Objective To investigate the feasibility, safety, and short-term efficacy of minimally invasive McKeown esophagectomy (MIME) in patients with locally advanced thoracic esophageal squamous cell carcinoma (TESCC) after neoadjuvant immunotherapy. Methods The clinical data of the patients with locally advanced TESCC in the First Affiliated Hospital of University of Science and Technology of China from July 2022 to March 2023 were restrospectively analyzed. They were divided into a neoadjuvant immunotherapy (NI) group and a non-neoadjuvant immunotherapy (NNI) group according to different preoperative neoadjuvant therapy. The perioperative clinical data and 3-month follow-up data were compared between the two groups. Results A total of 47 patients were collected, including 31 males and 16 females with a mean age of (67.57±7.64) years. There were 29 patients in the NI group and 18 patients in the NNI group. There were no statistical differences in baseline data, perioperative complications, short-term complications, surgical time, intraoperative bleeding, postoperative adjuvant therapy, metastasis/recurrence within 3 months, R0 resection rate, postoperative pathological staging decline, or College of American Pathologists (CAP) tumor regression grade between the two groups (P＞0.05). Conclusion Neoadjuvant immunotherapy combined with minimally invasive McKeown esophagectomy can be safely and effectively performed for patients with locally advanced TESCC without increasing operation time, intraoperative blood loss and perioperative complications.

Nanomedicine is charactered with a high specific surface area, diversified structure and function, and charged surface. It can realize the targeted therap by functional modification of surface or introducing the stimuli-responsive unit. Therefore, nanomedicine is increasingly being concerned. Because nanomedicine can accumulate efficiently in the lungs, drug delivery systems based on nanotechnology have broad prospects in the field of the diagnosis, prevention, and treatment in pediatric lung diseases. Herein, we reviewed the research progress of nanomedicine in pediatric lung diseases, especially in respiratory syncytial virus infection and cystic fibrosis.

Objective:The aim of our study was to compare the short-term and long-term outcomes between minimally invaisive Ivor-Lewis esophagectomy(MIILE)and minimally invasive McKeown esophagectomy(MIME) for squamous cell carcinoma of middle and lower esophagus.Methods:The data of 268 patients diagnosed with middle and lower esophageal spuamous cell carcinoma who had received MIILE or MIME between August 2010 and March 2014 at department of thoracic surgery, The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), was analyzed retrospectively. We divided the subjects into two groups according to the mode of the operation, each group was identified 81 patients after propensity score matching. We were using t test, χ2 test, Kaplan- Meier curve and Log- rank test to compare preoperative data and overall survival of the two groups. Results:Compared with MIME, MIILE had lower complication in pulmonary infection and anastomotic fistula, also had less operating time, whereas MIME had an advantage in the number of lymph nodes dissection adjacent to recurrent laryngeal nerve( P<0.05). The 1-year、3-year、5-year survival rate of MIILE were 87.7%、59.2%、45.9%, and the 1-year、3-year、5-year survival rate of MIME were 86.4%、58.7%、42.8%.There were no significant difference between two groups in 5-year survival rate. Conclusion:For squamous cell carcinoma of middle and lower esophagus, minimally invasive Ivor-Lewis esophagectomy and minimally invasive McKeown have no significant difference in long-term survival, but minimally invasive Ivor-Lewis esophagectomy has advantages in reduce the operating time, decrease pulmonary infection and anastomotic fistula during perioperative period.Nevertheless minimally invasive McKeown has an advantage in dissection of the lymph nodes adjacent to recurrent laryngeal nerve.

To investigate the feasibility, safety and short-term efficacy of modified inflatable video-mediastinoscopy in patients with early esophageal cancer. Methods The study retrospectively evaluated 54 patients with cT1N0M0 esophageal carcinoma who received minimally invasive esophagectomy in the First Affiliated Hospital of University of Science and Technology of China between July 2017 and June 2018. Of those patients, 23 patients underwent modified inflatable video-assisted mediastinoscopic transhiatal esophagectomy(MIVMTS) and 31 underwent minimally invasive McKeown esophagectomy (MIME). The clinicopathologic factors, operational factors, postoperative complications and lymph node dissection of patients were compared. Results There was no significant difference in clinicopathological data between the MIVMTS group and MIME group. The incidence of total minor postoperative complications, pulmonary infection of minior postoperative complications, total postoperative complications and total pulmonary complications in MIME group were higher than MIVMTS group. The incidence of recurrent laryngeal nerve injury, arrhythmia and air leaks in minior and pulmonary infection, chylothorax, anastomotic fistula in major postoprative complications were no different in the two groups with P >0. 05. The intraoperative blood loss, duration of surgery and postoperative thoracic drainage fluid volume of MIVMTS group were less than MIME group, the difference was statistically significant. The postoperative hospitalization of the two groups have no statistics significance(P >0. 05). There were no significant difference in the lymph node dessection of the left laryngeal recurrent nerve lymph nodes, paraesophageal lymph nodes, subcarinal lymph nodes and superior phrenic lymph node of the two groups. However, when compared with MIVMTS group, the MIME group have advantage in the right laryngeal recurrent para-nerve lymph node dissection. Conclusion MIVMTS can be safely and effectively performed for early esophageal cancer with favorable short-term efficacy.

Objectives: To evaluate the diagnostic value of CT for lymph node metastasis of thoracic esophageal carcinoma with a diameter of more than 1 cm, and to find the optimal diagnostic index by comparing relevant CT indexes. Methods: Totally 80 patients with pathologically proved thoracic esophageal cancer with preoperative CT examination revealed lymph node diameter greater than 1 cm admitted at Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China from January 2016 to January 2018 were enrolled in this study. There were 70 males and 10 females, aging of (60±14) years (range: 40-85 years). According to the pathological result of lymph nodes, all the patients and lymph nodes were divided into two groups (N+group: 47 patients, 62 lymph nodes; N-group: 33 patients, 39 lymph nodes). The average number of dissected lymph nodes were 21±4 and 101 lymph nodes′ diameter were greater than 1 cm. The clinicopathologic factors, postoperative complications, lymph node dissection and relevant CT indexes like the minimum diameter of lymph nodes (Min D), the maximum diameter of lymph node (Max D), lymph node axial ratio(LAR), the enhancement of lymph node (ELN) and the boundary of lymph node (BLN) were compared. The clinicopathological data, lymph node dessection and CT parameters of the two groups were compared by t test, χ² test or Wilcoxon rank sum test. Receiver operating characteristic (ROC) curve analysis was used to compare the ability to predict lymph node metastasis between Min D, Max D, LAR, ELN and BLN. Multiple Logistic regression analysis were performed to determine the independent variables for prediction of lymph node metastasis. Results: The difference of tumor segmentation, pN stage, pTNM stage, total number of metastatic lymph nodes, total number of abdominal lymph node metastases, Min D, Max D, ELN and BLN between the two groups were statistically significant. The results of univariate and multivariate analyses showed that gender (OR=0.128, 95%CI: 0.019 to 0.858, P=0.034), pTNM stage (OR=1.514, 95%CI: 1.020 to 2.247, P=0.039), Min D (OR=0.102, 95%CI: 0.010 to 0.995, P=0.050) and LAR (OR=0.195, 95%CI: 0.052 to 0.731, P=0.015) were the independent relative factors. The area under the curve of ROC curve analysis of Min D, Max D, LAR, ELN and BLN were 0.679, 0.666, 0.561, 0.650 and 0.820, respectively. BLN was the best CT index to diagnosis lymph node metastasis, while the accuracy of dignosis of lymph node metastasis of BLN was 97.0%. The Youden index of Min D, Max D and LAR were 1.25 cm, 1.64 cm and 0.77, respectively. Combining the BLN and ELN had a higher diagnostic rate (97.0%) of lymph node metastasis. Conclusions CT has high diagnostic value for lymph node metastasis in thoracic esophagel cancer when the lymph node diameter is greater than 1 cm. BLN is the best diagnostic index for lymph node metastasis.

Objective To observe the impact of minimally invasive Sweet esophagectomy on short term quality of life for patients with Siewert typeⅡesophagogastric junction adenocarcinoma.Methods From January 2015 to September 2017, 60 patients underwent minimally invasive Sweet esophagectomy(MISE group) and 60 patients underwent open sweet esophagecto-my(OSE group).The questionnaires(EORTC QLQ-C30 and QLQ-OES18) were applied to assess the quality of life of the pa-tients before and 1,2,4,8 weeks after operation.The clinicopathologic factors, operational factors and postoperative complica-tions of the two groups were compared by t test and χ2test.The Mann-Whitney test was used to test for statistical significance because the responses were not normally distributed.Results The two groups were similar in terms of clinical characteristics and preoperative QOL scores(P ＞0.05).The MISE group was associated with a significant decrease in surgical blood loss [(88.1 ±32.2)ml vs.(119.5 ±34.1)ml, t＝5.052, P＝0.001], chest tube duration[(8.1 ±4.4)d vs.(10.5 ±4.0)d, t＝3.110, P＝0.002] and postoperative stay[(9.1 ±4.6)d vs.(11.6 ±3.8)d, t＝3.167, P＝0.002] relative to the OSE group.The postoperative in-hospital mortality and total morbidity did not differ between the two groups (P＞0.05).The MISE group was associated with significantly fewer respiratory complications than the OSE group (8.5%vs.22.7%, t＝4.063, P＝ 0.044).The MISE group was associated with a significant increase in hospitalization costs [(54 106 ±4 352) yuan vs. (51 143 ±5 315)yuan, P＝0.001] relative to the OSE group.MISE group gained higher scores in physical function, role func-tion, emotional function, Global QOL and lower scores in pain, fatigue, acid reflux than OSE group after surgery.Conclusion Our minimally invasive technique for Siewert typeⅡesophagogastric junction adenocarcinoma can be safely and effectively performed with favorable early outcomes.Compared to conventional open Sweet approach, MISE impoved the short term quality of life after surgery.

Inflammatory bowel disease(IBD),including ulcerative colitis and Crohn's disease,was often associated with malnutrition in the course of disease development. Enteral nutrition ( EN ) can improve the nutritional status of IBD patients, relieve the illness, and promote the recovery of the disease. Therefore, we should pay attention to the significance of EN in the IBD treatment,and strengthen the implementation of EN in IBD patients.

Objective: To investigate the feasibility, safety, short-term efficacy and long-term efficacy of elective lymph node dissection in patients with early esophageal cancer. Methods: The study retrospectively evaluated 405 patients with cT1N0M0 esophageal carcinoma who received minimally invasive esophagectomy in the First Affiliated Hospital of University of Science and Technology of China between March 2007 and March 2013. Of those patients, 208 patients underwent systematic lymph node dissection (SLND) and 197 patients underwent elective lymph node dissection (ELND). The clinicopathologic factors, operational factors, postoperative complications, lymph node dissection and prognosis of patients were compared by independent sample t test, χ² test, or Mann-Whitney rank test. The 5-year overall survival was calculated by the Kaplan-Meier estimation method using the Log-rank test. Results: There was no significant difference in clinicopathological data between the SLND group and the ELND group. The incidence of pulmonary infection (8.2% vs. 2.9%, P=0.04) and arrhythmia (6.2% vs. 2.0%, P=0.03) of the minor postoperative complications in the SLND group were higher than the ELND group. The incidence of pulmonary infection (6.2% vs. 2.0%, P=0.03), Chylothorax (5.8% vs.1.5%, P=0.02), anastomotic or pleural hemorrhage requiring reoperation (2.9% vs.0.5%, P=0.04) of major postoperative complications in the SLND group were higher than the ELND group, the difference was statistically significant. In the perioperative data of two groups, the incidence of total postoperative complications, total pulmonary complications, operation time, intraoperative blood loss, postoperative hospitalization, postoperative thoracic drainage duration and postoperative thoracic drainage fluid volume of the SLND group were higher than the ELND group, the difference was statistically significant. The mean numbers and stations of dissected lymph node in the SLND were 30.2±4.2 and 12.1±2.7, the mean numbers and stations of dissected lymph node in the ELND were 25.7±3.8 and 8.4±3.6. The survival rates of 1, 3, 5 years of all patients were 100%, 95.9% and 82.5%, respectively. The median survival time was 87.4 months. Further analysis showed that the 1, 3 and 5 years survival rate of patients with stage Ⅰ esophageal cancer was 100%, 97.1% and 88.9%, respectively. The median survival time was 89.3 months. The 1, 3 and 5 years survival rate of patients with stage Ⅱa esophageal cancer was 100%, 93.2% and 76.8%, respectively. The median survival time was 77.2 months. There was no significant difference in survival rate between the SLND group and the ELND group in 1, 3 and 5 years. When taking a further analysis of stage Ⅰ esophageal cancer, the survival rates between 188 patients in the SLND group and 180 patients in the ELND group were no significant difference. When focus on the stage Ⅱa esophageal cancer, the 1, 3 and 5 years survival rate were higher in the SLND group than that in the ELND group (100%, 94.5%, 83.2% vs. 100%, 91.3%, 72.1%, P=0.047), the difference was statistically significant. Conclusion ELND can be safely and effectively performed for early esophageal cancer with favorable short-term efficacy and long-term efficacy.

Objective To investigate the clinical efficacy of re-modified Sugiura procedure for the treatment of portal hypertension.Methods The retrospective cohort study was adopted.The clinical data of 119 patients with portal hypertension who were admitted to Second People's Hospital of Yichang from June 2006 to October 2014 were collected.Seventy-two patients who underwent pericardial devascularization were allocated into the Hassab group,and the other 47 patients who underwent the re-modified Sugiura procedure were allocated into the R-M Sugiura group.All the patients firstly underwent splenectomy.The patients of the Hassab group received the classical surgery of pericardial devascularization,and the operation in the R-M Sugiura group was improved on the modified Sugiura procedure in several aspects:(1) the cardia was transected obliquely.(2) Paraesophageal vessels were preserved by selective pericardial devascularization.(3) The pedicled omentum covered the anterior anastomosis and was sutured to the posterior abdominal wall.Observed indices included (1) intraoperative and postoperative situations:operation time,volume of intraoperative blood loss,postoperative anal exhaust time and duration of postoperative hospital stay.(2) Postoperative complications:postoperative pleural effusion,perioperative digestive tract re-bleeding,difficult swallowing,portal vein thrombosis and gastric dynamic dysfunction.(3) Situation of follow-up.The follow-up was performed by telephone interview and outpatient examination to observe the grading of the esophageal varices at postoperative month 6 and 18 using gastroscope till February 2016.Measurement data with normal distribution were presented as x ± s,and comparison between groups was done by the t test.Count data were analyzed by the chi-square test.Ranked data were analyzed by Wilcoxon rank test.Results (1) Intraoperative and postoperative situations:operation time of the Hassab group and the R-M Sugiura group was (201 ± 27) minutes and (255 ± 32) minutes,respectively,with a statistically significant difference between the 2 groups (t =9.67,P ＜ 0.05).The volume of intraoperative blood loss,postoperative anal exhaust time and duration of postoperative hospital stay were (380 ± 86) mL,(2.7 ± 0.7) days,(14.2 ± 2.4) days in the Hassab group and (401 ± 72) mL,(3.0 ± 1.7) days,(15.1 ± 2.7) days in the R-M Sugiura group,respectively,showing no statistically significant difference (t =1.35,1.26,1.86,P ＞ 0.05).(2) Postoperative complications:dysphagia was detected in 3 patients of the Hassab group and in 10 patients of the R-M Sugiura group at the postoperative day 10,with a statistically significant difference between the 2 groups (x2 =0.86,P ＜ 0.05).However,dysphagia was detected in 1 patient of the Hassab group and in 4 patients of the R-M Sugiura group at the postoperative day 20,showing no statistically significant difference between the 2 groups (x2 =2.03,P ＞ 0.05).The number of postoperative pleural effusion,perioperative digestive tract rebleeding,portal vein thrombosis and gastric dynamic dysfunction of the Hassab group and the R-M Sugiura group were 23,6,10,8 cases and 20,1,6,6 cases,respectively,showing no statistically significant difference (x2=1.39,1.02,0.03,0.08,P ＞ 0.05).(3) Situation of follow-up:all the patients were reexamined using gastroscope to observe the grading of esophageal varices.There were 0,7,56,9 patients of G0,G Ⅰ,G Ⅱ,G Ⅲ grading of varices in the Hassab group and 35,12,0,0 patients in the R-M Sugiura group at postoperative month 6,showing a statistically significant difference between the 2 groups (Z =-9.64,P ＜ 0.05).There were 0,0,48,24 patients of G0,G Ⅰ,G Ⅱ,G Ⅲ grading of varices in the Hassab group and 24,20,3,0 patients in the R-M Sugiura group at postoperative month 18,showing a statistically significant difference between the 2 groups (Z =-9.28,P ＜ 0.05).Conclusion The re-modified Sugiura procedure is more effective than the Hassab operation in curing portal hypertension,and it could also reduce the rate of rehemorrhage and improve the short-term and long-term prognosis.

Objective To investigate the changes of thyroid function and carotid atherosclerosis in patients on maintenance hemodialysis (MHD).Methods A total of 110 stable MHD patients undergoing hemodialysis for at least three months were enrolled in the study.Serum free-T3 (FT3), free-T4 (FT4) and thyroid stimulating hormone (TSH) concentrations were measured by electrochemiluminescence.Plasma levels of homocysteine (Hcy) and C-reactive protein (CRP) were detected.Clinical data and biochemical indicators were collected.These patients were divided into thyroid dysfunction group and euthyroidism group.Prevalence of atherosclerosis was detected by carotid ultrasonography.The associations between the changes of thyroid function and carotid atherosclerosis were analyzed by Logistic regression model.Results Among these 110 patients, 42 (38.18％) patients had thyroid dysfunction.Hcy and CRP concentrations were significantly higher in thyroid dysfunction group than those in euthyroidism group (P ＜ 0.05).The intima-media thickness, number of plague and arteriostenosis of carotid were higher in thyroid dysfunction group than those in euthyroidism group (P ＜ 0.05).Multivariate logistic regression analysis showed that increased Hcy and CRP, decreased serum FT3 were independent risk factors for carotid atherosclerosis.Conclusions Thyroid dysfunction with low serum FT3 is frequently found in MHD patients.In MHD patients, FT3 is closely correlated to carotid atherosclerosis.