Objective To investigate the monitoring of the recurrent laryngeal nerve (RLN)function during thyroid surgery by recording the compound muscle action potential (CMAP) of lateral cricoarytenoid muscle(LCA) under block anaesthesia of the cervical plexus. Methods Nicolet Endeavor CR(Viasys Healthcare, USA) was applied for the intraoperative monitoring. A pair of needle electrodes were inserted into LCA to record CMAP, and a concentric electrode was used to intermittently stimulate the RLN for monitoring the RLN function during operation under block anaesthesia of the cervical plexus.Results In these 28 cases 31 RLNs were exposed during operation, CMAPs appeared with consistent latency when stimulation was applied at the exposed segment. The stimulating intensity threshold ranged from 0.2 to 1.6 mA. The average value was 0.96 mA. 25 of 31 showed CMAPs with consistent latency when stimulation was provided along the possible pathway of the unexposed segment. The stimulating intensity threshold ranged from 1.3 to 3.5 mA. The average value was 2. 03 mA. 6 of 31 did not evoked CMAP even though the maximal stimulating intensity was 5 mA. When these six nerves were exposured, compound muscle action potential were evoked consistently. All of the 28 patients had normal phonation function after surgery.Conclusions It is a safe, effective and feasible method to monitor the RL N function by recording the CMAP of lateral cricoarytenoid muscle under block anaesthesia of the cervical plexus.

OBJECTIVETo investigate the roll of bone sialoprotein (BSP), a secreted glycoprotein, found in mineralized tissues in the development and progression of human esophageal squamous cell carcimoma (ESCC), and explore its association with clinicopathological characteristics and five-year survival of the patients.

METHODSThe expression of BSP was determined in 211 primary ESCC tumors and their paired nontumorous tissues using tissue-array, RT-PCR and immunohistochemistry.

RESULTSPrimary ESCC tissues showed a significantly higher expression rate of BSP mRNA than their paired nontumorous tissues (93.8% vs. 16.6%, P < 0.001), the same with BSP protein (56.9% vs. 31.3%, P < 0.001). The expression rate of BSP protein was correlated to lymph node metastasis and TNM stage (P < 0.05). The 5-year survival rate of BSP protein-positive ESCC patients was significantly lower than that of BSP protein-negative ESCC patients (P < 0.05). Multivariate analysis showed that tumor differentiation, TNM staging and BSP protein expression were independent factors affecting the prognosis of ESCC patients (P < 0.05).

CONCLUSIONSThe abnormal expression of BSP may play a significant role in the malignant progression and prognosis of ESCC, and BSP might be a marker reflecting the biologial behavior of ESCC.

Blotting, Western ; Carcinoma, Squamous Cell ; diagnosis ; metabolism ; Esophageal Neoplasms ; diagnosis ; metabolism ; Humans ; Immunohistochemistry ; Integrin-Binding Sialoprotein ; genetics ; metabolism ; Lymphatic Metastasis ; Neoplasm Staging ; Prognosis ; RNA, Messenger ; Survival Rate

Objective To investigate the role of cell adhesion molecule L1 like (CALL) in the genesis and development of esophageal squamous cell carcinoma (ESCC).Methods From July 2007 to December 2010,a total of 100 patients with ESCC who received radical resection of esophageal cancer were enrolled.The ESCC tissues and corresponding tumor-adjacent normal tissues were obtained.The expression of CALl was determined by tissue microarray technology and immunohistochemical staining.The CALL over-expressed esophageal cancer cell line was established.The effects of CALL on cell migration and invasion were detected by wound-healing assay and Transwell assay,respectively.The effects of CALL on actin microfilament was analyzed by filamentous actin (F-actin) staining.Chi square test,Fisher's exact test,multivariate analysis and t test were performed for statistical analysis.Results The positive expression rate of CALL in ESCC tissues was 56 ％ (56/100),which was lower than that of tumor-adjacent normal tissues (95％,95/100),and the difference was statistically significant (x2=41.114,P＜0.01).There were statistically significant differences in CALL expression at protein level among patients with ESCC of different differentiation degree,different pathological T stage,lymph node metastasis and different TNM stage (x2=13.702,5.317,21.453,Fisher's exact test;all P＜ 0.05).The five year disease related survival rate of ESCC patients with down-regulated expression of CALL was 0(0/49),which was lower than those with normal CALL expression (25.5％,13/51),and the difference was statistically significant (x2 =43.338,P＜0.01).The median survival time of CALL expression down-regulated group was 17 months,and that of normal expressed group was 38 months.CALL expression was an independent risk factor of disease special survival rate (hazard ratio (HR) 0.353,95％ confidence interval (CI) 0.188 to 0.666,P=0.001).The results of wound-healing assay showed that the migration ability of CALL overexpressed CALL-k30 cells was lower than that of Vec-k30 cells in control group on 24 hours after wound.The results of Transwell invasion test showed the number of migrating cells penetrating CALL k30 cells attached to the inferior surface of the membrane was 44.000±13.748,which was less than that of the Vec k30 cells (154.333±25.007),and the difference was statistically significant (t=5.136,P=0.036).The results of F-actin staining demonstrated that actin filaments of CALL-k30 cells was 234.667 ± 65.118,which was lower than that of Vec-k30 cells (597.000± 119.929),and the difference was statistically significant (t=4.707,P=0.042).Conclusions CALL lowers the migration and invasion abilities of esophageal cancer cells by inhibiting F-actin microfilaments.Its abnormal expression may play an important role in the genesis,development and prognosis of ESCC.

Objective To explore the etiology,types,treatment,and prognosis of new-onset epilep-sy in elderly dementia.Methods A retrospective analysis was conducted on 45 new-onset epilepsy in elderly dementia admitted to our department from January 2017 to December 2023.According to their etiology,they were divided into a degenerative dementia group(with AD as the main cause,AD dementia group,24 cases,)and a non-degenerative dementia group(non-AD dementia group,21 cases).Seizure types and and electroencephalogram(EEG)findings were compared be-tween the two groups.The medication and efficacy were also compared between the two groups in 3 months after treatment with antiepileptic drugs.Results Each patient had at least one type of seizure.The AD dementia group had a lower incidence of generalized seizure,but higher incidences of focal seizure and non-convulsive seizure(NCS)when compared with the non-AD dementia group(P＜0.05,P＜0.01).At least one type of abnormal EEG findings was observed in each pa-tient,but there was no statistical difference in the occurrence of EEG abnormalities between the two groups(P＞0.05).Among the 45 patients,42(93.3％)received antiepileptic drugs,and 38(90.5％)patients were well controlled,with the AD dementia group having a higher effective rate of single antiepileptic drug than the non-AD dementia group(95.5％vs 85.7％,P＜0.05).Conclu-sion Dementia combined with epilepsy(especially NCS)is often hard to detect,and continuous EEG monitoring is essential for elderly dementia patients.Most new-onset epilepsy in elderly de-mentia can be effectively controlled through antiepileptic drug therapy.

Objective:To investigate the clinical characteristics, imaging features, treatment, prognosis, and possible causes of myelodysplastic syndrome complicated by acute cerebral infarction.Methods:The clinical data of four patients with myelodysplastic syndrome complicated by acute cerebral infarction who received treatment at Peking University International Hospital and Beijing Jingcheng Boai Hospital from January to December 2021 were retrospectively analyzed.Results:All four patients experienced myelodysplastic syndrome complicated by acute cerebral infarction for the first time. They were aged 60-69 years, with a median age of 65 years. Bone marrow suppression occurred in the four patients with myelodysplastic syndrome after chemotherapy, resulting in a remarkable reduction in the number of platelets. All four patients had just been transfused with platelets before the onset of myelodysplastic syndrome complicated by acute cerebral infarction. The main clinical manifestations were dyskinesia, language disorder, paresthesia, and dizziness. Three patients had multiple foci, two of them involved bilateral cerebral hemispheres, and only one patient had a single focus. Circulation improvement and symptomatic treatment were given after admission. Two patients with cerebral hernia died, and two patients were discharged after improvement.Conclusion:The pathogenesis of myelodysplastic syndrome complicated by acute cerebral infarction is complex. It includes many causes rather than common risk factors for stroke. Myelodysplastic syndrome complicated by acute cerebral infarction is rare in the clinic. It is difficult to treat, is serious, and has a poor prognosis.

With the development of society and economy, the disease spectrum of Chinese residents has undergone a major change, and the public health emergencies have occasionally occurred. The new situation has put forward higher requirements on the emergency capacity, professional technical level and treatment quality of critical care treatment system. Combining with the advantages of hospital aviation, ground and Internet emergency, Henan Provincial People's Hospital established a new construction path of emergency and critical care treatment system, namely "trinity" rescue system of aviation, ground and Internet emergency treatment and the "five-ring" model of critical care treatment system in hospital. The purpose of this paper is to summarize the practical experience of the construction of emergency and critical care system in Henan Provincial People's Hospital, so as to provide reference for the management of emergency and critical care in China.

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

Objective To investigatethe relationship between gastroesophageal reflux disease (GERD) symptoms and clinicopathological characteristics, p53 expression, and survival of Chinese patients with esophageal adenocarcinoma. Methods A total of 3882 patients with esophageal adenocarcinoma, 970 matched patients with esophageal squamous cell carcinoma, and 970 matched patients with gastric cardia adenocarcinoma were included to compare the incidence of GERD symptoms. Patients with esophageal adenocarcinoma were divided into two groups according to the presence and absence of GERD symptoms. The differences in clinicopathological characteristics and p53 expression between the two groups were compared by chi-square test, and the differences in survival between the two groups were compared by landmark analysis. Results The incidence of GERD symptoms increased successively in esophageal squamous cell carcinoma, esophageal adenocarcinoma, and gastric cardia adenocarcinoma. In patients with esophageal adenocarcinoma, the proportions of male, less than 65 years old, lower thoracic tumors, tumors without squamous cell carcinoma, poorly differentiation, early tumors (stage 0-I), and p53-positive tumors in the group with GERD symptoms were higher than those in the group without GERD symptoms; moreover, the long-term survival (≥15 years) was better. Conclusion GERD symptom is an important clinical sign of esophageal adenocarcinoma. It is closely related to specific clinicopathological characteristics, p53 overexpression, and good long-term prognosis.