Early diagnosis of esophageal cancer is essential for improving both the effectiveness of esophageal cancer treatment and the prognosis of patients.As a new technology for esophageal cancer early diagnosis,narrow-band imaging (NBI) enables surgeon to clearly observe the mucosa and submucosal blood vessels changes in early esophageal cancer.It has initially shown excellent application value in the early diagnosis.In particular it has obvious advantages to the ordinary white light endoscopy which is currently used in esophageal cancer early diagnosis.If combined with Lugol iodine staining,magnifying endoscopy and other diagnostic methods in clinical,NBI will have a better value in early diagnosis of esophageal.

Objective:To investigate the efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis.Methods:60 patients with myasthenia gravis were selected and randomly divided into two groups.The observation group(32 cases) received video assisted thoracic surgery.The control group(28 cases) received thoracic surgery.The efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis was evaluated by perioperative indexes,QMG scores before operation,after 3 months,6 months operation and complications during 6 months follow-up.Results:During the perioperative period,there was no statistical significance in the operation time between two groups(P＞0.05).The bleeding volume of observation group was less than that of the control group (P＜0.05).The drainage time,hospitalization and incision length of observation group were shorter than those of the control group (P＜0.05).Before operation,there was no statistical significance in the QMG scores.At 3 months,6 months after operation,the QMG scores were decreased in both groups.The QMG score of observation group was lower than that of the control group (P＜0.05).During 6 months' follow-up,complications were observed in 7 cases of the observation group and 17 cases of the control group,the major complication was pulmonary infection.The incidence of complications in the control group was higher than that of the observation group (P＜0.05).Conclusion:Video assisted thoracic surgery had advantages of smaller surgical incision,faster recovery and higher safety in the treatment of myasthenia gravis.

Objective:To systematically evaluate the efficacy and safety of neoadjuvant chemoradiotherapy (NCRT) plus surgery versus neoadjuvant chemotherapy (NCT) plus surgery in the treatment of advanced esophageal squamous cell carcinoma.Methods:Clinical controlled trials of comparing the treatment of NCRT plus surgery with NCT plus surgery for esophageal squamous cell carcinoma were electronically searched from the databases including PubMed, The Cochrane Library, EMbase, CBM, CNKI, WanFang and VIP from the inception of databases to January, 2019. Two reviewers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. And then, a meta-analysis was performed by using RevMan 5.3 software.Results:A total of 8 clinical control studies were included, including 995 patients with esophageal squamous cell carcinoma. Meta-analysis results showed that compared with the NCT group, the R 0 resection rate was significantly higher ( OR=2.14, 95% CI: 1.03-4.45, P=0.040) and the pathological complete response (pCR) rate was significantly higher ( OR=4.19, 95% CI: 1.71-10.28, P=0.002) in the NCRT group. The incidence of postoperative complications ( OR=1.37, 95% CI: 0.76-2.48, P=0.300) and the risk of perioperative death ( OR=1.28, 95% CI: 0.58-2.83, P=0.54) were not significantly different between two groups. The long-term survival of patients with esophageal squamous cell carcinoma in the NCRT group was significantly better compared with that in the NCT group ( HR=0.77, 95% CI: 0.64-0.92, P=0.005). Conclusions:Compared with NCT plus surgery for advanced esophageal squamous cell carcinoma, NCRT plus surgery has higher R 0 resection rate and pCR rate, does not significantly increase the risk of perioperative complications or perioperative death, and significantly improves the long-term survival of esophageal squamous cell carcinoma patients.

China is a high risk region of esophageal cancer in the world,and 95％ of the esophageal cancer is the squamous cell carcinoma.Surgery is the main therapy for esophageal squamous cell carcinoma,however,the efficacy of single surgery for locally advanced esophageal squamous cell carcinoma is unsatisfactory.Compared with postoperative adjuvant treatment,neoadjuvant chemotherapy may reduce tumor volume,increase surgical resectability,eliminate subclinical metastases,prolong survival time and improve prognosis of patients with esophageal squamous cell carcinoma.Through combining recent evidence-based medicine,the authors review research progress of new adjuvant chemotherapy for esophageal squamous cell carcinoma.

Objective To study the expression of serum tumor necrosis factor receptor-6 (TR6) [decoy receptor 3 (DcR3)] in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure,and to analyze its influence on prognosis.Methods 134 patients with AECOPD admitted to our hospital from March 2015 to March 2017 were selected as the study subjects.According to whether or not respiratory failure occurred,they were divided into respiratory failure group (65 cases) and non-respiratory failure group (69 cases).Another 60 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group.Serum albumin (ALB),C-reactive protein (CRP),first-second forced breathing volume (FEV1％),first-second forced breathing vdume (FEV1/FVC),arterial partial oxygen pressure (PaO2) and arterial partial carbon dioxide pressure (PaCO2) were collected.Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of interleukin-8 (IL-8),tumor necrosis factor-alpha (TNF-α) and DcR3.Results The levels of ALB,FEV1,FEV1/FVC and PaO2 in respiratory failure group were significantly lower than those in non-respiratory failure group and control group (P ＜ 0.05),and those in non-respiratory failure group were significantly lower than those in control group (P ＜ 0.05);the levels of CRP,PaCO2,IL-8,TNF-α and DcR3 in respiratory failure group were significantly higher than those in non-respiratory failure group and control group (P ＜ 0.05).The survival rate of high DcR3 level group was significantly lower than that of low DcR3 level group (P ＜ 0.05).High levels of TNF-α and DcR3 were independent risk factors for adverse prognosis of AECOPD patients with respiratory failure (P ＜ 0.05).Conclusions The high expression of DcR3 in serum of AECOPD patients with respiratory failure is an independent risk factor for adverse prognosis.

Minimally invasive esophagectomy is the preferred treatment for esophageal cancer, which has been widely popularized and developed in clinical practice. However, anastomotic complications are still common, such as anastomotic leakage, anastomotic stenosis, and gastroesophageal reflux, which seriously affect the rapid recovery and quality of life of patients after surgery. Esophagogastrostomy is the core and difficulty of the operation. In recent years, different esophagogastric anastomosis methods and techniques have been found to reduce the incidence of anastomotic complications and improve clinical outcomes. This article will summarize the development and progress of esophagogastric anastomosis techniques at home and abroad in recent years in order to provide reference for the majority of thoracic surgeons and to promote the progress of esophagogastric anastomosis techniques.

Objective:To investigate whether chlorogenic acid can inhibit the proliferation, migration, invasion and promote apoptosis of lung cancer A549 cells by causing mitochondrial dysfunction through PI3K-Akt pathway.Methods:A549 cells were treated with chlorogenic acid at concentrations of 0, 25, 50, 100, 150, and 200 μg/ml for 48 h. CCK-8 assay was used to detect the cell proliferation rate and calculate the half maximal inhibitory concentration (IC 50). A549 cells were divided into three groups: control group, chlorogenic acid group (IC 50) and chlorogenic acid + 740-YP group (IC 50 chlorogenic acid +50 μg/ml 740YP). After 48 h of intervention, the cell migration distance was detected by cell scratch assay. Cell invasion assay was used to detect cell invasion ability. Cell cycle, apoptosis and mitochondrial membrane potential were detected by flow cytometry. The content of malondialdehyde (MDA) in cell supernatant was detected by enzyme-linked immunosorbent assay (ELISA). Western blotting was used to detect the protein expression of p-PI3K, p-Akt and Caspase3. Results:The IC 50 of chlorogenic acid to A549 cells was 57.45 μg/ml. The results of cell scratch assay showed that the 48 h migration distances of the control group, chlorogenic acid group and chlorogenic acid + 740YP group were (424.80±14.43), (289.67±18.93) and (402.22±17.99) μm, respectively. The results of cell invasion assay showed that the numbers of invasive cells after 48 h were 96.00±6.24, 35.33±7.64 and 83.00±2.00, and the results of flow cytometry showed that the 48 h apoptosis rates were (6.15±0.17) %, (54.63±0.72) % and (17.27±0.39) %, respectively, among the three groups with statistically significant differences ( F=105.98, P<0.001; F=90.62, P<0.001; F=8 321.99, P<0.001). Compared with the control group, the cell migration distances and invasive numbers of chlorogenic acid group and chlorogenic acid + 740YP group were decreased (all P<0.05), while the apoptosis rates were significantly increased (both P<0.001). Compared with chlorogenic acid group, the cell migration distance of chlorogenic acid + 740YP group increased ( P<0.001), the number of cell invasion increased ( P<0.001), and the apoptosis rate decreased ( P<0.001). The results of flow cytometry showed that the proportions of cells in G 0/G 1 phase in the control group, chlorogenic acid group and chlorogenic acid + 740YP group were (65.75±0.58) %, (55.84±0.78) % and (55.24±1.37) %, respectively. The proportions of G 2/M phase were (11.21±1.03) %, (20.23±0.62) % and (9.96±0.33) %, and the proportions of S phase were (23.04±0.49) %, (23.92±1.36) % and (34.80±1.15) %, respectively, with statistically significant differences ( F=111.02, P<0.001; F=181.26, P<0.001; F=113.05, P<0.001). Compared with the control group, the proportions of G 0/G 1 phase cells in chlorogenic acid group and chlorogenic acid + 740YP group decreased (both P<0.001), and the proportion of G 2/M phase in chlorogenic acid group increased ( P<0.001), and the proportion of S phase cells in chlorogenic acid + 740YP group increased ( P<0.001). Compared with chlorogenic acid group, the proportion of G 2/M phase cells decreased and the proportion of S phase cells increased in chlorogenic acid + 740YP group (both P<0.001). The results of mitochondrial membrane potential detection showed that the JC-1 fluorescence intensity of mitochondria in the control group, chlorogenic acid group and chlorogenic acid + 740YP group were 39.51±1.32, 10.05±0.19 and 21.85±1.45, respectively, with a statistically significant difference ( F=508.82, P<0.001). Compared with the control group, the fluorescence intensity of chlorogenic acid group and chlorogenic acid + 740YP group decreased (both P<0.001). Compared with chlorogenic acid group, the fluorescence intensity of chlorogenic acid + 740YP group increased ( P<0.001). ELISA results showed that the MDA contents of the control group, chlorogenic acid group and chlorogenic acid + 740YP group were (0.47±0.01), (0.61±0.01) and (0.56±0.01) nmol/ml, respectively, with a statistically significant difference ( F=162.30, P<0.001). Compared with the control group, MDA contents in chlorogenic acid group and chlorogenic acid + 740YP group increased (both P<0.001). Compared with chlorogenic acid group, MDA content in chlorogenic acid + 740YP group decreased ( P=0.001). Western blotting results showed that the relative protein expression levels of p-PI3K in the control group, chlorogenic acid group and chlorogenic acid + 740YP group were 1.01±0.33, 0.28±0.14 and 0.34±0.20, respectively. The relative protein expression levels of p-Akt were 1.00±0.16, 0.43±0.05 and 0.95±0.14, and the relative protein expression levels of Caspase3 were 1.00±0.04, 1.41±0.05 and 0.70±0.13, respectively, and there were statistically significant differences ( F=8.48, P=0.018; F=19.11, P=0.002; F=57.50, P<0.001). Compared with the control group, the expressions of p-PI3K and p-Akt protein in chlorogenic acid group decreased, and the expression of Caspase3 protein increased (all P<0.05). The expressions of p-PI3K and Caspase3 protein in chlorogenic acid + 740YP group decreased (both P<0.05). Compared with chlorogenic acid group, the expression of p-Akt protein in chlorogenic acid + 740YP group increased, and the expression of Caspase3 protein decreased (both P<0.05) . Conclusion:Chlorogenic acid may inhibit the PI3K-Akt pathway by reducing the phosphorylation of PI3K and Akt proteins, resulting in the damage of mitochondrial function and the accumulation of MDA, which eventually leads to the damage of lung cancer A549 cells function and the reduction of cells activity, and then promotes cells apoptosis.

Objective:To analyze and compare the short-term efficacy and safety of sintilimab and tislelizumab in neoadjuvant therapy for advanced esophageal squamous cell carcinoma.Methods:The clinical data of 95 patients with esophageal squamous cell carcinoma who received neoadjuvant chemotherapy (paclitaxel + nedaplatin) combined with immunotherapy in the Department of Thoracic Surgery of the Affiliated Hospital of North Sichuan Medical College from January 2021 to October 2022 were collected. According to the different use of immune drugs, they were divided into the sintilimab group ( n=58) and the tislelizumab group ( n=37). The objective remission rate (ORR), adverse reactions, R0 resection rate, pathological complete response (pCR) rate, etc. were analyzed and compared between the two groups after neoadjuvant therapy. Results:After 2 cycles of neoadjuvant therapy, the sintilimab group and the tislelizumab group had a similar ORR [72.4% (42/58) vs. 56.8% (21/37), χ2=2.48, P=0.115]. The main adverse reactions of the two groups of patients included gastrointestinal reactions (nausea, vomiting, diarrhea), hematological toxicity, hypothyroidism, alopecia, liver and kidney dysfunction, pneumonia, etc. The incidence of grade 3 adverse reactions was less than 15%, with no grade 4 adverse reactions. The incidence of hypothyroidism in the sintilimab group was significantly higher than that in the tislelizumab group [56.9% (33/58) vs. 16.2% (6/37) ], with a statistically significant difference ( χ2=15.45, P<0.001) ; There was no statistically significant difference in surgical resection ( χ2=1.26, P=0.661) and pCR rate [31.0% (18/58) vs. 32.4% (12/37), χ2=0.02, P=0.886] between the two groups of patients. In terms of postoperative complications, both groups of patients experienced partial pulmonary infections and anastomotic fistulas, but the incidence was relatively low [19.0% (11/58) vs. 24.3% (9/37), 3.4% (2/58) vs. 2.7% (1/37) ], with no statistically significant difference ( χ2=0.39, P=0.532; χ2<0.01, P>0.999) . Conclusion:For preoperative neoadjuvant therapy of advanced esophageal squamous cell carcinoma, the use of either sintilimab or tislelizumab in addition to chemotherapy has good short-term efficacy and safety. Thyroid function should be monitored carefully when using sintilimab.

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.

Objective     To investigate the influencing factors for the clinical remission of advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemotherapy, establish an individualized nomogram model to predict the clinical remission of advanced ESCC with neoadjuvant chemotherapy and evaluate its efficacy, providing serve for the preoperative adjuvant treatment of ESCC. Methods     The clinical data of patients with esophageal cancer who underwent neoadjuvant chemotherapy (nedaplatin 80 mg/m2, day 3+docetaxel 75 mg/m2, day 1, 2 cycles, 21 days per cycle interval) in the Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College from February 2016 to August 2020 were analyzed retrospectively. According to the WHO criteria for efficacy assessment of solid tumors, tumors were divided into complete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD). CR and PR were defined as effective neoadjuvant chemotherapy, and SD and PD were defined as ineffective neoadjuvant chemotherapy. Univariate and multivariate analyses were used to analyze the influencing factors for the short-term efficacy of neoadjuvant chemotherapy. The R software was used to establish a nomogram model for predicting of the model. C-index, calibration curve and receiver operating characteristic (ROC) curve were used to evaluate the predictive performance of the nomogram. Results     Finally 115 patients were enrolled, including 93 males and 22 females, aged 40-75 (64.0±8.0) years. After receiving docetaxel+nedaplatin neoadjuvant chemotherapy for 2 cycles, there were 9 patients with CR, 56 patients with PR, 43 patients with SD and 7 patients with PD. Among them, chemotherapy was effective (CR+PR) in 65 patients and ineffective (SD+PD) in 50 patients, with the clinical effective rate of about 56.5%(65/115). Univariate analysis showed that there were statistical differences in smoking history, alcoholism history, tumor location, tumor differentiation degree, and cN stage before chemotherapy between the effective neoadjuvant chemotherapy group and the ineffective neoadjuvant chemotherapy group (P<0.05). Logistic regression analysis showed that low-differentiation advanced ESCC had the worst clinical response to neoadjuvant chemotherapy, moderately-highly differentiated ESCC responded better (P<0.05). Stage cN0 advanced ESCC responded better to neoadjuvant chemotherapy than stage cN1 and cN2 (P<0.05). The C-index and the area under the ROC curve of the nomogram were both 0.763 (95%CI 0.676-0.850), the calibration curve fit well, the best critical value of the nomogram calculated by the Youden index was 70.04 points, and the sensitivity and specificity of the critical value were 80.0% and 58.0%, respectively. Conclusion    The established clinical prediction model has good discrimination and accuracy, and can provide a reference for individualized analysis of the clinical remission of advanced ESCC with neoadjuvant chemotherapy and the screening of new adjuvant treatment subjects.