0.05). Conclusions:Compared with normal esophageal mucosa, the expression of HSP27 mRNA in esophageal squamous carcinoma and mucosa with atypical hyperplasia was markedly decreased.This indicated that the expression of HSP27 mRNA to a greater or less extent lost in the carcinogenesis and development of esophageal squamous carcinoma. To up-regulate the expression of HSP27 mRNA in esophageal squamous carcinoma may be a very effective biological therapy.

Objective To investigate the change of gastroesophageal reflux including acid reflux,duodenogastroesophageal reflux (DGER) and its effect on expression of COX-2 and TNF-α in the remnant esophagus in different period after esophagectomy for cancer.Methods Thirty-two patients who underwent esophagectomy for cancer were selected randomly.Twentyfour-hour pH and spectrometric bilirubin monitoring,endoscopy were periodically performed.Esophageal mucosa samples were obtained by endoscopic biopsy.Expression of COX-2 and TNF-α within remnant esophageal mucosa was detected using immunohistochemical assay.Results ( 1 ) The incidence of reflux esophagitis and extent of acid reflux gradually increased over time after surgery for cancer ( P ＜ 0.05 ).(2) Very low level of COX-2 and TNF-α expression was detected in normal esophageal squamous mucosa.The expression of COX-2 and TNF-α was observed in cytoplasm of basal cell of esophageal epithelium after esophagectomy for cancer.High intensity of COX-2 and TNF-α expression was detected in the metaplastic columnar mucosa.The level of TNF-α expression in the remnant esophagus where reflux esophagitis occurred was higher than that in the normal remnant esophagus ( P =0.0274 ).There was no significant difference in level of COX-2 expression in the remnant esophagus between reflux esophagitis occurred and not ( P =0.7403 ).Conclusion ( 1 ) The extent of acid reflux and incidence of esophagitis gradually increases over time.(2) The expression of COX-2 and TNF-α may represent an early change associated with gastroesophageal reflux.The expression of COX-2 may serve as a molecular marker of gastroesophageal reflux occurred.( 3 ) The durative expression TNF-α is likely involved with the pathogenesis of chronic reflux esophagitis.

Objective To investigate the effect of different operative approaches on perioperative respiratory and cardiac function of patients with gastric cardia carcinoma. Methods The perioperative changes of SpO2 ,Breath Rate (BR) and Heart Rate(HR) of patients with gastric cardia carcinoma underwent surgical therapies through transthoracic ( n = 30 ), transabdominal ( n = 37 ) or trans-thoracoabdominal ( n = 10 )approaches were compared respectively. Results On the postoperative 1st,2nd,4th and 7th day,the changes of BR in transthoracic (5. 20 ± 0. 96,5. 17 ± 1. 58,3.93 ± 1.53,2. 63 ± 1.25 )/min and trans-thoracoabdominal (5.80 ±0. 79,6. 10 ± 1.20,4. 80 ± 1.32,3.00 ± 1.49)/min approach groups were significantly greater than that of transabdominal group (4. 35 ± 1.06,3.89 ±0. 99,2. 24 ± 1.30,1.16 ±0. 65)/min (Ps ＜0. 05). At the meanwhile, the changes of SpO2 at 2nd, 4th postoperative day of transthoracic ( [ 8. 30 ± 1.95 ] %, [ 7.23 ±2. 01 ] % ) and trans-thoracoabdominal ( [ 8.60 ± 1.43 ] %, [ 7. 70 ± 2. 11 ] % ) approach groups were significantly greater than that of transabdominal group ( [ 7. 08 ± 1.82 ] %, [ 6.24 ± 1.88 ] % ) ( Ps ＜ 0. 05 ), but there were no significant differences observed among three groups on the postoperative 1st,7th day. On the postoperative 1 st,2nd and 4th day, the changes of HR of transthoracic ( 18.00 ± 3.79,13.47 ± 4. 42,8. 60 ±4. 13 )/min and trans-thoracoabdominal ( 19. 80 ± 4. 96,14. 80 ± 3.33,8.70 ± 3.47)/min approach groups were significantly greater than that of transabdominal group ( 13.62 ± 4. 00,10. 84 ± 4. 16,6. 32 ± 2. 53 )/min, too (Ps ＜0. 05) ,but no differences were observed among three groups on the postoperative 7th day (Ps ＞0. 05).Coniclusion Transthoracic,transabdominal and trans-thoracoabdominal approachs resulted in different effects on respiratory and cardiac function in patients with gastric cardia carcinoma.

Objective:To analyze the relationship between the circumferential resection margin status and prognosis and clinicopathological features of esophageal squamous cell carcinoma.Methods:The information of esophageal squamous cell carcinoma patients who underwent radical resection at the Fourth Hospital of Hebei Medical University from October 2017 to March 2019 were collected. All patients were diagnosed with advanced squamous cell carcinoma by postoperative pathology. Demographic data including sex, age, T stage, N stage, tumor location, lesion length, gross pathological type, vascular tumor embolization, nerve invasion and circumferential resection margin were collected and analyzed. The circumferential resection margins were evaluated using the College of American Pathologists(CAP) criteria. A total of 328 cases were included in this study according to the inclusion criteria. Using SPSS 20.0 statistical software, univariate survival analysis was assessed by Kaplan- Meier survival curves, survival curves were compared using Log- rank tests, and multivariate analysis was carried out by Cox regression. The Fisher exact and Chi- square tests were used to compare counting data. Results:As of the follow-up date, the 1-year and 2-year overall survival rates of 328 patients with esophageal squamous cell carcinoma were 91.9% and 84.8%, respectively. The median overall survival was 16 months(range 2-25 months). Univariate analysis showed that T stage, vascular embolism and nerve invasion were the influencing factors of overall survival, multivariate analysis showed that nerve invasion was an independent risk factor for overall survival, stratified analysis showed that the circumferential resection margin was related to overall survival in patients less than 60 years old( P=0.006), patients with ulcerative type of gross pathology( P=0.002) and patients with tumor length ≥4 cm( P=0.046). The 1-year and 2-year disease-free survival rates of the whole group were 89.7% and 67.8%, respectively. The median disease-free survival was 16 months(range 2-25 months). Univariate analysis showed that N stage was the influencing factor of disease-free survival in patients with esophageal squamous cell carcinoma, and stratified analysis showed that the disease-free survival rate of patients with ulcerative type( P=0.002), tumor length ≥4 cm( P=0.015) and circumferential resection margin negative group were better than that of circumferential resection margin positive group. There were 66 patients with positive circumferential resection margin in the whole group, and the positive rate of circumferential resection margin was 20.1%. Univariate analysis showed that T stage, N stage, vascular embolism, nerve invasion and gross pathological type were the influencing factors of circumferential resection margin, while multivariate logistic regression analysis showed that T stage, vascular embolism and gross pathological type were the influencing factors of circumferential resection margin. Conclusion:According to CAP criteria, circumferential resection margin is not related to the prognosis of patients with esophageal squamous cell carcinoma.Positive circumferential resection margins of esophageal squamous cell carcinoma correlate with T stage, vascular embolism, and gross pathologic type, but not with other clinicopathologic features.

Objective:To analyze the clinical characteristics and possible causes of familial spontaneous pneumothorax in combination with literatures.Methods:The detailed clinical information of 8 cases of FSP were retrospectively reviewed, and the clinical characteristics of FSP were analyzed combined with literatures.Results:Among 265 FSP patients in 76 families, the ratio of male to female is 1.55∶1, age of onset over 40 years old was 48.30%, 17.11%(13/76)of the cases occurred in the same generation, 67.10%(51/76)in two generations, 14.47%(11/76)in three generations and 1.31%(1/76)in four generations, and no intergenerational phenomenon was found. The proband had the mutation in the FLCN gene. The recurrence rates of observation, thoracentesis, chest tube drainage and operation were 21.62%(8/37), 48.39%(30/62), 38.89%(35/90)and 4.00%(4/100), respectively.Conclusion:Compared with sporadic cases of PSP, the clinical characteristics of FSP are as follows, the incidence of pneumothorax in man is higher than women, but women is significantly higher, and the age of pneumothorax is later, most of them are two generations, which may be related to heredity. And the effect of surgical treatment is the best.