Objective To evaluate a new surgical approach for the treatment of carcinoma of the gastric cardia. Methods The GI stapler was used to perform intramediastinal esophagogastrostomy for cardial carcinoma in 89 cases and esophago-jejunostomy in 16 cases undergoing total gastrectomy by the transabdominal approach with incising the crus dextrum of the diaphragm. Results The average length resected of the lower part of the esophagus was over 7 cm. Intramediastinal lymph node metastasis was found by pathology in 209% (22/105).There was no operative mortality and the morbidity rate was 476%, 5 year survival rate was 39%. Conclusions The technique enables lymphadenectomy within the lower mediastinum and a sufficiently long enough resection of the esophagus. Transabdominal incision of the crus dextrum of the diaphragm makes a clear operative field for the purpose of radical operation for carcinoma of the gastric cardia. The anastomosis by GI stapler effectively prevents anastomotic leakage.This procedure is indicated for cardial carcinoma cases in which the esophageal involvement is within 2 cm.

Objective To introduce the techniques and specification of complete-block radical gastrectomy, and to compare with traditional radical gastrectomy in the operative time, surgical costs and postoperative complications. Methods Thirty gastric cancer patients meet the criteria were randomly divided into 2 groups. Group A: complete-block radical gastrectomy;group B: radical gastrectomy. Analysis and comparison were made on tumor site, time consuming of block, the proportion of gastrointestinal reconstruction, operative time, cost of block, pathological TNM stage, length of stay, postoperative complications and postoperative chemotherapy. Results Group A has longer operative time than group B (P<0.05). However, there was no significant statistical difference in the other indicators between these 2 groups. Conclusions Complete-block technology can separate cancer more completely during operation with the advantage of simplicity, low-cost, little effect on the subsequent operation. The incidence of postoperative complications and length of stay with the traditional surgery there was no significant difference.

Objective To explore the expression of c-met mRNA in nasopharyngeal carcinomas(NPC) and its relation with clinical biological behavior. Methods In situ hybridisation was used to detect mRNA expression of c-met in 15 cases NP and 55cases NPC. Results The positive rate of c-met mRNA in NP and NPC cells were were 13.3 %(2/15) and 61.8 %(34/55) respectively. The expression of c-met mRNA was significantly correlated with lymphnode metastasis, local invasion(basilar destroying) (P 0.05). Conclusions The abnormality expression of c-met gene expression was well correlated with the biological behavior of metastasis and invasion. The expression of c-met mRNA could serve as an important index to estimate the prognosis of NPC. c-met may be a new diagnostic/therapeutic targert of NPC.

Objective To investigate the efficacy of the Ivor-Lewis cervical stapled esophagogastrostomy via thorax in the treatment of middle esophageal carcinoma.Methods The clinical data of 303 patients with middle esophageal carcinoma who were admitted to the Rugao Boai Hospital (107 patients) and the Rugao People's Hospital (196 patients) from March 2005 to March 2013 were prospectively analyzed.All the patients received Ivor-Lewis stapled cervical esophagogastrectomy (Ivor-Lewis group,151 patients) or Sweet stapled cervical esophagogastrostomy (Sweet group,152 patients) according to the admission order.The intraoperative condition,perioperative complications,lymph node dissection and postoperative follow-up of the 2 groups were analyzed.All the patients were followed up via out-patient examination till December 2012.The measurement data,enumeration data and the ranked data were analyzed using the independent samples t-test,chi-square test or Fisher exact probability and Wilcoxon rank sum test,respectively.The survival curve was drawn by the Kaplan-Meier method,and the postoperative mortality rate was analyzed using the Cox proportional hazard model.Results The operation time of the Ivor-Lewis group was (239 ± 21)minutes,which was significantly longer than (188 ± 30)minutes of the Sweet group (t =11.32,P ＜ 0.05).The surgical resection rate of the Ivor-Lewis group was 98.68％ (149/151),which was significantly higher than 92.76％ (141/152) of the Sweet group (x2 =6.45,P ＜ 0.05).The positive rate of the upper resection margin of the esophagus,postoperative morbidity rate and operative were 0.67％(1/149),10.07％ (15/149) and 0 in the Ivor-Lewis group,and 0.71％ (1/141),11.35％ (16/141) and 0.71％(1/141) in the Sweet group,with no significant difference between the 2 groups (P ＞ 0.05).The number of lymph nodes dissected from the cervical-thoracic junction and the upper abdomen were 3.6 ± 1.1 and 3.5 ± 1.1 in the Ivor-Lewis group,which were significantly greater than 2.3 ± 0.8 and 2.4 ± 0.8 in the Sweet group (Z =9.96,9.02,P ＜ 0.05).The number of positive lymph nodes dissected from the cervical-thoracic junction was 0.7 ± 1.1 in the Ivor-Lewis group,which was greater than 0.3 ± 0.6 of the Sweet group,with significant difference between the 2 groups (Z =3.26,P ＜ 0.05).Of the 290 patients who received surgical treatment,273 were followed up with the follow-up rate of 94.14％ (273/290),and the median time for follow-up was 28.0 months.The 1-,2-,3-year tumor recurrence rates were 8.21％ (11/134),19.64％ (22/112) and 29.35％ (27/92) of the Ivor-Lewis group,which was significantly lower than 19.05％ (24/126),35.24％ (37/105) and 44.19％(38/86) of the Sweet group (x2=6.55,7.33,5.03,P ＜ 0.05).There were significant differences in the 1-,2-,3-year locoregional recurrence rate of the lymph nodes between the 2 groups (x2 =7.03,9.68,6.87,P ＜0.05).The 1-,2-,3-year accumulative survival rates of the Ivor-Lewis group were 90.30％ (121/134),80.36％(90/112) and 71.74％ (66/92),which were significantly higher than 80.95％ (102/126),59.05％ (62/105)and 51.16％ (44/86) of the Sweet group (x2=4.65,1 1.73,7.97,P ＜ 0.05).Conclusion Ivor-Lewis stapled cervical esophagogastrostomy via thorax has advantages of high resection rate,better safety and better quality of life of patients,and it could be an optimized design of the treatment for patients with middle esophageal cancer without intumescent lymph node of neck.

Adenocarcinoma ; metabolism ; pathology ; Humans ; Stomach Neoplasms ; metabolism ; pathology ; alpha-Fetoproteins ; metabolism

Objective To observe the effect of combining acupuncture with transcranial magnetic stimulation (rTMS) in treating post-stroke dysphagia of oral stage.Methods Thirty-nine stroke survivors with dysphagia of oral stage were randomly divided into an experimental group (n=19) and a control group (n =20).Both groups were given basic supportive treatment and rehabilitation,including rTMS for 4 weeks.The experimental group additionally received acupuncture.Modified barium swallowing impairment profiles (MBSImPs) and oral transit time (OTT) were used to assess both groups after the intervention.Results There were no significant differences between the two groups before the treatment.After the treatment the average MBSImP score (8.26±2.92) and OTT (12.79±2.54)s were significantly better in the experimental group compared to before the treatment and compared to the control group's averages.In the control group a significant improvement was observed only in the average MBSImP score (10.60±4.09),but not in the average OTT.Conclusions Acupuncture combined with repetitive transcranial magnetic stimulation has positive effects on poststroke dysphagia of the oral stage.It is worthy of application and popularization.

Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.