Objective To review and summerize effectiveness and method of the Boston's balloon dilation in cardiac achalasia. Methods The intensified guide wire was inserted into stomach through mouth cavity under TV controll. The Boston's balloon was inserted to the cardiac stricture through the guide wire and dilatated with 15% contrast medium with to a maximum diameter for five minutes and then the balloon was dilatated again for 3～5 minutes, all together for 3～4 times. The severe stricture must be pre dilatated with 20～25mm diameter balloon. Results The balloon insertion was technically successful in all 26 patients. The once succese of ballon dilation was achieved in 24 patients and twice in other 2. Follow up time was from 2 weeks to 31 months(mean 10.6 months). Recurrent stenosis had not occurred in all patients. Remission rate of dysphagia was 100%. Esophageal reflux occurred in 3 patients. Conclusions The Boston's balloon dilatation is simple and effective for treatment of cardiac achalasia. The method sometimes may replace surgical procedure.

Objective To evaluate the effect of vitreoretinal surgery with lens sparing technique in treating the detachment with giant retinal tear(GRT) associated with proliferative vitreoretinopathy(PVR). Methods Thirty one consecutive eyes with GRT underwent vitrectomy were analysed retrospectively. Operative techniques included peeling of pre retinal membrane, injection of perfluorodecalin liquid, retinotomy and retinectomy,endolaser,and silicon oil or C 2F 6 gas tamponade. Lens sparing vitrectomy was performed in 28 phakic eyes. Follow up period ranged from 11 to 34 months. Results Anatomic retinal attachment was achieved intraoeratively in 29 eyes. In 16 eyes of 28 eyes with postoperative cataract formation,3 eyes underwent cataract surgery with or without intraocular lens implantation. The corrected final visual acuity ranged from 0.4 to 0.01. Conclusion Most phakic eyes of retinal detachment with GRT PVR can be successfully operated on with an outcome of improving the visual acuity by using techniques of lens sparing vitrectomy, perfluorodecalin liquid and silcone oil tamponade.

Objective To discuss the effect of pericardial devascularization plus gastric fundus transaction in advance schis?tosomiasis patients with portal hypertension. Methods Thirty?six advanced schistosomiasis patients with portal hypertension treated with devascularization plus gastric fundus transaction(a portal hypertension group),as well as 10 patients treated with modified Sugiura operation(a modified Sugiura operation group)in the Third People’s Hospital of Yangxin County since 2006 were chosen as the observation objects,and the clinical effects of the two groups were observed and compared. Results The op?eration time,indwelling time of stomach tube,time to taking food after operation,drainage tube removal time of the portal hy?pertension group were all shorten than those of the modified Sugiura operation group(all P<0.05). The hospitalization expenses of the two groups were(25 466.00 ± 2 888.48)Yuan and(34 517.10 ± 4 948.39)Yuan respectively,and the difference was al?so statistically significant(P<0.05). The incidence rates of portal thrombosis of the portal hypertension group and modified Sug?iura operation group were 33.33%(12/36)and 40.00%(4/10),respectively,and the incidence rates of rehaemorrhagia of the two groups 12 months after the operation were 16.67%(6/36)and 10.00%(1/10),respectively,but the differences had no sta?tistically significance(both P>0.05). In addition,1 case with delayed gastric emptying and 1 case with stomal leak of esopha?gus happened in the modified Sugiura operation group,while no corresponding complications happened in the portal hyperten?sion group. Conclusions Pericardial devascularization plus gastric fundus is a relatively easy procedure which has a good short?term clinical effect,and therefore it is suitable for application in primary hospitals. However,its long?term effect still needs fur?ther observation.

Objective To observe the effect of JWSNS serum on proliferation and apoptosis hepatic stellate cells.Methods After being added different concentrations of JWSNS (the low concentrations of JWSNS:0.78 g/ml of crude drug; the medium concentration group of JWSNS:1.56 g/ml of crude drug; the high concentration group of JWSNS:3.12 g/ml of crude drug) drug-containing serum in vitro HSC-T6 cells for 12h,24 h and 48 h respectively,detected serum HSC-T6 proliferation with MTT colorimetry method and measured HSC-T6 apoptosis with flow cytometry and TUNEL method.Results (①) After applied JWSNS on rats HSC-T6,the Cell proliferation was inhibited which showed a time-concentration dependence.The differences were significant when comparing each JWSNS group with the control group (P＜0.01).High concentration of JWSNS group showed significant difference when compared with Biejiaruangan tablets group (P＜0.05) with high concentration of JWSNS (0.399± 0.041) ％ after 48h,and Biejia-Ruangan tablets (0.429± 0.037) ％ after 48 h.② Flow cytometry analysis showed each JWSNS group and Biejiaruangan tablets group had significant increased cell apoptosis when compared with the control group (P＜0.05) after 12 h,24 h,and 48 h.JWSNS medium concentration group [12 h was (17.83±0.25)％,24 h was (26.06±0.26)％,48 h was (39.30±2.25) ％] and JWSNS high concentration group [12 h was (27.15±0.29)％,24 h was (38.96±0.51)％,48 h was (49.34± 0.77) ％] had a significant increased cell apoptosis compared to the Biejia-Ruangan tablets group [ 12 h was (8.31 ± 0.30) ％,24 h was (16.25 ± 0.25) ％,48 h was (27.12± 0.39) ％].③ TUNEL detection showed that each concentration of JWSNS group [the low concentration of JWSNS:was (25.1 ± 1.48)％,medium concentration group of JWSNS was(39.30±2.25)％,high concentration group of JWSNS was(39.30±2.25)％] had a significant increased cell apoptosis rate than Biejiaruangan tablets group (30.0± 3.92) after 48 h (P＜0.01).Conclusion JWSNS containing serum can inhibit the proliferation of HSC-T6 in vitro,promote the apoptosis

Objective To discuss the effect of staining with the mixture of methylene blue and meglucamine diatrizoate on removal and diagnosis of minute mammary lesion(diameter≤ 1. 0cm). Methods 212 cases of mammary lesion were removed and diagnosed by the method of B-ultrosound and staining with the mixture of methylene blue and meglucamine diatrizoate. Results All of cases were removed and diagnosed successfully, including 7cases of early invasive ductus cancer and 1 case of ductal carcinoma in situ. Conclusion The method of staining with the mixture of methylene blue and meglucamine diatrizoate could significantly improve the accuracy of removal of minute mammary lesion and the percentage of diagnois of early breast cancer, and have high safety.

Objective To explore the efficacy and safety of irinotecan as neoadjuvant chemotherapy (INAC) plus radical surgery (RS) for cervical cancer.Methods According to International Federation of Gynecology and Obstetrics (FIGO),81 cases were divided into Ⅱ B,ⅡA,and Ⅰ B2 groups.According to the tests of UGT1A1 gene polymorphisms,we adjusted the injection dose of irinotecan.The parameters were analyzed,including the efficacy,operation time and bleeding volume,postoperative pathology,survival time,and adverse reactions.The articles on irinotecan or paclitaxel combined with cisplatin for neoadjuvant chemotherapy between 2005 and 2015 were collected,and compared.Results The effective rate of chemotherapy was 81.5％ (Ⅰ B2 group:85.7％;Ⅱ A group:83.3％;and ⅡB group:72.2％),operation time was (5.3 ± 1.1) h,and blood loss was (781 ± 361.7) ml.After chemotherapy,37 cases were delayed diarrhea,70 cases were nausea,48 cases were vomiting,and 40 cases were bone marrow suppression.The infiltration rate,operation time,and blood loss on Ⅱ B group was significantly higher than that on Ⅱ A and Ⅰ B2 groups(P ＜ 0.05),and there was no significant difference in the chemotherapy efficiency,invasion depth,lymphatic metastasis,survival time and adverse reactions(P ＞0.05).Compared to three articles,the total effective rate in this study was higher than that in previous studies,also in Ⅱ A and Ⅱ B group.Conclusions Irinotecan chemotherapy regimens combined with cisplatin is effective and well tolerated.It is worthy of popularization and application.Detection of UGT1A1 gene polymorphism has guiding significance for chemotherapy regimen on irinotecan combined with cisplatin.

Objective To evaluate the effect of polydatin on neuropathic pain in rats.Methods Forty male Sprague-Dawley rats,aged 6-8 weeks,weighing 200-230 g,were randomly divided into 5 groups (n =8 each) using a random number table:sham operation group (group S),neuropathic pain group (group NP),polydatin 5 mg/kg group (group P1),polydatin 10 mg/kg group (group P2),and polydatin 20 mg/kg group (group P3).Neuropathic pain was induced by chronic constriction injury in NP and P1-3 groups.In group S,the sciatic nerve was only exposed but not ligated.In S and NP groups,normal saline 0.1 ml was injected intraperitoneally immediately after operation and at 1,3,5 and 7 days after operation (T1-4).In P1-3 groups,polydatin 5,10 and 20 mg/kg (in normal saline 0.1 ml) were injected intraperitoneally immediately after operation and at T1-4.At 1 day before operation (T0) and T1-4,the mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured.After measurement of pain threshold at T4,the rats were sacrificed,and L4-6 segments of the spinal cords were removed for determination of the expression of high-mobility group box 1 (HMGB1),Toll-like receptor 4 (TLR4),interleukin-1beta (IL-1β),tumor necrosis factor-alpha (TNF-α) and monocyte chemotactic protein-1 (MCP-1) by Western blot.Results Compared with group S,the MWT was significantly decreased,and the TWL was significantly shortened at T1-4 in group NP,the MWT was significantly decreased at T1-4,and the TWL was significantly shortened at T2-4 in group P1,the MWT was significantly decreased at T1-4,and the TWL was significantly shortened at T3.4 in group P2,the MWT was significantly decreased at T1-4 in group P3,and the expression of HMGB1,TLR4,IL-1β,TNF-α and MCP-1 was significantly up-regulated in NP,P1 and P2 groups (P＜0.05).Compared with group NP,the MWT was significantly increased at Tt-4,and the TWL was significantly prolonged at T1,2 in group P2,the MWT was significantly increased,and the TWL was significantly prolonged at T1-4 in group P3,the expression of HMGB1,TLR4,IL-1β,TNF-α and MCP-1 was significantly down-regulated in P2 and P3 groups (P＜0.05),and no significant change was found in the parameters mentioned above in group P1 (P＞0.05).Compared with group P1,the MWT was significantly increased at T4 in group P2,and the MWT was significantly increased at T14,the TWL was significantly prolonged at T3,4,and the expression of HMGB1,TLR4,IL-1β,TNF-α and MCP-1 was significantly down-regulated in group P3 (P＜0.05).Compared with group P2,the MWT was significantly increased at T3,4,and the expression of TLR4,IL-1β,TNF-α and MCP-1 was significantly down-regulated in group P3 (P＜0.05).Conclusion Polydatin can alleviate neuropathic pain through inhibiting inflammatory responses in the spinal cord of rats.

Objective To evaluate the clinical effect and safety of transcatheter thrombus-breaking combined with local infusion of reteplase (rPA) in treating severe pulmonary thromboembolism (PTE). Methods During the period from June 2010 to June 2013 at authors’ hospital, transcatheter thrombus-breaking combined with local infusion of reteplase was carried out in 26 patients (17 males and 9 females) with severe pulmonary embolism. The changes of pulmonary circulation and the cardio - pulmonary hemodynamics after the treatment were analyzed. Results The preoperative mean pulmonary artery pressure, arterial blood oxygen partial pressure and the blood pressure were (63.78 ± 6.89) mmHg, (73.23 ± 11.51) mmHg and (87.35 ± 10.92) mmHg respectively, while the postoperative ones were (26.23 ± 10.27) mmHg, (93.48 ± 6.17) mmHg and(127.14 ± 13.15) mmHg respectively, and the differences between preoperative and postoperative ones were statistically significant (P<0.01). All the patients were followed up for 6 - 36 months. Significant stable clinical improvement was obtained in 25 patients, and recurrence was seen in one patient. Conclusion Transcatheter thrombus-breaking combined with local infusion of reteplase can quickly improve the pulmonary circulation and the clinical conditions for patients with severe pulmonary thromboembolism, and it has no obvious complications. This technique carries excellent value in maintaining the stability of hemodynamics.

ObjectiveTo investigate the value of diffusion tensor imaging (DTI) at high b value for unilateral middle cerebral artery (MCA) occlusive disease in patients without obvious infarct lesions on conventional MR imaging.MethodsDTI at high b value (2200 s/mm2 ) was performed using a 3.0 Tesla MR scanner in 34 patients with unilateral middle cerebral artery occlusion,who had no obvious infarct lesions on conventional MR imaging. Fractional anisotropy (FA),apparent diffusion coefficient (ADC),axial diffusivity (eigenvalue λ1) and radial diffusivity (eigenvalues λ2,λ3) were measured at the ipsilateral and contralateral corona radiata,anterior and posterior limbs of the internal capsule,cerebral peduncle and pons in all subjects.Mean ADC,FA,λ1,λ2 and λ3 values of corona radiata,anterior and posterior limbs of the internal capsule,cerebral peduncle and pons were compared between the ipsilateral and contralateral MCAterritory by t test. Results Among the 34 patients,left MCA occlusion in M1 segment occurred in 16 patients and right MCA occlusion in Ml segment occurred in 18 patients.At the ipsilateral corona radiata,mean FA,ADC,λ1,λ2 and λ3 were 0.419 ±0.032,(5.975 ±0.272) × 10 3,(5.704 ±0.365) ×10-3,(6.412 ±0.368) × 10-3 and (6.605 ±0.343) × 10-3 mm2/s,respectively.At the contralateral corona radiata,mean FA,ADC,λ1,λ2 and λ3 were 0.443 ± 0.033,(5.804 ± 0.282) × 10 -3,(5.651 ±0.350) × 10-3,(6.099 ±0.353) × 10-3 and(6.372 ±0.355) × 10-3 mm2/s,respectively.At the ipsilateral corona radiata,mean FA was significantly decreased(t =11.614,P ＜0.01),and mean ADC (t=12.421,P＜0.01),λ1(t =7.447,P＜0.01),λ2(t=10.244,P＜0.01) and λ3(t=9.890,P＜0.01) were significantly increased.At the ipsilateral anterior and posterior limb of the internal capsule,mean FA were 0.609 ±0.026 and 0.674 ±0.033,λ1 were(5.330 ±0.462) × 10 -3 and(5.171 ±0.456) ×10-3 mm2/s,respectively.At the contralateral anterior and posterior limb of the internal capsule,FA were 0.622 ±0.026 and 0.694 ±0.034,λ1 were(5.064 ± 0.448) × 10 -3 and(4.924 ± 0.365) × 10 -3 mm2/s,respectively.Mean FA was significantly decreased (t =7.823,8.013,all P ＜ 0.01) and mean λ1 was significantly increased (t =7.811,8.800,all P ＜0.01) at the ipsilateral anterior and posterior limbs of the internal capsule.There was no significant difference in ADC,λ2 and λ3 value between the ipsilateral and contralateral sides.And all the DTI parameters,including mean ADC,FA,λ1,λ2 and λ3 values,showed no statistical difference between both sides of cerebral peduncle and pons.ConclusionDTI at high b valuc can provide useful information for visualizing ischemic white matter injury in patients without obvious infarct lesions on conventional MR imaging.

Objective To evaluate the clinical efficacy of total mesoesophageal excision and sanye lymph node dissection in the radical resection of esophageal carcinoma under thoracoscopy and laparoscopy,and to investigate its safety and feasibility, and to find a more reasonable and effective surgical treatment of esophageal carcinoma. Methods One hundred and twenty-six cases of esophageal cancer who underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in Central Hospital of Hengyang from October 2015 to September 2017 were retrospectively analyzed. Among them,Sixty-four patients accepted total mesoesophageal excision and sanye lymph node dissection under thoracoscopy and laparoscopy (observation group ), Sixty-two cases accepted with conventional esophagectomy under thoracoscopy and laparoscopy ( control group) . The operation time, blood loss, indwelling time of thoracic drainage tube, postoperative drainage volume,postoperative hospitalization time,number of lymph node dissection,lymph node metastasis degree,perioperative complications of the two groups were analyzed and compared. The number of lymph node dissection and lymph node metastasis degree in different regions were compared between the two groups. The number of recurrence and death were recorded in the two groups. Results Compared with the control group,the operation time was longer in the observation group((264. 9±32. 9) min vs. (233. 5±30. 4) min,t= -5. 56,P<0. 001),but blood loss was less((152. 7±26. 4) ml vs. (235. 5± 30. 6) ml,t = 16. 27,P<0. 001). There was no significant difference in the indwelling time of thoracic drainage tube, postoperative drainage volume or postoperative hospitalization time between the two groups (P>0. 05). The number of lymph nodes in the observation group was significantly higher than that in the control group ((32. 7±15. 5) pieces vs. (20. 9±11. 2) pieces,t = - 4. 93,P< 0. 001),and lymph node metastasis degree in the observation group was smaller than that of the control group ( 6. 7% vs. 9. 3%, χ2 = 7. 22, P < 0. 01) . There were no significant differences in perioperative complications such as pulmonary complications, arrhythmia, anastomotic fistula, chylothorax,hemorrhage,recurrent laryngeal nerve injury,tracheal injury and perioperative death (P>0. 05). Left and right recurrent laryngeal nerve,thoracic esophagus,celiac artery lymph node dissection of the number of observation group was higher than that of the control group ((4. 7 ± 3. 2) pieces vs. (1. 5 ± 1. 4) pieces, t= -7. 25;(6. 0±2. 7) pieces vs. (3. 1±1. 7) pieces,t = -7. 12;(5. 7± 2. 4) pieces vs. (3. 2± 1. 9) pieces,t= -6. 48;P<0. 001). Left and right recurrent laryngeal nerve,thoracic esophagus lymph node metastasis degree in the observation group was smaller than that in the control group (8. 7%(26/ 300) vs. 18. 1%(17/ 94),χ2= 6. 53;8. 9%(34/ 382) vs. 17. 9%(35/ 195),χ2 = 10. 04;P<0. 05) . There were no significant differences in the recurrence rate of tumor recurrence at 1 and 24 months after operation in the observation group and the control group(3 cases(4. 7%) vs. 4 cases(6. 5%),χ2 = 0. 92,P > 0. 05) . There were no deaths in the two groups. Conclusion Total mesoesophageal excision and three-field lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy is safe and feasible,the recent effect does not increase the surgical complications, but its long-term effect need a lot of long-term follow-up. A relatively thorough cleaning of the esophageal mesentery and its lymph nodes can minimize the tumor in the subendothelial micrometastasis,and is beneficial for the prognosis of patients with esophageal cancer.