Objective To investigate the distribution of pathogens and changes in serum humanβ-defendin-3(HBD3)and FMS like tyrosine kinase 3 ligand(Flt3L)levels in patients with pulmonary infection after esophageal cancer radical surgery.Methods Prospectively,patients who underwent radical resection of esophageal cancer and developed pulmonary infection from January 2022 to January 2024 were selected as the infection group(75 cases),and patients who underwent radical resection of esophageal cancer and did not develop pulmonary infection were selected as the non-infection group(93 cases).Patients in the infection group were divided into the mild group(25 cases),the moderate group(39 cases),and the severe group(11 cases)based on the CURB-65 score.The distribution of pathogenic bacteria in patients of the infection group was analyzed by the fully automatic microbial identification instrument.The expression levels of HBD3 and Flt3L in serum were detected by enzyme-linked immunosorbent assay(ELISA).Multivariate Logistic regression was applied to analyze the risk factors for postoperative pulmonary infection in esophageal cancer patients.ROC curve was applied to analyze the diagnostic value of HBD3 and Flt3L levels for postoperative pulmonary infection in esophageal cancer patients.Results Among 75 infected patients,90 strains of pathogens were detected,including 49 strains(54.44％)of Gram negative bacteria,29 strains(32.22％)of Gram positive bacteria,and 12 strains(13.33％)of fungi.The serum HBD3 and Flt3L levels in the infection group were greatly higher than those in the non infection group(P＜0.05).The serum HBD3 and Flt3L levels in the severe group were higher than those in the moderate group and mild group(P＜0.05),while the serum HBD3 and Flt3L levels in the moderate group were higher than those in the mild group(P＜0.05).Multivariate Logistic regression analysis showed that HBD3,Flt3 L,tumor location in the upper/middle segment,intraoperative bleeding ≥ 500 ml,diabetes,and smoking history were all factors influencing the pulmonary infection after radical resection of esophageal cancer(P＜0.05).According to the ROC curve,the AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum HBD3 level alone was 0.789.The AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum Flt3L level alone was 0.863,the AUC value of the combined diagnosis of the two was 0.934,which was greatly higher than that of the individual diagnosis(Zcombination vs HBD3=3.723,Zcombination vs Flt3L=2.098,P＜0.05).Conclusion The serum HBD3 and Flt3L levels in patients with pulmonary infection after esophageal cancer radical surgery are highly expressed,and the serum HBD3 and Flt3L levels are correlated with the severity of pulmonary infection.The two are risk factors for postoperative pulmonary infection in esophageal cancer patients after radical surgery,and their combination can effectively diagnose postoperative pulmonary infection in esophageal cancer patients.

Objective To investigate the distribution of pathogens and changes in serum humanβ-defendin-3(HBD3)and FMS like tyrosine kinase 3 ligand(Flt3L)levels in patients with pulmonary infection after esophageal cancer radical surgery.Methods Prospectively,patients who underwent radical resection of esophageal cancer and developed pulmonary infection from January 2022 to January 2024 were selected as the infection group(75 cases),and patients who underwent radical resection of esophageal cancer and did not develop pulmonary infection were selected as the non-infection group(93 cases).Patients in the infection group were divided into the mild group(25 cases),the moderate group(39 cases),and the severe group(11 cases)based on the CURB-65 score.The distribution of pathogenic bacteria in patients of the infection group was analyzed by the fully automatic microbial identification instrument.The expression levels of HBD3 and Flt3L in serum were detected by enzyme-linked immunosorbent assay(ELISA).Multivariate Logistic regression was applied to analyze the risk factors for postoperative pulmonary infection in esophageal cancer patients.ROC curve was applied to analyze the diagnostic value of HBD3 and Flt3L levels for postoperative pulmonary infection in esophageal cancer patients.Results Among 75 infected patients,90 strains of pathogens were detected,including 49 strains(54.44％)of Gram negative bacteria,29 strains(32.22％)of Gram positive bacteria,and 12 strains(13.33％)of fungi.The serum HBD3 and Flt3L levels in the infection group were greatly higher than those in the non infection group(P＜0.05).The serum HBD3 and Flt3L levels in the severe group were higher than those in the moderate group and mild group(P＜0.05),while the serum HBD3 and Flt3L levels in the moderate group were higher than those in the mild group(P＜0.05).Multivariate Logistic regression analysis showed that HBD3,Flt3 L,tumor location in the upper/middle segment,intraoperative bleeding ≥ 500 ml,diabetes,and smoking history were all factors influencing the pulmonary infection after radical resection of esophageal cancer(P＜0.05).According to the ROC curve,the AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum HBD3 level alone was 0.789.The AUC value for diagnosing postoperative pulmonary infection in esophageal cancer patients with serum Flt3L level alone was 0.863,the AUC value of the combined diagnosis of the two was 0.934,which was greatly higher than that of the individual diagnosis(Zcombination vs HBD3=3.723,Zcombination vs Flt3L=2.098,P＜0.05).Conclusion The serum HBD3 and Flt3L levels in patients with pulmonary infection after esophageal cancer radical surgery are highly expressed,and the serum HBD3 and Flt3L levels are correlated with the severity of pulmonary infection.The two are risk factors for postoperative pulmonary infection in esophageal cancer patients after radical surgery,and their combination can effectively diagnose postoperative pulmonary infection in esophageal cancer patients.

Objective: To investigate the anatomical and surgical approaches to middle cranial fossa through orbital lateral wall under endoscope. Methods: Cadaveric formalin fixed specimens and fresh colored silicone injected specimens were used for this study. All anatomic technical measurements were performed under 0° and 30° endoscope and infrared rays navigation. The surgical approach was designed with the bony opening on the lateral wall of orbit through which the lateral side of the middle cranial fossa could be directly entered under endoscope. One case of recurrent meningioma was performed through this surgical approach. SPSS 20.0 software was used for statistical analysis. Results: The approach can directly enter the middle cranial fossa and expose anatomic landmarks including superior orbital fissure, lateral side of cavernous sinus, foramen rotundum, foramen ovale, foramen spinosum, petrosal bone and others as well as Ⅱ, Ⅲ, Ⅳ, Ⅴ, Ⅵ cranial nerves under endoscope. The maximal bony opening through the lateral wall of orbit was measured, with a horizontal diameter of (1.38±0.68) cm, a vertical diameter of (2.02±0.32) cm, a depth of (1.44±0.42) cm from bony opening margin to the dura. The recurrent meningioma involving lateral side of the middle skull base was successfully removed by this surgical approach through lateral wall of orbit. Conclusion Lateral transorbital endoscopic approach to the lateral side of middle skull base is a safe, feasible, and minimally invasive method, which allows surgeons to directly manipulate diseases involving this area with good visualization and minimal invasion under endoscope.

Objective To evaluate the value of glycogen phosphorylase isoenzyme BB (GPBB) in the diagnosis of early acute myocardial infarction (AMI). Methods The plasma levels of GPBB were mea-sured by sandwich ELISA in 115 patients with suspected AMI at admission within 6 hours after onset of chest pain and 55 normal healthy subjects. The plasma concent of cardiac troponin-Ⅰ (cTnI), creatine kinase-MB (CK-MB) and myoglobin (MYO) was assayed at the same time by using corpuscle chemiluminescence. The patients were classified retrospectively into AMI group (n = 45) , unstable angina pectoris (UAP) group (n =40) , stable angina pectoris (SAP) group (n = 13) and non-cardiac chest pain (NCCP) group (n =17).The diagnostic validity was evaluated in terms of sensitivity and specificity. Results The diagnostic sensitivity of GPBB for AMI was 64.29 % within 3 hours and 88.89 % within 6 hours after onset of chest pain,which is significantly higher than that of cTnI (28.57 %, 60.00 %) and CK-MB (21.43 %, 64.44 % ). There was no significant difference in specificity among the four markers. The diagnostic accuracy of GPBB within 3hours and 6 hours (80.77 %, 89.57% ) was significantly higher than that of cTnI (61.54%, 81.74% ),CK-MB (50.00%, 75.65%) and MYO (73.08% ,73.91%). Conclusions GPBB seems to be a sensitive and specific biochemical cardiac marker for AMI in the early stage. Its diagnostic accuracy is higher than that of cTnI, CK-MB, MYO.