Objective To explore the clinical application value of non-inflatable mediastinoscopy combined with laparoscopic radical resection for esophageal cancer patients complicated with cardiovascular and pulmonary diseases.Methods A retrospective analysis was made on clinical data of 20 patients with esophageal cancer complicated with cardiovascular and pulmonary diseases treated with non-inflatable mediastinoscopy combined with laparoscopic radical resection in our hospital from January 2021 to October 2024.The cervical and abdominal surgical teams worked simultaneously.During the operation,a left neck incision was made to free the cervical esophagus.After inserting a mediastinoscope,an ultrasonic knife was used to free the thoracic esophagus from top to bottom and clean the lymph nodes adjacent to the esophagus.The laparoscopic procedure(freeing the stomach and esophagus from bottom to top)was connected in the mediastinum to complete the esophageal freedom,and a tubular stomach was made and anastomosed at the neck.Results All the 20 operations were successfully completed without conversion to thoracotomy.The operation time was(130.5±25.5)min,the intraoperative blood loss was(60.5±32.5)ml,a total of 3-11 mediastinal lymph nodes and1-5 abdominal lymph nodeswerecleared,andthe postoperative hospital stay was(20.0±6.0)d.There were 2 cases of anastomotic leakage,2 cases of anastomotic stenosis,2 cases of pleural effusion,2 cases of pulmonary infection,1 case of chylothorax,and 1 case of recurrent laryngeal nerve injury.After conservative treatment,all of which were cured.Postoperative pathology showed 18 cases of squamous cell carcinoma and 2 cases of adenocarcinoma.Postoperative TNM staging was 6 cases in stage Ⅰ,10 cases in stage Ⅱ,and 4 cases in stage Ⅲ,consistent with preoperative evaluation.All the20 cases were followed up for1-24 months,with a median follow-up time of 12 months.CT re-examinations showed no recurrence,and no death case was recorded.Conclusion Non-inflatable mediastinoscopy combined with laparoscopic radical resection is safe and feasible for esophageal cancer patients complicated with cardiovascular and pulmonary diseases.

Objective To investigate serum β2-MG, sCHE, and PSGL-1 expression in patients with esophageal cancer and their relationship to lung infection after mediastinoscopy. Methods A total of 118 patients with esophageal cancer were selected and divided into infected and uninfected groups according to whether they developed lung infection after surgery. An automatic microbiological identification system was used to detect the pathogenic bacteria of lung infection. ELISA was used to detect the levels of β2-MG, sCHE, and PSGL-1. Multivariate logistic regression was used to analyze the influencing factors of postoperative lung infection in patients with esophageal cancer. ROC curves were plotted to analyze the assessment value of serum β2-MG, sCHE, and PSGL-1 on postoperative lung infection. Results Fifty-two strains of bacteria were isolated from the sputum of 38 patients with postoperative lung infections, and these included 35 (67.31%) Gram-negative, 14 (26.92%) Gram-positive, and 3 (5.77%) fungal strains. The difference in long-term smoking history between the infected and uninfected groups was statistically significant (P<0.05). Serum β2-MG and PSGL-1 levels were significantly higher and sCHE levels were significantly lower in the infected group than in the uninfected group (P<0.05). Serum β2-MG and PSGL-1 levels were sequentially higher (P<0.05) and sCHE levels were sequentially lower (P<0.05) in the mild, moderate, and severe lung infection groups. Long-term smoking history, β2-MG, and PSGL-1 were risk factors affecting postoperative lung infection in patients with esophageal cancer (P<0.05), and sCHE was a protective factor (P<0.05). The AUCs of serum β2-MG, sCHE, and PSGL-1 for assessing postoperative lung infections were 0.807, 0.845, and 0.800, respectively, and the AUC of the three combined factors for assessing postoperative lung infections was 0.954, which was superior to that assessed individually (Z_{combination vs. β2-MG}=2.576, Z_{combination vs. sCHE}=2.623, Z_{combination vs. PSGL-1}=2.574, all P<0.05). Conclusion The serum levels of β2-MG and PSGL-1 increase and the sCHE level decreases in patients with esophageal cancer and postoperative pulmonary infection, which are also related with lung infection. Combined testing can improve the evaluation value of postoperative pulmonary infection in patients.

BACKGROUND:The pathogenesis of moyamoya disease is unclear,and there is a lack of early diagnostic methods and effective medical treatments.OBJECTIVE:To identify biomarkers of moyamoya disease through machine learning,and analyze the therapeutic mechanism of Bu Huang Si Wu Tang in moyamoya disease.METHODS:Moyamoya disease gene dataset from gene expression omnibus database was retrieved.R language was used to screen differentially expressed genes and perform enrichment analysis on differentially expressed genes.Moyamoya disease biomarkers were screened using least absolute shrinkage and selection operator and support vector machine-recursive feature elimination machine learning algorithms.A diagnostic model was constructed by establishing a column chart,and its clinical utility and diagnostic value were evaluated and further validated through detecting clinical serum markers of patients with moyamoya disease.In vitro experiments were performed to observe the effect of Bu Huang Si Wu Tang on umbilical vein endothelial cells under oxygen glucose deprivation,and the main components of Bu Huang Si Wu Tang were selected for molecular docking and molecular dynamics simulation with the screened targets to explore its potential mechanism.RESULTS AND CONCLUSION:This study identified 76 differentially expressed genes,mainly enriched in immune and metabolic related pathways.Two potential biomarkers,complement factor D(CFD)and DKFZp434L192,were obtained through machine learning.The calibration curve,decision curve analysis,and clinical impact curve showed that the column chart had good predictive ability.qRT-PCR analysis showed that CFD and DKFZp434L192 expression levels were significantly upregulated in patients with moyamoya disease(P<0.001).In vitro experiments showed that Bu Huang Si Wu Tang significantly enhanced the activity and migration ability(P<0.01)of umbilical vein endothelial cells under oxygen glucose deprivation.Molecular docking results showed that all four active ingredients of Bu Huang Si Wu Tang could bind to the target site,and the dynamic simulation results further verified its binding stability.To conclude,CFD and DKFZp434L192 exhibit good diagnostic efficacy for moyamoya disease and can serve as potential diagnostic biomarkers and therapeutic targets for moyamoya disease.Bu Huang Si Wu Tang has a certain protective effect on vascular endothelial cells under ischemic conditions,which may be related to CFD.

Objective To explore the clinical application value of non-inflatable mediastinoscopy combined with laparoscopic radical resection for esophageal cancer patients complicated with cardiovascular and pulmonary diseases.Methods A retrospective analysis was made on clinical data of 20 patients with esophageal cancer complicated with cardiovascular and pulmonary diseases treated with non-inflatable mediastinoscopy combined with laparoscopic radical resection in our hospital from January 2021 to October 2024.The cervical and abdominal surgical teams worked simultaneously.During the operation,a left neck incision was made to free the cervical esophagus.After inserting a mediastinoscope,an ultrasonic knife was used to free the thoracic esophagus from top to bottom and clean the lymph nodes adjacent to the esophagus.The laparoscopic procedure(freeing the stomach and esophagus from bottom to top)was connected in the mediastinum to complete the esophageal freedom,and a tubular stomach was made and anastomosed at the neck.Results All the 20 operations were successfully completed without conversion to thoracotomy.The operation time was(130.5±25.5)min,the intraoperative blood loss was(60.5±32.5)ml,a total of 3-11 mediastinal lymph nodes and1-5 abdominal lymph nodeswerecleared,andthe postoperative hospital stay was(20.0±6.0)d.There were 2 cases of anastomotic leakage,2 cases of anastomotic stenosis,2 cases of pleural effusion,2 cases of pulmonary infection,1 case of chylothorax,and 1 case of recurrent laryngeal nerve injury.After conservative treatment,all of which were cured.Postoperative pathology showed 18 cases of squamous cell carcinoma and 2 cases of adenocarcinoma.Postoperative TNM staging was 6 cases in stage Ⅰ,10 cases in stage Ⅱ,and 4 cases in stage Ⅲ,consistent with preoperative evaluation.All the20 cases were followed up for1-24 months,with a median follow-up time of 12 months.CT re-examinations showed no recurrence,and no death case was recorded.Conclusion Non-inflatable mediastinoscopy combined with laparoscopic radical resection is safe and feasible for esophageal cancer patients complicated with cardiovascular and pulmonary diseases.

BACKGROUND:The pathogenesis of moyamoya disease is unclear,and there is a lack of early diagnostic methods and effective medical treatments.OBJECTIVE:To identify biomarkers of moyamoya disease through machine learning,and analyze the therapeutic mechanism of Bu Huang Si Wu Tang in moyamoya disease.METHODS:Moyamoya disease gene dataset from gene expression omnibus database was retrieved.R language was used to screen differentially expressed genes and perform enrichment analysis on differentially expressed genes.Moyamoya disease biomarkers were screened using least absolute shrinkage and selection operator and support vector machine-recursive feature elimination machine learning algorithms.A diagnostic model was constructed by establishing a column chart,and its clinical utility and diagnostic value were evaluated and further validated through detecting clinical serum markers of patients with moyamoya disease.In vitro experiments were performed to observe the effect of Bu Huang Si Wu Tang on umbilical vein endothelial cells under oxygen glucose deprivation,and the main components of Bu Huang Si Wu Tang were selected for molecular docking and molecular dynamics simulation with the screened targets to explore its potential mechanism.RESULTS AND CONCLUSION:This study identified 76 differentially expressed genes,mainly enriched in immune and metabolic related pathways.Two potential biomarkers,complement factor D(CFD)and DKFZp434L192,were obtained through machine learning.The calibration curve,decision curve analysis,and clinical impact curve showed that the column chart had good predictive ability.qRT-PCR analysis showed that CFD and DKFZp434L192 expression levels were significantly upregulated in patients with moyamoya disease(P<0.001).In vitro experiments showed that Bu Huang Si Wu Tang significantly enhanced the activity and migration ability(P<0.01)of umbilical vein endothelial cells under oxygen glucose deprivation.Molecular docking results showed that all four active ingredients of Bu Huang Si Wu Tang could bind to the target site,and the dynamic simulation results further verified its binding stability.To conclude,CFD and DKFZp434L192 exhibit good diagnostic efficacy for moyamoya disease and can serve as potential diagnostic biomarkers and therapeutic targets for moyamoya disease.Bu Huang Si Wu Tang has a certain protective effect on vascular endothelial cells under ischemic conditions,which may be related to CFD.

Objective:To explore the safety, effectiveness, economy and surgical techniques of bronchial priority treatment in single-port thoracoscopic right upper lobectomy by comparing it with conventional single-port thoracoscopic right upper lobectomy.Methods:Clinical data of 72 patients who underwent single-port thoracoscopic right upper lobectomy from Mar. 2019 to Feb. 2022 were collected. According to different surgical treatment sequences, the patients were divided into observation group (bronchial priority treatment, 36 cases) and control group (conventional surgery, 36 cases). The general clinical characteristics, operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, postoperative pain score, and number of staplers used in the two groups were compared.Results:All operations were successfully completed without conversion to thoracotomy. There was no significant difference between the two groups in clinical characteristics, intraoperative blood loss [ (25.3±12.8) ml vs 32.5±14.2) ml, P>0.05], postoperative hospital stay[ (4.7±1.6) d vs (4.9±1.5) d, P>0.05], postoperative pain score [ (3.3±1.1), (4.8±1.4), (3.7±1.1) vs (3.5±1.2), (5.5±1.4), (4.1±1.4), P>0.05], number of lymph node dissection (9.1±1.8 vs 8.3±1.7, P>0.05), or postoperative complications (16.7% vs 27.8%, P>0.05). Compared with the control group, the observation group had significant advantages in the operation time [ (87.2±6.1) vs (106.4±21.8) min, P<0.05] and the number of staplers used (3.7±0.8 vs 5.8±1.3, P<0.05) . Conclusions:Single-port video-assisted thoracoscopic right upper lobe resection with bronchial priority treatment is safe and effective. It simplifies the surgical procedure, reduces the use of disposable consumables, does not increase the risk of perioperative period, and has clinical application prospects.

Objective:By comparing the advantages and disadvantages of different forms of purse suture, to explore how to minimize the incidence of anastomotic complications after cervical anastomosis of esophageal cancer.Methods:The clinical data of 45 patients with esophageal cancer who underwent mediastinal endoscopy combined with laparoscopic radical resection of esophageal cancer from Jan.2019 to Jun.2020 in Department of Thoracic Surgery, Henan Chest Hospital were selected. In the observation group, 22 cases were sutured with spiral packing at the esophageal stump, and in the control group, 23 cases were sutured with conventional loading forceps. The clinical effects of the two groups were objectively evaluated.Results:There was no significant difference between the two groups in operation time, intraoperative blood loss or hospitalization days ( P>0.05) . In terms of postoperative complications, the incidence of anastomotic leakage and anastomotic stenosis in the observation group (4.54%, 9.09%) was significantly lower than that in the control group (17.39%, 39.13%) , and there was significant difference in the incidence of anastomotic stenosis ( P<0.05) . Conclusion:The spiral continuous suture of esophageal stump can reduce the incidence of anastomotic fistula/anastomotic stenosis without increasing surgical trauma or prolonging operation time, which is worthy of clinical application.

Objective To assess the effect of video-assisted thoracoscopic thymectomy in treatment of myasthenia gravis (MG) and the factors associated with clinical efficacy. Methods 183 patients with MG who underwent video-assisted thoracoscopic thymectomy from January 2011 to May 2016 were enrolled, and the clinical data were retrospectively analyzed. Therapeutic efficacy was evaluated based on the MGFA. Furthermore, the potential factors associated with the clinical efficacy were analyzed using univariate analysis and Cox's proportional hazards regression model. Results 173 in 183 patients completed the whole follow-up. Among whom, 115 patients achieved complete stable remission (66.5%), 13 patients achieved pharmacologic remission (7.5%), 2 patients achieved minimal manifestations (1.2%), 20 patients had no changes (11.6%), 8 patients showed recurrent MG (4.6%), and 3 patients died (1.7%). Further analysis shown age (RR = 1.53, P = 0.031), pathological type of thymus (RR = 5.84, P = 0.022) and MGFA classification (RR = 3.72, P = 0.028) were main factors associated with the therapeutic efficacy. Conclusions Thoracoscopic expand resection is effective in the treatment of MG patients with satisfactory therapeutic efficacy, and age, pathological type and MGFA type were the main factors associated with the therapeutic efficacy.