The definition of esophagogastric junction (EGJ) adenocarcinoma and progress in multidisciplinary treatment for the tumor were revised in this review. Siewert classification is especially useful for the surgical approach of EGJ adenocarcinoma. Siewert I should be treated as esophageal cancer, and Ivor-Lewis esophagogastrectomy (right thoracotomy and laparotomy) is recommended as an extended two-field lymphadenectomy. For Siewert II or III tumors, left thoracophreno-laparotomy is preferred, especially in case of positive thoracic lymph nodes or positive resection margin. If there is any contraindication against thoracotomy, or a high operating risk, a transhiatal esophagectomy with lower mediastinal lymphadenectomy is an alternative. Preoperative chemoradiotherapy or perioperative chemotherapy improves overall survival and the rate of complete resection for patients with large tumor or lymph node metastasis. Neoadjuvant chemoradiotherapy is associated with high but acceptable postoperative complications. Adjuvant chemoradiotherapy remains a rational standard therapy for curatively resected EGJ cancer with T3 or greater lesion or positive nodes.
Adenocarcinoma ; surgery ; therapy ; Combined Modality Therapy ; Esophageal Neoplasms ; surgery ; therapy ; Esophagogastric Junction ; Humans ; Stomach Neoplasms ; surgery ; therapy

Objective To construct directional expressing cDNA library from normal testes in Chinese males for further studying the structure and functions of spermatogenesis related genes. Methods mRNA of normal testes from a Chinese male was isolated and the cDNA synthesized by reverse transcription.After being digested by SalI and NotI ,dscDNA was subcloned into expressing plasmid pSPORT1 directionally.Finally,the directional expressing cDNA library from normal testes in Chinese males was constructed. Results The transformation rate of the library was 7?10 5.Ten clones were chosen and analysed. Digested by SalI and NotI ,the fragments of 0.5～2.0 kb were obtained with cDNA inserted. Conclusions The present study indicates that the directional expressing cDNA library from normal testes in Chinese males is qualified to screen genes and is considered to be helpful for studying the structure and functions of spermatogenesis related genes.

Objective To analysis the impact of ? blocker therapy on symptoms of benign prostatic hyperplasia(BPH). Methods 148 cases of BPH patients had been treated with ? blocker for 4 weeks. Symptom score, uroflowmetry and post voiding residual urine were recorded and analyzed. Results After 4 weeks of treatment, the IPSS, uroflowmetry and residual volume were improved significantly, P 0.1. Conclusions Reduction of symptoms and improvements of uroflowmetry in BPH patients treated with ? blocker.might be initiated through different mechanisms.

BACKGROUND:Proximal humeral fracture fixation can provide a more stable fixation, has a stronger biomechanical stability, but open reduction and fixation wil cause extensive soft tissue dissection and heavy damage to the rotator cuff. Closed wear nail has a high failure rate of fixation, fracture re-displacement and other defects. OBJECTIVE:To investigate the technical methods of applying closed reduction, percutaneous pinning anatomical external fixation in repair of proximal humeral fracture, and to analyze the application characteristics and safety in different types of proximal humerus fractures. METHODS:Based on the special anatomical structure of proximal humerus, a shoulder external fixator has been independently researched and developed by author. The clinical data of 23 patients treated with closed reduction and percutaneous pinning anatomical external fixation (homemade) because of proximal humerus fracture at the Department of Traumatology, Tianjin Hospital during March 2010 to March 2014 were retrospectively analyzed. In accordance with Neer classification type, there were 19 cases of 2-part fractures of the humerus, 4 cases of 3-parts fractures of the humerus, with greater tuberosity avulsion fractures, which were al fresh fractures and were treated with closed reduction pinning and external fixation. Regular fol ow-up was conducted after treatment. Radiographic assessment, pain and function evaluation were conducted during fol ow-up, so as to work out the functional recovery, determine the final repair result. RESULTS AND CONCLUSION:Al patients were fol owed up for 6-24 months. Total y 23 patients initial y healed in fracture within 8 weeks. After treatment, visual analogue pain score of patients was 0.8 points. In the final fol ow-up, the American Shoulder and Elbow Surgery Association of shoulder function scoring system (ASES) score was an average of (91.7±2.6) points, Constant shoulder function score was an average of (88.3±4.7) points, the University of California (UCLA) shoulder joint scoring system score was (31.9±3.1) points, simple shoulder test (SST) system score was an average of (9.6±2.4) points. The shoulder function assessment (UCLA score) of these 12 patients was excel ent, of 9 cases was good, and of 2 cases was poor. The excel ent rate reached 91%after treatment. These results suggest that the application of closed reduction, percutaneous nailing anatomical external fixation in repair of proximal humerus fractures has the features of stable fixation, and smal damage of soft tissue. Standardizing the angle of closed nailing and entrance point, fixing from the intersection of three planes in arcuate-shape and connecting with external fixation can achieve a more stable fixed effects.

Objective To investigate the sequence variations of mitochondrial D-loop region in chronic glomerular nephritis patients and family members and their possible associations with chronic glomerular nephritis.Methods 20 patients with chronic glomerular nephritis and 48 unaffected pedigree members,as well as 122 cases of normal control were recruited.mtDNA extracted from peripheral blood were examined by PCR-based assay for D-loop sequence variations,followed by sequencing analysis.Results Compared with the normal control and standard sequence,a total of 61 sequence variants were detected,among these,three high variations were found,and the base variation rate of patients with chronic glomerular nephritis(CGN)and unaffected pedigree members(UAPM)(0.88%,0.72%)significantly increased compared with the control group(0.61%).The distibutional difference of base variation rate in the experimental groups were significantly higher than those in the control group(x2=21.220,7.964,all P<0.05).Especially in microsatellite variation in D310 region,the mutation frequency and base variation rate in patients with CGN were 100.00% and 30.00%,respectively,which of UAPM were 81.30% and 17.95%,respectively,while those in the normal control group were 53.30% and 6.05%,respectively.Among them,the patients with CGN compared with the control group had statistically significant differences(x2=15.610,150.047,all P<0.05).Likewise,UAPM also had statistically significant difference compared with the control group(x2=11.347,66.188,all P<0.05).Conclusion D-Loop of mitochondrial genome mutations may be related to the development of chronic glomerular nephritis.

Objective To evaluate the therapeutic effect of Pingyangmycin lipiodol emulsion (PLE) embolization for cavernous hemangioma of liver (CHL). Methods Seldinger technique was adopted and the catheter was super-selectively sent into the supplying artery of tumors in 18 CHL patients, 5-10 ml of Lidocaine and 5-20 ml of PLE were slowly injected. Before the embolization, 50-100 mg of pethidine was routinely injected. The embolization was conducted in several times in patients with large tumors, with multiple supplying arteries, and whose age was above 60 years. During the 3-48 months'follow-up after the operation,the change of the tumor diameter before and after the embolization was compared by using CT and ultrasound. The clinical symptomatic relief and the complications were also observed. Results The CHL of all the 18 cases were filled up by PLE. The foci were completely vanished in 9 cases, reduced by over 50% in 7 cases,and reduced by 25%-50% in 2 cases,respectively. The follow-up angiographic examination was performed in six cases, the tumor staining was completely vanished and the tumor-supplying artery was closed up. The improving rate of the clinical symtoms reached 89% . There were no serious complications. Conclusion The PLE embolization in hepatic cavernous hemangioma proves to be reliable, safe, minimally invasive, and with little side effect. This therapy, therefore, can be the first method of choice in treating the cavernous hemangioma of the liver.

Objective To investigate the safety and efficacy of vardenafil,a novel selective phosphodiesterase type 5 inhibitor, in the treatment of male erectile dysfunction (ED). Methods This multicenter,randomized,double blind,placebo controlled study was performed at 7 domestic sites.A total of 624 men with mild to severe ED were enrolled in this trial of 4 weeks of washout and 12 weeks of treatment with either placebo or 5,10,20 mg of vardenafil on demand but not more than once a day. Results Analysis of safety and efficacy of vardenafil was performed on 602 cases who completed the trial.Primary endpoints were Q3 (vaginal penetration) and Q4 (maintenance of erection) of the International Index of Erectile Function (IIEF).In the intent to treat population (n=602),the changes from baseline with 5,10,20 mg vardenafil groups were all improved ( P

Objective To review the experience in diagnosis and treatment of pheochromocytoma in a single center. Methods A total number of 142/145 pheochromocytoma cases treated surgically in our institute from August 2002 to February 2010 were retrospectively reviewed. The mean diameter of tumor was 5.9 cm (1.3- 18. 0 cm). The majority of the tumors (92.9%) were adrenal pheochromocytomas. Ninety-eight patients (69.0 % ) presented initially with hypertension, whereas 44 patients (31%)presented with adrenal incidentaloma. A specific anti-hypertensive pre-surgery preparation with phenoxybenzamine or doxazosine mesylate was started over 1 week before the operation.Of the 142 patients, 91 accepted open surgery, 54 accepted laparoscopic surgery, of which, 5 converted from laparoscopic surgery to open surgery. Results Histopathological results showed that all the cases were pheochromocytoma, while 83 cases were benign, 23 cases were malignant and 37 cases were suspected malignant. Sudden rising of blood pressure during operation was related to the preoperative serum level of catecholamine. Eighty-seven of 98 patients with preoperative hypertension had normal postoperative blood pressure; the remaining 11 patients reduced the dosage of anti-hypertension medication postoperatively. During the follow-up of 3-96 months (median 46 months), 10 of 91patients had a recurrence or metastasis. Six patients died of recurrences or metastasis within 5 years.Conclusions The procedures of qualitative and locative diagnosis of phechromocytoma include clinical manifestations, biochemical tests and imaging investigation. Surgical excision is the fundamental treatment for cure. Patients with high serum level of catecholamine tend to have a sudden rising of blood pressure during operation. Preoperative management is extremely important for the safety of the patient. Intensive follow up is necessary.

Background Both functional and morphological changes in amblyopic development are known to occur at various levels in the central visual pathway.However,whether the retina is involved or not during amblyopic progression remains controversial.Objective This study was designed to compare the thicknesses of the fovea and retinal nerve fiber layer (RNFL) of the normal fellow eye of amblyopic eye using optical coherence tomography (OCT) in children with myopic anisometropia.Methods Twenty-two patients with unilateral myopic anisometropic amblyopia were included as the anisometropia amblyopia group.Ten unilateral myopic anisometropic amblyopia subjects received treatment and recovered were used as the amblyopic cure group,and 11 individuals with simple myopic anisometropia without amblyopia were enrolled as the control group.OCT was performed on both eyes of all the subjects with informed consent.Fovea retinal thickness and RNFL thickness from the superior,inferior,nasal and temporal quadrants in the peripapillary region were evaluated.The measurement parameters were bilaterally compared in all the individuals by paired t test.The multiple regression model was used to analyze the correlation of retinal thickness with amblyopia patients.This study was approved by the Ethic Committee of this hospital.Written informed consent was obtain from each subject prior to the eye examination.Results Fovea retinal thickness increased in the amblyopic eyes compared with the fellow eyes,showing a statistically significant difference between them (P =0.001).However,no significant differences were found in the fovea retinal thickness between both eyes in the amblyopic cure group and simple myopic anisometropia without amblyopia group (P =0.778,0.943).Among the anisometropia amblyopia group,amblyopia cure group and simple myopic anisometropia without amblyopia group,the RNFL thicknesses of the temporal quadrant was significantly thicker in the higher myopic lateral eyes than those of the fellow eyes (P＜0.001,P =0.003,P =0.046).However,the differences in the superior,inferior,nasal and the average RNFL thickness were not statistically significant between the two eyes (P＞0.05).A negative correlation was found between the inferior retinal thickness with age (r=-0.559,P=0.016).Conclusions The fovea may be affected in unilateral myopic anisometropic amblyopia.There is no significant difference in the RNFL thickness between simple myopic eye and unilateral myopic anisometropia amblyopic eye.Improvement in amblyopia is coming along with the reduction of the thickness of the fovea.

Objective To lay the foundation for further exploration on parasitifer's defence reaction to pneumolysin through constructing ply gene-deletion strain of Streptococcus pneumoniae and researching on its virulence change. Methods A linker fragment with erm gene in middle and homologous upstream and downstream fragment of ply gene at both sides was prepared by long flanking homology-polymerase chain reaction(LFH-PCR). The linker fragment was transformed into Streptococcus pneumoniae. ply-deficient strain was then screened out from blood plate which contains erythromycin and identified by PCR. ply-deficient strain growth in vitro was observed and virulence change was observed through infecting mouse model. Results PCR results showed that ply gene was replaced completely by erm gene. The ply deficient strain was successfully constructed. The growth of single strain culture medium showed that ply genetic defect made no influence on bacterial's external growth. While in the mice nasal cavity infecting experiment, deficient strain enter into blood after 6 h from infecting which obviously slower than that did wild-type(2 h). And the number of bacteria at each point was much smaller than that of wild-type(P ＜0. 01 ). The mice peritonaeum infecting experiment showed that median lethal time of wild-type was 3 d, while that of deficient strain was 18 d(P＜0. 01). Conclusion It is a good way to completely substitute ply gene using LFH-PCR. ply deletion made no influence on baterial's growth in vitro, but it resulting in reduction of bacterial virulence in vivo.