Objective To compare the curative effects between minimally invasive and standard direct approach of pri?mary total hip arthroplasty (THA) in elderly patients. Methods One hundred and eighteen geratic patients with hip disease were divided into minimally invasive group (n=61) and standard group (n=57). All the patients were followed up from 15 months to 3 years. The length of incision, surgical duration, intraoperative blood loss, postoperative drainage, number of blood transfusion, hospitalization time and the Harris hip scores were compared between two groups. Results The length of incision, intraoperative blood loss, postoperative drainage, number of blood transfusion and hospitalization time were signifi?cantly lower in minimally invasive group than those in standard group, but the Harris hip scores were significantly higher 3 months after the operation in minimally invasive group than those in standard group (P<0.05). First intention wound healing was found in all patients in two groups. The postoperative complications were significantly lower in minimally invasive group than those in standard group (3.28%vs 15.79%, P<0.05). Conclusion Compared with standard incision of primary total hip arthroplasty , minimally invasive direct lateral approach has its advantages, including small surgical trauma, less hospitaliza?tion time, fewer complications, and which can help restore joint function quickly, making the curative effect satisfied in elderly patients.

Objective:To study the related factors of severe acute radiation-induced lung injury (SAR) caused by IMRT and concurrent chemotherapy for non-small cell lung cancer. Methods:We retrospectively analyzed the data of 2 323 non-small cell lung cancer pa-tients who underwent IMRT radiotherapy and concurrent chemotherapy at the Department of Radiotherapy of Tianjin Medical Univer-sity Cancer Institute and Hospital from January 2010 to January 2014. We analyzed the clinical factors and parameters that affect dose by univariate and multivariate analysis. Results:A total of 2 323 patients enrolled and 1 241 cases suffering from acute radiation-in-duced lung injury with the rate of 53.4%. Only 185 cases suffered from SARP with a rate of 7.96%. Univariate analysis showed that the gender, histopathological type, total radiation dose, V5 (%), and average dose rate are not related to SARP (P>0.05). By contrast an age of>60 years, 1%predicted FEV, docetaxel+carboplatin/cisplatin chemotherapy, V20 (%), V30 (%), and mean lung dose (MLD) are sig-nificantly related to SARP (P<0.05). Multivariate analysis showed that a patient age of>60 years, docetaxel+carboplatin/cisplatin che-motherapy, V20 (%), and V30 (%) are the independent risk factors of SARP. Conclusion:Among the non-small cell lung cancer patients undergoing IMRT radiotherapy and concurrent chemotherapy, further attention should be given to elderly patients, patients receiving docetaxel and platinum chemotherapy, as well as V20 and V30 with high doses. The necessary preventive treatment should be given to reduce the incidence of SARP, improve the quality of life of patients, and reduce the incidence of respiratory failure and mortality.

Objective To obtain a stably inherited Sprague-Dawley rat model of congenital umbilical hernia by in-breeding, and to observe the structure of umbilical hernia and treat it surgically.Methods Congenital umbilical hernia rats were fostered by full-sib mating.The birth number and umbilical hernia quantity were recorded, and the umbilical hernia rate of rats was analyzed.Six female and 6 male rats with congenital umbilical hernia of 6-month aged F2 generation were selected randomly, among which 2 female and 2 male rats were examined anatomically, and the rest rats underwent surgical suture. Results The umbilical hernia rate was increased along with the increasing inbreeding coefficient, and the rats of F12 and F13 generations were all with congenital umbilical hernia.The umbilical hernia rate in female rats was significantly higher than that in male rats based on the total number of rats from F1 to F13 generation (c2 =11.1, P=0.001).Female and male rats had the same structure of umbilical hernia, and all rats recovered 3-4 weeks after surgery without recurrence.Conclusion After 13 consecutive generations of full-sib mating, a rat model of congenital umbilical hernia with stable genetic properties is successfully established.

Objective To investigate the effects of different metastatic sites on the prognosis of extensive?stage small cell lung cancer ( SCLC ) . Methods A retrospective analysis was performed among 322 patients pathologically or cytologically diagnosed with extensive?stage SCLC ( stage ⅠV defined by the seventh edition of the American Joint Committee on Cancer) who were admitted to our hospital from 2011 to 2015. In those patients, 246 had primary lesions with distant metastasis and 76 primary lesions with non?regional lymph node metastasis;261 had single?organ metastasis and 61 multi?organ metastases. Survival rates were calculated using the Kaplan?Meier method. Between?group comparison of the survival was made by the log?rank test. A multivariate prognostic analysis was made by the Cox proportional hazard model. Results In all the patients, the median survival time ( MST) was 11. 7 months;1?and 2?year overall survival ( OS) rates were 47. 9% and 19. 5%, respectively. The patients with single?organ metastasis had significantly longer MST and significantly higher 1?and 2?year OS rates than the patients with multi?organ metastases ( 12. 4 vs. 8. 9 months;52. 5% vs. 30. 5%;21. 9% vs. 11. 2%;P=0. 014) . In the patients with single?organ metastasis, those with liver metastasis had the worst prognosis with a MST of 8. 5 months, while those with non?regional lymph node metastasis had the best prognosis with a MST of 14. 5 months ( P= 0. 001 );there was no significant difference in the prognosis between patients with metastasis to different organs other than the liver ( P=0. 139) . In the patients with multi?organ metastases, those with liver metastasis and bone metastasis had the worst prognosis ( P=0. 016,0. 006);there was no significant relationship between brain metastasis and the prognosis of extensive?stage SCLC with multi?organ metastases ( P=0. 995) . There was no significantdifference in the prognosis between those with liver metastasis only and multi?organ metastases ( P=0. 862) . Conclusions Liver metastasis predicts the worst prognosis in patients initially diagnosed with extensive?stage SCLC and single?organ metastasis. Liver metastasis and bone metastasis predict the worst prognosis in patients with multi?organ metastases. Brain metastasis has no significant effect on the prognosis. There is no significant difference in the prognosis of extensive?stage SCLC between patients with single?and multi?organ metastases once liver metastasis occurs.

Objective To investigate the factors associated with radiation-induced lung damage in non-small cell lung cancer (NSCLC) treated with radical three-dimensional conformal radiotherapy (3DCRT). Methods Eighty-six patients with NSCLC were treated by radical 3DCRT (total dose 60-66 Gy, 1.8-2.0 Gy/f, 5 d/w). Several clinical and dosimetric factors were analyzed retrospectively, inclu-ding sex, age, smoking history, heart disease history, pulmonary function, tumor location, clinical stage,pathological diagnosis, chemotherapy, total dose, numbers of fields, mean lung dose (MLD), V_5, V_(10),V_(15), V_(20), V_(25), V_(30), V_(35), V_(40), V_(45), V_50, V_55, V_(60) and V_(65). Radiation-induced lung damage was graded ac-cording to the Common Terminology Criteria for Adverse Events version 3.0. Univariate and multivariate an-alyses were performed to identify the predictive factors. Results The median follow-up was 12 months (range, 1-36 months). The incidence of≥ grade 3 radiation-induced lung damage was 13.9%. In univari-ate analysis, V_5, V_(10),V_(15), V_(20), V_(25), V_(30), V_(35)and MLD were all significantly associated with radiation-induced lung damage, while the clinical factors, total dose, numbers of fields, V_(40), V_(45), V_50, V_55, V_(60)and V_(65) were not. In Logistic regression analysis, Vs was the only factor significantly associated with radiation-induced lung damage (χ~2=5.15,P=0.023). The incidence of ≥ grade 3 radiation-induced lung damage in the group with V_5≤45% and V_5 > 45% were 2.3% and 26.2%, respectively (χ~2= 10.24, P = 0.001). Conclu-sions The lung damage may dependent on the irradiated volume more than the radiation dose. A number of doaimetric factors are significantly associated with radiation-induced lung damage. However , V_5 should be considered in radical 3DCRT for NSCLC patients to reduce the incidence of radiation-induced lung damage.

Objective To investigate the effect of preemptive parecoxib on blood coagulation in patients undergoing abdominal hysterectomy. Methods This was a randomized, double-blind controlled study. Seventy ASA Ⅰ or Ⅱ patients aged 38-56 yr weighing 50-75 kg undergoing abdominal hysterectomy under combined spinal-epidural anesthesia were randomized to one of 2 groups (n=35 each): parecoxib group (group P) received intravenous parecoxib 40 mg/2 ml at 20 min before anesthesia and control group (group C) received normal saline 2 ml instead of parecoxib. Both groups received patient-controlled intravenous analgesia (PCIA) with butorphanol after surgery. The PCIA solution contained butorphanol 0.2 mg/kg and ondansetron 4 mg in normal saline 100 ml.The PCIA was set up with background infusion 2 ml/h, incremental dose 2 ml, and lockout interval 15 min. VAS score was used to assess the intensity of pain (O= no pain, 10 = worst pain). Venous blood samples were taken before and at 30 min and 2 h after parecoxib or normal saline administration for coagulation test and platelet count.The postoperative ambulation time and adverse response were recorded. Butorphanol consumption per hour during postoperative analgesia and total consumption of butorphanol within 24 h after operation were also recorded. Results Compared with those before parecoxib administration, prothrombin time and thrombin time in group C and thrombin time in group P were significantly prolonged and fibrinogen concentration was significantly lower in group C at 30 min after parecoxib administration (P＜ 0.05), but no significant difference was found in the other parameters of blood coagulation and platelet count at 30 min after parecoxib administration in group P ( P＞0.05).The fibrinogen concentration was significantly higher, the incidence of postoperative nausea and vomiting was significantly lower, the postoperative ambulation time was significantly shorter, and butorphanol consumption per hour during postoperative analgesia and total consumption of butorphanol within 24 h after operation were significantly lower in group P than in group C ( P＜0.05 ), but there was no significant difference in the other parameters of blood coagulation and platelet count between group P and group C ( P ＞ 0.05 ). Conclusion Preemptive parecoxib 40 mg can enhance blood coagulation in patients undergoing abdominal hysterectomy.

Objective To investigate the effects of different chemoradiotherapy ( CRT) schemes on the prognosis of extensive?stage small?cell lung cancer ( SCLC ) . Methods A retrospective analysis was performed in 322 patients with extensive?stage SCLC who were admitted to our hospital from 2011 to 2015.All patients received standard EP/CE ( etoposide+cisplatin/carboplatin) chemotherapy. According to RECIST criteria, the efficacy of chemotherapy was divided into complete response, partial response, stable disease, and progressive disease ( PD). A total of 232 patients without PD after chemotherapy were enrolled as subjects and divided into radiotherapy group (n=187) and non?radiotherapy group (n=45).The patients undergoing radiotherapy were further divided into early radiotherapy group ( before 3 cycles of chemotherapy, n=65) and late radiotherapy group (after 3 cycles of chemotherapy, n=122),or concurrent CRT group ( n=45 ) and sequential CRT group ( n=142 ) . The survival rates were analyzed using the Kaplan?Meier method. Between?group comparison was made by log?rank test. The Cox regression model was used for multivariate prognostic analysis. Results In all the patients, the median overall survival ( OS ) , progression?free survival (PFS),and local recurrence?free survival (LRFS) time was 13?2,8?7,and 14?6 months, respectively. The non?radiotherapy group had significantly shorter median OS, PFS, and LRFS time than the radiotherapy group ( 8?7 vs. 15?0 months, P=0?00;5?6 vs. 9?8 months, P=0?00;5?9 vs. 19?2 months, P=0?00).There were no significant differences in median OS, PFS, or LRFS time between the early radiotherapy group and the late radiotherapy group ( 15?4 vs. 14?6 months, P=0?720;8?0 vs. 10?8 months, P=0?426;19?2 vs. 18?1 months, P=0?981) . The concurrent CRT group had significantly longer median OS time than the sequential CRT group (19?4 vs. 13?8 months, P=0?036),while there were no significant differences in median PFS or LRFS time between the two groups ( 10?8 vs. 9?8 months, P=0?656;19?8 vs. 17?8 months, P= 0?768 ) . Generally, patients undergoing radiotherapy had increased incidence rates of adverse reactions than those without radiotherapy (P=0?038).However, the incidence rates of grade ≥3 adverse reactions were similar between the two groups ( P=0?126) . Conclusions In the treatment of extensive?stage SCLC, thoracic radiotherapy improves the treatment outcomes without increasing the incidence rates of severe adverse reactions. When to receive radiotherapy has nothing to do with the prognosis. Concurrent CRT may further improve the treatment outcomes, which still needs further studies.

Objective:To evaluate the radiotherapeutic strategy for the treatment of recurrent esophageal cancer after radical re-section and determine relevant prognostic factors. Methods:A total of 66 patients with esophageal carcinoma and exhibited recurrence after radical surgery were retrospectively reviewed from Jan 2007 to Jun 2010. The median interval of recurrence from the initial sur-gery was 10.6 months. Among the 66 patients, 50 suffered from loco-regional recurrences alone, and 16 developed distant metastases in addition to loco-regional recurrences. Among the 66 patients, 10 were treated with radiotherapy after recurrence, 23 were treated with chemotherapy alone, and 33 were treated with radiotherapy combined with chemotherapy. Among the 33 patients, 22 were initially treat-ed with chemotherapy and 11 were initially treated with radiotherapy. The median total dose of the external radiotherapy was 60 Gy with 6 MV X-ray of a linear accelerator. Results:The median survival period after recurrence was 14.3 months (95%CI=12.4~16.2 months). The 1-, 2-, and 3-year survival rates were 61.9%, 25.9%, and 16.5%, respectively. The median survival period after recurrence in the patients who were treated with chemotherapy alone, radiotherapy alone, and radiotherapy combined with chemotherapy were 11.4, 25.5, and 14.3 months, respectively. The patients who developed distant metastases treated with chemotherapy initially showed better survival outcome than those treated with radiotherapy (P=0.032). Univariate analysis results showed the following prognostic factors:tumor location before surgery;operation mode;whether or not recurrence was detected with distant metastases;and therapy af-ter recurrence. Multivariate analysis results showed that tumor location before surgery was an independent prognostic factor. Conclu-sion:Tumor location may indicate prognosis after recurrence. Patients with recurrent esophageal carcinoma and developed distant me-tastases treated with chemotherapy may initially benefit from a longer survival rate.

To retrospectively analyze the safety and efficacy of low dose subcutaneous decitabine regimen in patients with acute myeloid leukemia (AML) and intermediate-or higer-risk myelodysplastic syndrome (MDS).Of 6 AML cases,2 achieved complete remission (CR),2 with partial remission(PR),1 with stable disease(SD),1 with progressive disease(PD).As to the 8 MDS patients,one achieved CR and 6 with hematologic improvement (HI),1 case SD.Low dose subcutaneous decitabine regimen could be an alternative choice of older AML or MDS patients.

Esophagectomy is one of the most complex interventions in thoracic surgery.Traditional open esophagectomy requires large incision and is associated with many complications.Video-assisted thoracoscopic surgery (VATS) contributes to less complications and hospital stay,and uniportal VATS has more minimal advantages over multi-portal VATS.Due to the technical complexity of esophagectomy,uniportal VATS is highly difficult.Surgeons from Taiwan reported uniportal VATS esophagectomy for the first time in 2015,and this uniportal technique was also reported by surgeons from other institutions.Nowadays,uniportal VATS esophagectomy is still in its initial stage,skills are immature,and long-term,large sample,controlled studies are demanded.Here,authors reviewed the development,skills,short-term outcomes,current practice in West China Hospital,the advantages and challenges for unipotrtal VATS esophagectomy.