Cervical anastomosis by the thoracic approach for the treatment of upper esophageal cancer can simplify surgical steps and reduce incidence of anastomotic leak. This approach has been used for 26 patients with upper esophageal cancer who were admitted to the Jiangsu Cancer Hospital from July 2006 to August 2009. The mean length between lesion and incisor was 23.3 cm. General anesthesia and double-lumen intubation through left posterolateral incision in the fifth intercostal space was adopted. The stomach was dissociated with the technique of "in situ dissociation", and esophagus was dissociated conventionally. Double purse-string suture was adopted to fix the esophageal mucosa onto the supportive base of the stapler, and make purse-string suture to fix stomach on the center pole of the stapler. There was one failure case which has been converted to the manual cervical anastomosis, and the operations for the rest 25 cases were completed successfully, without anastomotic leakage and positive margin. The average blood loss was (352 ±211 )ml, and the average operation time was (3.7 ±0.6 )hours.

Objective To investigate the clinicopathological features,diagnosis,differential diagnosis and prognosis of renal collecting duct carcinoma (CDC).Methods The clinical data of 3 patients with renal collecting duct carcinoma,during the period from January 2015 to November 2017,were retrospectively analyzed.3 patients were male with age ranged from 42 to 73 years old,mean of 57.5 years.Two lesions were located in the right kidney and one in the left kidney.Clinical manifestations were hematuria,abdominal mass and waist and abdomen pain.No laboratorial abnormality was found.CT examination showed the tumor diameter ranged from 3.1 to 5.1 cm,mean 3.9 cm.The tumors located in the medullary and renal pelvis with low density or mixed density.Those tumors extended to the peripheral of the kidney,which the boundary was unclear.During enhancement CT,the uneven enhancement effect could be observed.Radical nepheroectomy was performed in all patients.Results Postoperative pathological examination showed surface of incision was gray.The texture of tumor was hard.The invasive growth pattern could be noticed.Under the microscope,the tumors had small ducts and papillary structures of tubules with interstitial fibrosis and some sarcomatous differentiation.Immunohistochemical staining showed strong positive expression of vimentin,CK-L,CKpan and P504S,and positive expression of PAX-2,CK7 and EMA in different degrees.RCC,KSP,CD10,CD117,MOC-31 and TFE3 were all negative.All 3 cases were followed up from 1 to 15 months with an average of 6 months.One case was treated with chemotherapy because of extensive metastases after surgery.Chemotherapy was performed by dissolving 1 500 mg of fluorouracil in 1 000 ml of 5％ normal saline and instillation.It was administered once every 10-12 hours and once a day for 5 days in one cycle.However,the outcome was poor.1 patient died of tumor metastasis and recurrence 7 months after surgery.1 patient had no tumor remaining after surgery.Conclusions CDC is a very rare malignant epithelial neoplasm in kidney.It has obvious clinical symptoms,strong invasive pattern and poor prognosis.Imaging and ultrasonography only play an auxiliary role in diagnosis.CDC's unique histopathology is the main basis of diagnosis and differential diagnosis.

Objective To discuss the feasibility and value of indocyanine green combined with methylene blue in sentinel lymph node biophy (SLNB) for patients with breast cancer.Methods 196 breast cancer patients who received surgery were studied.SLNB was performed by indocyanine green combined with methylene blue .Frozen section was performed,followed by conventional histopathology .The evaluation criterion of Louisvill University on SLNB was adopted to judge the detection rate ,accuracy rate,sensitivity,false negative rate.Results Among the 196 cases,196 cases were detected with SLN ( detection rate was 100.0%).SLN was all stained in 196 cases. Furthermore,56 cases had ALND metastasis,140 cases had no metastasis,and the sensitivity was 91.8%(56/61). The SLN and ALN fully complied with pathological examination in 191 cases,and the accuracy rate was 97.5%(191/196).Five cases were false negative,and the false negative rate was 8.2%(5 /61).No case was false positive.The total SLNs was 705,and average number of detected SLNs was 3.59 pieces(2-6 pieces).The average ALN was 17.66 pieces(12-26 pieces).Conclusion With the advantages of real-time visual,precise positioning,no radio-active pollution and reduce the operation difficulty ,indocyanine green joint methylene blue as lymph tracer shows high detection rate,accuracy when it is used for SLNB in patients with breast cancer ,it is worthy of clinical application.

Objective:To investigate the strategy and the clinical effect of single stage treatment for intracranial or extracranial artery stenosis with intracranial aneurysm.Methods:The clinical data of 15 patients with intracranial aneurysms and extracranial or intracranial artery stenosis treated by one-stage endovascular therapy at Department of Neurosurgery of Peking University First Hospital from April 2013 to September 2018 were analyzed,respectively.There were 6 males and 9 females,aged (63.9±9.1)years (range:43 to 79 years).Fifteen arterial stenosis were found, including 8 in anterior circulatiion and 7 in posterior circulation, and the stenosis rates ranged from 75% to 95%. There were 17 aneurysms, among which 11 in the anterior circulation and 6 in the posterior.The maximal diameter was (5.3±1.2)mm (range:3 to 7 mm).All patients were treated with stenting and embolization at one stage. The operation choices, perioperative and postoperative symptoms,imaging data and complications were recorded.Results:Stents were successfully implanted into arterial stenosis of 15 cases, reducing the stenosis rates to less than 30%.Among the 17 aneurysms,10 cases were treated by coil embolization alone,7 cases by stenting and coil embolization. Eventually all the 17 aneurysms reached complete embolization.One patient had mild symptoms of the cerebral infarction during the perioperative period,and the rest had not shown surgical complications.The follow-up time was (43.8±8.2)months (range:24 to 85 months). All the patients underwent digital subtraction angiography 6 to 12 months after operation.Among them,2 cases had asymptomatic in-stent restenosis,and no recurrence was found in aneurysms.Up to the last follow-up,no patients had showed new symptoms or signs of intracranial hemorrhage or ischemic stroke.Conclusions:For patients suffered from both stenosis and aneurysms,individualized treatment should be made based on the location and severity of the vascular stenosis and aneurysms.With careful preoperative evaluation and surgical planning,the single stage endovascular treatment for intracranial or extracranial artery stenosis combined with intracranial aneurysm is safe,feasible and effective for selected patients.

Objective To investigate the effect of problem-based learning health education for patients with prostate cancer.Methods A total of 64 prostate cancer patients were selected from January 2013 to December 2015 in our hospital, and were divided into control group and observation group according to the random number table method, with 32 cases in each group.The control group was given oral education combined with routine health education, and the observation group was given problem-based learning(PBL) health education.Prostate cancer knowledge such as clinical symptoms, risk factors, screening methods by self-made evaluation scale were compared;Life quality measurement scale by European Cancer Research and Treatment Organization were used to evaluate the quality of life;Pulmonary complications including bladder neck sclerosis and vesiculitis, epididymitis, and postoperative compliance in medication, regular check were compared.Results Awareness rate of clinical symptoms, risk factors, screening methods of prostate cancer knowledge in the observation group was significantly higher than of the control group (P<0.05);Overall function, emotional function, body function, role function, cognitive function in the two groups were statistically significant differences(P<0.05);The incidence of postoperative complications was lower, and compliance rate was higher in the observation group than that in the control group (P<0.05).Conclusion PBL health education can help patients to independently and effectively grasp the knowledge of health education, and improve the quality of life of patients with prostate cancer.

Objective To investigate the effect of problem-based learning health education for patients with prostate cancer.Methods A total of 64 prostate cancer patients were selected from January 2013 to December 2015 in our hospital, and were divided into control group and observation group according to the random number table method, with 32 cases in each group.The control group was given oral education combined with routine health education, and the observation group was given problem-based learning(PBL) health education.Prostate cancer knowledge such as clinical symptoms, risk factors, screening methods by self-made evaluation scale were compared;Life quality measurement scale by European Cancer Research and Treatment Organization were used to evaluate the quality of life;Pulmonary complications including bladder neck sclerosis and vesiculitis, epididymitis, and postoperative compliance in medication, regular check were compared.Results Awareness rate of clinical symptoms, risk factors, screening methods of prostate cancer knowledge in the observation group was significantly higher than of the control group (P<0.05);Overall function, emotional function, body function, role function, cognitive function in the two groups were statistically significant differences(P<0.05);The incidence of postoperative complications was lower, and compliance rate was higher in the observation group than that in the control group (P<0.05).Conclusion PBL health education can help patients to independently and effectively grasp the knowledge of health education, and improve the quality of life of patients with prostate cancer.

Objective:To investigate the strategy and the clinical effect of single stage treatment for intracranial or extracranial artery stenosis with intracranial aneurysm.Methods:The clinical data of 15 patients with intracranial aneurysms and extracranial or intracranial artery stenosis treated by one-stage endovascular therapy at Department of Neurosurgery of Peking University First Hospital from April 2013 to September 2018 were analyzed,respectively.There were 6 males and 9 females,aged (63.9±9.1)years (range:43 to 79 years).Fifteen arterial stenosis were found, including 8 in anterior circulatiion and 7 in posterior circulation, and the stenosis rates ranged from 75% to 95%. There were 17 aneurysms, among which 11 in the anterior circulation and 6 in the posterior.The maximal diameter was (5.3±1.2)mm (range:3 to 7 mm).All patients were treated with stenting and embolization at one stage. The operation choices, perioperative and postoperative symptoms,imaging data and complications were recorded.Results:Stents were successfully implanted into arterial stenosis of 15 cases, reducing the stenosis rates to less than 30%.Among the 17 aneurysms,10 cases were treated by coil embolization alone,7 cases by stenting and coil embolization. Eventually all the 17 aneurysms reached complete embolization.One patient had mild symptoms of the cerebral infarction during the perioperative period,and the rest had not shown surgical complications.The follow-up time was (43.8±8.2)months (range:24 to 85 months). All the patients underwent digital subtraction angiography 6 to 12 months after operation.Among them,2 cases had asymptomatic in-stent restenosis,and no recurrence was found in aneurysms.Up to the last follow-up,no patients had showed new symptoms or signs of intracranial hemorrhage or ischemic stroke.Conclusions:For patients suffered from both stenosis and aneurysms,individualized treatment should be made based on the location and severity of the vascular stenosis and aneurysms.With careful preoperative evaluation and surgical planning,the single stage endovascular treatment for intracranial or extracranial artery stenosis combined with intracranial aneurysm is safe,feasible and effective for selected patients.

Objective:To evaluate the application of enhanced recovery after surgery in patients undergoing laparoscopic gastric cancer surgery and its impact on the systemic inflammatory response (SIR).Methods:The clinical data of patients undergoing laparoscopic gastric cancer surgery at the Department of Gastrointestinal Surgery, Zhongnan Hospital, Wuhan University from Mar 2021 to Mar 2023 was retrospectively analyzed.Results:A total of 234 patients with gastric cancer were enrolled (120 cases in ERAS group and 114 cases in routine group). There were no significant differences in preoperative indexes between the two groups (all P>0.05). After laparoscopic surgery, the postoperative ventilation time and hospital stay of patients in ERAS group were significantly shorter than those in the conventional group (all P<0.05). Neutrophil to lymphocyte ratio (NLR) , platelet to lymphocyte ratio (PLR) and systemic immune-inflammatory (SII) index of patients in ERAS group were significantly lower on day 1 and day 3 after surgery than in conventional group (all P<0.05). The ratio of lymphocyte to monocyte (LMR) in ERAS group was significantly higher than that in conventional group on day 1 and day 7 after surgery (all P<0.05). Conclusions:ERAS can improve postoperative SIR indexes in patients undergoing laparoscopic gastric cancer surgery, shorten postoperative recovery time, and enhance the efficacy of laparoscopic gastric cancer surgery by reducing perioperative systemic inflammation.

Objective To understand the application effect of early screening scale and behavioral intervention effect in children with autism spectrum disorder (ASD). Methods A total of 348 children with suspected ASD were selected and evaluated using the Modified Checklist for Autism in Toddlers (M-CHAT) and Autism Behavior Checklist (ABC). The evaluation results were compared with those from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Children enrolled were given Early start Denver model (ESDM) intervention. The evaluation results of Gesell Developmental Scale and Autism Treatment Evaluation Checklist (ATEC) scores were compared before and after intervention. Results The sensitivity, specificity, accuracy and Kappa value of M-CHAT for evaluating ASD in children aged 1-3 years were 89.53%, 90.70%, 89.92% and 0.78. The corresponding values of ABC were 78.49%, 81.40%, 79.46% and 0.56. The sensitivity, specificity, accuracy and Kappa value of M-CHAT for evaluating children aged >3-6 years were 87.30%, 77.78%, 84.44% and 0.64. The corresponding values of ABC were 85.71%, 77.78%, 83.33% and 0.62. The sensitivity and accuracy of M-CHAT were higher than ABC for evaluating ASD in children aged 1-3 years (P<0.05). There were no significant differences in sensitivity, specificity and accuracy between M-CHAT and ABC for evaluating ASD in children aged 3-6 years (P>0.05). After intervention, development quotients (DQ) of personal-social aspects, adaptability, language, gross motor, and fine motor of children with ASD were higher than those before intervention (P<0.05). ATEC scores for language, behavior, sensation, and social contact of children with ASD were lower than those before intervention (P<0.05). Conclusion M-CHAT and ABC both can be used for early screening of ASD in children, especially M-CHAT. Early behavioral intervention can effectively improve the condition and developmental level of children with ASD.