In recent years a large number of studies have been conducted to investigate the role of vitamin D and its metabolites in cancer.However,the picture for lung cancer is not clear at the present time.There are three integral components of the vitamin D pathway:the vitamin D receptor(VDR),CYP27B1 and CYP24A1.Besides,vitamin D inhibits the carcinogenesis of lung by indirectly influencing IGF signaling,TGF-β signaling,and Wnt/β-catenin signaling pathway.Their differential expressions in normal lung tissue and lung cancer offer clues and lay the foundation for research of the inhibitory function in lung cancer pathogenesis.

Objective To identify the diagnostic criteria and investigate the incidence and distribution of the patellofemoral arthritis in aged people in Wuchuan region of the Inner Mongolia of China. Methods A population-based cross-sectional survey was conducted among 1030 residents aged 50 years and over of Wuehuan County, Inner Mongolia. Survey participants, mostly farmers, reported heavy physical activity, completed an interview-based questionnaire and Skyline View weight-bearing films were evaluated for KeU-gren and Lawrence (K/L) grade. Radiological patellofemoral arthritis (RPFA) and symptomatic patellofemoral arthritis (SPFA) were defined. Statistical package SPSS 14.0, crosstabs chi-squae test and Excel were adopted for statistical analysis. Results One thousanod and twenty-five participants were included in this study and 2050 knee joint Skyline View weight-bearing films were analyzed. The incidence of RPFA was 8.72%(6.8% in men, and 10.5% inwomen). The incidence of SPFA was 6.33% (4.8% in men, and 8.0% in women).The RPFA incidence of age groups 50～, 60～,≥70 was 3.8%, 10.6%, 22.9% respectively, while the incidence of SPFA was 2.7%, 7.7%, 17.3% respectively. The Three age groups' SPFA/RPFA was 71.7%, 72.0%, 75.6% respectively. The incidence of RPFA was 6.00/0, 7.3%, 11.0%, 11.3%, and the incidence of SPFA was 4.2%,5.2%, 7.3%, 9.6% and the four SPFA/RPFA was 70.0%, 71.3%, 66.7%, 84.8% in people whose BMI was less than 18.5, 18.5～, 23.0～ and higher than ≥25.0 kg/m~2 respectively, 73.6% people had joint pain among RPFA.Conclusion The prevalence of symptomatic patellofemoral arthritis in the rural areas of China is 6.8%, the incidence of that in women is higher than in men, and elder people suffer a high incidence. And the heavier the people are, the higher the incidence of patellofemoral arthritis.

Objective To investigate the distribution and antimicrobial resistance of Coagulase-negative staphylococci ( CoNS) isolated from cerebrospinal fluids in neurosurgical patients.Methods CoNS strains isolated from cerebrospinal fluids of neurosurgical patients were collected from Beijing Tiantan Hospital of Capital Medical University during January 2013 and December 2015.CoNS infection was diagnosed according to the standards of US Centers for Disease Control and Prevention, and the distribution and antimicrobial resistance of pathogenic CoNS strains were analyzed. Results A total of 19 756 cerebrospinal fluid specimens were collected and 1 386 bacterial strains were isolated, in which 650 (46.9%) were CoNS.Among 650 CoNS strains, 130 were diagnosed as the pathogen, and the top 4 CoNS species were Staphylococcus epidermidis (77/130, 59.2%), Staphylococcus hominis (18/130, 13.8%), Staphylococcus haemolyticus (11/130, 8.5%) and Staphylococcus capitis (9/130, 6.9%).The rest 520 CoNS strains were contaminating strains.According to antimicrobial susceptibility test, there were 103 strains of methicillin-resistant CoNS (MR-CoNS) accounting for 79.1% (103/130).And among 77 Staphylococcus epidermidis isolates, 67 were MR-CoNS strains (87.0%) .More than 90.0%Staphylococcus epidermidis isolates were sensitive to vancomycin and linezolid, and the rest CoNS strains were also highly sensitive to these two antibacterial agents.Conclusions CoNS plays an important role in post-surgery infection in neurosurgical patients, and Staphylococcus epidermidis is the dominant CoNS species.Most CoNS strains are methicillin-resistant, but are highly sensitive to vancomycin and linezolid.

Esophagectomy is one of the most complicated procedures. Satisfactory anesthesia not only ensures the safety in terms of low morbidity and mortality postoperatively, but also one of the potential factors relevant to long-term survival. Most of physicians, however, ignore the significance of anesthesia. This article focuses on the recent advances of anesthesia for esophagectomy in preoperative preparation for induction, rapid-sequence induction, one-lung ventilation, fluid management during surgery and postoperative early extubation and analgesia.
Analgesia ; Anesthesia ; methods ; Esophagectomy ; methods ; Fluid Therapy ; Humans

OBJECTIVETo investigate the cause and the management of treatment and prevention of reoperation following esophagectomy.

METHODSClinical data of 946 cases with esophageal cancer undergoing esophagectomy from January 2000 to December 2012 by the same surgical team in the Beijing Cancer Hospital were retrospectively analyzed. Among them, 19 patients underwent reoperation after esophagectomy because of serious complications. Clinical features and treatment course of these 19 cases were summarized.

RESULTSThe indications and procedures of reoperation included thoracotomy for hemorrhage (n=4), diaphragmatic hernia repair (n=4), thoracic duct ligation for chylothorax (n= 4), re-suturing for incision dehiscence (n=4), re-laparotomy and re-thoracotomy for drainage of traumatic pancreatitis (n=1), re-laparotomy for intestinal obstruction (n=1), and tracheotomy for bilateral recurrent laryngeal nerve paralysis (n=1). All the 19 patients were successfully cured without perioperative deaths and further complications.

CONCLUSIONSThe indications of reoperation following esophagectomy include postoperative bleeding, diaphragmatic hernia, chylothorax and abdominal incision dehiscence.

Adult ; Aged ; Aged, 80 and over ; Esophageal Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Reoperation ; Retrospective Studies

OBJECTIVETo summarize the mortality of esophagectomy in our series and compare the different mortalities based on 30-day deaths and 90-day deaths postoperatively.

METHODSA total of 954 patients undergoing esophagectomy by single-surgeon-team between January 2000 and December 2012 from our prospective database were enrolled. The mortalities based on 30-day and 90-day deaths postoperatively were compared, and the causes of deaths within 30 days and 90 days were analyzed.

RESULTSAmong all these 954 patients, a total of 20 postoperative deaths(2.1%) were observed: 11 within 30 days(1.1%) and 9 between 30 and 90 days after surgery(1.0%). The reasons for deaths within 30 days were as follows: 3 for respiratory failure related to anastomotic leakage,1 for bleeding after stenting due to anastomotic fistula, 1 for sepsis, 3 for respiratory failure from presenting preoperative respiratory morbidities, 2 for cardiac arrest caused by preoperative heart disorder, and 1 for multiple organ failure caused by early adjuvant chemotoxicity. The reasons for deaths between 30 and 90 days were as follows: 1 for respiratory failure related to anastomotic leakage, 1 for cardiac arrest from preoperative heart disorder, 1 for cerebrovascular accident, 1 for liver failure from liver cirrhosis presenting preoperatively, 1 for renal failure after operation, 1 for tumor progression and 2 for unknown reasons.

CONCLUSIONSince postoperative mortality calculated based on 30 days deaths postoperatively may underestimate the risk of esophagectomy, mortality calculated based on 90 days may be a better option.

Anastomotic Leak ; Cause of Death ; Esophageal Neoplasms ; surgery ; Esophagectomy ; mortality ; Humans ; Postoperative Period ; Prospective Studies ; Risk Factors ; Stents

Objective: To discuss the effect and safety of continuous pumping for home enteral nutrition after esophagectomy. Methods: The current study retrospectively analyzed the esophageal cancer patients who underwent transthoracic esophagectomy between January 2017 and November 2017 at First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute. There were totally 108 cases, including 88 males and 20 females, with an average age of 62 years. The patients were divided into pump feeding group (n=56) and traditional tube feeding group (n=52). The postoperative short-term safety, weight maintenance, enteral nutrition tolerance and nutritional support complete rate of the 2 groups were compared by χ² test, Fisher exact test and t test, respectively. Results: Compared with traditional tube feeding group, the patient safety in pumping feeding group was significantly better, with complications within 2 months after discharge were 11/52 and 4/56 respectively (χ²=2.393, P=0.035); the weight maintenance was significantly better, the weight loss within 4 weeks after discharge were 3.90 kg and 0.13 kg, respectively (t=7.720, P=0.000); the general enteral complications were significantly lower (26/52 vs. 5/56, χ²=22.225, P=0.000), the nutritional support complete rate was significantly higher (23/52 vs. 55/56, χ²=39.167, P=0.000). Conclusions Continuous pump feeding enteral nutrition support after discharge postoperatively could help improve patient safety after discharge, which is better for weight maintenance of the patients. Pump feeding could also enhance tolerability of tube feeding and ensure the effective accomplishment of nutritional support.

Objective:To evaluate the effect of dual-tube epidural segmental injection of lidocaine analgesia on the delivery outcome and maternal and infant complications of persistent posterior occipital position postpartum or lateral occipital position postpartum patients with protracted active phase.Methods:The full and single-term primiparas ( n=216, 37 to 42 weeks gestation, 22 to 35 years) diagnosed as persistent posterior or lateral occipital position during the active period were selected from the Department of Obstetrics of Qingdao Municipal Hospital from January 2015 to October 2019. The subjects were randomly assigned into two groups: double-tube epidural block group ( n=108) and single-tube epidural block group ( n=108), 1% lidocaine was used for epidural analgesia respectively under ultrasound guidance. Senior midwife or obstetricians implement new partogram, and guide women to perform position management, and push or rotate the fetal head in a timely manner. Observation indicators: general condition, the use of non-pharmacological analgesic measures, analgesia related conditions and pain visual analogue scale (VAS) score, delivery-related indicator, cesarean section indication, anesthesia-related indicator, maternal and child complications. Results:(1) General condition: the age, weight, height, gestational age, the ratio of persistent lateral or posterior occipital position, cephalic score, and neonatal birth weight between the two groups of women were not statistically significant (all P>0.05). (2) The use of non-pharmacological analgesic measures: the women’s Lamaze breathing method, Doula delivery companionship, percutaneous electrical stimulation, and other measures between two groups were compared, and there were not significant differences (all P>0.05). (3) Analgesia related conditions and VAS scores of women undergoing vaginal delivery: compared with the single-tube epidural block group ( n=40), the second-partum time of the women in the double-tube epidural block group ( n=59) was significantly shortened [(124±44) vs (86±33) minutes, P<0.01]; after 30 minutes of analgesia (4.4±0.5 vs 0.9±0.5, P<0.01), during forced labor in the second stage of labor (5.7±0.6 vs 1.3±0.4, P<0.01), the VAS scores of pain were also significantly reduced ( P<0.01). (4) Labor-related indicators: compared with the single-tube epidural block group, the natural delivery rate (21.3% vs 49.1%) and the delivery experience satisfaction rate (51.9% vs 98.1%) of women in the double-tube epidural block group were significantly increased (all P<0.01), cesarean section rate (63.0% vs 45.4%), instrument assisted rate (15.7% vs 5.6%) decreased significantly (all P<0.05). (5) Cesarean section indications: compared with the single-tube epidural block group, the cesarean section rate caused by prolonged labor or protracted active phase of women in the double-tube epidural block group was significantly reduced (38.0% vs 22.2%； P<0.05), and the fetal distress, intrauterine infection, and social factors caused by cesarean section between the two groups were compared, while the differences were not statistically significant (all P>0.05).(6) Anesthesia related indexes: the block planes of the maternal upper tube administration in the double-tube epidural block group were mostly T7, T8, T9-L2 and L3,While,the block planes in the single-tube epidural block group were mostly T10, T11-S1, S2, S3, and the modified Bromage score were all 0. (7) Maternal and child complications: compared with the single-tube epidural block group, the postpartum hemorrhage rate (18.5% vs 7.4%), the perineal lateral cut rate (20.4% vs 5.6%), the neonatal asphyxia rate (12.0% vs 3.7%), ICU rate of transferred neonates (13.9% vs 4.6%) in the double-tube epidural block group were significantly reduced (all P<0.05). Soft birth canal injury rate, puerperal disease rate and neonatal birth rate between two groups were compared, and there were not statistically significant differences (all P>0.05). Conclusion:Dual-tube epidural segmental injection of lidocaine analgesia could increase the natural delivery rate of women with posterior occipital or lateral occipital position with active stagnation, reduce the rate of cesarean section and the rate of transvaginal instruments, and reduce the complications of mother and child.

Esophagectomy is one of the most complicated procedures. Satisfactory anesthesia not only ensures the safety in terms of low morbidity and mortality postoperatively, but also one of the potential factors relevant to long-term survival. Most of physicians, however, ignore the significance of anesthesia. This article focuses on the recent advances of anesthesia for esophagectomy in preoperative preparation for induction, rapid-sequence induction, one-lung ventilation, fluid management during surgery and postoperative early extubation and analgesia.

Objective To summarize the mortality of esophagectomy in our series and compare the different mortalities based on 30-day deaths and 90-day deaths postoperatively. Methods A total of 954 patients undergoing esophagectomy by single-surgeon-team between January 2000 and December 2012 from our prospective database were enrolled. The mortalities based on 30-day and 90-day deaths postoperatively were compared, and the causes of deaths within 30 days and 90 days were analyzed. Results Among all these 954 patients, a total of 20 postoperative deaths (2.1%) were observed: 11 within 30 days (1.1%) and 9 between 30 and 90 days after surgery (1.0%). The reasons for deaths within 30 days were as follows: 3 for respiratory failure related to anastomotic leakage,1 for bleeding after stenting due to anastomotic fistula, 1 for sepsis, 3 for respiratory failure from presenting preoperative respiratory morbidities, 2 for cardiac arrest caused by preoperative heart disorder, and 1 for multiple organ failure caused by early adjuvant chemotoxicity. The reasons for deaths between 30 and 90 days were as follows: 1 for respiratory failure related to anastomotic leakage , 1 for cardiac arrest from preoperative heart disorder, 1 for cerebrovascular accident, 1 for liver failure from liver cirrhosis presenting preoperatively, 1 for renal failure after operation, 1 for tumor progression and 2 for unknown reasons. Conclusion Since postoperative mortality calculated based on 30 days deaths postoperatively may underestimate the risk of esophagectomy, mortality calculated based on 90 days may be a better option.