Lymph nodes (LN)are the main parts of the esophageal cancer metastasis,and the current status of LN is the important indicator of prognosis.LN metastasis appears in early stage of esophageal cancer.One side,LN metastasis easily appears in the regions near the tumor and some special areas.On the other side,LN metastasis has the characteristics of wide metastasis and skip metastasis.Therefore,the researches of the pattern of esophageal cancer lymph node metastasis can help to comform the scope of the esophageal cancer lymph node dissection and the target regions of radiotherapy.

Objective To explore the clinical characteristics and the treatments on traumatic diaphragmatic rupture and diaphragmatic hernia.Method A retrospective study was carried out in 49 cases of traumatic diaphragmatic rupture and diaphragmatic hernia.Results There were 32 cases with left diaphragmatic hernia,13 cases with right diaphragmatic hernia and 4 cases with bilateral diaphragmatic hernia.One case with closed combined thoraco-abdominal wound and shock,died of multiple organ failure after the surgery,3 cases were diagnosed more than 24 h after injury,the others closed injury patients were diagnosed within 24 h and cured.In patients with open diaphragmatic rupture and diaphragmatic hernia,16 cases underwent laparotomy surgery,5 cases of misdiagnosis experienced re-thoracotomy,7 cases thoracotomy,2 cases changed the thoraco-abdominal surgery.Three cases underwent thoraco-abdominal surgery.Twenty-five cases were cured; 1 patient with suppurative costal chondritis,duration up to 13months.Conclusion Traumatic diaphragmatic rupture and diaphragmatic hernia is easily missed and misdiagnosed,the establish of rational examination preoperatively can reduce complications,misdiagnosis and mortality.

Objective To observe the relationship between carotid stiffness and coronary angiography in elderly patients of coronary heart disease (CHD) complicated with hypertension.Methods The patients were divided into three groups.Coronary angiography was performed in 40 elderly patients of CHD complicated with hypertension.The carotid stiffness was measured by ultrasound.Results There were significant differences on hypertension in arterial stain,arterial distensibility and arterial stiffness.There was significant correlation between coronary angiography score and carotid stiffness among three groups(r=-0.353,-0.125,0.376,P<0.01).Conclusion There is close relationship between carotid atherosclerosis and coronary atherosclerosis in elderly patients of CHD complicated with hypertension.

Objective To study in vitro anti-HIV activity of an extract of herb medicines,SanJiangDan,and the possible mechanism.Methods The main active ingredient of SanJiangDan was extracted by distillation.Three subtypes of HIV pseudovirus (B subtype,C subtype,CRF01_AE subtype) were used to evaluate the anti-HIV activity of SanJiangDan extract in vitro.The possible mechanism was evaluated through analyzing the effects of SanJiangDan extract on the expression of surface receptors and cytokines by T cells.The cytotoxicity of SanJiangDan extract was detected by using four different sources of cell lines including epithelial cells Caco-2 cells,TZM cells,Huh7 cells derived from liver cells and lymphocyte Jurkat-T cells.Results SanJiangDan extract effectively inhibited the infection of HIV pseudoviruses at concentrations of 1.6 mg/ml and 0.16 mg/ml.The inhibition rates were 30.9％,36.6％ and 65.0％ for B subtype,C subtype and CRF01_AE subtype respectively at the concentration of 0.16 mg/ml.As the concentration increased to 1.6 mg/ml,the inhibition rates increased to 96.4％ (B subtype),97.4％ (C subtype) and 99.5％ (CRF01_AE subtypes),but no toxicity to host cells was detected.Moreover,SanJiangDan extract inhibited the expression of HIV surface receptors including CD4,CXCR4 and CCR5 on TZM-bl cells,but enhanced IL-2 production.Conclusion SanJiangDan extract could inhibit HIV pseudovirus infection without causing cytotoxicity to host cells in vitro.The possible mechanism might be associated with the reduced expression of CD4,CXCR4 and CCR5 and enhanced secretion of IL-2 as well.

This study was aimed to observe influence on clinical symptoms of Qing-Fei Pei-Yuan Wei-Wan (QFPY-WW) for pulmonary infection HIV/AIDS cases with the syndrome of phlegm-heat obstructing the lung. A total of 141 pulmonary infection HIV/AIDS cases with the syndrome of phlegm-heat obstructing the lung were randomly divided into the treatment group (94 cases) and the control group (47 cases). The treatment group was given basic western medication combined with QFPYWW. The control group was given basic western medication. After 4 weeks treat-ment, observation was made on changes of main symptoms. The results showed that on the 28th day, compared with the control group, there was improvement on symptoms such as cough, breathing and chest tightness (P< 0.05). Com-parison on coughing up phlegm degree showed that the treatment group was significantly better than the control group (P< 0.05). On the 7th day treatment, the treatment group had better effect on lowering body temperature than the control group (P< 0.05). It was concluded that QFPYWW can improve symptoms such as cough, breathing, chest tightness and cough up phlegm among pulmonary infection HIV/AIDS patients.

To ensure the quality of building basic test bank and to effectively measure the quality of medical exam questions,now,we analyze the problems of the basic test papers from 13 north medical universities in many aspects such as cognitive rank,difficulty,conformity and core content etc.Having found the main problems of the testing papers,we supply the viewpoint for improvement and make better foundation for the construction of test bank.

Objective: To observe the clinical efficacy of umbilical therapy with herbal cakes made of Ge Gen Qin Lian Tang prescription of different dosages in treating damp-heat diarrhea in young children. Methods: Seventy-two kids with diarrhea of damp-heat pattern were recruited and divided into a high-dosage group and a low-dosage group using the random number table method, with 36 cases in each group. They all received conventional antidiarrheal treatment and umbilical application with herbal cakes. However, the herbal cakes for the high-dosage group were made of the mixture of Ge Gen Qin Lian Tang powder and water, and those for the low-dosage group consisted of 10％ Ge Gen Qin Lian Tang powder and 90％ auxiliary materials (corn starch) plus water. The treatment duration was 3 d. The clinical efficacy, antidiarrheal rate, effective rate for symptoms and signs of traditional Chinese medicine (TCM), TCM symptoms score, and safety indicators were compared between the two groups. Results: After the treatment, the TCM symptoms scores dropped significantly in both groups (P<0.01) and were lower in the high-dosage group than in the low-dosage group (P<0.05). The clinical efficacy was more significant in the high-dosage group than in the low-dosage group after the treatment, and the between-group difference was statistically significant (P<0.05); the antidiarrheal rate was markedly higher in the high-dosage group than in the low-dosage group (P<0.05). Regarding the TCM symptoms and signs, the high-dosage group showed better results in improving the greasy and yellowish tongue coating, bowel movement frequency, watery excrement, short and dark urine, red tongue body, red anus, vomiting, bowel sounds, and abdominal bloating compared with the low-dosage group, and the between-group differences were statistically significant (P<0.01). Conclusion: Umbilical therapy with herbal cakes made of Ge Gen Qin Lian Tang is safe, reliable, and effective in treating damp-heat diarrhea in young children; the high-dosage herbal cakes produce more significant efficacy than the low-dosage ones and are worth further investigation.

Primary seminal vesicle adenocarcinoma is a rare malignant tumor of reproductive system. A 21-year-old patient with primary seminal vesicle adenocarcinoma was treated in our hospital in August 2014. Without surgical treatment, the patient survived for 4.5 years after 6 cycles of chemotherapy and pelvic radiotherapy. Local recurrence was found in February 2019 and laparoscopic radical prostatectomy was performed. There was no local recurrence and metastasis after follow-up for 10 months.

Objective:To evaluate the effect of trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) on reflux and micro-aspiration during induction of general anesthesia in the patients undergoing laparoscopic cholecystectomy.Methods:A total of 60 patients, regardless of gender, aged 18-60 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=30 each) using a random number table method: routine mask ventilation group (group C) and trans-nasal humidified rapid insufflation ventilatory exchange group (group H). Patients in group C were pre-oxygenated with a mask for 5 min, oxygen flow of 6 L/min and FiO 2 100%, after the induction of anesthesia, the pressure mask was used to artificially assist positive pressure ventilation for 2 min when the patient′s consciousness disappeared, and 2 min later endotracheal intubation was performed.Patients in group H were pre-oxygenated with THRIVE for 5 min, oxygen flow of 30 L/min and FiO 2 100%.The oxygen flow was increased to 50 L/min during anesthesia induction.After anesthesia induction, the oxygen flow was increased to 70 L/min when the patient′s consciousness disappeared, and chin lift and/or jaw thrust was used during apnoea to maintain an open airway, the patient′s mouth was kept closed during the whole process, and 2 min later endotracheal intubation was performed.Ultrasound was used to measure the cross-sectional area (CSA) of the gastric antrum and to monitor the occurrence of gastric insufflation, and the incidence of CSA greater than >3.4 cm 2 was recorded on admission to the operating room and immediately after tracheal intubation.Supraglottic and subglottic secretions were collected at the time of tracheal intubation using visual laryngoscopy after exposing the glottis, and the pepsin content was determined using enzyme-linked immunosorbent assay to assess reflux (content of pepsin in supraglottic secretion >216 ng/ml) and micro-aspiration (content of pepsinin subglottic secretion >200 ng/ml), and arterial blood gas analysis was simultaneously performed.The apnoea time was recorded, and P ETCO 2 at the first mechanical ventilation after tracheal intubation were recorded. Results:Compared with group C, PaO 2 was significantly increased and CSA was decreased immediately after tracheal intubation, and the incidence of CSA greater than >3.4 cm 2 immediately after tracheal intubation was decreased, and the incidence of gastric insufflation, reflux and micro-spiration was decreased, apnoea time was prolonged, and P ETCO 2 at first mechanical ventilation was increased in group H ( P<0.05). Conclusions:THRIVE applied during induction of general anesthesia can reduce the occurrence of reflux and micro-aspiration while ensuring oxygenation in the patients undergoing laparoscopic cholecystectomy.

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pulmonary function in the patients undergoing robot-assisted radical resection of colon cancer.Method:Ninety-four patients of either sex, aged 50-80 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with ARISCAT grade of medium risk, undergoing elective robot-assisted radical resection of colon cancer, were enrolled in this study. The patients were divided into TEAS group (group T, n=47) and sham-TEAS group (group S, n=47) using a random number table method. In group T, patients received 30 min of TEAS at Hegu (LI4), Quchi (LI11), Zusanli (ST36) and Feishu (BL13) between 5: 00 and 7: 00 a. m. from 1st day before operation to 3rd day after operation, with disperse-dense wave 2/100 Hz, and the stimulation intensity was the maximum intensity that the patient could tolerate. Patients in group S were also connected to the device without electrical stimulation. Both groups adopted lung-protective ventilation strategy during operation. The oxygenation index was calculated at the time of entering the operating room (T 0), 5 min after anesthesia induction (T 1), 5 min of pneumoperitoneum (T 2), 5 min after changing to Trendelenburg position (T 3) and immediately after the end of pneumoperitoneum (T 4). Peak airway pressure, plateau airway pressure, driving pressure and dynamic lung compliance were recorded at T 0-T 4. The serum concentration of lung Clara cell 16 kDa protein was recorded using enzyme-linked immunosorbent assay at T 0, T 4 and 2 h after extubation (T 5). On 1 day before operation and 1, 3 and 7 days after operation, the forced expiratory volume in the first second (FEV 1) and forced vital capacity (FVC) were measured, and the FEV 1/FVC was calculated, and the concentrations of serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation were simultaneously determined using enzyme-linked immunosorbent assay. The occurrence of pulmonary complications within 7 days after operation was recorded. Results:There was no significant difference in pH values, PaCO 2, oxygenation index, peak airway pressure, plateau airway pressure, driving pressure, and dynamic lung compliance at each time point between the two groups ( P>0.05). Compared with S group, the serum Clara cell 16 kDa protein concentrations were significantly decreased at T 5, FEV 1 and FVC were increased at 3 and 7 days after operation, the serum tumor necrosis factor-alpha, interleukin-6 and cardiopulmonary resuscitation concentrations were decreased at 1, 3 and 7 days after operation, the incidence of unexpected oxygen supply and total incidence of postoperative pulmonary complications were decreased ( P<0.05), and no significant change was found in FEV 1/FVC at each time point in T group ( P>0.05). Conclusions:TEAS can improve lung function in the patients undergoing robot-assisted radical resection of colon cancer.