ObjectiveTo compare the outcomes and safety of 23G and 20G vitrectomy for treatment of infectious endophthalmitis.MethodsThis was a retrospective case study.Sixty-seven eyes of 67 eyes suffering from infectious endophthalmitis with a history of trauma or intraocular operation history were enrolled in this study.They were diagnosed by the examinations of best corrected visual acuity,intraocular pressures,slit lamp microscope,indirect ophthalmoscopy,B-scan ultrasound and CT.There were 49 males (49 eyes) and 18 females (18 eyes).The patients aged from 18 to 72 years with a mean age of (43±13)years.There were 60 patients (60 eyes) with a history of trauma,7 patients (7 eyes) with intraocular operation history.The patients were enrolled into 20G vitrectomy group (35 patients,35 eyes) before December,2009 and 23G vitrectomy group (32 patients,32 eyes) after January,2010 when 23G vitrectomy system was imported in this hospital.Vitreous purulence was taken in all patients at the beginning of the surgery for bacteria and fungal culture and drug sensitivity test. A standard vitrectomy with artificial posterior vitreous detachment followed by internal limiting membrane peeling,and (or) intraocular laser photocoagulation,cryocoagulation,fluid-air exchange with intraocular silicone oil or gas tamponade were performed in all eases.Broad-spectrum antibiotics and glucocorticoids were used systematically for one week after surgery,but glucocorticoids were not used for fungal infections.The follow-up was ranged from two to nine months with a mean of (7 ± 1) months.The surgical time,inflammation situation,visual acuity,intraocular pressure, retinal reattachment rare,iatrogenic retinal hole rate, bulbar conjunctiva scar formation rate,reoperation rate and eye retention situation before and after surgery were comparatively analyzed.ResultsThe mean surgical times were (126 ± 12) and (89 ± 12) minutes in 20G and 23G group,which was significantly different (t=3.125,P＜0.05).The major surgery complications were ora serrata dialysis and other iatrogenic retinal breaks,and were occurred in 34 eyes,including 30 eyes (85.71％) in 20G group and 4 eyes (12.50％) in 23G group (x2 =35.85,P＜0.05).These 4 eyes in 23G group received foreign body removal surgery previously.The inflammation was controlled in 65 eyes (97.01％) including 34 eyes (97.14％) and 31 eyes (96.88％) in 20G and 23G group respectively,which was not significantly different (x2=0.004,P＞0.05).At last follow-up,There was no statistical difference of visual acuity between the two groups (t=3.12,P＞0.05).Fourteen eyes underwent silicone oil tamponade including 13eyes (37.14％) and 1 eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=11.703,P＜0.05).Nine eyes underwent reoperation (13.43％),including 8 eyes (22.86％) and 1eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=5.597,P＜0.05).The 8 re-operated eyes in 20G group included 1 eye of recurrent endophthalmitis and 7 eyes with retinal detachment,the 1 re-operated eye in 23G group was of recurrent endophthalmitis.There was significantly different (x2=7.147,P＜0.05) for the rate of retinal detachment between the 2 groups.There were 40eyes with bulbar conjunctiva scar including 35 eyes (100.00％) and five eyes (15.63％) in 20G and 23G group.Conclusion 23G vitrectomy is an effective treatment for infectious endophthalmitis with shorter surgery time,lower reoperation rate,lower retinal reattachment rate and fewer bulbar conjunctiva scar.

Objective To investigate the remote effects of epidermal growth factor(EGF)and early removal of eschar combined with skin grafting for the treatment of skin lesion produced by mustard gas.Methods A 3-year follow-up survey was condueted in 39 patients with skin lesion produced by mustard gas.The condition of healing was observed and evaluated.Results Good epithelial healing with pigmentation was observed in all the surveyed patients,and only in a few of them showed local recurrence of wound.Itching and paresthesia in the wounded parts were the main complaints.The sequelae remained unpredictable.Conclusion The early use of epidermal growth factor and early removal of eschar followed by skin grafting for the treatment of skin lesion produced by mustard gas may achieve satisfactory therapeutic effect.

0.05).The effectual time for pain relief was2～17days(4.1days in av?erage).Serum calcium level declined after treatment and reduction of bone radioactive isotope collection was found in34pa?tients.The follow-up periods ranged from3months to30months.Fratures were found only in two patients.CONCLUSION:Domestic pamidronate disodium has satisfactory therapeutic effect on postoperative bone metastasis of non-small cell lung cancer.

Objective To summarize the early experience of thymectomy by robot-assisted thoracoscopic surgery (RATS) with the da Vinci S Surgical System.Methods A total of 16 patients was underwent thymectomy from October 2016 to May 2017 by RATS.Among them,there were 10 cases of thymic hyperplasia,5 cases of thymoma and 1 case of thymic small cell carcinoma,including 11 cases of myasthenia gravis (MG).The Osserman types were as follows:type Ⅰ (5),type ⅡA (3),type ⅡB (2),and type Ⅲ (1).Clinical data were collected and analyzed.Results The operations were successfully accomplished by RATS in all the 16 patients without any conversion to open surgery and major complication.The docking time was 2-45 (11.69 ± 11.03) min.The operation time was 47-152 (84.06 ± 25.67) min.The blood loss was 0-150 (57.50 ± 37.32) ml.The diameter of thymus or tumor was 4-19.5 cm and (8.22 ± 3.64) cm.Fourteen cases were removed tracheal intubation in the operation day,and the other 2 cases taked off in 6th and 8th days.One case occurred myasthenia gravis crisis after surgery.All patients were followed up for 2-7 months after discharge without MG recurrence.Conclusions The da Vinci S Surgical System can be safely,accurately and stably used for thymectomy.

Objective Summing up and analyzing outcome and influencing factors following thymectomy in patients with ocular myasthenia gravis tries to provide clinical evidence for an option of the treatment modalities.Methods From May 2007 to November 2014,thymectomy was performed in 129 patients with ocular myasthenia gravis consisting of 110 patients by Video-assisted thoracoscopic surgery(VATS) and 19 by partial sternotomy.Follow-up information was obtained by outpatient visit and telephone contact.The outcome evaluation after thymectomy was classified into full remission,partial remission,unchanged and deteriorated.Statistical analysis was done using x2 test and Cox regression model.Results There was no perioperative death.Seven(5.4％) postoperative complications occurred and cured after treatment.Follow-up was complete in 123 patients(95.3％) and the mean duration of follow-up was 49(range 21-99) months.Surgical outcome revealed full remission in 40 patients,partial remission in 68,unchanged in 9 and deteriorated in 6 patients.Response(full remission and partial remission) rate was 87.8％ and no benefit(unchanged and deteriorated) rate was 12.2％.Four of 6 patients in deteriorated condition progressed into generalized myasthenia gravis(3.3％).The significant difference was noted in 24 months or less of preoperative clinical duration (P =0.004) and thymic hyperplasia (P =0.001) in postoperative pathology among the full remission,partial remission and no benefit group.On the other hand,there was no statistical difference in sex,age,symptoms,comorbidities,preoperative taking acetylcholinase inhibitor,corticosteroid,surgical approach,and associated thymona among the three groups.Multivariate Cox regression analysis also demonstrated that a preoperative duration of symptoms 24 months or less and postoperative histology being thymic hyperplasia favourably influenced the outcome.Conclusion The role of thymectomy in patients with ocular myasthenia gravis can relieve symptoms effectively and avert or decrease the potential development of generalized symptoms.Thymectomy,which has a low postoperative mortality and morbidity,may be a first-line option of the therapeutic armamentarium to treat ocular myasthenia gravis.Thymectomy via VATS has clinical advantages of minimal trauma,less pain,fast recovery,and the comparable clinical results over via the traditional sternotomy.Therefore,this procedure deserves to be advocated for ocular myasthenia gravis.

Objective To investigate the promotion effect of human transcriptional positive cofactor 4 (PC4) overexpression on lymphatic metastasis in lung adenocarcinoma .Methods 96 samples of lung adenocarcinoma tissue were collected .The immuno‐histochemistry(IHC) and real‐time quantitative polymerase chain reaction (qRT‐PCR) were adopted for detecting the expression levels of PC4 protein and mRNA .The correlation of PC4 expression with lymphatic metastasis and TNM stage was analyzed .Re‐sults The expression of PC4 protein was positively correlated mRNA in lung adenocarcinoma (r=0 .63 ,P<0 .01);the expression of PC4 protein was positively correlated with lymph node metastasis (χ2 =8 .29 ,P<0 .01) and TNM stage (χ2 =4 .71 ,P<0 .05);the expression of PC4 mRNA was also positively correlated with lymph node metastasis (χ2 = 8 .40 ,P< 0 .01) and TNM stage (χ2 =5 .10 ,P<0 .05) .Conclusion PC4 overexpression is found to be closely associated with the lymph node metastasis and TNM stage .PC4 may facilitate the lymph node metastasis of lung adenocarcinoma .

Objective To review the outeonle of intrathoracic esophageal reconstruction using circular stapler after esophageal or cardiac cancer resection.Methods From June 1996 to April 2007,744 patients underwent tumor removal and intrathoracie esophageal reconstruction in Daping Hospital.Of all patients,658 suffered from thoracic esophageal cancer and the other 86 from cardiac cancer.The operative modalities consisted of gastroesophageal anastomosis at the top of tim thoracic cavity or above the aortic arch in 402 patients,gastroesophageal anastomosis below the aortic arch in 317,and total gastrectomy in 25(esophageal replacement with colon in 21 patients and esophagojejunostomy in 4).Results Anastomotie bleeding oecurred in 5 patients intraoperatively.One patient died of acute respiratory distress syndrome,1 of septic shock and 1 of hepatic failure postoperatively.Psychiatric disorder was observed in 5 patients,respiratory complications in 34,anastomotie fistula in 4,and anastomotic stricture in 20.Three weeks after the operation,the esophageal manometric examination in 25 patients showed that intraesophageal,anastomotie and intragastric pressures were(-0.2±2.0),(1 1.2±4.4)and(2.4±1.5)mm Hg(1 mm Hg=0.133 kPa),respectively.Twenty-four hour pH monitoring demonstrated that 13 patients had abnormal DeMeester score(＞14.72),3 of thenl developed reflux symptoms and got relieved after receiving acid suppression therapy for 1.0-2.2 months.The 13 patients with abnormal DeMeester score were followed up for 3-38 months,and the pH value of the esophagus was back to normal in 2 patients,and it almost remained the same in 9 patients.Two patients died of tumor reculTenee of metastasis.Conclusions Intratlmracic esophageal reconstruction with circular stapler is safe,reliable and able to reduce the postoperative complications such as anastomotic fistula.

Objective To evaluate the short-term outcome of side-to-side staple cervical esophagogastrostomy after esophagectomy. Methods The clinical data of 105 patients with esophageal cancer who were admitted to the Daping Hospital from January 2006 to March 2009 were retrospectively analyzed. Of the 105 patients, 97 received side-to-side stapled cervical esophagogastrostomy and eight received traditional hand-sewn end-to-end cervical esophagogastrostomy. Nine patients were selected from the 97 patients who received side-to-side stapled cervical esophagogastrostomy to conduct matched pair analysis. The efficacy of the two methods was analyzed using the t test. Results No postoperative death was observed. The mean operation time of side-to-side staple cervical esophagogastrostomy was (21 ± 3 )minutes (range, 15-30 minutes). Postoperative complications were observed in 16 patients, including pulmonary complications in seven patients, vocal cord paralysis in four patients, anastomotic leakage in three patients and anastomotic stricture in two patients. The mean anastomotic diameter of patients who received side-to-side staple cervical esophagogastrostomy was ( 3. 01 ± 0. 17 ) cm, which was significantly longer than ( 1.69 ± 0. 26) cm of patients who received traditional hand-sewn end-to-end cervical esophagogastrostomy (t =2. 093, P ＜0.05 ). Dysphagia occurred in two patients who received side-to-side stapled cervical esophagogastrostomy and in four patients who received traditional hand-sewn end-to-end cervical esophagogastrostomy.Conclusions Side-to-side stapled cervical esophagogastrostomy is simple, safe and effective for patients with esophageal cancer after esophagectomy. This technique could decrease the incidence of postoperative dysphagia and improve the pharyngo-esophageal motor function.

Objective To analyze the perioperative clinical characteristics of non-small cell lung cancer ( NSCLC ) complicated with dermatomyositis ( DM) . Methods Six cases of NSCLC complicated with DM received lobectomy and lymph node dissection by video-assisted thoracoscopic surgery. The same kind of operations were carried out in another six NSCLC cases without DM in the same period. The twelve cases in two groups were 1 ∶ 1 matched study. The operation time, operative blood loss, postoperative pneumonia or atelectasis rate, postop-erative wound recovery, thoracic drainage in postoperative three days, incidence of postoperative atrial fibrillation, perioperative hospital stay were compared between the two groups. Results In operative time, blood loss and thoracic drainage volume in postoperative three days, there was no significant difference in two groups (P>0. 05). In paients with and without DM, the occurrence rate of atrial fibrillation was respectively 50. 00% (3/6) and 16. 66% (1/6), the occurrence rate of postoperative pneumonia or atelectasis was respectively 50. 00%(3/6) and 16. 66% (1/6), and postoperative hospital stay was respectively (16. 28 ± 3. 61) d and (11. 11 ± 2. 92) d. It was of significant differences (P<0. 05). Conclusion Compared with NSCLC patients without DM, postoperative atrial fibrillation and pneumonia or atelec-tasis occured more often in the DM cases. And patients with DM have longer hospital stays.

Objective To compare the clinical effects of lobectomy by single utility port video-assisted thoracoscopic surgery (SP-VATS) and video-assisted mini-thoracotomy(VAMT) for treating early-stage non-small cell lung cancer(NSCLC) .Methods 286 patients with early-stage NSCLC in our hospital from October 2010 to October 2012 were randomly divided into the SP-VATS group(n=150) and the VAMT group(n=136) ,and received lobectomy and lymph node dissection by SP-VATS and VAMT re-spectively .The operative time ,intraoperative blood loss ,chest drainage duration ,postoperative total drainage volume ,lymph node dissection number ,postoperative complications and postoperative pain were compared between the two groups .Results The two groups were smoothly performed the operation .There was no perioperative death .The operative time ,lymph node dissection num-ber and postoperative complications showed no statistically significant difference between the two groups (P>0 .05) .However ,intr-aoperative blood loss ,postoperative total drainage volume ,chest drainage duration and postoperative pain scores (postoperative 1 -3 d) in the SP-VATS group were less than those in the VAMT group ,the differences showed statistical significance (P<0 .05) . The incidence of complications in the two groups showed no statistically significant difference (P>0 .05) .Conclusion SP-VATS lo-bectomy for treating NSCLC is safe and reliable with less injury and rapid postoperative recovery compared with VAMT .SP-VATS lobectomy may be as a preferred surgical mode for early-stage NSCLC .