Objective: To assess, the safety and early oncologic results of minimally invasive esophagectomy (MIE) combined with super-extended two-field lymph node dissection for treating esophageal squamous cell carcinoma. Methods A total of 49 patients who underwent MIE through McKeown approach (right chest, left neck, and abdomen) between May 2012 and Dec. 2013 were enrolled in this study. Lymph node dissection fields included whole mediastinum, lower para-esophagus via thoracoscope route, and abdomen. Results: The patients included 44 males and 5 females, with an age range of 45-78 years old and a median of 58 years old. Sixteen (32. 7%) patients were at Stage I. Forty-eight (98. 0%) patients received complete resection, and 18 (36. 7%) patients had post-operation complications, including 9(18. 4%) with neck leakage and 7 (14. 3%) with vocal cord paralysis. Post-operative early death occurred in one case. The mean number of removed lymph nodes was 18 and the lymph node metastasis rate was 42. 9% (21/49); 28. 6% (6/21) of the positive nodes were found in the upper mediastinum and lower para-esophagus areas. Seven of the 18 patients who were followed up had recurrence, with a recurrent rate of 38. 9%. The 7 cases included 5 in the locoregional areas and 2 in distant organs. Conclusion: MIE combined with super two-field dissection can achieve the lymphadenectomy effect recommended by National Comprehensive Cancer Network (NCCN), with satisfactory safety. Short-term follow-up indicates that the locoregional recurrence is more frequent than distant metastases, demanding more thorough mediastinal lymph node dissection.

183 Background More clinical Sdoctors tend to choose minimally invasive treatments for patella fracture. Because patients have lower complications, better function and perfect incision, which makes them early continue working and influences a little on their careers and life. Objective To explore the efficacy of minimally invasive treatment of patella transverse of young people, we choose percutaneous cannulated screw and titanium cable that we design to operate surgery.we observe the surgical incision, hemorrhage and function Methods From February 2009 to June 2012, we applied the minimally invasive technique of percutaneous cannulated screw and titanium cable to treat 30 cases of patella transverse, 16 males and 14 females. Aged 24-45 years, mean 35.4 years.injury mechanism:10 cases in the traffic accident, 6 cases in the fall s injury, 14 cases in the kneeling injury. fracture type:6 cases proximal pole fracture, 11 cases middle pole fracture and 13 cases distal pole fracture. Result All patients healed incision. 30 cases were followed up for mean 18 months. Fracture healed in mean 6.8 weeks. According to Lysholom function score, excellent in 27 cases, good in 2 cases, good rate of 100%. Conclusion Minimally invasive technique of percutaneous cannulated screw and titanium cable to treat the patella transverse fracture is the better choice. It fixes reliable, follow the biomechanical and have low surgical damage. Patients have less complication and get a good clinical efficacy. It is a better choice to treat patella transverse fracture of young fracture.

Objective To investigate the color differences of enamel and dentin of natural teeth, so as to lay a foundation for reducing the color differences of natural dentin and core of all ceramic restorations. Methods X-rite Color i7 Spectrophotometer was used to examine the chroma value and chromatic difference (δE) of enamel and dentin of natural teeth (thickness 0. 9 mm, 0. 6 mm and 0. 3 mm, n = 30). Results The L* values (lightness) of enamel and dentin increased with the decrease of slice thickness, and the a* values (red-green) and b* values (yellow-blue) decreased with the decrease of slice thickness (P<0. 05). The absolute L*, a* and b* values of the dentin were significantly greater than those of enamel of same thickness (P<0. 05). There were great color differences between enamel and dentin of different thicknesses, with the mean δE values within a range of 5. 303-13. 109. The color difference gradually increased with the thickness increase of enamel and dentin. The δE value of the enamel and dentin of the same thickness was 5. 115 (0. 9 mm), 5. 855 (0. 6 mm), and 6. 053 (0. 3 mm), respectively. Conclusion There is noticeable color difference between the enamel and dentin of natural teeth, and the difference increases with the increase of their thickness difference. The dentin has a more yellowish color and less lightness compared with the enamel. So each laminate of all ceramic restorations needs a shade selection for all ceramic restorations, and more attention should be paid on the color matching of natural dentin and core ceramic laminate.

Objective: To investigate the effect of human vascular endothelial growth factor on restenosis after angioplasty. Methods: A rabbit model of injured carotid artery was established using percutaneous transluminal angioplasty. The pcDNA3/hVEGF165（500 μg,n=12） and pcDNA3 （500 μg,n=12） were separately transfected into injured arterial wall with 30 min incubation. The carotid artery was imaged by arotic angiography at the end of week 2 and week 4. Pathology analysis and Northern blot analysis were performed for harvested injured artery segment. Results: Arotic angiography showed carotid artery diameter narrowness were obviously lessened at week 2 and week 4 in experimental group than that in control group; H-E stains showed lumina narrow ratio were obviously reduced at week 2 and week 4 in experimental group than that in control group［（9.58±1.35）% vs (31.72±1.72)%；(18.09±2.93)% vs (44.05±3.28)%， P<0.01 ］; By Northern blot analysis, the expression of hVEGF165mRNA in experimental group were upregulated than in contol group. Conclusion: pcDNA3/hVEGF165 can be transfected into smooth muscle cell and continue to secret bioactivity protein at least for 4 weeks; it can accelerate reendothelialization and prevent restenosis.

OBJECTIVE: Aconite is a traditional Chinese herbal medicine that has been found to inhibit the development of liver cancer; however, its exact molecular mechanisms in this process remain unclear. This study explores how aconite aqueous extract (AAE) inhibits hepatocellular carcinoma (HCC). METHODS: An in vivo mouse model of subcutaneous liver cancer was established. After AAE treatment, immunohistochemistry (IHC) was used to determine the effect of AAE on natural killer (NK) cells. Subsequently, C57BL/6 mice were used to establish the subcutaneous tumor model, and a group of these mice were treated with anti-PK163 antibody to remove NK cells, which was verified by flow cytometry and IHC. The effect of AAE on the proliferation of HCC cells in vitro was determined using cell counting kit-8. The effect of AAE on chemokine production in HCC cells was measured using real-time quantitative polymerase chain reaction and an enzyme-linked immunosorbent assay. The effect of AAE on the migration of NK cells was determined using a transwell assay. Finally, the molecular mechanism was investigated using the Western blotting method. RESULTS: We demonstrated that the ability of AAE to induce overexpression of the cytokine C-C motif chemokine ligand 2 (CCL2) in HCC cells is fundamental to the infiltration of NK cells into the tumor bed. Mechanistically, we found that the upregulation of CCL2 was achieved by the activation of c-Jun N-terminal kinase but not extracellular regulated protein kinase or p38. CONCLUSION Our findings suggest that AAE can be used as an effective immune adjuvant to enhance antitumor immunity by increasing NK cell infiltration into tumors, which could help to improve the efficacy of HCC treatments. Please cite this article as: Yang KD, Zhang X, Shao MC, Wang LN. Aconite aqueous extract inhibits the growth of hepatocellular carcinoma through CCL2-dependent enhancement of natural killer cell infiltration. J Integr Med. 2023; 21(6): 575-583.
Animals ; Mice ; Carcinoma, Hepatocellular/drug therapy* ; Liver Neoplasms/drug therapy* ; Aconitum ; Ligands ; Mice, Inbred C57BL ; Killer Cells, Natural/metabolism* ; Chemokines/pharmacology* ; Cell Line, Tumor

OBJECTIVETo raise the awareness of adenosquamous carcinoma of pancreas and discuss the treatment of it.

METHODSClinical data of 80 cases of pancreas adenosquamous carcinoma patients in the Department of Pancreas Surgery of Changhai Hospital of Second Military Medical University from December 2003 to October 2011 were analyzed. The diagnose and treatment methods were discussed. There were 61 male cases and 19 female cases who aged from 28 to 81 years, with an average age of 60 years. The primary symptoms included 46 cases (57.5%) of abdominal malaise, 6 cases (7.5%) of low back pain, 4 cases (5.0%) of abdominal swelling pain with low back pain, 15 cases (18.8%) of abdominal swelling pain with jaundice, 5 cases (6.3%) of painless jaundice, 3 cases (3.8%) of significantly decreased body-weight and 1 case (1.3%) of no symptom. All the patients had been identified as pancreas tumor suffers by ultrasound, enhanced CT scan or MRI. Totally there were 43 cases of head/unciform process tumors, 15 cases of pancreas body tumors and 22 pancreas tail cases.Health situation of all cases were follow-up observed in the outpatient department or telephoned every 3 months till 24 months after the surgery.

RESULTSAmong the 80 patients, 19 patients underwent pancreaticoduodenectomy (PD) , 19 patients received pylorus-preserving PD, with 4 cases of palliative resection and 1 case of total pancreatectomy. The volume of bleeding during the surgery varied from 50 to 3 500 ml with a blood transfusion volume varied from 0 to 4 000 ml. Consumed time for PD procedures was 90 to 260 min with 60 to 150 min for body and (or) tail resection with or without lienectomy. The mean diameter of tumor was (4.9 ± 2.2) cm. Pathological tests showed 35 cases of positive lymph nodes, adjacent organ invasion happened in 35 patients, however, nerve invasion were found in 68 cases.Eighteen cases occurred postoperative complications, including bleeding, pancreatic fistula, gastric emptying, incision fat liquefaction and infection, pleural effusion, ascites and nervous diarrhea. There were only 48 effective follow-up patients, with a loss ratio of follow-up by 40.0%, reasons for the loss includes change of contact information, refuse or unable to provide useful information by the relatives of the patients.Sixteen patients received chemotherapy, and 8 patients received radiotherapy after operation. All patients were dead in the effective follow-ups. The postoperative median survival time was 6 months (0.1 to 23.0 months).

CONCLUSIONSAdenosquamous carcinoma of pancreas is a rare kind of malignant tumor, nerve invasion can be found in almost all the cases. Patients with adenosquamous carcinoma of pancreas have an unfavorable prognosis. The principle treatments are surgery, radiotherapy and chemotherapy.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Adenosquamous ; mortality ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreas ; pathology ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; mortality ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Postoperative Complications ; mortality ; Prognosis ; Young Adult

Objective: To examine the prognostic value of four important driver gene mutations in patients with radical resection of pancreatic cancer. Methods: The clinical data and follow-up data of pancreatic cancer patients undergoing radical pancreatectomy and targeted sequencing from January 2016 to March 2018 at Department of Hepato-Biliary-Pancreatic Surgery, Changhai Hospital were retrospectively analyzed.There were 159 males and 88 females,aged of (60.8±8.7)years(range:33-83 years) and preoperative CA19-9 of (492.4±496.6)kU/L(range: 2-1 200 kU/L). One hundred and fifty nine cases of tumors were located in the head and 88 cases in the body and tail of the pancreas. After univariate analysis of clinical pathological factors (including gender, age, preoperative CA19-9, tumor location, tumor differentiation, pathological T and N stage, Micr. perineural invasion, Micr. lympho-vascular invasion, resection margin), the variable whose P<0.1 was included in COX regression model with four important driver gene mutations to find which mutation was related to prognosis independently. The number of gene mutations and KRAS subgroups were analyzed by Kaplan-Meier curve. Results: Among 247 patients,the number of KRAS,TP53, SMAD4 and CDKN2A mutations was 212 cases(85.8%), 160 cases(64.8%), 66 cases(26.7%) and 44 cases(17.8%),respectively.KRAS mutation was correlated with the tumor differentiation and pathological T stage (χ²=24.570/6.690, P=0.000/0.035), TP53 mutation was correlated with the tumor differentiation and the resected margin(χ²=5.500/4.620, P=0.019/0.032), and CDKN2A mutation was correlated with gender(χ²=16.574, P=0.000).COX regression model analysis showed that only KRAS mutation was an independent risk factor for disease free survival and overall survival(HR=1.776, 95%CI: 1.079-2.923, P=0.024; HR=1.923, 95%CI: 1.016-3.639, P=0.045); KRAS^G12D mutation was associated with shorter OS(P=0.007). Conclusion KRAS and its subgroup KRAS^G12D mutation can be used as a prognostic index for patients with radical resection of pancreatic cancer.

OBJECTIVETo discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and prognosis.

METHODSA total of 42 patients with ischemic contracture in the lower limb were included in this study. According to different types of disturbance and degrees of severity, surgical reconstructions consisting of nerve decompression, tendon lengthening or transfer, intrinsic foot muscle release and sural-tibial nerve anastomosis were performed in every patient.

RESULTSPostoperatively, all patients were able to walk on flat ground. Drop foot was corrected in 10 patients, and 5 patients still felt some difficulty during stair activity. Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and their walking stability was improved. Seven patients accepted ipsilateral sural-tibial nerve anastomosis, and sensitivity recovery reached to S2 in 2 patients and S3 in 5 patients.

CONCLUSIONSIschemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb.

Adolescent ; Adult ; Child ; Female ; Humans ; Ischemic Contracture ; physiopathology ; surgery ; Leg ; blood supply ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Walking

OBJECTIVETo explore the clinical and laboratory characteristics of myleodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN) with PDGFRβ abnormalities.

METHODSChromosome specimens were prepared directly and/or short-time culture of bone marrow cells. Karyotyping was performed with R-binding technique. Fluorescence in situ hybridization (FISH) was performed using PDGFRβ, PDGFRα, FGFR1 break-apart probes and whole chromosome 5 and 12 painting probes, respectively. The expression of JAK2 V617F was measured with quantitative PCR.

RESULTSThe clinical and hematological findings of 27 patients were compatible with diagnosis of MDS/MPN. PDGFRβ rearrangement was detected in 4 patients with D-FISH, and 2 of which were confirmed as t(5;12) by chromosome painting. PDGFRα, FGFR1 and JAK2 V617F mutation were not detected in these 4 PDGFRβ positive MDS/MPN patients with.

CONCLUSIONSPDGFRβ gene rearrangement may be detected in some MDS/MPN patients. FISH is a convenient and reliable approach to detect PDGFRβ gene.

Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Myeloproliferative Disorders ; genetics ; Neoplasms ; Receptor, Platelet-Derived Growth Factor beta ; genetics