Chest?regional recurrence and metastasis are the main modes of treatment failure after surgery for patients with esophageal cancer. As one of the primary approaches for local therapy, radiotherapy has a satisfactory efficacy in the reduction of postoperative chest?regional recurrence in patients with esophageal cancer. Right now, the value of postoperative adjuvant therapy for patients with positive lymph nodes has been widely recognized by clinicians. Postoperative adjuvant chemoradiotherapy has become a standard treatment mode. However, there is no consensus on whether adjuvant radiotherapy should be performed in patients with negative lymph nodes. To determine whether patients with stage pN0 esophageal cancer should receive postoperative adjuvant therapy, this paper reviews the current research advances in possible evidence for the necessity of postoperative adjuvant radiotherapy for patients with stage pN0 esophageal cancer, current related reports, and the effects of different surgical methods on treatment outcomes of postoperative adjuvant therapy.

Laser ablation of hard tissue allows very precise pre-programmed incisions with complete free geometry and it has advantage of leaving no tissue damages. Those disadvantages of thermal side effects and low cutting rates had been overcome by introducing ultra-short pulses and ultra-power laser systems. This review highlights the recent advances in the laser ablation of hard tissues.

Ojective To study the diagnosis and treatment of upper extremity edema after radical mastectomy. Methods Diagnosis depended on B type ultrasoundgraphy, CT, lymphography, venography, biopsy and axilla exploration. Lymphaticovenous anastomosis (LVA) with microsurgery technology was used for the treatment of simple lymphoedema. Results In 40 cases of lymphoedma after radical mastectomy, 7 patients were diagnosed as metastasis of cancer. 3 patients were diagnosed obstrcution of lymphatic and vein. 30 patients with simple lymphedema were treated with LVA. Short term efficacy was observed in all patients.The efficacy at 3～12 years was 83.3%. Conclusion The diagnosis of upper limb edema after radical mastectomy is essential. Metastasis and obstruction of vein are the causes. Biopsy conducted under high frequency B type ultrasoundgraphy may be a good method for the diagnsosis of matastasis, but a few patients were diagnosed only by axilla exploration. LVA may be given first priority to the theraphy of lymphedema after radical mastectomy.

Objective:To analyze the factors affecting lymph node failure pattern after radiotherapy/chemotherapy in esophageal squamous cell carcinoma without initial clinical metastasis. Methods:A total of 263 patients, who were diagnosed as thoracic esopha-geal carcinoma from January 2002 to December 2009, were included in this retrospective study. Factors affecting lymph node failure pattern with general clinical data and tumor local factors were analyzed. Results:Among the 263 esophageal cancer cases, 31 (11.8%) had lymph node metastasis after treatment, including 18 cases of simple lymph node metastasis and 13 other cases of lymph node metas-tasis with esophageal and other organ metastasis or recurrence. The numbers of cases for lymph node metastasis in the upper, middle, and lower thoracic esophagus were 11 (13.3%), 13 (10.1%), and 7 (13.7%), respectively. Univariate analysis showed that recent cura-tive effect, length of tumor on X-rays, maximum tumor diameter, and tumor volume were the significant factors associated with lymph node metastasis (χ2=7.597, 9.717, 5.361, and 4.815;P=0.006, 0.002, 0.021, and 0.028). Logistic regression analysis results showed that recent curative effect and length of tumor on X-rays were independent significant factors (P=0.004 and 0.026). Conclusion:Recent cu-rative effect and length of tumor on X-rays were the significant factors associated with lymph node failure pattern after radiotherapy/chemotherapy in esophageal squamous cell carcinoma without initial clinical metastasis.

Objective To apply RNA interference technique for reducing the expression of MDC1 gene in esophageal carcinoma cell line ECA109, observe the changes in cell cycle and radiosensitivity after radiation, and discuss related mechanisms. Methods Three pairs of effective interference sequences and negative control sequences were synthesized for MDC1 mRNA sequence, and a recombinant plasmid was constructed with the vector pSIH1?H1?copGFP. RT?PCR and Western blot were used to determine the expression levels of MDC1 mRNA and protein. Colony?forming assay was applied to measure radiosensitivity, flow cytometry to determine cell cycle, Western blot to determine the expression of CHK1 and CHK2 proteins, and laser scanning confocal microscope to observe the number of MDC1 blotches inside the nucleus. One?way analysis of variance was used to analyze the differences between groups. Results The pSIH1?H1?copGFP plasmid was constructed successfully and ECA109 cells were infected to obtain ECA109M cells with stable transfection. The expression levels of MDC1 mRNA and protein in ECA109M cells were lower than those in ECA109N and ECA109 cells ( P= 0. 032 and 0. 041, respectively ) . After 5?Gy radiation, ECA109M cells had a lower proportion of G2+M cells than ECA109N and ECA109 cells ( P=0. 026) . After 5?Gy radiation, ECA109, ECA109N, and ECA109M cells had similar expression levels of CHK1 and CHK2 proteins ( P= 0. 345 and 0. 451, respectively ) , and ECA109M cells had a lower expression level of CHK2 T68 protein than ECA109 and ECA109N cells ( P=0. 012) . ECA109 cells had a D0 value of 3. 06 Gy and an SF2 value of 0. 91;the D0 values for ECA109N and ECA109M cells were 2. 90 Gy and 1. 88 Gy, respectively, and the SF2 values for them were 0. 89 and 0. 84, respectively ( P=0. 021 and 0. 037, respectively ) . Conclusions RNA interference can reduce the expression levels of MDC1 protein and cell cycle?related proteins, release cell cycle arrest, and enhance radiosensitivity in esophageal carcinoma ECA109 cells.

Objective To investigate the differences of low frequency fluctuation (ALFF)in the resting state between short-term heroin and methamphetamine abusers after withdrawal.Methods Sixteen male short-term heroin abusers and fourteen male short-term methamphetamine abusers were performed the functional magnetic resonance imaging (fMRI).The differences of ALFF be-tween the two groups were performed with preprocessing softwares.Threshold was set to 0.05.Results Compared with metham-phetamine-dependent patients,heroin-dependent patients showed increased ALFF in the left side of the lingual gyrus and the left ton-sil of cerebellum and decreased ALFF in the left side of the brain stem,midbrain and the left side of the cerebellar vermis.Conclusion There are differences between the short-term heroin and methamphetamine abusers in the function of the brain,mainly involving the brain regions associating with cognition and affection.

Objective To explore the value of MR diffusion tensor imaging ( DTI) in diagnosis of traumatic Axonal injury ( TAI) .Methods Twenty nine patients with traumatic brain injury ( TBI) and matched 22 control subjects were performed with DTI . Fractional anisotropy ( FA) was calculated from semioval center , corpus callosum , internal capsule and pons of controls and TBI pa-tients.According to Glasgow Score (GCS), TBI patients were divided into mild group (GCS≥13) and moderate-severe group (GCS≤12), each group compared with control group in FA value .The correlation between FA values in different regions and GCS score were analyzed in DTI group .Results FA value of semioval center was decreased in mild DTI group ( P <0.01 ) .FA values of semio-val center , corpus callosum , and internal capsule were decreased in moderate-severe DTI group ( P <0.05 ) .The FA values in semio-val center , corpus callosum , and internal capsule were positively correlated with GCS score in TBI group ( P <0.05 ) .Conclusions DTI is sensitive to detect the traumatic axonal injury??Changes of FA value in ROIs can access the severity of axonal injury ?? which ishelpful for diagnosis earlier and improving prognosis.

Objective To investigate the diagnostic values of direct lymphangiography for the thoracic duct outlet obstruction.Methods The image data of direct lymphangiography were retrospectively analyzed in 124 patients with lymphedema,Chylothorax,chylous ascites,chyluria and intestinal lymphangiectasis,and compared with the results of neck thoracic duct surgical exploration,2 radiologists reviewed DLG DSA images in a double blind manner.The number of neck stem,subclavian stem,bronchialmediastinal stem and TD terminal into blood obstruction on the operation side showed by DLG were assessed using Kappa analysis.Results Of 124 patients,80 patients had the left cervical lymphatic stem reflux on DLG,75 patients with the left subclavian lymphatic stem reflux,30 patients with the left bronchial-mediastinal lymphatie stem reflux,118 patients showed the thoracic duct outlet barrier into the blood.The consistency rate of DLG were 89.9％ (80/89),92.6％ (75/81),90.9％ (30/33) and 95.2％ (118/124) compared with the neck thoracic duct surgical exploration.Tow radiologists had a high degree of diagnostic consistency (K =0.82,P ＜ 0.05).In addition,114 patients (91.9％) had tortuous,dilated waist lymphatic stem,only 10 patients (8.1％) were normal.The cisterna chyli reflux were found in 92 patients (74.2％),intestinal stem reflux in 16 patients (12.9％),reflux to the kidney area in 11 patients (8.9％),to the pericardium reflux in 5 patients (4.0％),vaginal lymphatic leakage in 7 patients (5.6％),retroperitoneal lymph leakage in 2 patients (1.6％),pleural lymphatic leakage in 3 patients (2.4％),tracheal lymph leakage in 1 patient (0.8％).Conclusion Direct lymphangiography has a high consistency with the cervical thoracic duct surgical exploration in displaying thoracic duct outlet obstruction.

Objective To evaluate the diagnosis and therapy of intestinal lymphangiectasia.Methods In this study 15 patients were admitted in our hospital during recent 7 years.Clinical manifestations included hypoalbuminemia,symmetrical edema,emaciation,diarrhea and lymphopenia.Lymphangiography,lympanscintigraphy and biopsy were performed for diagnosis.Therapy conducted included conservative therapy,low-fat and medium-chain triglycerides(MCT)diet,albumin infusions,diuretics,total parenteral nutrition and octreotide.Surgical therapy ineluded thoracic duct-vein anastomasis and segmental resection.Results In this group 8 patients receiving conservative therapy were followed-up from 1.5 to 7 years(average 2.5 years).Symptoms were alleviated in 6 patients.Seven patients underwent operative therapy,among them,4 patients received thoracic duct-exterior jugular vein anastomasis and followed-up from 1 to 5 years,with symptoms mitigated in 2 patients.3 patients underwent local intestinal resection,follow-up from 1 to 3 years found one patient was cured,one was improved,and 1 patient died 3 months afterthe operation. Conclusion Intestinal lymphangiectasia is rather rare and there was no definite and effective therapy.

Objective To evaluate the prognostic significance of 3 clinical stage system in 3-dimensional conformal radiotherapy (3DCRT) for esophageal squamous cell carcinoma. Methods From January 2004 to August 2007, 179 cases of esophageal squamous cell carcinoma were treated with 3DCRT.Before radiation, each patient was staged with UICC 2003 TNM stage, stage of Chinese esophageal cancer cooperation group (cooperation group' stage), and Zhu's clinical stage respectively. Concordance of each clinical stage and prognosis was analyzed with SPSS 11.5. Results In 179 cases of esophageal cancer,Concordance was better in T stage ( Kappa = 0. 271 ) than in TNM stage ( Kappa = 0. 167 ) between cooperation group' stage and Zhu's stage. Among them, 98 cases was staged with UICC stage, concordance of T stage was better between UICC-T and cooperation group' T stage (Kappa =0. 261 ) than between UICCT and Zhu's T stage (Kappa = 0. 045 ) ;concordance of TNM stage was better between UICC-TNM and Zhu's TNM stage ( Kappa = 0. 597 ) than between UICC-TNM and cooperation group' TNM stage ( Kappa =0. 299 ). With multivariate analysis, T ( χ2 value is 11.58, 26. 00 and 51.05, all P ＜ 0. 01 ), N ( χ2 value is 15.28, 16. 10 and 16. 10,all P＜0. 01), M (χ2 value is 5.59, 27.78 and 27.78,all P＜0. 01), and TNM (χ2 value is 15.77, 34,35 and 51. 10,all P＜0. 01 ) stage in 3 kinds of clinical stage were independent prognostic factors. In UICC stage, T1-T3 was difficult to definite and the prognosis was not significantly different in T1 -T3 stage. Conclusions In this study, 3 kinds of clinical stage could evaluate prognosis of esophageal cancer after radiotherapy;cooperation group' stage and Zhu's stage need further application, with further accuracy needed.