Objective To evaluate the effect of chest backplate in treating multiple rib fractures in patients with focal abnormal breathing.Methods The clinical data of 36 patients with multiple rib fractures and focal abnormal breathing who were treated by Chrisofix chest backplate were analyzed.Results Thirtyfour patients were cured by chest backplate and other conservative treatments,and 2 patients underwent rib internal fixation surgery.The numeric rating scales scores before and after the application of the chest backplate were (8.1 ± 0.7) scores and (5.2 ± 0.5) scores respectively(P ＜ 0.01).Seven patients had skin blisters forming around the shield,which were cured by liquid extraction with a syringe and gauze covered with povidone iodine.No patients stopped treatment because of allergy.Conclusions Chest backplate is an effective,easy and inexpensive method for patient with multiple rib fractures and focal abnormal breathing who doesn't need exploratory thoracotomy.It is worthy to spread in clinical treatment.

Objective To investigate the value of ionic-contrast esophagogram in diagnosis of intrathoracic anastomotic leakage after oesophagectomy.Methods The data of 728 patients suffered esophagectomy were retrospectively collected.723 patients without clinical manifestations of anastomotic leakage were divided into group A(esophagogram before eating,n=465) and group B(non-esophagogram before eating,n=258).The incidence of anastomotic leakage was compared between the two groups.Results The discovery rates of anastomotic leakage in group A and B were 0.43%(2/465) and 0.78%(2/258),respectively,the difference was no statistically significant between the two group(P=0.55).The total incidence rates of anastomotic leakage in group A and B were 0.65%(3/465) and 0.78%(2/258),respectively,the difference was no statistically significant between the two groups(P=0.84).5 patients with clinically suspected anastomotic leakage,all had loculated pleural effusion,4 cases had fever,and 2 cases had abnormal chest drainage.Finally,4 cases(80%) were confirmed to be anastomotic leak by esophagogram.Conclusion Routine ionic-contrast esophagogram before eating do not improve intrathoracic anastomotic leakage detection rate after esophagectomy,but when patients have fever,loculated pleural effusion and abnormal chest drainage,esophagogram is necessary and can improve the detection rate of esophageal anastomotic leak.CT radiography may detect smaller anastomotic leakage than conventional esophagogram.

Objective To analysis the difference of lymph node cleaning and operative complication rate between thoracoscope surgery and routine thoracotomy on patients with thoracic segment esophageal cancer.Methods A summary of 62 patients with thoracic segment esophageal cancer in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from August 2012 to August 2014,who were carried with thoracoscope surgery,were randomly chosed and designed as the thoracosc0Pe group,and 62 patients with thoracic segment esophageal cancer over the same period,carried out with routine thoracotomy,were designed as the control group.All the clinical data of the two groups were collected.The total of thoracic lymph node cleaned and the group of thoracic lymph node cleaned were compared between the two groups.The operation time,intraoperative blood loss,chest tube placement time and postoperative hospital duration were collected and compared.All the patients were followed up at least for one year.The incidence of postoperative complications such as pulmonary infection,pneumothorax,atelectasis,recurrent laryngeal nerve injury and anastomotic leakage in the follow-up period were compared.The follow-up time,mortality and recurrence rate were compared.Results The total of thoracic lymph node cleaned(13.36±3.28) and the group of thoracic lymph node cleaned(3.35±0.84) in the thoracoscope group were lower then these of the control group ((14.22± 2.78) and (3.58±0.75)),but with no statistical difference (t =1.57,1.61,P＞ 0.05).The operation time of the thoracoscope group((314.63±38.72) min) were higher then that of the control((217.46±41.54) min),and the intraoperative blood loss ((205.73 ± 114.38) ml),chest tube placement time ((6.83 ± 1.92) d) and postoperative hospital duration((18.47±5.36) d) of the thoracoscope group were remarkably lower then these of the control ((345.72 ±175.62) m1,(10.04±2.41) d,(22.65±6.84) d,t=13.47,5.26,8.20,3.79,P＜0.05).The incidence of pulmonary infection (4.8％ (3/62)) and atelectasis (1.6％ (1/62)) of the thoracoscope group,were evidently lower then these of the control (17.7％ (11/62),1.3％ (7/62),x2 =5.15,4.81,P＜0.05).There was no significant difference in mortality and recurrence ratebetween the two groups during the follow-up period (3.2％ (2/62) vs.8.1％ (5/62),11.3％ (7/62) vs.14.5％ (9/62),x2 =1.36,0.29,P＞0.05).Conclusion There are no significant difference inlymph node cleaning between thoracoscope surgery and routine thoracotomy on patients with thoracic segment esophageal cancer,but thoracoscope surgery can shorten the length of hospital duration,reduce the intraoperative blood loss,chest tube placement time and postoperative complications.So the thoracoscope surgery is a safe and feasible operation for patients with thoracic segment esophageal cancer.

Objective To investigate the clinical significance of WDHD1 protein expression in esophageal squamous cell carcinoma.Methods The expression of WDHD1 protein in esophageal squamous cell carcinoma,adenocarcinoma of esophagus and normal esophagus tissues by immunohistochemical MaxVision was detected.Results The expression of WDHD1 protein in the tissues of esophageal squamous cell carcinoma was significantly higher than that in the normal esophagus tissues and adenocarcinoma of esophagus (15.68 ± 3.01 vs.3.89 ± 2.98 and 4.66 ± 2.46)(P ＜ 0.05),there was no significant between normal esophagus tissues and adenocarcinoma of esophagus (P ＞ 0.05).The expression of WDHD 1 protein in the tissues of esophageal squamous cell carcinoma,high-middle differentiation tissues was higher than poorly differentiation,TNM stage Ⅲ + Ⅳ stage was higher than Ⅰ + Ⅱ stage,depth of invasion T3 + T4 was higher than T1 + T2,with lymph node metastasis tissue was higher than without,differences was statistically significant (P ＜0.05).Conclusions The higher expression of WDHD1 protein is the marker of high invasive and low histological grade of esophageal squamous cell carcinoma,and WDHD1 in esophageal squamous cell carcinomas may play an important role in development.

Objective Investigate the effect of valsartan combined with statins on coronary heart disease and its effect on BNP and CRP.Methods 92cases of patients with coronary heart disease were selected, which were treated in hospital from March 2015to March 2017, and were divided into the study group (46cases) and control group (46cases) .The patients of all two groups were treated with conventional treatment.The patients of control group were treated with valsartan (40mg/d, oral;if no hypotension after 3days of treatment, the dose increased to 80mg/d) , and on the basis of control group, the patients of study group were treated with atorvastatin calcium capsules (20mg/d, in 0.5hafter dinner) .The patients of two groups were all treated for 6months in a row.Compare the adverse reactions and changes of the levels of blood lipids, coronary plaques, BNP, CRP and LVEF of two groups.Results After the appropriate treatment, the TG, TC, LDL-C levels of the study group were significantly lower than those of the control group, and the HDL-C, LVEF levels of the study group were significantly higher than those of the control group (P<0.05);the lipid plaque, fibrous plaque, calcified plaque, mixed plaque levels of the study group were significantly lower than those of the control group (P<0.05);The BNP, CRP levels of the study group were significantly lower than those of the control group (P<0.05);There were acute myocardial infarction, unstable angina, heart failure and other adverse events occurred in both two groups, and the difference was statistically significant between the two groups (P<0.05) .Conclusion Valsartan combined with statins in the treatment of patients with coronary heart disease can improve blood lipid levels, reduce coronal plaque area, inhibit inflammatory response, which makes it worthy of clinical promotion.