Objective To evaluate the clinical value of CT scan in the diagnosis of tracheoesophageal groove lymph node (TEGLN) metastasis of thoracic esophageal carcinoma. Methods Forty-six patients with thoracic esophageal carcinoma underwent esophagectomy with three-field dissection (3FD) of the cervical, mediastinal, and abdominal lymph nodes. CT findings of TEGLN were compared with that of pathological findings. Results Among the 46 patients who underwent esophagectomy with 3FD, 14 (30%) were found to have TEGLN metastases. Of the 277 TEGLNs excised by operation, 16 were found to have metastases. Primary sites of the thoracic esophageal carcinoma with TEGLN metastasis in upper, middle, or lower portion were 66.67%, 22.86%, and 40%, respectively. The difference between each portion was not statistically significant. The thoracic esophageal carcinoma with TEGLN metastasis in T 1, T 2, T 3 and T 4 staging were 50.00%, 25.00%, 28.57%, and 100.00%, respectively. There was no statistically significant difference between each T staging. 18 TEGLNs were found in CT scans. The average diameter of them was 1cm (0.3～2.5 cm). Sensitivity and specificity of CT examination were 87.50% and 98.47%, respectively. Positive predict value and negative predict value were 77.78% and 99.23%, respectively. Conclusion In patient with thoracic esophageal carcinoma, nodules appeared in tracheoesophageal groove could be diagnosed as lymph nodal metastases. Low cervical and mediastinal CT scan should be a conventional examination, and it was the basis of the radiation therapy plan. Dissection of TEGLN was very important for patient of thoracic esophageal carcinoma, but if bilateral tracheoesophageal grooves were negative in CT scans, and bilateral internal jugular chain and bilateral superclavicular lymph node were both negative in clinical examination. 3FD dissection, which could increase the rate of operative complication, was not conventionally used.

Objective:To evaluate the feasibility and safety of laparoscopic jejunostomy with central venous catheterization set (CVC, Arrow International Inc., USA) during the operation of totally minimally invasive Ivor-Lewis esophagectomy (MIIE). Methods:The clinical data of 88 patients with esophageal squamous cell carcinoma who were admitted to the Fudan University Cancer Hospital from February 2013 to April 2014 were retrospectively analyzed. Among them, 48 patients with early mid-lower esophageal cancer un-derwent laparoscopic jejunostomy with CVC, and 40 patients accepted nasogastric tube nutrition. Short-term clinical outcomes were collected. Results:No significant difference in nutrition index was found between the two groups, but the rate of unplanned extubation in the laparoscopic jejunostomy with CVC group was less than that in the nasogastric tube nutrition group. Conclusion:Laparoscopic jejunostomy with CVC set is a safe and feasible technique. It is potentially accepted as an optional approach in MIIE for post-operative nutrition support.

Objective Totally MIIE with per-oral placement of anvil has been reported elsewhere,but MIIE with manual pursestring and per-thoracic port placement of anvil has been seldomly reported.The feasibility of the latter technique was proved in this study.Methods Patients with mid-lower thoracic esophageal cancer were prospectively treated with totally MIIE at Shanghai Cancer Center of Fudan University from Feberay 28,2013 to August 31,2013.Laproscopic intracorporeal construction of the gastric conduit and needle catheter J-tube were performed in the first stage of MIIE.In the second stage a hand sewn pursestring was made with endostitch system and the anvil of EEA stapler was inserted via the tenth inter costal port prior to the intrathoracic anastamosis.Short-term clinicopathologic outcomes were collected.Results 39 cases were treated with totally MIIE,media age 61 years,ranged 48-69 years,10 females and 29 males.There was 1 conversion to open surgery.The median duration of operation was 245 minutes.The median intraoperative blood loss was 210 ml.All the patients were margin negative and staged from pT1N0M0 to pT3N2M0.The average lymph node yields were 16.5 per patient.The median postoperative hospital stay was 7 days.There was no mortality.Perioperative morbidity occurred in 4 patients (10％).2 patients were complicated with late stage gastric paralysis which began 2 or 3 days after oral feeding and both recovered in 1 month.1 patient was with minor anastamotic leakage which was endoscopically demonstrated on the 14th day postoperatively and the patient recovered in 1 month post leakage.1 patient was complicated with severe pneumonitus and ARDS; the ICU stay of that case was 19 days and the recovered patient was discharged 27 days postoperatively.Conclusion MIIE with regular EEA stapler and intrathoracic anastamosis is feasible in patients with thoracic esophageal cancer.Prospective randomized clinical trials could be conducted to compare the open procedure and totally MIIE with regular EEA stapler.

Objective To investigate the correlation of the anti-cardiolipin(aCL) antibodies and anti-β2 glycoprotein Ⅰ(anti-β2GPI) antibodies in missed abortion women.Methods Fourteen patients diagnosed missed abortion were chose as trial group,while 20 normal females received induced abortion in the same time as control group.Chemiluminescence method was used to measure the serum levels of IgG/IgM aCL and IgG/IgM anti-β2GPI antibodies in the two groups.Results The median levels of serum IgM aCL antibodies and serum IgM anti-β2GPI antibodies in trial group were significantly higher than those of control group(21.3(2.2-39.4)KU/L vs.6.0(1.5-10.7) KU/L,11.9(1.2-25.4) KU/L vs.1.9(1.1-4.0) KU/L;u=2.031,2.912;P ＜0.05).There were no significant differences in terms of the levels of serum IgG aCL antibodies and serum IgG anti-β2GPI antibodies between trial group and control group (P＞0.05).Conclusion There is correlation between IgM aCL as well as IgM anti-β2GPI antibodies and missed abortion,so in reducing the incidence of missed abortion,early and dynamic detection of anti-cardiolipin and anti-β2 glycoprotein I antibodies in childbearing women has a certain clinical significance.

Objective To explore the feasibility of electromagnetic navigation for hepatic ducts exploration by choledochoscope based on a three-dimensional (3D) printing model.Methods The retrospective descriptive study was conducted.The clinical data of 1 patient with obstructive jaundice combined with secondary biliary tract dilation who was admitted to the Beijing Tsinghua Changgung Hospital in April 2016 were collected.Digital imaging and standardized format data of enhanced computed tomography (CT) scan were collected,3D reconstruction of liver and bile duct were done under a 3D printing model,and then a hollow model of bile duct was achieved.Choledochoscope with internal electromagnetic probe was inserted into the printed hepatic ducts.Four points of anatomical markers in left and right hepatic ducts and common hepatic duct were chosen as fiducial markers for calibration and registration.Results After registration,the scope can be tracked in main hepatic segmental bile ducts.The locations of choledochoscope matched precisely the navigation results.Conclusion Electromagnetic navigation may bring accurate tracking effectiveness for choledochoscopic examination.

OBJECTIVETo compare the safety and efficacy between three-field lymphadenectomy and normative Ivor-Lewis two-field lymphadenectomy for thoracic esophageal squamous cell carcinoma METHODS: Clinical data of 375 patients with thoracic esophageal squamous cell carcinoma who underwent three-field lymphadenectomy(3FL) or Ivor-Lewis two-field lymphadenectomy(2FL, Ivor-Lewis) in Fudan University Shanghai Cancer Center during 2013 were retrieved and collected from electronic medical record system. Ninety-one patients received three-field lymphadenectomy (3FL group), including 16 cases of intra-cervical gastro-esophageal anastomosis and 75 cases of intra-thoracic gastro-esophageal anastomosis, while 284 patients received Ivor-Lewis two-field lymphadenectomy (2FL group) with all intra-thoracic gastro-esophageal anastomosis. Short-term outcomes were compared between two groups, including postoperative anastomotic leakage, pneumonia and respiratory failure, chylothorax, reoperation and 90-day death. Total harvested lymph nodes and positive lymph nodes in each group were also compared. A total of 338 patients were enrolled into survival analysis. Survival curve was presented by Kaplan-Meier method.

RESULTSAs compared to 2FL group, the 3FL group had significantly higher ratio of N3 patients [19.8% (18/91) vs. 5.3% (15/284), P=0.000], stageIII( patients [58.2%(53/91) vs. 43.0%(122/284), P=0.007], and upper thoracic cancer patients [12.1%(11/91) vs. 3.5%(10/284), P=0.027]; also the 3FL group had more harvested lymph nodes (40.1±14.6 vs. 25.3±9.4, P=0.000) and more positive lymph nodes (3.3±4.0 vs. 1.7±3.2, P=0.000). With respect to pneumonia and respiratory failure, chylothorax, reoperation and 90-day death, no significant differences were found between the group (P=0.447, P=0.751, P=0.678, P=0.685). The 3FL group had a significantly higher incidence of anastomotic leakage than 2FL group [7.7% (7/91) vs. 1.8% (5/284), P=0.011], while its incidence of intrathoracic anastomosis leakage was 4.0% (3/75), which was not significantly different with 1.8%(5/284) of 2FL group (P=0.372). Median follow-up was 33 months. Overall 1-, 2-, 3-year survival rates were 94%, 81% and 70%, while 1-, 2-, 3-year survival rates of 3FL group were 90%, 73% and 66%, of 2FL group were 95%, 84% and 72%, respectively, without significant differences between the two group(P=0.135). Further subgroup analysis showed that no significant differences of postoperative survival in stage I(, II( and III( patients were observed between the two groups (P=0.541, P=0.511, P=0.402), meanwhile no significant differences of postoperative survival in patients with metastasis and without metastasis were found between the two groups as well (P=0.985, P=0.233).

CONCLUSIONSThree-field lymphadenectomy can be performed with acceptable perioperative morbidity and mortality. The prognosis value of three field lymphadenectomy needs further investigation. Patients with thoracic esophageal squamous cell carcinoma may have favorable survival through normative Ivor-Lewis two-field lymphadenectomy.

Anastomotic Leak ; etiology ; Antineoplastic Protocols ; Carcinoma, Squamous Cell ; mortality ; surgery ; China ; Esophageal Neoplasms ; mortality ; surgery ; Esophagectomy ; adverse effects ; methods ; mortality ; Humans ; Incidence ; Lymph Node Excision ; adverse effects ; methods ; mortality ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Staging ; Prognosis ; Survival Analysis ; Survival Rate ; Thoracic Neoplasms ; mortality ; surgery ; Treatment Outcome

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.

Objective To research the influence of hypoxic preconditioning in anti-oxidative ability of brain tissues and neurological functions in rats after traumatic brain injury.Methods Forty eight adult male Sprague Dawley rats were randomly divided into sham-operated group,hypoxic preconditioning group (HPC),traumatic brain injury group (TBI) and hypoxic preconditioning+traumatic brain injury group (HPCT,n=12).The HPC rat models were made by hypobaric chamber for 3 d (50 kPa,3 h/d) and TBI were induced by Feeney's improved equipment.All rats were killed 24 h after injury,and the neurological functions of each group were evaluated by modified neurologieal severity scale (mNSS);the neuronal survival around contusion area was detected by NeuN immunohistochemical staining,and the protein and mRNA expressions of nuclear transcription factor-related factor 2 (Nrf2) and thioredoxin reductases 2 (TrxR2) in the brain tissues were detected by Western blotting and real-time quantitative PCR.Results The mNSS scores in the TBI and HPCT groups were significantly higher as compared with those in the sham-operated and HPC groups (P＜0.05),but those in the HPCT group was significantly lower than those in the TBI group (P＜0.05).The neuronal survival in the TBI and HPCT groups was decreased as compared with that in the sham-operated and HPC groups (NeuN expressions:0.274±0.033,0.281±0.042 vs 0.124±0.014,0.150±0.019),with significant difference (P＜0.05),while that in the HPCT group was statistically increased as compared with that in the TBI group (P＜0.05).The expressions of Nrf2 and TrxR2 in the brain tissues of TBI and HPCT groups were significantly increased as compared with those in the sham-operated and HPC groups (P＜0.05),and those in the HPCT group was significantly up-regulated as compared with those in the TBI group (P＜0.05).Conclusion HPC can increase the anti-oxidative ability and relieve the neurological functions missing after TBI.

Chronic pain is a worldwide public health problem in which neuropathic pain (NP) caused by nerve damage is the most common chronic pain. At present, NP lacks effective treatment for any reason. In recent years, increasing studies have shown that neuroimmunity and neuroinflammation play a key role in mediating NP, and nuclear factor-kappa B (NF-κB) plays the most important role in the expression of pain inducers and effectors in the immune and inflammatory systems. NF-κB promotes transcriptional up-regulation by a promoter that links to a variety of inflammatory factors. Therefore, this paper reviews the research status of the role of NF-κB in NP.

Objective:To investigate the expression and significance of T helper cell 17 (Th17), soluble intercellular adhesion molecule-1 (sICAM-1) and coagulation function in patients with infectious endocarditis(IE).Methods:From December 2016 to December 2018, IE patients in Beijing Anzhen Hospital Affiliated to Capital Medical University who met the inclusion criteria were selected for cardiac surgery to analyze prospectively, 38 IE patients were selected as the observation group, and 30 healthy people were selected as the control group.The concentrations of serum Th17 related factors (IL-1β, IL-6, IL-17 and IL-21), sICAM-1 and coagulation index(P selectin(sP-SLT)) were measured by enzyme-linked immunosorbent assay(ELISA) and the difference between the two groups were statistically analyzed.Results:The concentrations of serum IL-1β, IL-6, IL-17 and IL-21((29.88±6.49), (14.89±3.31), (21.89±3.01), (563.26±67.36) ng/L) in the observation group were significantly higher than those in the control group((16.56±4.11), (7.52±2.34), (12.91±1.01), (423.38±56.49) ng/L)(all P<0.05). The level of serum sICAM-1 and sP-SLT ((1 247.57(581.39, 1 794.66) μg/L, (60.29±6.61) mg/L)in the observation group were significantly higher than those in the control group((837.28(405.68, 954.47) μg/L, (27.37±5.56) mg/L), and the difference was statistically significant( Z=12.37, t=22.30, all P<0.05). The level of serum IL-1β, IL-6, IL-17 and IL-21 in patients with postoperative infective endocarditis((16.19±4.07), (7.73±2.40), (13.83±0.94), (425.33±52.12) ng/L) were significantly lower than those before operation((29.88±6.49), (14.89±2.31), (21.89±3.01), (563.26±67.36) ng/L), and the differences were statistically significant(t values were 11.02, 13.25, 15.76, 9.98, all P<0.05). The levels of sICAM-1 and sP-SLT1 in patients with postoperative infective endocarditis((901.46(472.15, 1276.58) μg/L, (30.70±5.31) mg/L) were significantly lower than those before operation((1 057.26±463.06) μg/L, (60.29±6.61) mg/L)and the differences were statistically significant( Z=11.16, t=21.51, P<0.05). Conclusion:Th17 related factors, sICAM-1 and sP-SLT were highly expressed in IE patients, and the concentrations of these factors decreased after operation, suggesting that the above factors may be used as related factors for the diagnosis and prognosis of IE patients.