The three-field lymphadenectomy for carcinoma of the esophagus remains debatable. There are several aspects that the debate focuses on. Firstly, should the positive cervical lymph nodes be considered a regional(N1) or a distant( M1) site of disease for tumors of esophagus? Secondly, can the extended lymphadenectomy prolong survival? Thirdly, the increase in the morbidity rates.

Objective To explore the feasibility and short-term efficacy of combined use of laparoscopic and thoracoscopic Ivor Lewis esophagectomy for the treatment of esophageal carcinoma.Methods A case of esophageal carcinoma was treated in our hospital in December 2007.Five trocars were used via laparoscopy to free the stomach and create a tube-like stomach.Afterwards,thoracoscopy was carried out via 4 trocars to remove the lesion and open the diaphragm,and then the tube-like stomach was pulled into the chest cavity and anastomosed to the chest wall.Results The operation time was 330 min,and the intraoperative blood loss was 200 ml.The lesion was removed completely with negative cutting edges.Postoperative pathological examination showed squamous cell carcinoma(stage T2N0M0).Follow-up was available for 3 months,during which no recurrence was found.Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy is feasible and safe for the treatment of esophageal carcinoma.

Background and purpose:The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial has been described as practice-changing of sentinel lymph node (SLN) positive breast cancers. The goal of this study was to determine the exportability of the criteria deifned by Z0011 trial for selecting patients who are eligible for avoiding axillary lymph node dissection (ALND) after a positive sentinel lymph node biopsy (SLNB) result in China.Methods:We collected 194 breast cancer patients with positive SLNs and classiifed them into two groups according to Z0011 criteria. One group was consisted of patients who were eligible for omitting ALND and with SLNB only. The other one was ALND group. Then the patients of SLNB group were compared with cohort included in the Z0011 trial and the ALND group of this study separately.Results:Seventy-seven patients were potentially eligible for omitting ALND and 117 patients were still needed to have ALND. Compared with Z0011 cohort, the SLNB group in this research had signiifcantly more T1 stage and ER positive tumors (P<0.05). More patients in SLNB group had positive LNs with the number less than 3 and negative NSLNs (P<0.05). The ALND group had more T2 and T3 stage tumors than the SLNB group but the difference was not signiifcantly. The number of positive LNs in ALND group was higher than the SLNB group signiifcantly (P<0.05). More patients in the ALND group had positive non-sentinel lymph node (NSLN) than the SLNB group and the difference was also signiifcantly (P<0.05).Conclusion:Applied to the SLN positive patients in this study, Z0011 criteria could make patients with better prognosis and lower risk than Z0011 cohort be selected and let these patients avoiding ALND more safely.

Objective To find out the distribution of TCM constitution on the patients with stroke in Beijing. Method The TCM Constitution Questionnaire was used to evaluate 489 patients with stroke in three hospitals in Beijing. Results The qi-deficiency constitution (140 patients, 28.63%), yin-deficiency constitution (95 patients, 19.43%), blood-stasis constitution(89 patients, 18.20%) and phlegm-heat constitution (73 patients, 14.93%) were the most common constitution, while qi-depression constitution (22 patients, 4.50%) and yang-deficiency constitution (20 patients, 4.09%) were the less common. The top three constitution in middle aged wereqi-deficiency (33 patients, 27.27%), phlegm-heat (23 patients, 19.01%) and blood stasis (22 patients, 18.18%). The top three constitution in the aged groupwere qi-deficiency (107 patients, 29.08%), yin-deficiency (76 patients, 20.65%) and blood-stasis (67 patients, 18.21%). Conclusions Stroke is closely related with imbalance of TCM constitution. The prevention and treatment of stroke patients with different ages should vary according to the constitutions.

Background and purpose:Endoscopic treatment is a promising therapeutic option for superifcial lesions throughout the gastrointestinal tract, this study was aimed to evaluate the efficacy of endoscopic resection (ER) using the new Duette multiband mucosectomy kit (DT-6) on treating esophageal disease. Methods:Since Jun. 2011, ER using DT-6 has been performed on 100 patients in a tertiary medical center. Data from those who have been followed up for over 6 months was analyzed. ER and esophagectomy were compared on treating high grade dysplasia (HGD) lesions and early esophageal cancer. Results:From Jun. 2011 to Jan. 2012, a total of 32 patients with esophageal lesions underwent 34 ER using DT-6 (22 male and 10 female, mean age 59.0 years, range 25 to 83 years). There were (3.4±1.0) specimen resected per operation, and the average greatest diameter was (11.8±2.7)mm. Intraoperative blood loss was (5.45±1.47)mL. The median follow-up period was 8.2 months with a 100%half-year-follow-up rate. Except one pneumothorax occurred during one endoscopic submucosal dissection (ESD), no other complications happened. When Comparing ER and esophagectomy on treating HGD and early esophageal cancer, ER showed advantages in terms of operation time, intraoperative blood loss, hospital stay and complications. Conclusion:ER using DT-6 is safe, simple, minimally invasive and effective for esophageal disease. Prospective study and long follow-up are needed to compare endoscopic resection and esophagectomy for HGD and early esophagus cancer.

Acute respiratory distress syndrome (ARDS) can cause pulmonary vascular dysfunction, increase right ventricular afterload and lead to right ventricular failure,also known as acute cor pulmonale. Mechanical ventilation to maintain oxygenation and ventilation has a negative impact on right ventricular function,which may lead to lung-right ventricular interaction and aggravate the deterioration of right ventricu-lar failure,which may be one of the causes of right ventricular failure. Therefore,in the treatment of mechani-cal ventilation for ARDS,attention must be paid to the right ventricular function of patients.

Objective To learn the current status of family doctor service at pilot communities in Guangzhou, and discover existing problems and influencing factors by investigating the residents who have contracted such service , those have not and the family doctors . Methods This study chose typical community health centers of six communities in Guangzhou in January 2016 .In random sampling , residents who visited doctors during the survey and all the family doctors were surveyed .EpiData was used to doubly inputdata,withSPSS20.0forstatisticalanalysis.Results 66.0％ofthoseresidentswhohavenot contracted the service are willing to contract a family doctor .According to the binary logistic regression analysis after eliminating the interference factors , there are two factors affecting their willingness:gender and whether needing a family doctor for themselves and their family for health management .According to the binary logistic regression analysis after eliminating the interference factors , the influencing factors of renewing contract are overall satisfaction and necessity for signing family doctors .Conclusions The smooth development of the family doctor service is faced with many bottlenecks , while improving willingness to contract and renew contract to family doctors are the cornerstone for sustainability of the family doctor system.

Effective cost control and structure optimization of medical consumables in public hospitals can facilitate a shift from extensive cost control to scientific and refine management.On the premise of ensuring medical quality,reducing the burden of patients'diagnosis and treatment and meeting the actual needs of hospital management,this approach aims to realize valuable healthcare outcomes.This study was conducted in a tertiary hospital,which balanced both the medical and economic val-ue of medical consumables.Using an integrated approach to specialty capacity building and disease structure optimization,the hospital restructured the use of medical consumables in Transcatheter Arterial Embolization(TAE)procedures.It developed standardized pathways and usage protocols tailored to specific diseases and surgical requirements.A targeted consumable usage policy framework was introduced,comprising"one department,one policy;one surgery type,one policy;and one consumable,one policy."This included initiatives such as validating the use of drug-loaded embolic microspheres,conducting multi-depart-mental review meetings,strictly regulating indications for these microspheres,limiting personnel involvement,and negotiating re-duced pricing on imported microspheres.Following implementation,the average case-mix index(CMI)for discharged patients undergoing TAE increased from 2.23 to 2.34(P＜0.001),while the average per-case cost of consumables decreased from 19 600 to 15 600(P＜0.001).These measures offer valuable decision-making and operational reference for hospitals nation-wide,supporting efficient,quality-focused consumables management.

Objective In the context of expanding in size and improving the quality of medical consumables,the"one product,one policy"approach has brought challenges to the management of consumables in public hospitals.This study investi-gated the potential management problems in the process of centralized procurement with volume of medical consumables in a pub-lic tertiary hospital in Guangdong Province,and accordingly worked out the corresponding management countermeasures and then assessed their implementation effects.Methods The fishbone diagrams was applied to systematically analyze the potential prob-lems in the implementation process of centralized procurement with volume of medical consumables.Targeted measures were worked out from May to July 2023 in the hospital.The time series data of centralized procurement of coronary stents,pacemak-ers,tubular/end-to-end anastomoses,and spinal products from December 2022 to December 2023 were analyzed.Changes in the monthly implementation rate and contract completion volume pre-and post-intervention were measured to evaluate the effectiveness of the intervention.Results The fishbone diagrams analysis revealed that the primary factors impeding procurement implementa-tion were internal system flaws,personnel management inadequacy,supply issues,and an absence of an information system.Post-intervention,the monthly implementation rate(t=-4.19,P＜0.05)and contract completion(t=-2.38,P＜0.05)significantly improved.Conclusion The implementation of intervention management for centralized procurement with volume of medical consumables can effectively promote the related implementation effect in the department.In the context of centralized pro-curement,clinical and health management personnel need to bolster their professionalism to ensure the procurement management efficiency and quality.It is crucial to deepen policy understanding and implementation,enhance production and distribution process supervision and disciplinary mechanisms,ensure multi-departmental coordination for supply security,and improve hospi-tal information systems and procurement platforms.