Objective:To compare the differences in clinical characteristics among the patients at clinical high risk for bipolar disorder(CHR-BD),the patients with bipolar disorder(BD),and the healthy controls(HC)at low risk,and to provide the basis for the diognasis and treatment of CHR-BD.Methods:For the first time,the BD risk criteria and prospective structured assessment tools were jointly used in outpatients aged 16-30 years,and 43 CHR-BD patients were included to ensure the accuracy of the assessment.Meanwhile,33 BD patients and 32 HC subjects were also enrolled.The clinical symptoms,neurocognitive function,and global functional levels of the subjects in the three groups were evaluated using observer-rated and self-rated tools.The CHR-BD and BD groups were combined,and Logistic regression analysis was used to identify the independent influencing factors related to diagnostic status;Pearson or Spearman correlation analysis was used to analyze the correlations between the global functional levels and the symptoms or neurocognitive characteristics of the patients in CHR-BD and BD groups.Results:There were statistically significant differences in the scores of symptom and global functional level scales among HC,CHR-BD,and BD groups(P<0.05).Compared with HC group,the scores of mood symptoms(anxiety,depression,and mania/hypomania),psychotic symptoms,total affective temperament questionnaire scores,and some dimensions(cyclothymic,depressive,irritable,and anxious temperaments)in CHR-BD and BD groups were significantly increased(P<0.001),while the global functional levels were significantly decreased(P<0.001).Compared with BD group,the lowest global functional level score in the past year in CHR-BD group was significantly increased(P=0.022),while the current global functional level score was significantly decreased(P=0.005).No significant differences were observed in neurocognitive function scores among the three groups(P>0.05).The lowest global functional level score in the past year was an independent influencing factor for BD diagnosis[odds ratio(OR)=0.952,95%confidence interval(CI):0.917-0.988,P=0.010].In both CHR-BD and BD patients,the current global functional levels were negatively correlated with depressive(r=-0.417,P=0.005;r=-0.617,P<0.001)and anxiety symptoms(r=-0.360,P=0.018;r=-0.506,P=0.003).In BD patients,the current global functional level was negatively correlated with lifetime manic/hypomanic symptoms(r=-0.360,P=0.039),psychotic symptoms(r=-0.502,P=0.003),and affective temperament scores(r=-0.479,P=0.005),while the lowest global functional level in the past year was negatively correlated with lifetime manic/hypomanic symptoms(r=-0.391,P=0.024).Conclusion:CHR-BD patients share similar mood symptom characteristics with BD patients,and their global functional levels are negatively correlated with depressive and anxiety symptoms.BD patients exhibit worse lowest global functional levels in the past year,and their global functional levels are negatively correlated with manic/hypomanic symptoms.

Objective To evaluate endoscopic surgical treatment of synchronous esophageal squamous cell carcinoma and adenocarcinonm at the esophagogastric junction.Methods The clinical data of 17 patients with synchronous esophageal squamous cell carcinoma associated with adenocarcinoma of esophagogatric junction between Jan 2010 and Jan 2017 were analyzed retrospectively.Results Among these 17 patients,9 patients underwent thoracoscopy and laparoscopy with partial resection of esophagus and proximal stomach,and gastroesophageal and neck anastomosis.3 patients underwent thoracoscopy and laparoscopy with partial resection of esophagus and proximal stomach,gastroesophageal intrathoracic anastomosis.Laparoscopic radical total gastrectomy combined with radiotherapy for esophageal cancer was performed in 5 cases.There was not perioperative death or serious complications.The cumulative survival rates of 1,3 and 5 years after surgery were 100％,42％ and 24％,respectively.Conclusion Thoracolaparscopic surgery combined with local radiation therapy is a safe and effective treatment for patients with synchronous esophageal squamous cell carcinoma and adenocarcinoma at esophagogastric junction.

Objective To compare the clinical therapeutic effect of radical resection of esophageal carcinoma under combination of thoracoscopy and laparoscopy (RECTL) with traditional radical resection of esophageal carcinoma(TREC).Methods 80 patients receiving RECTL and 80 patients receiving TREC were chosen in our hospital.The general conditions during operation,pathologic data,postoperative complications and recurrence or metastasis rates were compared between two groups.Results Compared with TREC group,RECTL group had longer operation time 、less bleeding、less postoperative chest drainage liquid amount and less postoperative morphine administration (P ＜ 0.05 or P ＜ 0.01).The postoperative hospital stays were not statistically different between the two groups(P ＞0.05).The length of resected esophagus specimen and tumor near end cutting edge length in RECTL group are longer than that in TREC group,but with the former no statistically different(P ＞0.05) and the latter statistically different(P ＜ 0.05).There were no statistical differences about the number of dissected lymph nodes and the incidence of complications and local recurrence by cut plant between the two groups(P ＞ 0.05).The incidence of postoperative reflux gastritis was 7.1％ in RECTL group and 45 ％ in TREC group,with significantly statistical difference(P ＜0.01).The two groups had similar recurrence or metastasis rate(P ＞ 0.05).Conclusion Radical resection of esophageal carcinoma under combination of thoracoscopy and laparoscopy,with small wound and early recovery,has the same effect as traditional operational resection of esophageal carcinoma.