Objective To study the influence of Ivor-Lewis surgery on lung function and quality of life of elderly patients with esophageal cancer .Methods 122 elderly patients with esophageal cancer were randomly divided into the observation group and the control group ,61 cases in each group .The control group was given Sweet surgery , observation group was given Ivor-Lewis surgery.The operative time,blood loss,number of lymph node dissection , drainage and hospitalization time were observed .Postoperative lung function 3 days after operation and life quality of patients 3 months after operation were compared between the two groups .Results The operative time,blood loss, drainage,and hospital stay in the observation group were (162.4 ±30.4) min,(260.1 ±33.7) mL,(1 254.1 ± 311.2)mL,(11.2 ±3.1)d,which were significantly lower than (201.6 ±33.6)min,(315.2 ±41.3)mL,(1 928.3 ± 346.1)mL,(17.6 ±3.6)d in the control group (t=3.627,4.662,2.716,3.772,all P<0.05).The number of lymph node dissection in the observation group was more than the control group (t=9.062,P<0.05).Before treat-ment,FEV1,FVC and PEF had no significant differences (t=0.612,0.301,0.772,all P>0.05).After treatment for 3 days,FEV1 of the control group and observation group were (1.89 ±0.47)L,(2.18 ±0.42)L;FVC were (2.44 ± 0.31)L,(2.87 ±0.25)L.PEF were (4.01 ±0.26)L/s,(4.52 ±0.29)L/s.After treatment for 3 days,FEV1,FVC and PEF in the control group were significantly decreased (t=4.162,3.997,5.012,all P<0.05).In the observation group,FEV1,FVC before and postoperative 3 days had no significant differences (t=1.032,0.924,all P>0.05), 3 days after treatment,PEF of the observation group was significantly decreased (t=3.128,P<0.05).After treat-ment for 3 days,FEV1 ,FVC and PEF of the observation group were significantly higher than those of the control group (t=5.186,3.017,3.112,P<0.05).Before surgery,scores of life quality in the control group and observation group were (5.41 ±1.83)points and (5.31 ±1.77)points.After surgery were (7.01 ±2.16)points and (8.35 ±2.27) points.Quality of life in two groups were improved after operation .Life quality of the observation group was significantly higher than the control group (t=2.864 4,P<0.05).Conclusion Ivor-Lewis surgical procedures can significantly improve lung function and quality of life in elderly patients with esophageal cancer .

Objective To study the feasibility of video-assisted thoracoscopic (VAT) minor pulmonary resection under local anesthesia. Methods From February to December 2000,8 patients (6 cases of peripheral pulmonary nodules,2 cases of respiratory insufficiency and radiographic pulmonary infiltrate)were operated on through video-assisted thoracoscopy under local anesthesia. Results Except 1 case was converted to general anesthesia and performed minithoracotomy to resect pulmonary coin lesion due to pleural adhesion,other 7 patients underwent VAT-pulmonary wedge ressction under local anesthesia and definitive diagonosis.(3 with tuberculosis,1 with metastatic adenocarcinoma,1 with inflammatory pseudotumor and 2 with pulmonary fibrosis)were obtained.The duration of the procedures was from 40 to 200 min. Spontaneous breathing and hemodynamics were maintained well during the operation.There was neither severe postoperative complications nor mortality.The postoperative hospitalized days were 2～5 days with a mean of 3 days. The average medical fee for pulmonary wedge ressction using our procedure was 5400 RMB. Conclusions VAT-minor pulmonary resection can be performed safely under local anesthesia.

Objective:To evaluate the effectiveness of integrated pediatric training course of extracorporeal membrane oxygenation(ECMO)based on simulation teaching.Methods:The instructors of ECMO team of Children′s Hospital of Fudan University developed the teaching curriculum.Team members as a unit were recruited to study simulation-based courses, whose theoretical knowledge, skills and teamwork were assessed, and feedback from the trainees were gathered.Results:Since May 2018, 22 teams of pediatric specialized hospitals or general hospitals have taken part in our ECMO simulation, with totally 132 participants, including 45 ICU doctors(34.1%), 60 ICU nurses(45.5%), 23 thoracic surgeons(17.4%) and four anesthesiologists(3.0%). Twelve of them(9.1%)had a little ECMO experience.After training, the trainees had a high evaluation on each part of the course, with average score more than four, of which the theoretical score was lowest.Their self-evaluation on the theory, skills, teamwork and confidence in the implementation of ECMO had been significantly improved.Most(80.3%)of the trainees were confident to carry out ECMO in their local hospitals.The trainees′ baseline score of theoretical knowledge was 55.2±7.6, and increased to 67.1±7.3 after training( P<0.001). The average teamwork score of the 22 teams was 70.2±8.2, and the qualified rate was up to 86.4%.The most prominent skill problems in operation assessment were no albumin and blood priming(90.9%), non-skill problems were extremely anxious during the overall assessment(84.8%)of the participants, poor team work(74.2%), poor leadership(68.2%). For the feedback of the whole course, 97.0% and 94.7% of the trainees thought that integrated training and simulation teaching were the highlights of the course.At present, 13(59.1%)units have successfully developed ECMO technology after the course, and the number of children treated has been up to 83, with a survival rate of discharge of 54.2%.However, it was found that the skill level of some participants decreased about 2 weeks after the course. Conclusion:As a new attempt of ECMO teaching, this curriculum has achieved certain efficiency in both teaching and clinical practice.At the same time, our study also plays a role in promoting the development of ECMO in pediatrics.

Objective To discuss the expression of X chromosome coupled zinc finger protein(ZFX) in the serum and pathology of patients with advanced non-small cell lung cancer before and after treatment and its evaluation in the chemotherapy efficacy.Methods Forty cases(NSCLC group)with non-small cell lung cancer treated in Baotou Central Hospital from January 2013 to October 2014 were retrospectively analyzed.The control group included 40 normal people who may have tumor by normal physical examination.Based on the blood tests of research subjects before and after treatment,the peripheral blood ZFX content was detected by the quantitative detection, ZFX expression was detected by tissue morphological identification and immunohistochemical methods.Results The level of adenocarcinoma ZFX serum was(15.32± 2.01)μg/L, squamous cell carcinomas ZFX serum level was(11.65±4.12)μg/L,the difference between the two groups was statistically significant(t=3.216,P<0.05); the ZFX serum level of non-small cell lung cancer group was (17.55±0.37)μg/L before treatment,and was(6.35± 0.06)μg/L after treatment which was significantly lower,the difference was statistically significant(t=188.97,P<0.05); the serum level of non-small cell lung cancer group before treatment was(17.55±0.37)μg/L,after treatment was(6.35±0.06)μg/L,compared with (2.29± 0.01)μg/L,(2.29 ± 0.01)μg/L in the control group,the differences were statistically significant (before treatment:t=260.75,after treatment t=422.14,P<0.05); the expression of ZFX in adenocarcinoma was(15.32±2.01)ug / L,higher than that of squamous cell carcinoma((11.65±4.12)μg/L),the difference was statistically significant(t=3.216,P<0.05);the expression of ZFX in CR+PR group before treatment was (17.35±0.46)μg/L,higher than that after treatment((6.24±0.11)μg/L),the difference was statistically significant(t=142.88,P<0.05).Conclusion The expression of ZFX in peripheral blood serum and pathology may be a marker for the diagnosis of non-small cell lung cancer,and it has guiding significance for the diagnosis and curative effect evaluation of lung cancer.