Objective:To investigation for common hepatic cartery lymph node metastasis of esophageal squamous cell carcinoma.Methods:From 2015 to 2017, 413 patients with esophageal squamous cell carcinoma who were dissected the common hepatic cartery lymp node were admitted in Cancer Hospital of Sichuan. The relationship between metastatic of rates of common hepatic cartery lymp node and the clinical data including sex, age, tumor site, diameter of tumor, invasion depth, differentiation degree, pathological stage, neurovascular invasion status were reviewed retrospectively.Results:A total of 10 649 lymph nodes were dissected.The lymph node metastatic rate was 45.27%(187/413), and the metastatic lymph node ratio was 7.96%(848/10 649). Lymph nodes adjacent to the middle esophagus, cervical esophagus, cardia of stomach had a higher metastatic rate, while the Lymph nodes adjacent to the hilar, supraclavicular, common hepatic cartery had a lower metastatic rate.A total of 775 lymph nodes were dissected in common hepatic cartery.The lymph node metastatic rate was 7.02%(29/413), and the metastatic lymph node ratio was 4.51%(35/775). To analysis the relationship between metastatic of rates of common hepatic cartery lymp node and the clinical data.We conclusion that the common hepatic artery lymph node metastatic rates of upper, middle and lower esophageal squamous cell carcinoma were 2.89%(2/69), 5.35%(12/224) and 12.50%(15/120), with significant difference.The common hepatic artery lymph node metastatic rates of patients with diameter of tumor under 3 cm, 3-5 cm and above 5 cm were 5.20%(9/173), 5.52%(9/163)and 14.28%(11/77), with significant difference.The common hepatic artery lymph node metastatic rates of sex, age, tumor site, diameter of tumor, invasion depth, differentiation degree, pathological stage, neurovascular invasion status, with no significant difference.Conclusion:The metastatic rates of common hepatic artery lymph node in esophageal squamous cell carcinoma is lower. For the upper thoracic esophageal cancer with tumor diameter under 5 cm, the dissection of common hepatic lymph node can be ommitted in surgery.

Lipoxin A4 is an arachidonic acid metabolite,it is an important endogenous anti-inflammatory mediators in the body,which is known as an inflammatory braking signal. Inflammatory response is an important factor for causing cerebral ischemia-reperfusion injury.Lipoxin A4 can exert neuroprotective effects by inhibiting inflammatory response.In addition,lipoxin A4 can also reduce blood-brain barrier permeability,reduce cerebral edema,and promote recovery of neurological function.This article reviews the neuroprotective roles and mechanisms of lipoxin A4 in cerebral ischemia-reperfusion.

Objective To investigate the protective effect of lipoxin A4 on diabetic rats with focal cerebral ischemia-reperfusion and its mechanisms.Methods Thirty-six adult male Sprague-Dawley rats were randomly divided into a sham operation group,a cerebral ischemia-reperfusion group,and a lipoxin A4 group (n=12 in each group).Diabetes was induced by repeated intraperitoneal injection of low-dose streptozotocin.A model of middle cerebral artery occlusion and reperfusion was induced by the intraluminal suture method.Five minutes after cerebral ischemia,lipoxin A4 0.03 nmol/5 μ1 was injected via intracerebroventricular in the lipoxin A4 group.The other groups were injected equal volume of saline.Two hours after ischemia,the suture was pulled out and reperfusion was achieved.Neurological deficit scores were performed at 24 hours.Then the rats were decapitated and their brains were taken out.2,3,5-triphenyl tetrazolium chloride (TTC) staining was used to detect infarct size.Western blotting was used to detect the expression of cortical tumor necrosis factor-α (TNF-α) and nuclear factor-κB (NF-κB).Results The neurological deficit score showed that no neurological deficit was observed in the sham operation group (score 0).The neurological deficit score in the lipoxin A4 group was significantly lower than that in the cerebral ischemia-reperfusion group (2.20 ± 1.03 vs.3.20 ± 1.03; P ＜0.05).TTC staining showed that no infarct was observed in the sham operation group.The infarct size in the lipoxin A4 group was significantly lower than that in the cerebral ischemia-reperfusion group (27.52％ ± 5.71％ vs.55.45％ ± 9.29％ ; P ＜0.05).Western blotting showed that the expression levels of TNF-α in the sham operation,cerebral ischemiareperfusion,and lipoxin A4 groups were 0.64 ± 0.16,1.85 ± 0.52,and 1.40 ± 0.34,respectively.There were significant differences among the 3 groups (F =18.868,P ＜0.001).The expression level of TNF-α in the lipoxin A4 group was significantly lower than that in the cerebral ischemia-reperfusion group (P ＜0.05).The expression levels of NF-κB in the sham operation,cerebral ischemia-reperfusion and lipoxin A4 groups were 0.79 ±0.24,2.09 ± 0.47,and 1.27 ± 0.35,respectively.There were significant differences among the 3 groups (F =16.736,P ＜ 0.001).The expression level of NF-κB in the lipoxin A4 group was significantly lower than that in the cerebral ischemia-reperfusion group (P ＜0.05).Conclusions Lipoxin A4 has certain protective effect on focal cerebral ischemia-reperfusion injury in diabetic rats,its mechanism may be associated with the inhibition of the expression of TNF-α and NF-κB.

Objective To investigate the roles of tumor necrosisfactor-α(TNF-α) and nuclear factor-κB (NF-κB) in cerebral ischemia-reperfusion injury in rats w ith diabetes mel itus. Methods Thirty-six healthy male Sprague-Daw ley rats w ere divided into a euglycemic sham operation group, a euglycemic isc hemia-reperfusion group, and a diabetes ischemia-reperfusion group (n=12 in each group) according to a random number table. A diabetes model w as induced by intraperitoneal injection of streptozotocin, and then a focal cerebral ischemia-reperfusion model w as induced by the suture method. The neurological deficit score was performed at 24 h after reperfusion. 2,3,5 triphenyl tetrazolium staining was used to measure the cerebral infarction area. Western blotting w as used to detect the expression levels of NF-κB and TNF-αon the ischemic sides. Results The neurological function scores w ere 0.00 ±0.00, 2.50 ±1.08, and 3.20 ± 1.03, respectively in the euglycemic sham operation, euglycemic cerebral ischemia-reperfusion and diabetes cerebral ischemia-reperfusion groups, and there w ere significant differences (F=38.015, P<0.001). The neurological deficit scores of the diabetes cerebral ischemia-reperfusion group w ere significantly aggravated compared with the euglycemic cerebral ischemia-reperfusion group (P<0.05). The infarct areas of the euglycemic sham operation, euglycemic cerebral ischemia-reperfusion and diabetes cerebral ischemia-reperfusion groups w ere 0.00% ±0.00%, 33.09% ±5.17%, and 55.45% ±9.29%, respectively, and there w ere significant differences among the groups (F=206.614, P<0.001), in w hich the infarct area in the diabetes cerebral ischemia-reperfusion group w as enlarged significantly compared w ith the euglycemic cerebral ischemia-reperfusion group ( P< 0.05 ). At 24 h after reperfusion, there w ere no significant differences in the expression levels of the cortical NF-κB (F=29.993, P<0.001) and TNF-α(F=28.722, P<0.001) on the ischemic sides in each group, in w hich the expression levels of NF-κB and TNF-αin the diabetes cerebral ischemia-reperfusion group w ere increased significantly compared w ith the euglycemic cerebral ischemia-reperfusion group (al P<0.05). Conclusions Diabetes may aggravate cerebral ischemia reperfusion injury. The upregulated expression of TNF-αand NF-κB may be one of the mechanisms of diabetes aggravating cerebral ischemia-reperfusion injury.

Objective To compare the ameliorating effect of collagen peptide chelated calcium (CPCC) and estrogen on the bone quality in ovariectomized rats in order to serve the development of safe drugs for prevention of osteoporosis (OP).Methods Bilateral ovariectomized rats were divided into ovariectomized group (OVX),sham group,17β-estradiol injection group (OVX+E2) and CPCC gavage group (OVX+CCCP).Bone and serum indices of these groups were assessed and compared at 9 weeks after treatment.Results Bone density of the OVX group was significantly lower than the sham group (P<0.01),indicating that the rat OP model was successfully established.Like estrogen,CPCC inhibited the abnormal changes of all indices and maintain similar levels with those of the sham group (P>0.05),while the body weight gain of the E2 group at weeks 8 and 9 was significantly lower than those of the sham group (P<0.01).As regarding the prevention of bone loss,the Mg and Ca levels of the E2 group were significantly lower than those of the moderate and high dose CPCC groups.The Cu level was not significantly different compared with the sham group,while those in the moderate and low dose CPCC groups were significantly higher than the sham group.The Mn,Zn and hydroxyproline levels of the E2 group were significantly lower than those of the sham group,while the CPCC group maintained levels similar to that of the sham group.In regarding to the inhibiting effect on the increased blood BGP and StrACP,the E2 group was still maintained at levels similar to that of the OVX group,while those of the CPCC group were significantly lower than the OVX group.As regarding the decreased blood Ca,the E2 group was not significantly different with that of the OVX group,while that of the CPCC group was significantly higher than the OVX group.Conclusions CPCC is more effective than estrogen in ameliorating the bone quality of ovariectomized rats.

Objective To summarize the experience of single incision thoracoscopic surgery (SITS),and to explore its feasibility and safety for treating thoracic diseases.Methods The clinical data in 186 cases of SITS in our hospital from August 2014 to March 2016 were retrospectively analyzed.Local lesion resection was performed in 171 cases and pulmonary lobectomy in 15 cases.Results The average operation time in local lesion resection was 46(10-75)min and average blood loss amount was 23(5-65)mL;11 cases were converted to double holes during operation and 6 cases converted to three holes;the average postoperative hospitalization stay was 4.7(3-9)d.The average operation time in the cases of pulmonary lobectomy was 152(95-215)min and average blood loss amount was 96(60-195)mL;2 cases converted to double holes during operation and 2 cases converted to three holes during operation;the average postoperative hospitalization stay was 6.7(5-9)d.No perioperative death or severe complications were observed in all cases.Conclusion SITS for treating thoracic diseases is safe,reliable and beautiful with little complications,less trauma and faster recovery.

BACKGROUND: Dynamic hip screw (DHS) is a standard internal fixation for intertrochanteric fracture, whereas the patient combined with osteoporosis, cut-out incidence of lag screw is common. The articles in China and abroad indicate bone cement augmentation of DHS to achieve firm fixation. As for normal bone, no reports is published that whether bone cement augmentation is effective.OBJECTIVE: To investigate the biomechanics of DHS with bone cement augmentation for the fixation of intertrochanteric fracture specimen that has a normal bone density.DESIGN, TIME AND SETTING: Bilateral contrast observation study of the same sample was performed in the Laboratory of Biomechanics, Hebei Orthopaedic Research Institute (Shijiazhuang, Hebei Province, China) between March and April In 2005.MATERIALS: Bilateral upper femora from the embalmed male cadaver were provided by Anatomy Department of Hebei Medical University (China). X-ray scan results proved the absence of tuberculosis, anatomical deformity and tumor.METHODS: Twenty-four matched pairs of the upper femora (48 sides) were used to make the specimens of the intertrochanteric fracture of type A2. The right femur specimens were fixed with DHS augmented by bone cement, as the augmentation group (The screw track of femoral neck was expended by curette, and the femoral head facing upwards were injected with 2mL low viscosity bone cement. Then lag screw was wrested to keep the position unchanged till the bone cement coagulated. Placing barrel, compressing through tighten tail screw, and cortical screw fixing side-plate were. followed). And the left femur specimen was fixed with DHS conventional fixation, as the control group. The bending and torsional tests were performed in the two groups.MAIN OUTCOME MEASURES: The maximum load and the maximum torque in the two groupsRESULTS: The maximum load and the maximum torque were (3852.1602±143.6031) N and (15.5+2.6) Nm in the augmentation group, and (3702.9667±133.8601) N and (14.7±3.4) Nm in the control group. There was no significant difference in the biomechanical effects between the two groups (P>0.05).CONCLUSION: The augmenting fixation with bone cement for intertrochanteric fracture specimen has no significant effect on the strength of DHS fixation or on the overall stability of the fractured bone in normal bone density.

ObjectiveTo explore the effect of different nutritional support mdoes on humoral immunity and outcomes after esophagectomy in patients with esophageal carcinoma.MethodsForty-six patients with middle or low thoracic esophageal carcinoma underwent Ivor Lewis esophagectomy.The patients were randomized into enteral nutrition group ( EN,n =23 ) and enteral combined parenteral nutrition group ( EN + PN,n =23 ) based on the nutrition support modes.Serum levels of immunoglobulin (IgG,IgA,IgM,IgE,κ/λ light chain) and comphments (C3/C4) were assayed and compared on the 1st pre-operative day and at 18 hours as well as 3rd and 7th day after operation.The clinical outcomes including infection-related complications and hospital stay were compared between two group s.ResultsThere was no significant difference in all humoral immunity indicators between two groups at the eachpost-operative time point.In both two groups,the levels ofIgG [ (8.90 ± 1.75),(7.53 ±1.41) g/Land (8.64±2.44),(7.48±2.16) g/L],κ [ (2.14±0.46),(1.78±0.41) g/L,and (2.15 ±0.63),( 1.86 ± 0.62) g/L] and λ light chain [ ( 1.34 ± 0.45 ),( 1.11 ± 0.31 ) g/L and ( 1.20 ± 0.32),( 1.08 ± 0.35 ) g/L] were significantly lower 18 hours and 3rd day after operation than the pre-operative levels [ (12.15±2.86)and (11.11±2.96) g/L,(2.90±0.77) and (2.77±0.79) g/L,(1.79±0.57) and (1.56±0.41) g/L] (P=0.000,P=0.000,and P=0.004,P=0.000,and P=0.000,P=0.000,and P=0.011,P=0.000,and P=0.004,P=0.000,and P =0.008,P =0.000),and returned to the preoperative levels by the postoperative 7th day (P＞0.05),except for the level of κ light chain 7th day after operation in EN group [ ( 2.42 ± 0.69) g/L] ( P =0.027 ).The levels of IgA,IgE,and C3 were not significantly different during the perioperative period ( P ＞ 0.05 ).The level of IgM was not significantly different during the perioperative period in EN group (P ＞0.05),and was significantly lower on the 3rd post-operative day [ ( 1.00 ±0.53) g/L] than the pre-operative level [ ( 1.47 ±0.76) g/L] in the EN + PN group (P =0.031 ),and were not significantly different on the other time points (P ＞ 0.05 ).In the EN group,the C4 level was significantly lower at the postoperative 18 hours [ (0.24 ±0.08) g/L] than the pre-operative level [ (0.37 ±0.36) g/L] (P =0.030),and were not significantly different at the other time points ( P ＞ 0.05 ).In the EN + PN group,the C4 level was not significantly different during the perioperative period ( P ＞ 0.05 ).There was no significant difference in the infection-related complications and hospital stay between these two groups ( P =0.300,P =0.371 ).ConclusionsThe effects of EN or EN + PN on humoral immunity and outcomes after esophagectomy in patients with esophageal carcinoma are not different.Both these two nutritional support modes can not completely alleviate the harm to the humoral immunity.The EN is more cost-effective.

The application of minimally invasive esophagectomy in the treatment of esophageal carcinoma has drawn much attention. At present, results of quite a number of clinical researches show that minimally invasive esophagectomy is helpful to reduce trauma and complications of esophageal surgery, especially cardiopulmonary complications with shorter length of hospital stay. However, there are still controversies on resection extent, lymph node dissection and survival as compared to traditional open esophagectomy. This paper discusses the minimally invasive esophagectomy on the telescopic esophagectomy of primary lesion, lymph node dissection and survival based on the worldwide reports of telescopic esophagectomy researches.
Carcinoma ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Length of Stay ; Lymph Node Excision ; Minimally Invasive Surgical Procedures ; Postoperative Complications

Background and purpose: Postoperative chemotherapy targets the metastatic cancer in the remaining lymph nodes, but the heterogeneity in multidrug resistance (MDR) of metastatic cancer cells is a main factor affecting chemotherapeutic efficacy. Recent studies only examined the primary lesion of esophageal squamous cell carcinoma(ESCC). There is no report about heterogeneity between the primary tumor and metastases lymph node. The purpose of this study was to explore the heterogenous expression and clinical signiifcance of multidrug resistance (MDR) associated proteins in primary tumors and metastatic lymph nodes in patients with thoracic ESCC. Methods:The expressions of lung cancer associated resistance protein (LRP), P-glycoprotein (P-gp), topoisomeraseⅡ(TOPO-Ⅱ), thymidylate synthase (TS), glutathione S-transferase-π (GST-π) were examined by immunohistochemistry in primary lesions and corresponding metastatic lymph nodes in 54 patients with thoracic ESCC. The differences between expression of primary lesions and matched metastatic lymph nodes were compared and analyzed in relationship with tissue differentiation degree. Results: The discordant rates of the expression and drug resistance between primary lesions and corresponding metastatic lymph nodes in LRP, P-gp, TS, TOPO-Ⅱ and GST-π were 63.0% and 26.9%, 42.6%and 22.2%, 48.1%and 25.9%, 50.0%and 29.6%, 18.5%and 1.9%respectively. The expression of LRP showed signiifcant difference between the primary tumors and lymph nodes (P=0.026). No signiifcant differences were found for the other four proteins, and GST-πwas expressed in all patients in both the primary tumors and lymph nodes. Protein expression was not associated with degree of differentiation. Conclusion:There is evident of heterogenous expression of MDR associated proteins in metastatic lymph nodes compared to the primary tumors of ESCC. The examination of expression levels of MDR associated proteins in metastatic lymph nodes is helpful to select the postoperative rational chemotherapy plan.