Objective To study the clinical management of non-missile penetrating brain injury and intracranial foreign body.Methods Retrospectively analyzed 5 cases of non-missile penetrating brain injury and intracranial foreign body,and reviewed relative literature.Results Eady surgical management for all 5 cases,4 cases were cured except hemiparesis in 1 case.There were not active bleeding during surgical treatment,and there were not intracranial infection,epilepsy and cerebrospinal fluid leakage in post-operation in all 5 cases.Conclusions The surgical plan is rely on skull X-rays and brain CT scan.To keep the penetrating object in situ posttrauma,early surgical intervention,remove the penetrating object and prevent secondary brain injury may provide a better outcome.

Objective To investigate the feasibility,safety and curative effect of combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity.Methods We retrospectively evaluated 357patients with esophageal carcinoma who received minimally invasive esophagectomy(MIE) in our center between October 2011 and March 2014.Of those 357 patients,219 underwent MIILE and 138 underwent MIME.The clinicopathologic factors,operational factors,postoperative complications and postoperative recurrence were compared.Results The 2 groups were similar in terms of age,sex,American Society of Anesthesiologists grade,tumor location,preoperative staging.The MILLE approach was associated with no significant decrease in surgical blood loss.Duration of operation,chest tube duration,hospitalization expenses and postoperative stay relative to the MIME approach(P ＞ 0.05).There was no significant difference between the 2 groups in postoperative complications(P ＞0.05).The MIILE approach was associated with significantly fewer anastomotic fistula,RLN injury,anastomotic stensis than the MIME approach(P ＜0.05).Conclusion Our MIILEtechnique can be safely and effectively performed for intrathoracic anastomosis during esophageal surgeries with favorable early outcomes.

Objective:To investigate the feasibility, safety, and short-term effect of minimally invasive McKeown esophagecto-my. Methods: We conducted a retrospective evaluation of 88 patients with esophageal carcinoma who received minimally invasive esophagectomy in our center from October 2013 to April 2014. Among the 88 patients, 46 patients underwent total endoscopy McKe-own esophagectomy (TEME) and 42 patients underwent thoracoscope combined with laparotomy Mckeown esophagectomy (TLME). The clinicopathologic factors, operational factors, and postoperative complications of the two approaches were compared. Results:The two groups were similar in terms of age, sex, American Society of Anesthesiologists grade, tumor location, preoperative staging, and co-morbidity. The TEME approach was associated with a significant decrease in abdominal blood loss and postoperative pain relative to the TEME approach (P<0.05). No significant differences were found between the two groups in terms of histologic type, postoperation TNM staging, abdominal operation time, intensive care unit stay, chest tube duration, postoperative stay, the number of total lymph nodes dissected or the stations of the total lymph nodes dissected, and lymph metastasis rate (P>0.05). The total morbidity and total re-spiratory complications in the TEME group were lower than those in the TLME group (P<0.05). Incidences of pneumonia, arrhythmia, wound infection of minor complications, and pneumonia of major complications were relatively low in the TEME approach. Conclu-sion:Our TEME technique can be safely and effectively performed for cervical anastomosis during esophageal surgeries to achieve fa-vorable early outcomes.

Objective To investigate the feasibility and clinical effect of laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision.Methods Compared 80 cases underwent laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision with 68 patients receivesd laparoscopic and thoracoscopic Ivor Lewis esophagectomy with an abdominal small incision.The peri operative conditions and complications of the two groups were analyzed.Results There were no significant difference in the operation time [(263.3 ± 71.5) min vs (273.3 ± 73.7) min,t =-0.750,P =0.454],intraoperative blood loss [(246.9 ± 150.4) ml vs (252.9 ± 159.7) ml,t =-0.238,P =0.812],the number of lymph node dissection [(19.2 ±4.3) vs (19 ±4.5),t =0.272,P =0.786],gastrointestinal decompression time [(11 ± 3.4) d vs (11.9±3.3) d,t=-1.647,P=0.102],chest tube indwelling time [(6.6±2.7) d vs (6.3±2.6) d,t=0.544,P=0.587],postoperative hospitalization time [(13.2 ±3.4) d vs (14 ±3.4) d,t=-1.493,P=0.138] and rate of early gastric emptying dysfunction [6.25％ (5/80) vs 4.41％ (3/68),x2 =0.016,P =0.898].Comparing to patients in the small incision group,the visual analogue scale evaluation score of postoperative pain was lower in the groups without small incision (P ＜ 0.05).There were no anastomotic fistula,thoracic gastric fistula,upper gastrointestinal bleeding and death during perioperative periods.Conclusion It is safe and feasible to treat middle and lower esophageal carcinoma with laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision,which can further reduce abdominal trauma,relieve postoperative pain and make the abdominal incision more beautiful.

Objective To compare the results and safety between video-assisted thoracoscopic surgery ( VATS ) and conventional radical operation in patients with stage Ⅰ , Ⅱ esophageal cancer. Methods Retrospectively reviewed 43 patients with stage Ⅰ , Ⅱ esophageal cancer,underwent either VATS radical operation (VATS group,16 cases) or conventional radical operation (control group,27 cases ) from September 2007 to September 2009. Patient's operative characteristics and postoperative courses were compared between two groups. Results In VATS group the operation time was ( 115.6 ± 48.0) min,the peri-operative blood loss was ( 131 ± 71 ) ml,the first postoperative day chest lead quantity was (331 ± 170)ml, the time of postoperative chest tube was (7.25 ± 2.35) d,the postoperative 36 h visual analogue scale (VAS) was (3.4 ± 1.2) scores,the postoperative drainage of chest was ( 1281 ± 534) ml,the 72 h postoperative locomotor activity of right upper extremity was (5.1 ± 1.5) cm. While in control group was ( 145.6 ± 20.6)min, (292 ± 111 ) ml, (494 ± 194) ml, ( 10.00 ± 2.79 )d, (7.3 ± 1.4) scores, ( 1780 ± 731 ) ml, ( 15.6 ± 3.1 )cm respectively (P ＜ 0.01 or ＜ 0.05 ). The lymph node dissection number,the total cost of hospital between were no statistically significant differences in two groups (P ＞0.05). Conclusion Comparing with conventional radical operation, VATS radical operation for patients with stage Ⅰ , Ⅱ esophageal cancer appears to be as effective but less morbid.

Recently,the main treatment for esophageal cancer remains curative resection combined with adjuvant chemoradiotherapy.With the application of minimally invasive esophagectomy (MIE) in the surgical treatment in recent years,patients with esophageal cancer who received MIE are proved to have less postoperative complications,better quality of life,and better surgical effect.However,different operation methods of MIE have different advantages and disadvantages,that makes the clinical promotion of MIE need further clinical experience,surgical techniques and procedures.The long-term effect of MIE remains to be further verification.

Background and purpose:High expression of excision repair cross-complementing 1 (ERCC1) is related to resistance in patients treated with platinum-containing regimens. The ERCC1 antibody 8F1 was usually used in past studies, but it was found to have no-speciifcity recently. This study aimed to investigate the predictive role of a new ERCC1 antibody 4F9 to platinum chemotherapy in non-small cell lung cancer (NSCLC) patients. Methods:Expression of ERCC1 was detected using antibody 4F9 by immunohistochemistry (IHC) in 72 NSCLC tissues. The relationship between the expression of ERCCl and the clinical pathological parameters, the efficacy of platinum chemotherapy and overall survival of patients were explored by statistical analysis. Results: The high expression of ERCCl protein was 55.5%in 72 cases. There was no signiifcant correlation between the ERCC1 expression with gender, age, pathological type, clinical stage and lymphatic metastasis (P>0.05). Patients with low expression of ERCC1 had signiifcantly higher response rates to platinum chemotherapy, longer median survival time and 2-years survival rate comparing with those with high expression of ERCC1 (62.5%vs 37.5%;22.9 vs 18.4 month;46.9%vs 37.5%), respectively (P<0.05). Conclusion:The expression analysis of ERCC1 using new ERCC1 antibody 4F9 by IHC method is helpful to assign chemotherapeutic regimen, and guide individual platinum chemotherapy for post-operation patients.

Objective:To explore the action mechanism of suppressing expression of mitogen- activated protein kinase 14（MAPK14）to alleviate glutamate excitatory toxicity and its neuronal protection effect.Methods:Lentivirus-mediated MAPK14 interference vector was synthetized by Shanghai Jikai Gene Chemical Technology Co.，Ltd. Astrocytes were obtained from SD rats 48 hours after birth，which were cultured in vitro and transfected by lentivirus-mediated transfection. According to the random number table，the cells were divided into three groups：（1）un-transfected group（normal group）with normal astrocytes and the cells were cultured in regular medium composed of Dulbecco's?modified Eagle's?medium（DMEM）；（2）negative control group with astrocytes transfected by MAPK14 no-loaded interference vector；（3）lentivirus transfected group with astrocytes transfected by MAPK14 interference vector. Seventy-two hours after transfection，astrocytes were co-cultured with neurons for 48 hours，and then they were cultured in a medium containing glutamate for 2 hours. The detection indexes included the optimal multiplicity of infection（MOI）value for astrocytes transfected by lentivirus vector，mRNA levels of MAPK14 and glial glutamate transporter 1（GLT-1）detected by rPCR 72 hours after transfection，protein levels of MAPK14 and GLT-1 detected by Western blot 72 hours after transfection，level of lactate dehydrogenase（LDH）and mortality of neurons measured by spectrophotometry and flow cytometry 2 hours after culturing in the medium with glutamate. Results:（1）The optimal MOI value for lentivirus transfecting astrocytes was 30，and astrocytes grew well after transfection.（2）Seventy-two after transfection，the mRNA level of MAPK14 in lentivirus transfected group（0.005 7±0.000 6）was significantly decreased as compared with un-transfected group（0.013 1±0.001 1）and negative control group（0.013 9±0.001 0）（ P<0.01），the mRNA level of GLT-1 in lentivirus transfected group（0.009 1±0.001 2）was not significantly changed as compared with un-transfected group（0.008 7±0.000 3）and negative control group（0.008 9±0.001 1）（ P>0.05）.（3）Seventy-two hours after transfection，the protein level of MAPK14 in lentivirus transfected group（0.29±0.04）was significantly decreased as compared with non-transfected group（0.61±0.05）and negative control group（0.63±0.01）（ P<0.01），the protein level of GLT-1 in lentivirus transfected group（0.73±0.06）was significantly increased as compared with un-transfected group（0.20±0.03）and negative control group（0.23±0.09）（ P<0.01）.（4）After astrocytes were co-cultured with neurons and subsequently cultured in the medium containing glutamate for 2 hours，the level of LDH in lentivirus transfected group［（109.67±2.40）U/L］was significantly lower than that in un-transfected group［（141.52±3.88）U/L］and negative control group［（141.29±3.61）U/L］（ P<0.01）. The mortality of neurons in lentivirus transfected group［（38.72±0.26）%］was significantly lower than that in un-transfected group［（52.94±1.36）%］and negative control group［（54.30±1.23）%］（ P<0.01）. Conclusions:The transfection with lentivirus-mediated MAPK14 interference vector can increase expression of GLT-1 in astrocytes to increase glutamate re-uptake and relieve the glutamate excitatory toxicity in neurons，which may provide a new experimental basis for future use of astrocyte gene regulation to alleviate neuronal injury caused by glutamate excitatory toxicity after traumatic brain injury.

Objective: To investigate the feasibility, safety, short-term efficacy and long-term efficacy of elective lymph node dissection in patients with early esophageal cancer. Methods: The study retrospectively evaluated 405 patients with cT1N0M0 esophageal carcinoma who received minimally invasive esophagectomy in the First Affiliated Hospital of University of Science and Technology of China between March 2007 and March 2013. Of those patients, 208 patients underwent systematic lymph node dissection (SLND) and 197 patients underwent elective lymph node dissection (ELND). The clinicopathologic factors, operational factors, postoperative complications, lymph node dissection and prognosis of patients were compared by independent sample t test, χ² test, or Mann-Whitney rank test. The 5-year overall survival was calculated by the Kaplan-Meier estimation method using the Log-rank test. Results: There was no significant difference in clinicopathological data between the SLND group and the ELND group. The incidence of pulmonary infection (8.2% vs. 2.9%, P=0.04) and arrhythmia (6.2% vs. 2.0%, P=0.03) of the minor postoperative complications in the SLND group were higher than the ELND group. The incidence of pulmonary infection (6.2% vs. 2.0%, P=0.03), Chylothorax (5.8% vs.1.5%, P=0.02), anastomotic or pleural hemorrhage requiring reoperation (2.9% vs.0.5%, P=0.04) of major postoperative complications in the SLND group were higher than the ELND group, the difference was statistically significant. In the perioperative data of two groups, the incidence of total postoperative complications, total pulmonary complications, operation time, intraoperative blood loss, postoperative hospitalization, postoperative thoracic drainage duration and postoperative thoracic drainage fluid volume of the SLND group were higher than the ELND group, the difference was statistically significant. The mean numbers and stations of dissected lymph node in the SLND were 30.2±4.2 and 12.1±2.7, the mean numbers and stations of dissected lymph node in the ELND were 25.7±3.8 and 8.4±3.6. The survival rates of 1, 3, 5 years of all patients were 100%, 95.9% and 82.5%, respectively. The median survival time was 87.4 months. Further analysis showed that the 1, 3 and 5 years survival rate of patients with stage Ⅰ esophageal cancer was 100%, 97.1% and 88.9%, respectively. The median survival time was 89.3 months. The 1, 3 and 5 years survival rate of patients with stage Ⅱa esophageal cancer was 100%, 93.2% and 76.8%, respectively. The median survival time was 77.2 months. There was no significant difference in survival rate between the SLND group and the ELND group in 1, 3 and 5 years. When taking a further analysis of stage Ⅰ esophageal cancer, the survival rates between 188 patients in the SLND group and 180 patients in the ELND group were no significant difference. When focus on the stage Ⅱa esophageal cancer, the 1, 3 and 5 years survival rate were higher in the SLND group than that in the ELND group (100%, 94.5%, 83.2% vs. 100%, 91.3%, 72.1%, P=0.047), the difference was statistically significant. Conclusion ELND can be safely and effectively performed for early esophageal cancer with favorable short-term efficacy and long-term efficacy.

Objectives: To evaluate the diagnostic value of CT for lymph node metastasis of thoracic esophageal carcinoma with a diameter of more than 1 cm, and to find the optimal diagnostic index by comparing relevant CT indexes. Methods: Totally 80 patients with pathologically proved thoracic esophageal cancer with preoperative CT examination revealed lymph node diameter greater than 1 cm admitted at Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China from January 2016 to January 2018 were enrolled in this study. There were 70 males and 10 females, aging of (60±14) years (range: 40-85 years). According to the pathological result of lymph nodes, all the patients and lymph nodes were divided into two groups (N+group: 47 patients, 62 lymph nodes; N-group: 33 patients, 39 lymph nodes). The average number of dissected lymph nodes were 21±4 and 101 lymph nodes′ diameter were greater than 1 cm. The clinicopathologic factors, postoperative complications, lymph node dissection and relevant CT indexes like the minimum diameter of lymph nodes (Min D), the maximum diameter of lymph node (Max D), lymph node axial ratio(LAR), the enhancement of lymph node (ELN) and the boundary of lymph node (BLN) were compared. The clinicopathological data, lymph node dessection and CT parameters of the two groups were compared by t test, χ² test or Wilcoxon rank sum test. Receiver operating characteristic (ROC) curve analysis was used to compare the ability to predict lymph node metastasis between Min D, Max D, LAR, ELN and BLN. Multiple Logistic regression analysis were performed to determine the independent variables for prediction of lymph node metastasis. Results: The difference of tumor segmentation, pN stage, pTNM stage, total number of metastatic lymph nodes, total number of abdominal lymph node metastases, Min D, Max D, ELN and BLN between the two groups were statistically significant. The results of univariate and multivariate analyses showed that gender (OR=0.128, 95%CI: 0.019 to 0.858, P=0.034), pTNM stage (OR=1.514, 95%CI: 1.020 to 2.247, P=0.039), Min D (OR=0.102, 95%CI: 0.010 to 0.995, P=0.050) and LAR (OR=0.195, 95%CI: 0.052 to 0.731, P=0.015) were the independent relative factors. The area under the curve of ROC curve analysis of Min D, Max D, LAR, ELN and BLN were 0.679, 0.666, 0.561, 0.650 and 0.820, respectively. BLN was the best CT index to diagnosis lymph node metastasis, while the accuracy of dignosis of lymph node metastasis of BLN was 97.0%. The Youden index of Min D, Max D and LAR were 1.25 cm, 1.64 cm and 0.77, respectively. Combining the BLN and ELN had a higher diagnostic rate (97.0%) of lymph node metastasis. Conclusions CT has high diagnostic value for lymph node metastasis in thoracic esophagel cancer when the lymph node diameter is greater than 1 cm. BLN is the best diagnostic index for lymph node metastasis.