Objective To explore economic valuation of the minimally invasive esophagectomy.Methods The cases undergone esophagectomy were studied retrospectively.Monofactorial analysis was done to evaluate the impact of various factors on the overall hospitalization costs.The correlated factors then were used as independent variables to carry out the multiple linear regression aimed at the hospitalization costs.Results The results of monofactorial analysis showed that the accompanying diseases,days during hospitalization,modes of esophagectomy,postoperative complications were correlated factors of the overall hospitalization costs.According to the multiple linear regression,it were sorted based on descending order duing to its effect of largenning the hospitalization costs:postoperative complications (β =0.439,P =0.000),days during hospitalization (β =0.397,P =0.000),accompanying diseases(β =0.257,P =0.000),modes of esophagectomy(β =0.132,P =0.000).The expenses caused immediately by the operations were statistically more of the minimally invasive surgery than that of the open procedures whatever the numerous or proportion of the overall costs (P =0.000).Conclusion Combined thoracoscopic and laparoscopic esophagectomy was more expensive than open operation.Nevertheless,impact of the other factors,such as postoperative complications,were more significant than that of the different procedure.h was a strategy to minimally invasive osophagectomy that hospitalization costs could be reduced by means of controlling complications and diminishing hospitalization days.

Objective The aim of this study was to investigate the diagnostic value of the intravoxel incoherent motion (IVIM) for discriminating nonmetastatic from metastatic mediastinal lymph nodes in lung cancer.Methods IVIM was performed preoperatively on 66 patients with lung cancer during October 2015 to June 2016 in Capital Medical University Affiliated Beijing Chaoyang Hospital.Preoperative examination including the chest MRI scan,chest CT,head MRI,bone scan-ning and the cardiopulmonary function.None of the patients was undergone any kind of treatment about the cancer before the examinations,the neoadjuvant chemotherapy or radiation therapy,immunotherapy and gene targeted therapy were included.Measured the short axis diameter and the IVIM parameters of the mediastinal lymph nodes,apparent diffusion coefficient(ADC),diffusion coefficient(D),pseudo-diffusion coefficient(D *),and perfusion fraction(f).All the patients underwent the lobectomy or wedge resection and lymph node dissection or systematic sampling.By comparing the IVIM parameters of the nonmetastatic and metastatic mediastinal lymph nodes according to the pathological examination,draw the ROC curves to find the best cutoff value for diagnosis.And 42 cases were used to comparing the value of the MRI and CT in differential diagnosis.Results MRI measured 184 groups mediastinal lymph nodes,including 164 groups without metastasis,20 groups with metastasis.The ADC,D,D *,f values and short axis diameter of the nonmetastatic lymph nodes(n =164) were(2.880 ± 0.785) × 10-3 mm2/s,(0.670 ± 0.179) × 10-3 mm2/s,(0.383 ± 0.123) × 10-3 mm2/s,0.422 ± 0.119,(6.546 ± 1.932) mm,respectively,and (1.897 ±0.657) × 10-3 mm2/s,(0.472 ±0.210) × 10-3 mm2/s,(0.354 ±0.130) × 10-3 mm2/s,0.412 ±0.090,(7.510 ± 2.773) mm respectively for the metastatic lymph nodes (n =20).The ADC and D value of the nonmetastatic lymph nodes were significantly higher than the metastatic lymph nodes(P ＜0.01).While the other paraneters(D *,f,and short axis diameter) between the two groups did not show significantly different.Optimal cutoff values(area under the curve,sensitivity,and specificity) for distinguishing metastatic from nonmetastatic lymph nodes were as follows:ADC =1.890 × 10-3 mm2/s (0.871,92.7％,80.0％);and D =0.648 × 10-3mm2/s(0.740,70.0％,84.1％).Conclusion IVIM is useful to distinguish metastatic from nonmetastatic lymph nodes in lung cancer.The ADC and the D values are significant higher in metastatic lymph nodes,which more sensitive than the other parameters(D *,f,and short axis diameter).As a result,IVIM can be used in the N-stage diagnosis of lung cancer.

Objective To study the drug resistance of neonatal sepsis caused by Klebsiella pneumoniae and provide evidence for drug treatment. Method Retrospectively analysis was conducted on the clinical data and antibiotic resistance of Klebsiella pneumoniae in 50 neonates with sepsis. Results The majority of the 50 cases were infected in hospital. There were 13 ESBLs strains in 50 Klebsiella pneumoniae strains (26%), and the others were negative ESBLs starins (74%). All the strains were multidrug-resistance to the β-lactam antibiotics and only sensitive to few antibiotics such as Imipenem and Amikacin. The sensitive rate was 100%. Conclusions The first selected antibiotic for the treatment of neonatal sepsis caused by Klebsiella pnemoniae was Imipenem or Amikacin.

Objective To verify the accuracy of the mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer and explore predictive value of the mathematical model in the postoperative complications.Methods The retrospective case-control study was conducted.The clinicopatholo gical data of 192 patients with esophageal cancer who underwent esophagectomy in the Beijing Chaoyang Hospital of Capital Medical University between October 2013 and October 2016 were collected.Among 192 patients,160 didn't have postoperative complications and 32 had postoperative complications (7 with postoperative anastomotic leakage,9 with pulmonary infection and 16 with dysfunction of gastralintestinal tract).Patients selected the appropriate surgical procedures according to individual conditions,and then volume of gastrointestinal decompression was recorded daily.According to the regression equation of influencing factors of volume of postoperative gastrointestinal decompression:average daily drainage volume within 5 days (mL)=262.287 + 132.873 × tubular stomach-72.160 × smoking history-27.904 × pathological type of tumor-36.368 × age,predictive value of postoperative gastrointestinal decompression was calculated and compared with real volume of gastrointestinal decompression.Observation indicators:(1) comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients without complications;(2) comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients with complications.Measurement data with normal distribution were represented as (x)±s and comparison was analyzed using the pairedsamples t test.Measurement data with skewed distribution were described as M (range),and comparison was analyzed using the Wilcoxon signed rank tests.Results (1) Comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients without complications:predictive value and real volume of postoperative gastrointestinal decompression in 160 patients without complications were respectively 187 mL (range,58-392 mL) and 207 mL (range,20-570 mL),with no statistically significant difference (Z=-1.106,P＞0.05).(2) Comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients with complications:7 patients had postoperative anastomotic leakage,including 1 with cervical anastomotic leakage and 6 with chest anastomotic leakage.The predictive value and real volume of postoperative gastrointestinal decompression in 7 patients with anastomotic leakage were respectively (215±58)mL and (338± 106)mL,with a statistically significant difference (t=-3.139,P＜0.05).The predictive value and real volume of postoperative gastrointestinal decompression in 9 patients with postoperative pulmonary infection were respectively (176±61) mL and (239± 111) mL,with no statistically significant difference (t =-1.805,P＞0.05).The predictive value and real volume of postoperative gastrointestinal decompression in 16 patients with dysfunction of gastralintestinal tract were respectively (236 ± 60) mL and (357 ± 107) mL,with a statistically significant difference (t =-4.716,P＜ 0.05).Conclusions The mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer is correct and feasible.There is a predictive value for patients with postoperative anastomotic leakage and dysfunction of gastralintestinal tract.

Objective To investigate the clinical value of preoperative serum carcinoembryonic antigen (CEA) detection in the prediction of esophageal cancer lymph node metastasis.Methods The clinical data of 111 patients with esophageal cancer who were admitted to the Chaoyang Hospital of Capital Medical University between December 2010 and January 2014 were retrospectively analyzed.Patients received preoperative serum CEA examination and enhanced CT of the chest.The surgical procedures were selected according to the condition of patients, including radical resection of esophageal cancer via left thoracic approach, transabdominal right thoracic approach (open and laparoscopic surgeries), cervico-thoracic-abdominal triple incision (open and laparoscopic surgeries) and transabdominal incision.The international standard was used for tumor location and TNM stage of esophageal cancer.The count data and comparison of ordinal data in the univariate analysis were analyzed using the chi-square test, Fisher exact probability and rank-sum test, respectively.The multivariate analysis was done using the stepwise logistic regression.The ROC curve was used for evaluating diagnostic value of serum CEA examination and enhanced CT of the chest.All the 111 patients were divided into 4 groups according to the interquartile range results of the CEA examination, and the lymph node metastasis rates of 4 groups were compared by the chi-square test.Results All the 111 patients underwent successful radical resection of esophageal cancer after preoperative serum CEA detection and enhanced CT of the chest, including 40 via left thoracic approach, 56 via transabdominal right thoracic approach, 8 via cervico-thoracic-abdominal triple incision and 7 via transabdominal incision.There were 3 patients with upper thoracic esophageal cancer, 52 with middle thoracic esophageal cancer, 36 with lower thoracic esophageal cancer and 20 with cancer of gastro-esophageal junction.The postoperative pathological type included 84 squamous cell carcinomas, 23 adenocarcinomas and 4 other carcinomas.There were 44 patients with negative lymph node metastases and 67 with positive lymph node metastases.The positive rate of elevated serum CEA in the 111 patients was 36.04％ (40/111).Tumor location, pathological type and N stage of tumor were clinical pathological factors affecting the positive rate of serum CEA of patients (Z =6.815, 6.608, 16.928, P ＜0.05).N stage of tumor was an independent risk factor affecting the positive rate of serum CEA of patients by multivariate analysis [OR =2.206, 95％ confidence interval (CI) :1.370-3.552, P ＜ 0.05].The T stage of tumor and serum CEA level were risk factors affecting lymph node metastasis of esophageal cancer by univariate analysis (Z =18.971, x2=10.081, P ＜0.05), and those were also independent risk factors affecting lymph node metastasis of esophageal cancer by multivariate analysis (OR =3.558, 3.936, 95％ CI: 1.798-7.041, 1.480-10.469, P ＜0.05).The lymph node metastasis rates of esophageal cancer were 46.43％, 48.28％ , 55.56％ and 92.59％ when CEA level≤ 1.75 μg/L, 1.75 μg/L ＜ CEA level ≤ 2.68 μg/L, 2.68 μg/L ＜ CEA level ≤4.21 μg/L and CEA level ＞ 4.21 μg/L by the stratified analysis, respectively, with a significant difference among the 4 groups (x2=16.026, P ＜ 0.05).The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.687 (95％ CI: 0.590-0.785) and 0.689 (95％ CI: 0.591-0.788) by ROC curve, which were significantly different from the area under the guides (P ＜0.05).The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.785 (95％ CI: 0.697-0.873, P ＜ 0.05).Conclusions Serum CEA detection not only has certain predictive value for lymph node metastasis of esophageal cancer, but has a higher predictive value combined with enhanced CT of the chest.There is a risk of lymph node metastasis for patients with deep tumor invasion and elevated CEA level, and the range of lymph node dissection should be expanded.

Objective To extract the loci of murine MHC gene and construct plasmids.Methods The RNA of mice was extracted and reversely transcribed into cDNA.By using nested PCR,the products were connected with T vector,cloned,and sequenced.Subsequently,the genes were digested by endonucleases,connected with expression vector,and sequenced again to choose the correct clones.Results After the nested PCR,the products were approved by sequencing.After being connected with the vectors,they were approved again by sequencing and the correct clones were chosen.Conclusion All of the loci of the MHC gene can be obtained by nested PCR.The plasmids from the correct clone can be used in the further experiments of transferring the gene to mitigate the transplantation rejection.

ObjectiveTo discuss the clinical experience and influence factors of airway complications after lung transplantation for end-stage lung diseases through reviewed 28 lung transplantation cases in our center.MethodsFrom August 2005 to December 2010,28 patients with end-stage lung diseases received lung transplantations consecutively in our center,in which 13 patients were bilateral-lung transplantation(BLT) and 15 patients were single-lung transplantation(SLT).The donor lungs were perfused with LPD solution antegrade and retrograde followed.During operation,the pulmonary artery pressure and flow rate were tested real time through the transesophageal echocardiography and Swans catheter.Postoperative care of patients was in respiratory intensive care unit,and immunosuppressive drugs were adjusted according to blood drug concentration.ResultsThere were no airway complications including anastomotic fistula or stenosis found in all patients.The mortality was 7.2％ in the early postoperative period ( 1-30 days).Cumulative survival rate was 94.1％ ％ at 1 year,76.2％ at 2 years,and 71.4％ at 3 years respectively.Four patients (14.3％) died in the postoperative 90 days.Three patients were reanastomosed pulmonary artery in operation because of stenosis detected by transesophageal echocardiography.After operation,three patients were reoperated,in which two were bleeding and one was pulmonary bulla and pneumothorax.All patients were followed from 1 year to 6.1 years after operation.The quality of life was improved significantly.ConclusionThe well improved technique of lung transplantation is helpful to reduce the operation related complications,decrease the early mortality post operation and play the important role in the effects of quality of life and long term survival rate.The intraoperative transesophageal echocardiography examination could detect the anomalous situation of vascular anastomosis.At the same time the patients should get benefits from the routine and close follow-up.

At present,no consensus has been reached on the methods of dissection of lymph nodes in radical resection of esophageal carcinoma,especially the number and range of lymph node dissection after neoadjuvant therapy,and the sensitivity of the number of lymph node dissection to the pathological N stage after neoadjuvant therapy is low.Therefore,the significance of lymph node dissection needs to be further confirmed.The dissection of the chest lymph nodes is necessary,regardless of the method of lymph node dissection.According to the American Joint Commission for Cancer(AJCC)/Union for International Cancer Control(UICC)and the Japan Esophagus Society(JES)standards,Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer(2017 edition)puts forward the Chinese standard of the thoracic lymph node grouping of esophageal carcinoma in order to meet the practical needs of Chinese patients.

Objective: To investigate the current status of prevention and treatment of venous thromboembolism (VTE) after thoracic surgery in China. Method: Chinese thoracic surgeons were investigated by the online questionnaire which was based on the Chinese version of International VTE questionnaire added with 6 extra questions with Chinese characteristics. Results: A total of 1 150 valid questionnaires were retrieved, accounting for about 20% of all the Chinese thoracic surgeons. The surgeons participating in this survey came from all over the country, most of whom were experienced professionals with high academic titles.For lung cancer patients, 66.96% (770/1 150) of the surgeons suggested that VTE prophylaxis should start 1 day after lung cancer resection, and 64.61% (743/1 150) of the surgeons suggested extending after discharge. For esophagestomy patients, and 48.35% (514/1 063) of the surgeons suggested that there was no need for patients to extend VTE prophylaxis after discharge. More than half of the surgeons participating in this survey made decision of the method and duration of VTE prophylaxis after lung cancer resection (53.91% (620/1 150)) or esophagectomy (52.49% (558/1 063)) depending on the clinical experience.Low molecular weight heparin was the common choice of most surgeons in VTE prophylaxis. More than half of the surgeons thought that previous history of VTE, advanced age, complicated with thrombophilia, obesity (body mass index>30 kg/m²), duration of surgery longer than 6 hours and family history of VTE were key risk factors of the occurrence of postoperative VTE. Conclusions The results of this survey are highly credible and are a good reflection of the current status of VTE prevention and treatment after thoracic surgery in China. This survey will play an important role in promoting VTE prevention and treatment in Chinese thoracic surgery department, it will also provide data support for government setting new policies, hospital construction of VTE prevention and control as well as raising physicians′ awareness.

Objective To explore the distribution and clinical significance of HBV genotypes in patients with HBV infection in China. Method Serum samples were collected from 2922 patients with HBV infection. HBV genotyping was performed with type-specific primers polymerase chain reaction, and the virological and biochemical markers were detected, which differences in the genotypes distribution between various regions and liver function and virological markers between various HBV genotyping were analyzed. Result The genotype B, C, B + C, D of 2922 patients with HBV infection accounted for 15.9% , 83.5% ,0. 41%, 0. 21% respectively. In Northern China, genotype C was most prevalent, accounting for 90% of all cases, while it was less common in Southern China; genotype C was present in Zhejiang and Jiangsu provinces, but genotype B was comparatively more common in Guangdong, Hunan, Hubei, and Jiangxi provinces. B, C genotype HBV infection patients in the sex difference was not statistically significant; B genntypes compared with C genotype HBV infection patients, the average age of is less ( P <0.001 ) ;HBeAg positive rate of C genotype HBV infection patients are higher than that of B genotype ( P = 0. 023 ) ;Viral load of genotype C HBV infection patients is higher than that of genotype B ( P =0. 038 ) ;.Cholinesterase and Albumin levels of genotype C HBV infection patients are lower than that of genotype B ( Pvalues were 0. 016, < 0. 001 ). Conclusion There were HBV genotype B, C, B + C and D in Chinese patients with HBV infection, with genotype B and C being the major ones. Mainly in northern regions of genotype C, C genotype significantly reduced the southern region, some of the southern region dominated by B genotype. Genotype C HBV infection patients are older, and their HBeAg-positive rate is higher, and their liver damage is more severe, but their viral load is less.