Objective:To summarize and analyze the clinical outcome of minimally invasive McKeown esophagectomy for esophageal squamous cell carcinoma.Methods:We retrospectively analyzed the clinical data of patients with esophageal squamous cell carcinoma who received minimally invasive McKeown esophagectomy in Peking Union Medical College Hospital from January 2017 to December 2022. Improved anesthesia methods, monitoring of recurrent laryngeal nerve, minimally invasive gastrostomy, and jejunostomy techniques were introduced in surgical procedure. We evaluated perioperative data and long-term follow-up survival in these patients.Results:A total of 226 esophageal squamous cell carcinoma patients who met the inclusion and exclusion criteria were enrolled, of which 48.2% received neoadjuvant therapy. The mean operation time was( 327 ± 68) min, with a total of 40.5(33, 50) lymph nodes and 27(19, 33) thoracic lymph nodes harvested. The postoperative hospital stay was 9(7, 12) days, and the postoperative complication rate was 36.3%. In terms of learning curve, after 50 patients intraoperative blood loss, postoperative hospital stay, and recurrent laryngeal nerve injury rate were significantly decreased. The number of total lymph nodes, thoracic lymph nodes, and the 106tbl harvested was significantly increased. The median follow-up time was 23.5(14, 47) months, with a loss of follow-up rate of 3.5%. The overall 2-year and 5-year survival rates were 82.6% and 71.8%, respectively.Conclusion:Improved minimally invasive McKeown esophagectomy for esophageal squamous cell carcinoma are safe and acceptable. Learning curve can be shortened, with increased lymph node harvested and decreased postoperative complications, which improving the short-term and long-term outcomes of patients.

Objective To investigate the relationship between volume of fracture fragment and surgical methods in patients with radial head fracture.Methods A retrospective study was conducted of the 60 patients with radial head fracture of Mason type Ⅲ who had been admitted to the Department of Hand Surgery,Wuhan Pu'ai Hospital from January 2013 to December 2016.They were 28 males and 32 females,aged from 26 to 71 years (average,54.5 years).Of them,41 underwent open reduction and internal fixation (incision group) and 19 radial head replacement (replacement group).The volumes of radial head and fracture fragment were measured by CT scan and three-dimensional reconstruction of the elbow joint before operation.A volume-weighted ratio R corresponding to a specific radial head fragment was calculated.Correlation between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score was calculated.At the last follow-up,the Broberg-Morrey elbow function score was used to assess the efficacy and complications were recorded in the 2 groups.Results All the 60 patients were followed up for 20 to 36 months (mean,28.6 months).At the last follow-up,the Broberg-Morrey elbow function score was 86.5 ±1.3 points (from 72 to 91 points) for the incision group and 93.6 ± 1.4 points (from 78 to 95 points) for the replacement group;the complication rate was 17.1％ (7/41) for the former and 15.8％ (3/19) for the latter.There was a linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the incision group.The linear regression equation between the two was:y=65.63+0.67x (R2=0.85,P=0.0006).There was no linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the replacement group (P =0.053).When the Broberg-Morrey elbow joint function score (93.6 points) for the replacement group was substituted into the linear regression equation y =65.63 + 0.67x (y =93.6),x =41.7.Conclusions In the patients with radial head fracture of Mason type Ⅲ,open reduction and internal fixation may lead to a better prognosis for those with a volume ratio ≥41.7 between the radial head and fracture fragment while radial head replacement may lead to a better prognosis for those with a volume ratio ＜41.7 between the radial head and fracture fragment and for those elderly ones with osteoporosis.

Objective    To explore the efficacy of a novel detection technique of circulating tumor cells (CTCs) to identify benign and malignant lung nodules. Methods     Nanomagnetic CTC detection based on polypeptide with epithelial cell adhesion molecule (EpCAM)-specific recognition was performed on enrolled patients with pulmonary nodules. There were 73 patients including 48 patients with malignant lesions as a malignant group and 25 patients with benign lesion as a benign group. There were 13 males and 35 females at age of 57.0±11.9 years in the malignant group and 11 males and 14 females at age of 53.1±13.2 years in the benign group. e calculated the differential diagnostic efficacy of CTC count, and conducted subgroup analysis according to the consolidation-tumor ratio, while compared with PET/CT on the efficacy. Results     CTC count of the malignant group was significantly higher than that of the benign group  (0.50/ml vs. 0.00/ml, P<0.05). Subgroup analysis according to consolidation tumor ratio (CTR) revealed that the difference was statistically significant in pure ground glass (pGGO) nodules 1.00/ml vs. 0.00/ml, P<0.05), but not in part-solid or pure solid nodules. For pGGO nodules, the area under the receiver operating characteristic (ROC) curve of CTC count was 0.833, which was significantly higher than that of maximum of standardized uptake value (SUVmax) (P<0.001). Its sensitivity and specificity was 80.0% and 83.3%, respectively. Conclusion     The peptide-based nanomagnetic CTC detection system can differentiate malignant tumor and benign lesions in pulmonary nodules presented as pGGO. It is of great clinical potential as a noninvasive, nonradiating method to identify malignancies in pulmonary nodules.

Objective To investigate the clinical effect of reconstruction of soft tissue defect in non-weight-bearing area of the foot with trimmed free anterolateral thigh muscle flap combined with skin grafting. Methods From January, 2009 to January, 2017, 25 patients with soft tissue defect in foot and ankle were treated with transplan-tation of the trimmed free anterolateral thigh muscle flap combined with skin grafting. Of the 25 cases, there were 5 cases located in medial foot, 10 cases in dorsum of foot, 7 cases in external of foot and 3 cases in the toe. The areas of wounds were 8.0 cm ×6.0 cm to 18.0 cm ×10.0 cm. The anterolateral thigh muscle flap was from 4.0 cm ×3.0 cm ×0.3 cm to 10.0 cm×8.0 cm×1.5 cm. All the cases were operated in fracture fixation and wound without obvious infection. Early rehabilitative exercise under the protection of orthosis were done after 4 weeks of the operation and to assess. The injuried limb function were assessed in 1 year postoperatively according to Marylands scale. Results All cases were followed-up for 12 to 24 months (average, 16.2 months). All the muscle flaps and skin survived. The healing time were 12 to 24 days, averaged of 17.1 days. Patients could wear shoes normally and resume normal life and work. The appearance and walking function were satisfying and no further debulking procedures were needed . The surgery function were assessed according to Marylands scale, and the results was 22 cases for excellent, and 3 cases for good. Conclusion Ttrimmed free anterolateral thigh muscle flap combined with skin grafting is a good option for the repair of foot and ankle defect at non-weight-bearing area, and it has the advantages such as the doner site is small inva-sive, the muscle flap is easy to be harvested, and can avoid debulking surgery to wear shoes normally.

Objective To investigate the diagnosis and surgical therapy of delayed diaphragmatic rupture.Methods Forty patients with traumatic diaphragmatic rupture with delayed presentation were collected in Peking Uniom Medical College Hospital from January 2000 to December 2016.In all 40 patients, 36 patients had traumatic past history, 32 patients had clini-cal manifestations when diagnosed.Left-sided diaphragmatic rupture was found in 32 patients and right in 8 patients.1 patient received emergency surgery and 39 received selective surgery.38 patients received transthoracic surgery and 2 patients received combined thoracic-abdominal surgery.36 patients received direct diaphragm suture and 4 patients received patch repair.Re-sults All patients were recovered from the hospital.The median length of postoperative hospital stay was 11 days( range, 5-26 days).1 patient was found intestinal obstruction and received enterolysis 19 days after surgery.Conclusion Delayed traumat-ic diaphragmatic rupture is a rare but serious disease.Careful past history, physical examination and CT scan with reconstruc-tion of diaphragm are helpful in diagnosis and differential diagnosis.Surgical therapy after diagnosis is the best treatment.

Objective:To investigate the significance of 3D printing technology in the treatment of skull base tumor.Methods: A 45-year-old male patient who felt headache and discomfort had progressive loss of vision to blindness in the left eye. Using MR plain scan found that there was a skull base tumor, so the patient was examined by brain CTA and 3.0T MR to obtain medical digital imaging of CT and MR and DICOM data which were input into computer for establishing three-dimensional model, and then printed it.Results: 3D reconstruction model can clearly display the anatomical structure of skull base tumor, three-dimensional space and peripheral blood around skull base tumor. Under the guidance of this new technology, the tumor was completely removed and the surrounding normal brain tissue was preserved as much as possible. The whole operation time was greatly reduced at the same time.Conclusion: The treatment of 3D printing technology is applied in skull base tumors can clearly display the anatomical structure, distinguish adjacent vessels around tumor; when it avoids missing tumor, also can more effectively assist preoperative planning, enhance the security for complex skull base surgery, accelerate the operation speed, improve operation accuracy; it has great application prospect in the precise treatment of neurosurgery.

Objective:To discuss the value of low dose scanning technique of 16-slice spiral CT for the diagnosis of pulmonary diseases.Methods: A retrospective analysis was adopted to analyze 43 image documents were scanned by 16-slice spiral CT and to evaluate their qualities.Results:All of patients were examined in accordance with the requirements and all of image qualities were more than good. Although their background noise were increased, the image quality did not affect the display of anatomical structure. Therefore, it can satisfy the requirements for the diagnosis of pulmonary diseases.Conclusion:The pulmonary multi-slice spiral CT based on low-dose scanning technology can improve the detection rate of lesions, reduce radiation dose for patients, prolong the service life of the tube and reduce the maintenance cost, therefore it is worthy for further promotion.

Objective:To study and analyze the quality assurance(QA) and quality control(QC) in chest radiography based on X-ray digital radiography (DR).Methods:600 cases ( 320 male cases, 280 female cases, age range from 2 to 68 years old, with an average 48.2 years old) chest radiography based on DR were random sampling from database during the period from Oct., 2015 to Dec., 2015. In accordance with chest imaging criteria, these images were graded, and calculated the share rate. After analyzing the causes that produced the bad images, a number of measures were provided to improve the quality of image.Results:The patients can be examined in short time, and there are a large number of information with high resolution and rich layers. The qualified rate was 100% (Grade A with 525, accounting for 87.5%,Grade B with 63, accounting for 10.5%; Grade C with 12 , accounting for 2%), and the rate of waste film was zero.Conclusion: DR produced by computer digital image processing technology combined with X-ray radiation technology has powerful post-processing function. This function can combine a series of quality control measures to improve image quality as reducing radiation dosage, and finally, to realize the target of QA and QC.

Objective: To explore the application value of multi-slice spiral CT based on low dose technique in diagnosis of rib fracture. Methods: 58 patients with highly suspected rib fracture patients were examined by DR and multi-slice spiral CT. 3D reconstruction were finished after MSCT examination at the workstation, including MPR(multi-planar reconstruction), and volume rendering technique(VR). And the results were compared between DR and CT. Results:58 patients all successfully completed the chest X-ray film and multi-slice spiral CT examination. Multi-slice spiral CT image quality fully met the requirements of clinic. It can not only diagnose, but also display the number, location and morphology of rib fracture. 45 cases were diagnosed with chest DR rib fracture and suspected fracture, and the positive rate was 77.59%(45/58). 56 cases were definitely diagnosed with multi-slice spiral CT scanning and three-dimensional reconstruction rib fracture, and the positive rate was 96.55%. Conclusion: The patients can receive lower dose and the tube can be used for a longer time by low dose technique. 3D reconstruction techniques of multi-slice spiral CT not only improve the accuracy of diagnosis, but also display rib fracture morphology clearly, so its clinical value is much higher than DR.

Objective:To investigate the necessity and measures about quality assurance (QA) and quality control (QC) in bedside photography based on digital radiography (DR). Methods: To do retrospective analysis on bedside photography in the same month of different years (2013.9 and 2014.9) by image storage and PACS system. Each has 200 cases. They were evaluated and analyzed of its causes in order to explore the QA improvement measures.Results:The application of DR and its quality control in bedside photography can improve image quality obviously, shorten the examination time greatly, reduce radiation dose, put an end to waste film.Conclusion: DR has obvious advantages in the bedside photography, can provide better image with more information for clinic work.