Objective    To evaluate the strategy of chemoradiotherapy following endoscopic R0 resection for esophageal cancer in M3-T1b stage. Methods    There were 45 esophageal cancer patients with M3-T1b stage with endoscopic R0 resection followed by additional chemoradiotherapy from ECETC (Esophageal Cancer Endoscopic Therapy Consortium) as a trial group with 34 males and 11 females at age of 61.37±7.14 years. There were 90 patients with esophagectomy from Fudan University Shanghai Cancer Center as a control group with 63 males and 27 females at age of 61.04±8.17 years. Propensity score match (1:2) was used to balance the factors: gender, age, position, depth of invasion and lymphovascular invasion (LVI), which may influence the outcomes. Overall survival (OS) rate, relapse free survival (RFS) rate, and local recurrence rate were compared between the two groups. Result    There was no statistical difference (HR=2.66 with 95%CI 0.87 to 8.11, P=0.179) in terms of OS rate between the two groups. One, two and three years overall survival rate of patients in the control group was 93%, 86%, and 84%, respectively. Nobody died in the trial group within 3 years after surgery. The RFS rate between the two groups didn’t significantly differ (HR=1.48, 95% CI 0.66 to 3.33, P=0.389). One, two and three years RFS rate of patients in the contorl group was 87%, 78%, and 76%, respectively, while 97%, 93%, and 73% in the trial group, respectively. The local recurrence rates between the two groups didn’t significantly differ either ( HR=0.53，95%CI 0.13 to 2.18, P=0.314). One, two and three years local recurrence rate of patients in the control group was 5%, 6% and 6%, respectively, while 0%, 0% and 21% in the trial group, respectively. Conclusion    Similar outcomes are found regarding OS, RFS and local recurrence rates between the two groups. The strategy of endoscopic R0 resection followed by additional chemoradiotherapy has prospect for the treatment of esophageal cancer in M3-T1b stage. And this kind of therapy may be provided for those with risk factors or can not tolerate surgery.

Objective:To analyze the 3D changes of pharyngeal airway in patients with skeletal Class Ⅲ malocclusion after rapid maxillary expansion(RME)and maxillary protraction.Methods:53 patients underwent orthodontic treatment with Hyrax palatal ex-panders and maxillary protraction.Cone-Beam computed tomography(CBCT)scan was taken before treatment(T0),after 1 6 d RME (T1 )and after about 5 month maxillary protraction(T2).Data were reconstructed into 3D model,sagittal and transversal measure-ments,cross sectional areas,volumes of the pharyngeal airway were computed.Results:After RME,the transversal measurements, cross sectional areas,volumes of nasal passage were increased(P <0.05).After maxillary protraction,the 4 nasopharyngeal measure-ments were increased(P <0.05).Conclusion:RME and maxillary protraction may increase pharyngonasal airway.

Objectives To evaluate the naso-maxillary complex width and pharyngeal airway volume changes after rapid maxillary expansion(RME).Methods Thirty-five patients were selected(18 males,17 females,mean age,12.1 ± 1.1 years).All patients underwent orthodontic treatment with Hyrax palatal expanders.Cone-beam CT(CBCT) scan was taken before treatment(T0),16 days(T1) and three months (T3) after RME.Naso-maxillary complex width and pharyngeal airway volume were measured.Results After treatment the width of piriform aperture and maxillary width were significantly increased compared with that before treatment(P＜0.05).Three months after RME,no statistical difference was found in maxillary width compared with that before treatment.The nasopharyngeal volume significantly increased by 29.9％ compared with that before treatment(P＜0.05),and the volume remained relatively stable after three months.Conclusions RME resulted in a significant increase in the naso-maxillary complex width and nasopharyngeal volume.

Objective To evaluate the short-term and long-term effects of pharyngeal airway in mandibular prognathism patients after the combined orthodontic and orthognathic treatment.Methods The sample included 28 skeletal Class Ⅲ patients (13 males,15 females) who had undergone mandibular setback surgery and orthodontic treatment.Cone-beam CT was taken one week before treatment (T0),6 months (T1) and 3 years after surgery (T2).Raw data were reconstructed into three-dimensional model.Sagittal and transversal measurements,cross sectional areas,partial and total volumes were computed.Results Six months after surgery,oropharyngeal volume [(9 021±4 263) mm3],hypopharyngeal volume [(9 236±5 963) mm3] and total volume [(28 619±9 854) mm3] decreased significantly (P＜0.05).Three years after surgery,only sagittal diameters [(15.9±3.5) mm] and cross sectional areas [(996±398) mm2] in the first cervical vertebra plane came back to the original levels (P＞0.05).Conclusions The pharyngeal airway space decreased after orthodontic-orthognathic therapy in the short term and it increased in some areas in the long term.

Objective To evaluate the application of three-dimensional measurement and computer-aided navigation system in treatment of orbitozygomatic complex fiacture.Methods Pre-and post-operative three-dimensional measurements were taken by Mimics software to locate the zygomatic bones of 15 patients with orbitozygomatic complex ftacture to determine distance of optical foramen to zygomaticotemporal suture (On-Zm)/ zygomaticofrontal suture (On-Or)/zygomaticomaxillary suture (OnTz),horizontal angle of zygomatic arch,horizontal angle of the zygomatic process,and inferior angel of the frontal process of zygomatic bone.Preoperative design and simulation,intraoperative real time navigation and postoperative evaluation were applied using computer assisted navigation system.Results OnTz,On-Or,and On-Zm was (48.6-±4.5)mm,(42.5±2.2)mm,and (47.5±3.2)mmin the unaffected side,but was (50.4 ± 2.2) mm,(37.2 ± 1.0) mm,and (53.4 ± 3.6) mm in the affected side before operation (P ＜ 0.05).Whereas On-Tz,On-Or,and On-Zm improved to (46.4 ± 3.7) mm,(41.2 ± 1.8) mm,and (46.4 ± 2.5) mm in the affected side after operation,similar with the values in the unaffected side (P ＜ 0.05).Horizontal angle of zygomatic arch,horizontal angle of the zygomatic process,and inferior angel of the frontal process of zygomatic bone was (144.7 ±4.1)°,(132.5 ± 2.3)°,and (112.0 ± 3.4)° in the affected side,with significant differences from (150.3 ± 8.0)°,(141.1 ±4.2)°,and (114.9 ±5.1)° in the affected side before operation (P ＜0.05),but they were improved to almost the normal values (144.6 ± 4.1) o,(132.8 ± 2.0) °,and (111.9 ± 3.6) ° after operation.Satisfactory surgical outcomes,such as three dimensional symmetry and recovery of normal mouth-openingand occlusion,had been achieved.Conclusions Three-dimensional measurement is a quantitative study on the spatial displacement of orbitozygomatic complex.Combined with computer-assisted navigation system with preoperative design and simulation,intraoperative real time navigation and postoperative evaluation,three-dimensional measurement attains the overall management of orbitozygomatic complex fracture.

Objective To assess the values of color Doppler and magnetic resonance imaging (MRI) in the identification of cervical lymph node micrometastasis of tongue cancer.Methods Totally 96 cases of tongue cancer with impalpable neck lymph node was examined with color Doppler and MRI within one week before surgery.Chi-square test was used to assess if the presence of regional lymph node micrometastasis,histopathological analysis as a golden standard lymph node micrometastasis.Results For the diagnosis of cervical lymph node micrometastasis,color Doppler was significantly better than MRI in sensitivity (72.5％ vs 50.0％,P=0.039) and the accuracy (78.1％ vs 64.6％,P =0.038),but no significant difference in the specificity (82.1％ vs 75.0％,P =0.357),the positive predictive value (74.4％ vs 58.8％,P =0.159) and the negative predictive value (80.7％ vs 67.7％,P =0.108).Conclusion Color Doppler is better than MRI in the sensitivity and accuracy for the diagnosis of cervical lymph node micrometastasis of tongue cancer.

Objective To investigate the distribution of pathogens in adult patients with community-acquired pneumonia (CAP) in Tangshan area. Methods The clinical data of 530 hospitalized patients with CAP were retrospectively collected in department of respiratory medicine from 6 hospitals in Tangshan area from October 2011 to September 2012. The sputum samples were isolated and cultured. Results A total of 195 strains were isolated from 530 patients with CAP. The most common types of pathogens included Klebsiella pneumoniae (64 strains,12.08%), Streptococcus pneumoniae (24 strains, 4.53%) and Bauman Acinetobacter (19 strain, 3.58%). The detective rates of Klebsiella pneumoniae and Pseudomonas aeruginosa were significantly higher in patients with basic diseases than those of patients without basic diseases (P<0.05). The detective rates of Klebsiella pneumoniae and Streptococcus pneumoniae were significantly higher in patients not taking antibiotics than those of patients taking antibiotics (P<0.05). The detective rates of Klebsiella pneumoniae, Bauman Acinetobacter and Pseudomonas aeruginosa were significantly higher in the age group≥60 years than those in the age group<60 years (P<0.05). The detective rates of Klebsiella pneumoniae were significantly increased with increased levels of PORT (P<0.05). There were no significant differences in the detective rates of pathogens between different regions and different seasons (P>0.05). Conclusion The gram-negative bacterial pathogens were the majority isolated from patients with CAP in Tangshan area. And Klebsiella pneumoniae was the primary bacteria. Patients with serious illness, above 60 years old, without antibiotic treatment before hospitalization, with basic diseases and above PORTⅢlevels should be given treatment of anti-gram-negative bacteria.

Objective To investigate the efficacy of laparoscopic cholecystectomy(LC)for patients with acute cholecystitis.Methods From May 2003 to November 2007,238 patients with acute cholecystitis underwent LC in our hospital.Four trocars were used in the operation.During the procedure,intraperitoneal pressure was controlled at 11 to 13 mm Hg(10 mm Hg for elderly patients).Retrograde cholecystectomy was performed on the patients with difficult anatomy caused by edema of the cystic triangle.For cases with calculi incarcerated in the cystic duct,the LC was performed after the stones were removed into the cyst(cholangiography was performed to exclude bile duct calculi).Results Of the 238 cases,LC was completed successfully in 220 patients,the other 18 cases were converted into open surgery because of massive hemorrhage and difficult anatomy(12 cases)or bile duct calculi(6 cases).After the LC,two patients received a second surgery because of postoperative hemorrhage;six patients developed bile leakage(occurred at 2-4 days after the LC with 50-80 ml of drainage)and were cured by conservative therapy including fasting,intravenous nutrition and anti-biotic therapy.This series were followed up for 1 to 12 months(mean,6 months).No post-operative complications were noticed during the period.Conclusions LC is a safe and effective for patients with acute cholecystitis or acute episode of chronic cholecystitis.Controlling the operation opportunity properly and dissecting the Calot's triangle area carefully to expose the cystic duct are the key steps during the operation.Convertion to open surgery is necessary in some difficult situations.

Objective To evaluate the approaches of percutaneous trans-hepatic stent for relieving malignant biliary obstruction and its clinical effect. Methods 20 stents were set up in bile duct to treat malignant biliary obstruction in 18 cases using two steps under x-ray fluoroscopy. After the stents set up successfully, the contrast agent was injected through the long sheath in order to find out the expansion and expedition of the stent. The stents were provided by Micro-Tech co.1td.(Nanjing). The patient’s jaundice, liver function and amylase (AMY)levels were observed after the procedure and all the patients were followed up for three to eleven months. Results Twenty stents were placed in 18 patients successfully in one time.STB , ALT, AST, r-GT and ALP decreased 66.27%, 57.83%, 62.21%, 44.74% and 47.57% respectively one week after the procedure. Early complications included hyperamylasemia , acute pancreatitis,hernobilia, bile leakage,ect.Late complications were displacement and restenosis of the stent . A patient died due to failure of heart and lung. Conclusion The percutaneous transhepatic insertion of biliary stent is an effective method in relieving malignant obstructive jaundice.

AIM: To explore the neuroprotective action of progesterone(PROG), which has been proved to be a "neuroactive steroid". METHODS: The model of focal cerebral ischemia was established in rats by reverserble inserting a nylon thread with a diameter of 0.2 mm into the anterior cerebral artery through the internal carotid artery. The effect of PROG was assessed by determining water,sodium, potassium, and calcium contents in striatum of rats subjected to 2 h ischemia followed by 22 h reperfusion. RESULTS: The water,sodium,and calcium contents of middle cerebral artery occlusion(MCAO) striatum were obviously higher,the potassium content was obviously lower than those of non-MCAO striatum in I/R and DMSO groups,but there was no significant difference between these two groups.Compared with the result in I/R and DMSO groups , water, sodium and calcium contents significantly decreased, but potassium(P0.05). CONCLUSION: Treatment with PROG can significantly reduce the striatal injury of rats with cerebral ischmia-reperfusion.