Objectives:To investigate the safety,feasibility and clinical effects of early EN(EEN) in postoperative patients with esophageal cancer. Methods:On the first postoperative day,40 patients were randomly divided into EEN group and TEN group(traditional enteral nutrition group), 20 patients per group.A series of parameters including plasma protein and lymphocyte count were tested before and after nutritional therapy.The complications,vital signs and resumption of gastrointestinal functions were carefully observed and recorded simultaneously. Results:Neither mortality nor serious morbidity occurred in all patients during the period of study.The concentrations of serum prealbumin and transferrin were significantly elevated after nutritional support in EEN group.The lymphocyte count was also higher in EEN group.The bowel movement resumed significantly earlier in EEN group than in TEN group. Conclusions:Postoperative EEN for esophageal cancer is safe and feasible,not only improving nutritional status and maintaining gastrointestinal function,but also ameliorating immunological function.

Objective To evaluate the clinical efficacy of transcatheter renal sympathetic denervation(RDN)in the treatment of resistant hypertension.Methods Clinical data of 10 patients with resistant hypertension treated by transcatheter renal sympa-thetic denervation were retrospectively analyzed.The blood pressure and complications were analyzed.Results In all of the 10 pa-tients,systolic and diastolic blood pressure decreased significantly after two weeks compared with preoperative,and further de-creased after 3 months (P <0.05 ).There were no statistical difference of systolic and diastolic blood pressure between 3 and 6 months(P >0.05).Before the RDN,the mean number of antihypertensive drugs was 5.3±0.9.After 6 months which was 3.2±0. 6,and which was decreased significantly compared with the preoperative (P <0.05).No adverse reactions were found.Conclusion The RDN can be quickly and sustained decrease the blood pressure in patients with resistant hypertension.

On 17th June 2017, a 50 years old man with refractory gout was admitted in our hospital. During the treatment, he was accompanied by intermittent fever (39 to 40 ℃) of unknown origin for 60 days and gastrointestinal bleeding, with difficult wound repair. After comprehensive treatment of thorough debridement, vacuum sealing drainage, skin graft, skin flap repair, and drug administration, the patient was discharged fully recovered on post hospitalization day 104.

Objective To establish a prognostic nomogram based on preoperative serum prealbumin levels for predicting overall survival(OS)in patients with unresectable hepatocellular carcinoma(HCC)treated with transcatheter arterial chemoembolization(TACE).Methods A total of 1 041 patients with unresectable HCC,who received TACE treatment at five medical centers in Suzhou city of China between January 2007 and December 2018,were divided into a training cohort(n=768)and a validation cohort(n=273).Cox regression analysis was used to analyzed the independent factors affecting one-,2-,and 3-year OS,based on which the nomogram was constructed,and validation of the nomogram was conducted in an internal test sequence.The performance of the nomogram was evaluated by concordance index(C-index),area under the receiver operating characteristic curve(AUC),calibration curve,and judgment curve analysis(DCA).Results COX regression analysis showed that AFP,BCLC,HBV,intrahepatic vascular invasion,number of tumors,PALB,PS,and tumor size were the independent risk factors affecting OS in patients with unresectable HCC treated with TACE.The C-index in the nomogram was 0.739(95％CI:0.719-0.759)for the training cohort and 0.715(95％CI:0.678-0.752)for the verification cohort.The AUCs of one-,2-,and 3-year OS in the training cohort were 0.877,0.794,and 0.799 respectively,which in the verification cohort were 0.840,0.741,and 0.671 respectively.The AUC-ROC values of the nomogram were higher than those of other traditional scoring systems,indicating that the nomogram had a good discriminatory power.The calibration curves demonstrated that a strong agreement existed between the predicted values of the nomogram and the actual observed values,and the DCA showed that the nomogram had high potential clinical utilization.The nomogram risk score revealed that the survival rate of patients in the low-risk group was significantly higher than that of patients in the high-risk group.Conclusion The nomogram based on preoperative serum prealbumin levels has excellent ability in predicting the prognosis of patients with unresectable HCC treated with TACE.

Objective: To study the segment of liver according to the large amount of three-dimensional(3D) reconstructive images of normal human livers and the vascular system, and to recognize the basic functional liver unit based on the anatomic features of the intrahepatic portal veins. Methods: The enhanced CT primitive DICOM files of 1 260 normal human livers from different age groups who treated from October 2013 to February 2017 provided by 16 hospitals were analyzed using the computer-aided surgery system.The 3D liver and liver vascular system were reconstructed, and the digital liver 3D model was established.The vascular morphology, anatomical features, and anatomical distributions of intrahepatic portal veins were statistically analyzed. Results: The digital liver model obtained from the 3D reconstruction of CAS displayed clear intrahepatic portal vein vessels of level four.Perform a digital liver segments study based on the analysis of level four vascular distribution areas.As the less anatomical variation of left hepatic portal vein, the liver was classified into four types of liver segmentation mainly based on right hepatic portal vein.Type A was similar to Couinaud or Cho′s segmentation, containing 8 segments(537 cases, 42.62%). Type B contained 9 segments as there are three ramifications of right-anterior portal vein(464 cases, 36.82%). The main difference for Type C was the variation of right-posterior portal vein which was sector shape(102 cases, 8.10%). Type D contained the cases with special portal vein variations, which needs three-dimensional simulation to design individualized liver resection plan(157 cases, 12.46%). These results showed that there was no significant difference in liver segmental typing between genders(χ²=2.179, P=0.536) and did not reveal any significant difference in liver segmental typing among the different age groups(χ²=0.357, P=0.949). Conclusions The 3D digital liver model can demonstrate the true 3D anatomical structures, and its spatial vascular variations.The observation of anatomic features, distribution areas of intrahepatic portal veins and individualized liver segmentation achieved via digital medical 3D visualization technology is of great value for understand the complexity of liver anatomy and to guide the precise hepatectomy.

Objective:To investigate the clinical effect of rectangular scar flap combined with autologous thinning split-thickness skin graft for repairing type Ⅳ axillary scar contracture deformity after extensive burns.Methods:From January 2015 to January 2019, patients with type Ⅳ axillary scar contracture deformity after extensive burns were admitted to the Department of Skin Wound Repair Center of Wuhan Third Hospital. Rectangular scar flaps were used to reconstruct the axillary area, Y-shaped incision was made on the short side to release the scar, the resulting defects after flap formation were repaired with autologous split-thickness skin grafts. The hyperplasia and contracture of the grafted skin, the size of rectangular scar flap, the appearance of axilla, the growth of residual axillary hair, and the range of motion of shoulder joint were observed during the follow-up of 18 months to 3 years.Results:A total of 6 cases were selected, including 2 males and 4 females, aged from 18 to 58 years, with the duration of scar contracture deformity ranging from 1 to 23 years. The rectangular scar flaps of all 6 patients survived. At the follow-up of 18 months to 3 years, the axillary scar hyperplasia and the skin graft contracture were mild. At 18 months after operation, the function of shoulder joint was restored with 180° shoulder abduction and lifting. Axillary appearance and residual axillary hair growth were satisfactory, the self-care ability and the quality of life of patients improved.Conclusions:Rectangular scar flap combined with autologous thinning split-thickness skin graft is a good method for repairing type Ⅳ axillary scar contracture in patients with lack of autologous skin sources for extensive burns.

Objective:To investigate the clinical effect of rectangular scar flap combined with autologous thinning split-thickness skin graft for repairing type Ⅳ axillary scar contracture deformity after extensive burns.Methods:From January 2015 to January 2019, patients with type Ⅳ axillary scar contracture deformity after extensive burns were admitted to the Department of Skin Wound Repair Center of Wuhan Third Hospital. Rectangular scar flaps were used to reconstruct the axillary area, Y-shaped incision was made on the short side to release the scar, the resulting defects after flap formation were repaired with autologous split-thickness skin grafts. The hyperplasia and contracture of the grafted skin, the size of rectangular scar flap, the appearance of axilla, the growth of residual axillary hair, and the range of motion of shoulder joint were observed during the follow-up of 18 months to 3 years.Results:A total of 6 cases were selected, including 2 males and 4 females, aged from 18 to 58 years, with the duration of scar contracture deformity ranging from 1 to 23 years. The rectangular scar flaps of all 6 patients survived. At the follow-up of 18 months to 3 years, the axillary scar hyperplasia and the skin graft contracture were mild. At 18 months after operation, the function of shoulder joint was restored with 180° shoulder abduction and lifting. Axillary appearance and residual axillary hair growth were satisfactory, the self-care ability and the quality of life of patients improved.Conclusions:Rectangular scar flap combined with autologous thinning split-thickness skin graft is a good method for repairing type Ⅳ axillary scar contracture in patients with lack of autologous skin sources for extensive burns.