Objective To evaluate the practicability of video-assisted thoracoscopic lower esophageal myotomy in the treatment of achalasia. Methods A series of 21 consecutive patients with achalasia received video-assisted thoracoscopic lower esophageal myotomy between June 1997 and June 2005. The operation was performed under general anesthesia with double-lumen endotracheal intubation. The patient was positioned in the right lateral decubitus. Four thoracoscopic ports were introduced into the left hemithorax. A 6~11 cm incision at the lower esophageal sphincter with an extension to the gastric wall for 0.5~1 cm in length was made, to the depth of the submucous layer. A flexible gastroscope was inserted to check the integrity of the esophageal mucosa intraoperatively. No anti-reflux procedures were conducted. Results All the procedures were accomplished smoothly. The intraoperative hemorrhage volume was 50~100 ml (mean, 58 ml) and the operation time, 60~270 min (mean, 137 min). Esophageal mucosal perforation occurred in 3 patients, in 2 of whom the perforation was repaired thoracoscopically and in 1 of whom, through open thoracotomy. All the patients were recovered uneventfully, without severe complications. Follow-up checkups for 1~80 months found recurrence of dysphagia in 2 patients at 2 and 4 months after operation, respectively. Out of the 21 patients, the relief of dysphagia was classified as “excellent” results in 8 patients, “good” in 10 patients, “fair” in 1, and “poor” in 2, respectively. Conclusions Video-assisted thoracoscopic lower esophageal myotomy is a surgical approach with simple performance, minimal invasion, quick recovery and good efficacy. It can be employed as the first of choice for the management of achalasia.

Objective To assess the usefulness video-assisted mediastinoscopy (VM) for diagnosis of disease characteristic with mediastinal mass. Analyze the correlations of clinical features of the disease with the pathologic diagnosis. Methods Between July 2000 and March 2006, 97 undiagnosed patients with mediastinal mass in chest radiography underwent biopsy of mediastinal lesions by either cervical mediastinoscopy (n=69) or parasternal mediastionoscopy (n=28). We also analyzed the correlation of symptoms, location and extent of the lesion with the pathologic diagnosis. Results All 97 patients recovered smoothly without postoperative complications. Histologic diagnosis was obtained in 96 patients. Patients with hoarse, dysphagia and superior vena cava obstruction syndrome indicate malignant lesions (26/26). The most common diseases in the super-anterior mediastinum are lymphoma(7/19), thymoma(4/19) and small cell lung cancer(SCLC) (4/19);The most common disease in the middle mediastinum are metastasis of non small cell lung cancer(11/37), sarcoidosis (9/37)and SCLC(7/37); The most possible disease involved both mediastinum and lung hilar lymph-node are scalerdosis(32/41) and SCLC(5/41). Conclusion Mediastinoscopy is effective and safe methods to establish a histologic diagnosis in patients with mediastinal mass. It is possible to make primary evaluation on some of these patients according to the typical symptoms and location, extent of the mass involvement.

Objective To elucidate the molecular basis for induced resistance of N. gonorrhoeae to ceftriaxone in vitro. Methods The reference strain ATCC49226 and clinical isolate ZSSY00205 of N. gon-orrhoeae were exposed to subinhibitory concentration of ceftriaxone for the induction of resistance. Then,suppression subtractive hybridization was performed with the pre-induction parent strains as drivers and post-induction mutant strains as testers to create a subtractive cDNA library. Following that, a total of 192 clones were randomly selected from the library, and arrayed by spotting onto nylon membranes. Finally, dif-ferentially expressed genes were screened by hybridization with labeled-RsaI restriction fragments from the sensitive and resistant N.gonorrhoeae strains respectively, and analyzed by sequencing and homology research using Blast program. Results A subtractive library for these resistant N.gonorrhoeae strains was generated by SSH technique. Microarray analysis and homology research confirmed 5 genes related to ceftriaxone resistance, i.e. mtrR, mtrC, gyrB, rpsJ and PJD1. Conclusions The induced resistance of N. gonorrhoeae to ceftriaxone may be associated with mtrR, mtrC, gyrB, rpsJ and PJD1 genes which probably mediate the resistance by enhancing the activity of efflux pump system.

Objective To explore the clinical new ways to repair the soft tissue defect of upper lip.Methods The soft tissue defect of upper lip caused by various reason were repaired with the buccal region of nasolabial groove flap.The size of flap was designed based on the range of soft tissue defect and located in the buccal region along nasolabial groove.The maximum scale of flaps between the length and width were 2∶1 and slit to the SMAS layer.The soft tissue defect of upper lip was repaired by direct vicinity aversion of the flap.The wound after the flap diversion was direct sut in favour of propulsion of the flap and relief the tension of flap pedicle.Results The flaps completely survived in 15 cases without obviously scar accrementition.The cosmetic result were satisfactory.Conclusion The buccal region of nasolabial groove flap is characterized by simple designation,easy dissection,reliable blood supply with the vascular net of fascia without well-known blood vessel damaged and repaired by direct vicinity aversion.Therefore,it is an ideal new method to repair the soft tissue defect of upper lip.

Objective To evaluate the diagnostic value of the early rheumatoid arthritis (RA) classification criteria for early RA and to assess the clinical efficacy of knee arthroscopic synovectomy for RA.Methods A total of 62 patients who had arthritic complaints with disease duration less than one year were treated with knee arthroscopic synovectomy.Patients were diagnosed as RA confirmed by changes of synoviomorphous under arthroscopy,synovial biopsy,immunological biochemical laboratory and MRI,and compared with the preoperative ERA diagnosis.The efficacy was assessed at the third months and more than 12 months after operation,including Health Assessment Questionnaire (HAQ),Lysholm score,laboratory parameters of erythrocyte sedi-mentation rate (ESR) and C-reactive protein (CRP).Results The sensitivity and specificity in the early RA classification criteria for RA diagnosis were 81.58％ and 91.67％.38 patients diagnosed as RA and the remaining 24 patients were significantly improved of HAQ,Lysholm score,ESR,CRP compared with preoperation,showed statistical difference (P ＜ 0.01).There were still statistical differences between the follow-up results of the group of patients with RA in different period after operation (P ＜ 0.01).Conclusion The early RA classification criteria is worthy of clinical application,because it has the advantages of simple,practical,and is beneficial to early diagnosis of RA.The early RA patients should be treated with knee arthroscopic synovectomy as far as possible.It can improve not only the knee function,but also the general symptoms,and it can interrupt the RA pathological process,effective maintain curative effect after operation.

Objective To evaluate the clinical efficacy and safety of a fractional bipolar radiofrequency device for the treatment of wrinkles of the face and neck.Methods This study enrolled 39 volunteers (including 37 females and 2 males aged 35-60 years) with Fitzpatrick skin type Ⅳ-Ⅴ and Fitzpatrick wrinkle scale score of 4-6.All the subjects received three sessions of treatment with a fractional bipolar radiofrequency device at intervals of 4-6 weeks.Follow-up visits were scheduled at one month after each treatment session for evaluation of efficacy (using standardized photography),subjective satisfaction and adverse effects.Results After three sessions of treatment,all the subjects experienced a significant decrease in Fitzpatrick wrinkle scale compared with baseline values,and wrinkle improvement score increased with the increase in treatment sessions.The Fitzpatrick wrinkle scale score for forehead wrinkles,glabella wrinkles,fishtail lines and neck wrinkles in these subjects after three sessions of treatment significandy differed from that before treatment (all P ＜ 0.01).Significant differences were also observed in the wrinkle improvement score for forehead wrinkles between these subjects after two sessions and one session of treatment (P ＜ 0.01),and observed in that for glabella wrinkles,fishtail lines and neck wrinkles between these subjects after three sessions and one session of treatment (P ＜ 0.05 or 0.01).Side effects were mild with no significant downtime.Conclusion Fractional bipolar radiofrequency may be a safe and effective option for the treatment of wrinkles of the face and neck in individuals with Fitzpatrick skin type Ⅳ-Ⅴ.

Objective To investigate the prevalence of hyperglycemia in patients with primary aldosteronism.Methods Thirty two patients diagnosed as primary aldosteronism(PA) in our hospital from 2010 to 2013 (PA group),and 40 patients as essential hypertension (EH group).Two groups were measured and compared,including blood pressure,plasma aldosterone,urine aldosterone,and plasma potassium.Oral glucose tolerance test (OGTT) was performed and homeostasis model assessment-insulin resistance index(HO-MA-IR) were calculated.Results The prevalence of hyperglycemia was 43.75％ in PA group,including 25％ patients of glucose intolerance and 18.75％ patients of diabetes mellitus,which was significantly higher than those of EH group (25％,12.5％,and 12.5％,respectively).PA group's fasting and 2-hour postprandial insulin levels and insulin resistance index were higher than that of EH group.Conclusions The present study indicated that patients with PA had a significantly high prevalence of glucose metabolism disturbance and insulin resistance.Screening test should be performed and avoid missed diagnosis.

Objective To investigate the expression of histone acetylated H3 and H4, methylated H3K4 and H3K9 in diffuse large B-cell lymphoma (DLBCL). Methods The expression of histone acetylated H3 and H4, methylated H3K4 and H3K9 were examined by SP immunohistochemistry technique in lymphoid tissue of 40 cases with DLBCL and 16 cases with proliferative lymphadenitis. Results The expression of histone acetylation of H3 and H4 were lower than that in proliferative lymphadenitis. Histone methylated H3K4 was lower in expression and H3K9 was in higher expression. There was a positive correlative expression between the global histone acetylation of H3 and H4, the global histone acetylation of H3, H4 and histone methylation of H3K4. Conclusion Improper modification of histone acetylations and methylations may play an important role in pathogenesis in DLBCL.

BACKGROUND:Because of osteoporosis, short-segment transpedicular fixation or screw-rod system fixation is prone to screw loosening depending on its poor anti-pul-out strength in patients with thoracolumbar fracture with ankylosing spondylitis.
OBJECTIVE:To probe the clinic outcomes of multi-segment transpedicle spinal fixation for thoracolumbar fractures with ankylosing spondylitis.
METHODS:Eleven patients with ankylosing spondylitis combined with thoracolumbar fracture in the Fourth Department of Orthopedics, Meizhou Hospital, Sun Yat-sen University, China from January 2009 to December 2012 were selected. Al the patients underwent posterior reduction and multi-segment transpedicle spinal fixation, among whom, six cases were subjected to internal fixation through the pedicle of fractured vertebra.
RESULTS AND CONCLUSION:Al of the 11 patients were fol owed up for 13 to 36 months. Solid bone healing was achieved in al of the patients, and there were no complications related to the internal fixation systems such as loosening or breakage. Three cases of spinal cord injury achieved Frankel’s class E from class C recovery. Lumbodorsal pain rate achieved 100%according to the Japanese Orthopaedic Association scoring. Results confirmed that it is effective to treat thoracolumbar fractures with ankylosing spondylitis by posterior reduction and multi-segment transpedicle spinal fixation. Strong internal fixation and fracture union can be achieved by operation.

In recent years, Shenyi Capsule has been proven to have certain anti-angiogenic effects, and to be effective to many cancers, but its effects on advanced esophageal cancer are scarcely studied.