Limited-stage small cell lung cancer(SCLC)is a highly malignant and rapidly progressing neuroendocrine tumor,while uremia is a complication of the end-stage of chronic renal failure.The patients with SCLC complicated with uremia have poor treatment tolerance,limited options for anti-tumor treatment regimens,and great difficulty in diagnosis and treatment.This study analyzed one case of a 69-year-old male patient with limited-stage SCLC complicated with uremia(with a history of regular hemodialysis,3 times per week),to discuss his first-line treatment regimen,efficacy,and the impact of hemodialysis on the plasma concentrations of the anti-tumor drugs,and reviewed the relevant literature to provide a reference for the treatment of similar patients.The patient was admitted to the hospital due to"cough and hemoptysis for half a month"and was diagnosed with limited-stage SCLC stage ⅢA(T2aN2M0)by computed tomography(CT)and lung puncture biopsy.After discussion by the multi-disciplinary treatment(MDT)team,the patient received 6 cycles of Etoposide(VP-16)+carboplatin chemotherapy combined with adebrelimab immunotherapy,followed by sequential adebrelimab maintenance therapy.The efficacy was evaluated as partial response(PR)and the response is ongoing.During the treatment,level 4 hemoglobin decrease,level 3 neutropenia,and level 2 leukopenia occurred,which were alleviated after symptomatic treatment.The blood concentration monitoring results showed that the plasma concentrations of etoposide and carboplatin increased rapidly during drug infusion,and gradually decreased after the end of infusion.Hemodialysis could rapidly reduce the plasma concentration of carboplatin,but had no significant effect on the plasma concentration of etoposide.Therefore,the immunotherapy combined with reduced-dose chemotherapy regimen is safe and effective for this type of patient.Plasma drug concentration monitoring can be used to observe drug metabolism,but the optimal monitoring time points and clinical value need further study and validation.

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

Objective    To investigate the feasibility of magnamosis rings designed based on magnetic compression technique in esophageal anastomosis reconstruction. Methods    According to the anatomical characteristics of esophagus in SD rats, the esophageal magnamosis rings were designed. SD rats were used as animal models (n=10, 5 males and 5 females) to complete the magnetic anastomosis reconstruction of the cervical esophagus using magnamosis rings, and the operation time, animal survival, postoperative complications, magnetic rings excretion time were recorded. Two weeks after operation, the rats were killed, and the esophageal anastomotic specimens were obtained. The blasting pressure of the anastomotic site was measured and the formation of the anastomotic site was observed with naked eyes. Results    Esophageal magnamosis was successfully performed in 10 SD rats, and the median operation time was 11 (8-13) min. All rats survived without anastomotic leakage, anastomotic stenosis, or magnetic rings incarceration. The magnetic rings were discharged after 8 (5-10) days and the burst pressure was higher than 300 mm Hg. Visual observation showed that the anastomotic muscle healed well and the mucosa was smooth. Conclusion    The magnetic compression technique  can be used for anastomosis reconstruction of esophagus, which has the advantages of simple operation and reliable anastomosis effect, and has clinical application prospect.

Based on the principle of magnetic anastomosis technique, the design of magnetic anastomosis system for endoscopic tissue clamping is proposed. The system includes a semi-ring magnet, a special structure transparent cap and a detachable push rod. With the help of the existing digestive endoscopy and endoscopic tissue gripper, the endoscopic close clamping and anastomosis of the bleeding or perforated tissue can be completed. After the anastomosis, the magnet falls off and is discharged through the digestive tract. Animal experiments showed that the system was easy to use, the fistula was clamped firmly, the magnet was discharged for 7~21 days, and there was no magnet retention and digestive tract obstruction. Further safety verification, optimization of endoscopic operation, the system can be used in clinical trial.
Anastomosis, Surgical ; Animals ; Constriction ; Endoscopy, Gastrointestinal ; Magnetics ; Magnets

Objective:To verify the feasibility of a self-designed laparoscopic magnetic anchoring device for assisting thoracoscopic wedge resection.Methods:Six healthy Beagle dogs were selected as animal models, and underwent thoracoscopic wedge resection after general anesthesia. We replaced the pulmonary forceps with a magnetic anchoring device to complete the traction exposure of the lobes, and recorded the operation time of the operation, the amount of intraoperative blood loss, and the safety and feasibility of the magnetic anchoring device.Results:Six Beagle dogs successfully completed a thoracoscopic wedge resection with the aid of a magnetic anchoring device. During the operation, the magnetic anchoring device can completely replaced the exposure function of the pulmonary forceps, effectively eliminating the " chopstick effect" between the instruments during the uniportal video-assisted thoracoscopic operation. The magnetic anchoring device provided sufficient traction for the surgery to achieve a clear exposure of the field. Tissue damage and magnetic anchoring pliers slip did not occur during the operation. The operation time was(22.67±3.25)min(range 18-26 min), and the intraoperative blood loss was less than 10 ml. The experimental animals survived well after surgery.Conclusion:Magnetic anchoring device is safe and effective for thoracoscopic wedge resection, which can eliminate mutual interference between operating instruments and has potential for clinical application.