The morbidity and nortality of esophageal carcinoma showed an upward trend in recent years.Neoadjuvant radiochemotherapy is the nain mode of treatment for advanced esophageal carcinoma,including neoadjuvant chemotherapy,neoadjuvant radiotherapy and neoadjuvant radiochemotherapy.However,there are still many controversies on efficacies and advantages or disadvantages of treatment mode.In this article,authors will investigate the present situations and future direction of neoadjuvant therapy for locally advanced esophageal carcinoma.

Objective To evaluate the safety and efficacy of thoracoscopic lobectomy for pulmonary benign diseases.Methods Between July 2002 and September 2007,35 cases with pulmonary benign diseases underwent thoracoscopic lobectomy in our hospital.Of the patients,video-assisted thoracoscopic lobectomy was performed on 12 cases,and totally endoscopic lobectomy was carried out in 23.Results The operation was completed in all of the cases except in one who was converted to open surgery because of massive hemorrhage.In this series,no peri-operational death occurred,however,complications occurred in 3 cases(morbidity rate: 8.6%),including 2 cases of persistent air leak and 1 case of pneumonia.The mean duration of chest tube drainage was 3.6 days(2 to 7 days),and average hospital stay after operation was 7.7 days(2 to 14 days).Postoperative pathological diagnosis included bronchiectasis in 15 patients,pulmonary inflammatory pseudo-tumor in 6,tuberculosis in 5,fungal infection in 5,pulmonary sequestration in 2,and bronchogenic cyst in 2.Conclusions Thoracoscopic lobectomy is safe and effective for pulmonary benign disease.

Bilingual teaching was taken into the part of computed tomography(CT)teaching in the medical image equipment for 2003 grade image undergraduates.In order to know the students' demands to the bilingual teaching as well as the students' requests in the bilingual teaching implementation process,the questionnaire was carried on to the students;at the same time the bilingual teaching test result was analyzed so as to evaluate its teaching effect.

Objective To find out the endoscopic characteristics of peptic ulcer disease in Monglian area.Methods 15826 cases in hospital within past 17 years were retrospectively analyzed.Results In all endoscopic cases,2298 cases of peptic ulcer were found,the detecting rate was 14.52%.Among them,58.98%(1376 cases) were of duodenal ulcer,32.16%(739 cases) were of gastric ulcer,7.96%(183 cases) were of complex ulcer.The detecting rates of male and female patients were 18.53% and 8.06% respectively,Monglian and Han nationalities were 18.43% and 13.15% respectively.Conclusions The detecting rate of peptic ulcer in Monglian nationality is higher than in Han nationality at Monglian area,has singnificant difference(P

Objective To compare the clinical effect of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) in the treatment of locally advanced esophageal squamous cell carcinoma.Methods The retrospective cohort study was conducted.The clinicopathological data of 156 patients with local advanced esophageal squamous cell carcinoma who were admitted to the Zhongshan Hospital of Fudan University from January 1,2010 to December 31,2015 were collected.Among 156 patients,59 undergoing nCRT were allocated into the nCRT group and 97 undergoing nCT were allocated into the nCT group.Patients in the nCRT group and nCT group respectively received 2 cycles chemotherapy by the TP regimen+40 Gy radiotherapy (2 Gy/d) and 2 cycles chemotherapy by the TP regimen.Patients were evaluated by imaging examinations after 6 weeks neoadjuvant therapy completion,and then underwent abdominal and right chest-left cervico three-incision thoracoscopic surgery.Observation indicators:(1) treatment situations;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed once every 3 months within 2 years and once every 6 months after 3 years up to January 2017.Follow-up included levels of tumor markers [carcinoembryonic antigen (CEA) and SCC-Ag],thoracic or abdominal computed tomography (CT),neck and abdominal ultrasonography and gastroscopy or PET/CT examination if necessary.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed using the nonparametric test.Count data were analyzed using the chi-square test or Fisher exact probability.Comparison of ordinal data was done by the nonparametric test.The survival rate was calculated using the life table method and survival was analyzed by the Log-rank test.Results (1) Treatment situations:all the patients in the 2 groups were able to burden neoadjuvant therapy and thoracic esophagectomy.Six patients in the nCRT group and 15 in the nCT group had conversion to open surgery.Operation time,volume of intraoperative blood loss,cases with postoperative readmission of ICU,cases with complications,cases with perioperative death and duration of hospital stay were (201 ± 25) minutes,(137± 66)mL,5,24 (10 with pulmonary complications,8 with anastomotic leakage,3 with hoarseness,2 with cardiovascular complications and 1 with chylopleura),0,12 days (range,9-93 days) in the nCRT group and (195±20) minutes,(133±58) mL,8,30 (11 with anastomotic leakage,10 with pulmonmy complications,4 with hoarseness,2 with cardiovascular complications,1 with postoperative hemorrhage,1 with delayed gastric emptying and 1 with chylopleura),1,11 days (range,9-78 days) in the nCT group,respectively,with no statistically significant difference between the 2 groups (x2 =0.883,t =0.102,0.692,x2 =0.048,1.541,Z =0.225,P＞ 0.05).(2) Postoperative pathological examination:R0 resection rate was 96.6％ in the nCRT group and 93.8％ in the nCT group,with no statistically significant difference between the 2 groups (x2 =0.589,P＞0.05).Results of postoperative pathological examination showed that G0,G1,G2 and G3 of tumor regression grade were respectively detected in 18,16,7,18 patients in the nCRT group and 4,5,4,84 patients in the nCT group,with a statistically significant difference between the 2 groups (Z=-7.151,P＜0.05).Stage 0,Ⅰ,Ⅱ,ⅢA,Ⅲ B and ⅣA of postoperative ypTNM stage were respectively detected in 16,9,23,4,6,1 patients in the nCRT group and 4,9,37,6,34,7 in the nCT group,with a statistically significant difference between the 2 groups (Z=-4.890,P＜0.05).The down-staging was detected in 48 patients of the nCRT group and 50 patients of the nCT group,with a statistically significant difference between the 2 groups (x2=13.957,P＜0.05).(3) Follow-up and survival situations:of 156 patients,153 were followed up for 12-82 months,with a median time of 36 months.The 1-,3-,5-year overall survival rates were 88.1％,61.4％,34.9％ in the nCRT group and 81.4％,43.8％,23.1％ in the nCT group,with a statistically significant difference between the 2 groups (x2=4.336,P＜0.05).Conclusion The nCRT in the treatment of locally advanced esophageal squamous cell carcinoma can enhance postoperative pathological response rate,down-staging rate and overall survival rate compared with nCT,without increasing incidence of perioperative complications.

Objective To observe the formation of asymmetric dimethylarginine (ADMA)and the expression of dimethylarginine dimethylaminohydrolase 2 (DDAH-2) of human umbilical vein endothelial cells (HUVECs) stimulated by uric acid (UA), and to explore the role of ADMADDAH axis in the vascular endothelial dysfunction induced by uric acid. Methods HUVECs were cultured in M199 medium supplemented with 10% FBS. Cells were exposed to different concentrations of UA (0, 60, 120 mg/L) for 6 h and 24 h. Under different concentrations and times, the level of ADMA in cell suspension was detected by high performance liquid chromatography (HPLC) technique; the gene and protein expressions of DDAH-2 were detected by RT-PCR and Western blotting; the fluorescence intensity of intracellular 2',7'-dichlorofluorescein (DCF) which represented the productions of ROS was detected by the flow cytometry (FCM). The activity of DDAH-2 in HUVCEs which were exposed to different concentrations of UA (0, 60, 120mg/L) or UA (120 mg/L) +NAC (10 mmol/L) for 24 h was estimated by directly measuring the amount of ADMA metabolized by the enzyme and the role of NAC in the activity was studied.Results The expression of ADMA induced by urid acid was dose-depent and higher at 24 h than that at 6 h in the same dosage (all P＜0.05). The dosage and stimulation time of UA did not have any influence on the expression of intracellular DDAH-2 (all P＞0.05). When HUVECs exposed to UA (120 mg/L) for 24 h, the production of intracellular ROS was significantly increased while the activity of DDAH-2 was decreasesd (all P＜0.05) as compared to 60 mg/L stimulation. This effect could be inhibited by the intervention of anti-oxidant NAC. Conclusions The high UA stimulation on HUVECs can increase the expression of intracellular ROS and inhibit the activity of DDAH-2 which increases the concentration of ADMA by decreasing the degradation of ADMA as well as the formation of NO. DDAH-ADMA axis may participate in the vascular endothelial dysfunction induced by UA.

Objective To assess the perioperative efficacy and complications of intra-aortic balloon pump(IABP) in patients with cardiac operation.Methods A total of 36 cases with IABP patients from January 2011 to September 2016 were studied in Luhe Hospital of Beijing Affiliated to Capital Medical University,inluding 27 patients with coronary atherosclerotic heart disease(CAD),8 patients with valvular heart diseaseand and 1 patient with left atrial myxoma.The clinical data was collected to analyze IABP efficacy and complications.Results There were 10(27.8%) patients died,the mortality rate of CAD patients was lower than that of non-CAD patients(18.5% vs.55.6%,X2=4.615,P=0.032).The related complications after IABP implantation included:6(16.7%) cases suffered from thrombocytopenia,3(8.3%) cases with lower limb ischemia,2(5.6%) cases with lower extremity arterial thromboembolism,2(5.6%) cases with femoral artery pseudoaneurysm,2(5.6%) cases with acute pancreatitis,1(2.8%) cases with intestinal necrosis by mesenteric ischemia,2(5.6%) cases with gastrointestinal bleeding,3(8.3%) cases with hemorrhage in puncture site,4(11.1%) cases of fever,1(2.8%) case with pipeline leak,and 1(2.8%) case no pressure lumen data.After treatment with IABP,in 26 cases survival patients,the hemodynamic indexes(mean arterial pressure,heart rate,central venous pressure,urine volume) were significantly improved and the amount of dopamine and epinephrine decreased(t=-22.35,64.41,53.31,-23.82,26.07,14.15 respectively,P<0.05).Conclusion IABP can significantly improve the perioperative efficacy.The active treatment on complications is important to reduce the death induced by IABP.

OBJECTIVETo explore the safety and feasibility of cervical triangulating stapled anastomosis(TSA) for esophagogastric anastomosis(EGA) after minimally invasive esophagectomy (MIE).

METHODSClinical data of 137 patients undergoing MIE for esophageal cancer(EC) in our department from January 2013 to March 2014 using end to side circular stapled anastomosis (CSA, 60 cases) or end-to-end triangulating stapled anastomosis (TSA, 77 cases) in the neck were retrospectively analyzed. The short-term outcomes between the two groups were evaluated and compared.

RESULTSCervical anastomotic leakage occurred in 3 patients(3.9%) of TSA group, but in six(10.0%) of CSA group (P=0.152). The incidence of anastomotic stenosis was 1.3%(1/77) and 15.0%(9/60) in TSA and CSA group respectively(P=0.002). The median hospital stay and perioperative mortality were not significantly different between the two groups as well as postoperative respiratory and cardiovascular complications.

CONCLUSIONSTSA is a safely and effectively alternative method for EGA with lower incidence of postoperative gastrointestinal complications, especially in anastomotic stricture.

Anastomosis, Surgical ; methods ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Neck ; surgery ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To explore the relationship of exposure to occupational hazards,labor intensity,dietary factors and the metabolic syndrome( MS) in male rolling mill workers. METHODS: A total of 1 105 male workers in a rolling mill were studied as research objects by judgment sampling method. The basic information of the subjects was collected by questionnaire survey and health examination. The prevalence of MS was analyzed according to different individual characteristics of workers. Multi-factor logistic regression analysis was conducted for analysis of the affecting factors of MS.RESULTS: The prevalence of MS in the subjects was 32. 5%( 359/1 105). The prevalence of MS in workers exposed to occupational hazards was higher than that in the control group( 33. 5% vs 20. 2%,P < 0. 05). The prevalence of MS increased with age( P < 0. 05),and decreased with the increase of labor intensity and family per capita monthly income( P < 0. 05). The prevalence of MS in smokers was higher than that in non-smokers( P < 0. 017),and the prevalence of MS in workers with animal dietary was higher than those with balanced dietary and with traditional dietary( P < 0. 017).The multivariate logistic regression analysis showed that after the adjustment of confounding factors such as age,seniority,family per capita monthly income,smoking and drinking,MS risk in a single factor of carbon monoxide exposure group,high temperature combined with carbon monoxide exposure group and high temperature combined with noise exposure group were higher than that of the control group without exposure to occupational hazards respectively( P < 0. 05),and the ratio of the 95% confidence interval were 2. 246( 1. 097-4. 597),2. 581( 1. 308-5. 094) and 2. 435( 1. 281-4. 627). The risk of MS in workers with animal dietary was higher than that with traditional dietary( P < 0. 01),the odds ratio and 95%confidence interval was 1. 497( 1. 106-2. 025). The grade of MS was 24. 6% lower than the original labor intensity with each increasing grade of risk( P < 0. 05). CONCLUSION: The animal dietary,increased labor intensity,exposure to carbon monoxide,high temperature combined with carbon monoxide and high temperature combined with noise can all increase the risk of MS.

The incidence of adenocarcinoma of esophagogastic junction (AEG) has been rising in recent years. Despite that multimodality therapy including surgery advances tremendously, the 5-year survival rate of AEG patients remains poor. Due to the particularity of anatomy and pathology of AEG, controversies persist with regard to staging, surgical approaches, scope of lymph node dissection, extent of gastrectomy as well as the reconstruction of digestive tract. High level of evidence based on clinical trials is still lacking. Here, in light of recent progress in surgical treatment of AEG, the authors investigate the related strategies of surgical treatment of AEG from the perspective of thoracic surgeon, in order to provide references to surgeons.