The standard treatment mode for locally advanced operable esophageal carcinoma is neoadjuvant chemoradiotherapy combined with radical esophagectomy. However, considering the clinical need for organ retention, the treatment strategies for those achieving complete clinical response after neoadjuvant chemoradiotherapy include watchful waiting (omitting surgery), delayed or salvage surgery, and strengthened systemic treatment. These treatment strategies can significantly improve the quality of patients' life while ensuring local control and long-term survival. The feasibility and clinical value of these treatment strategies are deeply explored, hoping to provide new treatment ideas for this group of patients.

Neoadjuvant chemoradiotherapy is the preferred treatment mode for the diagnosis and treatment of locally advanced operable esophageal carcinoma recommended by many guidelines. However, some problems remain to be further explored. In this article, current problems perplexing clinical practice were sorted out, aiming to provide constructive suggestions for the smooth development of neoadjuvant chemoradiotherapy for esophageal carcinoma in the future.

Objective:To investigate distribution characteristics of Treponema pallidum (Tp) in secondary syphilis lesions, and to analyze its correlation with histopathological findings. Methods:Totally, 41 patients were collected from Department of Dermatology and Venereology, Peking Union Medical College Hospital from January 2008 to December 2018, who were confirmedly diagnosed with secondary syphilis according to clinical manifestations and serological examinations, and had undergone histopathological examinations. Immunohistochemical results of skin tissue sections were analyzed, and differences in clinical and histopathological characteristics were analyzed between immunohistochemically Tp-positive and Tp-negative sections. Continuous data were compared by using t test or Kruskal-Wallis test, and categorical data were compared by using Chi-square test or Fisher′s exact test. Results:Immunohistochemical examination showed that Tp was detected in 68.3% of the 42 secondary syphilis tissue sections, and Tp was mainly distributed in the lower epidermis and superficial and middle dermis. The positive rate of Tp was significantly higher in secondary syphilis lesions mainly manifesting as maculae (80% [16/20]) than in those mainly manifesting as papules (50% [11/22], P < 0.05) . Among 10 pathological characteristics, extended rete ridges, basal cell liquefaction degeneration, neutrophil infiltration in the stratum corneum, lichenoid pattern of infiltration and punctate keratinocyte necrosis were observed more frequently in immunohistochemically Tp-positive sections than in Tp-negative sections (all P < 0.05) . Immunohistochemical study revealed that tissue sections with a larger number of Tp showed more pathological features ( H = 17.914, P < 0.001) . Immunohistochemical staining showed that there were 8, 7 and 6 syphilis-specific histopathological characteristics on average in 8 tissue sections with a larger number of Tp, 14 with a medium number of Tp and 5 with a small number of Tp, respectively; while only 4 syphilis-specific histopathological characteristics were observed on average in 15 immunohistochemically Tp-negative tissue sections. Conclusion:Immunohistochemical staining could show the distribution of Tp in secondary syphilis lesions, and it seems that tissue sections with a larger number of Tp present with more syphilis-specific histopathological characteristics.

Objective:To investigate the effects, complications and survival of patients tumor-type artificial knee prosthesis replacement for treatment of malignant bone tumors around the knee.Methods:The data of 47 patients undergoing tumor-type knee prosthesis replacement in Shanxi Medical University from January 2010 to April 2018 was retrospectively analyzed. There were 21 males and 26 females, with a median age of 21 years (7-70 years). There were 39 cases of osteosarcomas, 3 cases of chondrosarcomas, 2 cases of malignant fibrous histiocytomas, 2 cases of giant cell bone tumors, and 1 case of fibrosarcoma. The involved locations were the distal femur in 35 cases and proximal tibia in 12 cases. Patients with osteosarcoma and malignant fibrous histiocytomas received chemotherapy for 2 courses before operation and 4-6 courses after operation. The data included the survival time, prosthesis survival time, complications, limb function, tumor recurrence and lung metastasis of patients.Results:Patients were followed up for a median time of 25 months (5-102 months). The 1-year, 3-year and 5-year overall survival rates were 95.74%, 71.29% and 58.06%, respectively. The 1-year, 3-year and 5-year disease-free survival rates were 86.42%, 55.49% and 50.86%, respectively. Local tumor recurrence occurred in 10 patients (21.28%) within 3 years after operation. Of the 10 patients, 8 cases had a recurrence of the soft tissue tumor and then they received the resection surgery; the other 2 patients underwent amputation of the diseased limb. The pulmonary metastasis occurred in 15 patients (31.91%). The 5-year survival rate of prosthesis was 82.33%, and the 5-year survival rate of prosthesis in patients with tumor in the distal femur was higher than that in patients with tumor in the proximal tibia [86.96% vs. 75.00%, P = 0.338]. The periprosthetic infection occurred in 3 patients (6.38%), and 1 case (2.13%) received revision after prosthesis loosening, 1 case (2.13%) received revision after prosthesis breakage. At the patient's last follow-up, the Musculoskeletal Tumor Society (MSTS) score was 21 points (15 points, 24 points), and the excellent rate was 61.70% (29/47). The incidence of extensor lag in patients with tumor in the proximal tibia was higher than that in patients with tumor in the distal femur, and the difference was statistically significant [33.33% (4/12) vs. 2.86% (1/35), P = 0.016]. Conclusions:Tumor-type artificial knee prosthesis replacement can effectively treat malignant bone tumors around the knee and maintain satisfactory limb function and patients' survival rate. However, the postoperative complications may lead to limb salvage failure. It is necessary to reduce the occurrence of complications through standardized chemoradiotherapy, extensive and strict tumor resection and proper rehabilitation exercises.

Objective To report a pedigree with X?linked dominant protoporphyria(XLDPP), and to detect 5?aminolevulinic acid synthetase 2(ALAS2)gene mutations in this pedigree. Methods A clinical investigation was performed in a pedigree with XLDPP, and relevant data were collected from family members. A next?generation sequencing method was applied to screen possible mutation sites, and Sanger sequencing was performed to determine pathogenic gene mutations. Dermoscopy was conducted to observe skin lesions in the patients with XLDPP, and the Fotofinder system and very high frequency (VHF) ultrasound system were utilized to assess the severity of photodamage. Liver and gallbladder ultrasonography as well as blood examination were performed for all the family members. Results A deletion mutation, c.1706?1709ΔAGTG, was detected in the ALAS2 gene on the X chromosomes of all the patients in this family, which led to replacement or loss of 19-20 C?terminal residues through transcriptional frameshifting, and eventually caused an increase in ALAS2 activity. In the patients with XLDPP, skin photodamage was relatively severe;protoporphyrin?induced hepatobiliary damage was observed and aggravated with age;anemia and iron deficiency occurred sometimes. Conclusion The deletion mutation c.1706?1709ΔAGTG of the ALAS2 gene may be the underlying cause of XLDPP in this pedigree.

Objective:To evaluate the effectiveness of Minqing Ao dental desensitizer in the treatment of early childhood caries (ECC).Methods:41 0 teeth with ECC in 1 1 0 cases were divided into 3 groups.Minqing Ao dental desensitizer,fluoride toothpaste and ordinary toothpaste without fluoride were respectively used in group A,B and C.The laser fluorescence value(LFV)was meas-ured and compared before treatment,2,4,6 weeks and 6 months after treatment.Results:2 weeks after treatment,the LFV was not significantly changed in the 3 groups.4 weeks after treatment LFV in group A was decreased(P<0.01 ),the LFV in group A was lower than that in group B(P<0.05)and in group C(P<0.01 ).While there was no significant difference between group B and C(P>0.05).6 weeks after treatment LFV in group A and B was decreased(P<0.01 and P<0.05),there was significant difference be-tween each 2 groups(P<0.05).6 weeks and 6 months after treatment LFV in group A was lower than that in group B(P<0.01 ),and in group B was lower than that in group C(P<0.01 ).Conclusion:Minqing Ao is effective for treatment of early childhood caries.

Objective To investigate the value of 18 F-fluorodeoxyglucose FDG) positron emission tomography (PET)-computed tomography (CT) in predicting the progression-free survival (PFS)and overall survival (OS) of patients with esophageal squamous cell carcinoma (ESCC) after threedimensional (3D) radiotherapy.Methods A retrospective analysis was performed on 98 ESCC patients,who underwent FDG PET-CT before 3D radiotherapy from 2004 to 2010,to investigate their 1-,3-,and 5-year PFS and OS rates.The relationship of maximum standard uptake value (SUVmax),mean SUV (SUVmean),metabolic target volume (MTV),length of primary tumor on PET-CT before radiotherapy,and number of tumors on PET with PFS and OS were analyzed.The SUVs and clinical data were analysed by independent samples t-test or Hotelling T2 test; the Kaplan-Meier method was used for calculating PFS and OS rates,and the Logrank test was used for survival difference analysis;the prognostic factors were analysed using the Cox proportional hazard model.Results The follow-up rate was 100％ ;56 patients were followed up for at least 3 years,and 27 for at 5 years.The SUVmax SUVmean and MTV of primary tumor,length of primary tumor on PET-CT before radiotherapy,and number of tumors on PET were correlated with PFS and OS (x2 =8.99-41.82,all P ＜ 0.01).The Cox regression analysis showed that PFS could be well predicted based on SUVmean (x2 =4.41,P =0.036,RR =1.398) and number of tumors on PET (x2 =6.79,P =0.009,RR =3.650) and that OS could be well predicted based on number of tumors on PET (x2 =5.03,P =0.025,RR =3.740).Conclusions When estimating the long-term response to precise radiotherapy in patients with ESCC,SUV mean and number of tumors on PET may be used to predict PFS,and number of tumors on PET may be used to predict OS.

Objective To observation the clinical effect of anesthesia combined with epidural block for patients with COPD surgery.Methods 262 cases with COPD needed to line the chest and abdominal surgery and urology surgery patients.Patients were divided into control group and observation group according to the time sequence,underwent general anesthesia and anesthesia combined with epidural anesthesia,contrast observed in patients with operative time,postoperative extubation time,wake time and the analgesic effect of anesthesia (VAS score) was measured in patients with FVC,FEV1/FVC and FEF25％ to 27％ lung function,clinical efficacy and complication rate of two anesthesia methods.Results The patients extubation time,recovery time and VAS scores were significantly lower than those of control group,the differences were statistically significant(all P ＜0.05).Group of postoperative patients with FVC,FEV1/FVC and FEF25％ to 27％,such as lung function test results were significantly better than those of control group,and the difference was statistically significant (all P ＜0.05).Anesthesia control group total effective rate of 87.0％ observed in patients anesthesia total effective rate was 96.9％.Compared with the control group,the anesthesia clinical effect of the observation group was statistically significant (P ＜0.05).Operative time and postoperative complication rate of the two groups of patients showed no significant difference(P ＞0.05).Conclusion Anesthesia combined with epidural anesthesia used in surgery in patients with COPD can effectively improve the clinical effects of anesthesia,to enhance the safety of anesthesia,which will help the rehabilitation of patients and worth of clinical practice.

Objective To study the natural developing characteristics of language skill of the autistic children. Methods 300 untreated autism children were included. Their developmental characteristics of individuals were evaluated by the Psycho-Educational Profile-Revised (PEP-R). Results The developmental quotient of most children (89.33%) was less than 70. And the developmental quotient gradually decreased with age (P<0.01). The scores of language performance and language verbal were deviation (P<0.01). Conclusion Language characteristics of autistic children without treatment is abnormal in development progress and order, and the situation would be worse with age.

Objective To evaluate clinical factors as predictors of radiation pneumonitis(RP)in advanced stage non-small cell lung cancer(NSCLC)patients treated with concurrent radiochemotherapy when gross tumor volume is 70 Gy. Methods Data of 84 patients with histologically proved NSCLC treated with 3DCRT or IMRT were collected. To evaluate the correlation between clinical parameters and radiation pneumonitis(RP). The clinical parameters were considered: pathological type, therapy agents, age,gender, stage, karnofsky performance status(KPS), smoking status, diabetes, chronic obstructive pulmonary disease(COPD). Results The occurrence of grade 1,2 RP was 63%, 33%, respectively. In univariate analysis, diabetes was significantly associated with RP of ≥ grade 1(x2 =4.03, P = 0.045)and ≥grade 2(x2 = 15.59 ,P =0.000). KPS was significantly associated with RP of ≥grade 1(x2 =3.98 ,P = 0.046)and ≥grade 2(x2 = 5.21, P = 0.023). In logistic multivariate analysis, diabetes was significantly associated with RP of ≥grade 1(x2 =5.50,P =0.019)and ≥grade 2(x2 = 12.92,P =0.000). KPS was significantly associated with RP of ≥ grade 1(x2 = 6.29, P = 0.012)and ≥ grade 2(x2 = 6.61, P =0.010). Conclusion The definite statistical significant risk factors of RP are diabetes and KPS.