Objective To evaluate initial results of Ivor Lewis minimally invasive esophagectomy (MIE) for esophageal carcinoma using a diamond-shaped anastomosis with 45 mm linear-stapler.Methods Clinical data of 12 patients diagnosed middle to distal esophageal carcinoma and undergoing Ivor Lewis minimally invasive esophagetomy using a diamond-shaped anastomosis technique during Dec.2015 and Nov.2016 in Peking Union Medical College Hospital were collected and analyzed retrospectively.Results The mean operation time was (378 ± 56) min,the mean blood loss was (280 ± 120) ml,and the mean postoperative hospital stay was (12.2 ± 2.0) days.No positive margin,no peri-operative death occurred.Postoperative complication included atelectasis and pulmonary infection in 1 patient,paresis of left recurrent laryngeal nerve in 1 patient.No anastomotic leak or constriction occurred.Median follow up was 7 months,11 patients had no evidence of disease progress,1 patient had subcutanecous metastasis and was reoperated.Conclusion The diamond anastomosis technique utilizing in Ivor Lewis MIE for esophageal carcinoma is feasible,easy to manipulate,safe and reliable.

Objective To imitate the development process of new drugs with rutin as the model and to do multidiscipli-nary experiments of preparation and pharmacodynamics of rutin tablets .Methods Thin-layer chromatography was used to i-dentify rutin in Pagodatree flower bud .High-performance liquid chromatography was used for quantitative determination of ru-tin in Pagodatree flower bud and rutin products .The vasodilatation effect of rutin was investigated .The preparation of rutin tablets was completed .Results and Conclusion We completed the identification of Pagodatree flower bud ,extraction and puri-fication of rutin from Pagodatree flower bud ,the assay of rutin ,the pharmaco-dynamics study and the formulation of rutin tab-lets .The experiments helped the postgraduates to be familiar with the research process of new drugs and to improve their ex-perimental operation skills .

Background and objective Primary neuroendocrine carcinoma of thymus (pNECT) is a rare thymic neoplasm. Some pNECTs could produce an adrenocorticotropic hormone and cause Cushing syndrome (CS). hTe aim os this study is to discuss the diagnostic technique and surgical management of pNECT-caused CS and analyze prognosis factors to improve the clinical experience of the disease.MethodshTe outcome of surgery and follow-up of 14 cases (eight males and six females) of pNECT-caused CS were retrospectively analyzed from November 1987 to June 2013.ResulthTe median age of the patients was 29, and the median duration of the disease was four months (1 month-44 months). All cases exhibited clinical evi-dence for the diagnosis of CS, and thoracic computed tomography (CT) was used to detect thymic tumors. Surgical treatment signiifcantly decreased the concentration of both serum cortisol and adrenocorticotropic hormone (P<0.01) but caused one death in the perioperative period. With multidisciplinary therapy, the median survival was 38 months.Conclusion pNECT-caused CS is a rare disease with aggressive characteristics and unclear prognosis. Early diagnosis and therapy is a challenge for clinicians. hToracic CT is important for disease location and preoperative evaluation and should be routinely applied to all CS patients to allow early surgery and improved prognosis.

Lung cancer is one of the main causes of cancer burden and death in China,with nearly 800,000 newly diagnosed lung cancer patients each year,nearly half of whom are lung adenocarcinoma(LUAD)patients.According to cur-rent clinical guidelines,surgery is the main treatment for stage Ⅰ LUAD patients,but the 5-year overall survival rate of stage ⅠLUAD patients alone is still unsatisfactory,about 73％-90％,indicating that a considerable number of patients require other means to improve survival benefits.Chemotherapy and targeted therapy have achieved great success in the treatment of locally advanced and metastatic LUAD patients,but there is still controversy over whether they can benefit stage Ⅰ LUAD postopera-tive patients.Under the circumstances,many researchers have paid attention to this issue and made beneficial explorations.This review provides a brief review of the factors that affect the acceptance of adjuvant chemotherapy and targeted therapy in stage ⅠLUAD postoperative patients,as well as the relevant clinical research on the application of adjuvant chemotherapy and targeted therapy in stage Ⅰ LUAD postoperative patients,in order to gain a broader understanding of the latest developments in this field and find new breakthroughs to promote sustained research in this field.

Objective To investigate the effects of preoperative mental care on patients undergoing local anesthesia cataract extirpation .Methods One hundred cataract patients were randomly divided into the control group (n=50) and the experimental group (n=50).The control group was in conventional nursing care, while the experimental group was with preoperative mental care .The state of anxiety , discomfort during operation and the satisfaction rate of the operation were compared between groups .Results Before intervention , the blood pressure ( BP ) , heart rate ( HR ) , body temperature , oxygen saturation and SAS score had no significant differences (P>0.05).After implement the mental care, the score of SAS in the experimental group was (46.3 ±5.32), which was lower than that of the control group (57.6 ±6.18), the difference was statistically significant (t =9.798, P <0.01).During the operation, in the control group, 14 patients (28.0%) had a palpitation or chest distress , 8 patients(16.0%) had nausea, which was much more frequent than those in the experimental group (6.0%,4.0%),the difference was statistically significant (χ2 =8.575, 4.002, respectively;P<0.05).The score of satisfaction in the control group was (74.5 ±7.25) significantly lower than (82.6 ±8.32) in the experimental group (t=5.192, P<0.01).Conclusions Mental care can decrease the fluctuation of patients ’ BP and HR, furthermore it is benefit in achieving the operation and improving patients’ satisfaction.

Objective To analysis the clinicopathological features of skip N2 metastasis in NSCLC in our clinical center,therefore guide for clinical decision making for NSCLC patients.Methods A total of 120 NSCLC patients with N2 metastasis treated by surgery were enrolled from January 2017 to May 2018,of which 55 were males and 65 were females.The mean age of them were (58.36 ± 11.34) years old.36 patients had skip N2 metastasis,accounting for 30％ of patients with N2 metastasis.48 patients had a history of smoking or a definitive history of second-hand smoke exposure,compared with other 72 patients.Collected pre-and post-operation clinical data of those patients,and carried out relevant statistical analysis.Results Among the NSCLC with skip N2 metastasis,it occulted more frequently in right lower lobe and peripheral lung cancer.The main pathological type was adenocarcinoma with acinar subtype.The most cases of skip N2 metastasis were characterized by single N2 station metastasis.Age of patients showed a significant difference between the two groups(P =0.049).Gender,smoking history,T staging of lung cancer,pathological type and involvement of pulmonary membrane showed no statistic difference between the two groups(P ＞ 0.05).Conclusion Patient with skip N2 metastasis seemed to be elder,and the lesions of those patients were more likely to be lung adenocarcinoma in the right lower lobe and peripheral lung cancer,often involved single N2 station.The lung cancer in right upper lobe often skipped to level R2 + R4,which in right middle lobe often skipped to levels R2 + R4 and 7,in right and left lower lobes skipped to level 7,in the left upper lobe often skipped to level 5.

Objective:To analyze clinical features of aortoesphageal fistula (AEF) patients with massive upper gastrointestinal hemorrhage.Methods:Five AEF patients with massive upper gastrointestinal hemorrhage admitted in Peking Union Medical College Hospital from 2016 January 1st to 2019 December 31st. The clinical data, endoscopic findings, radiological manifestations, treatment and clinical outcomes were retrospectively analyzed.Results:Among 5 patients, 4 were males, 1 was female with an average age of (58±8) years old. The underlying conditions were atherosclerosis ( n=4), hypertension ( n=3), hyperlipidemia ( n=1); 2 cases had aortic aneurysm stent implantation and 1 case of rheumatic heart disease had valve replacement. All 5 patients were complicated with hematemesis and hypovolemic shock, and 4 cases had sentinel hemorrhage. Contrast-enhanced CT or CT angiography of the aorta showed thicken esophageal wall, local esophageal discontinuity, aortic aneurysm, gas around the aortic stent and contrast agent spilling over. The gastroscopy showed esophageal depression lesions, deep ulcers, mucosal erosion with bleeding. Conservative therapy and endoscopic hemostasis failed, 2 patients died without surgical intervention; 3 patients underwent emergency surgeries, 2 survived and 1 died perioperatively. Conclusions:Aortoesophageal fistula is in lack of specific clinical manifestations but is highly in mortality. Therefore CT and gastrocopic examination should be performed for suspected patients, early diagnosis and surgical treatment are the key to save patients′ lives.

Small cell lung cancer carries the worst prognosis among lung cancer. The current guidelines only recommend surgical treatment for patients in the Ⅰ-ⅡA stage, but surgical treatment is often in a neglected position in clinical practice. More and more recent studies have focused on this aspect. This article reviews the recent research literatures and reviews the progress of surgery in the multidisciplinary treatment of small cell lung cancer.

Background::Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.Methods::The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25-70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.Results::The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.Conclusions::We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.

Objective     To evaluate the influence of resection status, pathological type, pathological stage and postoperative adjuvant therapy on prognosis of surgically treated thymic carcinoma. Methods     In this retrospective study, 56 patients with surgically treated thymic carcinoma in the Department of Thoracic Surgery, Peking Union Medical College Hospital from January 2005 to December 2015 were enrolled. There were 30 males and 26 females aged 52.1±11.5 years ranging from 22 to 81 years. The survival curve was performed by Kaplan-Meier method. The prognostic factors affecting overall survival (OS) and disease-free survival (DFS) were analyzed by one-way analysis of variance (ANOVA). Results     R0 resection was performed in 37 patients (67.9%), and other resections in 19 (32.1%); 13 patients suffered thymic carcinoma with Masaoka stage Ⅰ-Ⅱ, 26 Ⅲ, and 17 Ⅳ. Low-grade thymic carcinoma was found in 42 patients, and high-grade in 14. Postoperative radiotherapy, chemotherapy and chemoradiotherapy were performed on 17, 12 and 18 patients respectively and 9 patients were untreated. Forty-one patients was followed up for 1 to 10 years, and the follow-up rate was 73%. The 1-, 3- and 5-year OS rates were 93%, 74% and 61%, respectively. Resection status and pathological stage affected OS. Postoperative radiotherapy after R0 resection affected DFS, but did not affect OS. Conclusion     Most patients with thymic carcinoma after surgery can survive for a long period, and R0 resection is the most important prognostic factor of thymic carcinoma. Postoperative radiotherapy after R0 resection in patients with Masaoka stage Ⅱ-Ⅲ is recommended.