaluate the clinical efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of patients with acute respiratory distress syndrome (ARDS), and to look for the predictors of failure of NPPV. Methods A retrospective observation was conducted. ARDS patients underwent NPPV admitted to emergency intensive care unit (EICU) of Guangdong General Hospital from January 2013 to December 2015 were enrolled. The patients were divided into success group and failure group according to the clinical efficacy. The condition of the patients in the two groups was evaluated, and ARDS classification and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score before treatment were recorded. Etiological composition of ARDS was analyzed. The parameters, including heart rate (HR), respiratory rate (RR), oxygenation index (PaO2/FiO2), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (SaO2), were recorded before and 2 hours after the treatment of NPPV. Multivariate logistic regression analysis was conducted for predicting the independent factors inducing the failure of NPPV treatment of patients with ARDS. Results The date of 137 patients with ARDS were collected, excluding the followed patients, 6 with coma, 18 with hemodynamic instability, 5 with severe hypoxia, and 5 with incomplete date. Finally, a total of 103 patients entered the statistics. There were 69 patients in NPPV success group, and 34 in failure group. Compared with success group, APACHE Ⅱ score in the failure group was higher (21.4±6.2 vs. 19.7±8.9), the ratios of patients with severe ARDS and those induced by pulmonary infection were higher [82.4% (28/34) vs. 5.8% (4/69), 32.4% (11/34) vs. 8.7% (6/69), respectively, both P < 0.05]. HR and RR before NPPV in the failure group were significantly higher than those of success group [HR (bpm): 124±13 vs. 117±12, RR (bpm): 39±5 vs. 33±4], and PaO2/FiO2, PaO2, PaCO2, and SaO2 were significantly lower than those of the success group [PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 104±10 vs. 156±12, PaO2 (mmHg): 53±8 vs. 68±7, PaCO2 (mmHg): 31±5 vs. 37±7, SaO2: 0.83±0.07 vs. 0.91±0.05, all P < 0.05]. It was shown by logistic regression analysis that severe ARDS [odds ratio (OR) = 10.533, 95% confidence interval (95%CI) = 5.847-89.852, P = 0.000], pulmonary infection resulted ARDS (OR = 4.831, 95%CI = 1.688-13.825, P = 0.003) and PaO2/FiO2 < 140 mmHg 2 hours after treatment (OR = 7.049, 95%CI = 1.266-39.236, P = 0.026) were the independent risk factors of NPPV failure for the treatment of patients with ARDS. Conclusions Patients with severe ARDS and pulmonary infection derived ARDS were the risk factors of failure to NPPV in ARDS. Lack of improvement in oxygenation 2 hours after NPPV is the predictor of NPPV failure and change to invasive ventilation.

Objective To investigate the clinical value of the ratio of plasma vascular endothelial growth factor level to platelet count (VEGF/PLT) in predicting 28-day prognosis in patients with sepsis.Methods A prospective cohort study was conducted.From September 2009 to March 2013,164 sepsis patients in Intensive Care Unit (ICU) of Guangdong General Hospital were included for study.Patients with age younger than 18 years old,the illness already reaching final stage of chronic diseases,suffering from two or more organs dysfunction within 3 days,acute pancreatitis without infection,or less than 28 days of expected survival time were excluded.Finally,135 patients were included in the further analysis.Peripheral blood samples were collected at admission.Routine blood tests were done,and then VEGF levels in plasma were measured by enzyme linked immunosorbent assay (ELISA).Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were recorded every day for 7 days.Patients' prognosis was assessed during the following 28 days.The patients were divided into 28-day survival group and non-survival group.Comparison between two groups was done by single factor analysis.Spearman rank correlation was used to analyze the correlation between VEGF levels and PLT.Mutivariate logistic regression analysis was performed to identify the independent risk factor for 28-day prognosis.Receiver operating characteristic curve (ROC curve) was plotted,and the effect of related indexes on predicting 28-day survival was evaluated by area under ROC curve (AUC).Results There were no significant differences in VEGF (ng/L:471.73 ± 198.34 vs.383.49 ± 266.54,t=-1.918,P=0.057),PLT (× 109/L:220.40±127.60 vs.246.42± 100.72,t=1.275,P=0.204),leucocyte counts (× 109/L:12.48 ±4.62 vs.13.70 ±5.97,t=1.063,P=0.292),mean arterial pressure [mmHg (1 mmHg=0.133 kPa):86.50 ± 12.04 vs.91.03 t 13.10,t=1.557,P=0.123] and blood lactic acid (mmol/L:1.79 ± 1.30 vs.1.50 ± 0.60,t=-1.768,P=0.079) at admission between the non-survival group (n=42) and survival group (n=93).VEGF/PLT (2.59 ± 1.44 vs.1.73 ± 1.13,t=-3.756,P=0.000) as well as APACHE Ⅱ scores (15.50 ± 4.50 vs.13.28 ± 4.61,t =-2.022,P=0.045) of the non-survival group were significantly higher than those of survival group,and oxygenation index (PaO2/FiO2) of the non-survival group was significantly lower than that of survival group (kPa:32.38 ± 11.12 vs.37.04 ± 10.97,t=2.278,P=0.024).Correlation analysis showed that the concentration of VEGF was positively correlated with PLT (r=0.271,P=0.001).It was shown by multivariate logistic regression analysis that only VEGF/PLT was the independent risk factor in predicting 28-day prognosis in patients with sepsis [odds ratio (OR) was 1.591,95％ confidence interval (95％CI) 1.164-2.175,P=0.004].AUC of VEGF/PLT was 0.704 ± 0.047 (P=0.000,95％CI:0.611-0.797) for predicting 28-day survival.The optimal cut-off point was 1.32,and the sensitivity and specificity were 81.0％ and 48.4％,respectively.Conclusion VEGF/PLT can be used as one of the indicators to predict 28-day survival in patients with sepsis.