Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.

Purpose Based on European lumbar spine phantom,to investigate the effect of different noise index(NI)combined with adaptive statistical interactive reconstruction-veo(ASiR-V)weights on the measurement of lumbar spine bone density,and to explore the optimal combination of the two parameters.Materials and Methods Using GE Revolution CT spectral imaging scanning,54 groups of scanning parameters with NI values of 4-20(interval 2)combined with ASiR-V weights of 0-100%(interval 20%)were selected for spectral scanning of European lumbar spine phantom.Regions of interest were placed in the middle of L1,L2 and L3,respectively.hydroxyapatite(HAP)-H2O based substances were selected to measure the HAP content of each vertebral body.The differences between the measured bone density value and the true value under different NI combined with different ASiR-V were compared to evaluate its accuracy.Results There were statistically significant differences in HAP measurements of L1,L2 and L3 vertebra in 54 groups of scanning conditions(all P<0.001).When NI=14,ASiR-V80%;NI=16,ASiR-V100%;NI=18,ASiR-V60%;NI=18,ASiR-V80%;NI=20,ASiR-V60%;NI=20,ASiR-V80%;NI=20,ASiR-V100%,there was no statistically significant difference between HAP measured value and true body model value(P>0.05).Conclusion With NI=18,ASiR-V60%,spectral CT can accurately measure lumbar spine bone density and significantly reduce the radiation dose.In clinical application,bone density can be measured by low dose scanning by increasing the weight of NI and ASiR-V.

OBJECTIVE: To investigate the maximum dose of continuous mivacurium infusion for intraoperative neuromonitoring (IONM) and observe the adverse reactions during thyroid surgery under total intravenous anesthesia (TIVA). METHODS: Thirty patients undergoing IONM during thyroid surgery received continuous infusion of mivacurium at the initial rate of 14.97 μg · kg RESULTS: The EC CONCLUSIONS In patients undergoing thyroid surgery under TIVA, the EC
Anesthesia, Intravenous ; Humans ; Mivacurium ; Propofol ; Remifentanil ; Thyroid Gland

The incidence of rib fracture in patients with chest trauma is about 70%. Simple rib fractures do not need special treatment. Multiple rib fractures and flail chest are critical cases of blunt trauma, which often cause serious clinical consequences and need to be treated cautiously. Nowadays, there is a controversy about the diagnosis and treatment of multiple rib fractures and flail chest. In the past, most of the patients were treated by non-operative treatment, and only less than 1% of the patients with flail chest underwent surgery. In recent years, studies have confirmed that surgical reduction and internal fixation can shorten the hospital stay, and reduce pain and cost for patients with flail chest, but there is still a lack of relevant clinical consensus and guidelines for diagnosis and treatment, which leads to great differences in clinical diagnosis and treatment plans. This article reviewed the treatment, surgical indications and surgical timing of multiple rib fractures and flail chest.

OBJECTIVE: To determine the maximum dose of continuously infused mivacurium for intraoperative neuromonitoring and observe its adverse effects in thyroid surgery. METHODS: Twenty-eight patients undergoing thyroid surgery with intraoperative neuromonitoring received continuous infusion of mivacurium at the initial rate of 5.43 μg?kg?min, and the infusion rate for the next patient was adjusted based on the response of the previous patient according to the results of neurological monitoring. The depth of anesthesia was maintained with sevoflurane and remifentanil during the surgery. The LD50 and 95% of mivacurium were calculated using Brownlee's up-and-down sequential method. RESULTS: The LD50 of continuously infused mivacurium was 8.94 μg?kg?min (95% : 8.89- 8.99 μg?kg?min) during thyroid surgery, which did not affect neurological function monitoring. Transient chest skin redness occurred after induction in 9 patients (32.1%). None of the patients experienced intubation difficulties or showed intraoperative body motions during the surgery. CONCLUSIONS In patients undergoing thyroid surgery under anesthesia maintained by inhalation and intravenous infusion, the LD50 of mivacurium was 8.94 μg?kg?min (95% : 8.89-8.99 μg?kg?min) for continuous infusion, which does not cause serious adverse effects during the operation.
Anesthesia ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Humans ; Intraoperative Neurophysiological Monitoring ; methods ; Lethal Dose 50 ; Mivacurium ; administration & dosage ; adverse effects ; Neuromuscular Nondepolarizing Agents ; administration & dosage ; adverse effects ; Remifentanil ; Sevoflurane ; Thyroid Gland ; surgery

Objective To explore the MSCT features of airway-invasive pulmonary aspergillosis.Methods MSCT features of 27 cases of airway-invasive pulmonary aspergillosis confirmed by pathology or clinical experience were analyzed retrospectively.Results The lesions in 27 cases were distributed along the blood vessel and bronchus and located mainly in the upper and middle lung field in 19 cases.Multiple centrilobular nodules and tree-in-bud sign were found in 27 cases and bronchial wall thickening and patchy opacities around the bronchi were in 25 cases.Bronchiectasis was seen in 17 cases,and cavity-like change and inter-cavity separation were in 15 cases.In 22 cases of follow-up,the lesion progressed within 1 week after diagnosised and treatmented in 20 cases and recurred in slow recovery stage in 5 cases.Conclusion MSCT findings of airway-invasive pulmonary aspergillosis are various which may rapidly progress within a short time.MSCT palys an important role in the evolution and follow-up of airway-invasive pulmonary aspergillosis.

Objective To analyze the relationship between CT image characteristics and the pathological subtypes of small lung adenocarcinoma (≤3 cm) with ground-glass opacity(GGO).Methods Two hundred and three cases of small lung adenocarcinoma proved by pathology were collected.Use the 2015 World Health Organization(WHO) classification of lung cancers as pathology standard.The relationship between CT findings and pathologic classification were analyzed statistically.Results There was a positive correlation between CT type and pathological type (rs =0.756).The size of atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS) and minimally invasive adenocarcinoma(MIA) lesions were smaller than invasive adenocarcinoma(IAC).AAH lesions were smaller than MIA(P＜0.008 3).However,there were no significant size differences in AAH and AIS lesions,or in AIS and MIA lesions (P＞0.008 3).The critical point of non-or-little-invasive (AAH,AIS and MIA) and IAC was 15.35 mm (sensitivity 80.8％,specificity 90.4 ％).Differences in lobulation,air bronchogram,vacuole sign,pleural indentation and vascular convergence among pathological types were statistically significant (P ＜0.05).Differences in shape,speculation and cavity among groups were not significant (P ＞0.05).Conclusion The higher CT type,lower GGO content and bigger lesion size are all associated with increasing tumor degree of malignancy.The size of IAC lesion is usually greater than 15.35 mm.Lobulation,air bronchogram,vacuole sign,pleural indentation and vascular convergence can help to diagnose IAC.

Objective To study the MSCT appearances of thymic neuroendocrine tumors (NETs)and its correlation with the WHO histological grade.Methods MSCT features of 16 patients with thymic NETs confirmed by pathology were analyzed retro-spectively.The patients were divided into 2 groups according to tumor's grade,i.e.low and intermediate grade,high grade.Results There were 8 patients in low and intermediate grade,8 in high grade.No difference was found among tumor location,size,tumor morphology,calcification,pericardiac thickening,pericardial effusion,pleural thickening,pleural effusion,disappearance of fat line around tumor and mass-pulmonary interface with irregular shape,but significant difference was detected in lymph node metastasis. On enhanced MSCT scanning,statistical difference was detected in linear enhancement of the blood vessels in the tumors,but no difference was found between necrosis and peripheral vessel invasion.Conclusion MSCT findings of different grades in thymic NETs have some characteristics and can be helpful in the grades of predictability.

Objective To investigate the protective effects of dexmedetomidine (Dex) against glutamate-induced cytotoxicity in PC12 cells and its mechanism.Methods PC12 cells were treated with varying concentrations of dexmedetomidine 1 h before exposure to a high concentration of glutamate.The cell viability was measured by MTT assay,and LDH release,MDA content and SOD activity were measured.The level of ROS was tested by DCFH-DA staining and flow cytometry.The level of intracellular Ca2+ was detected by Fluo-8 staining and flow cytometry,and the mitochondrial membrane potential (MMP) was determined with JC-1 staining and flow cytometry.Results Within the concentration range of 0.01 to 100 μrnol/L,Dex dose-dependently protected PC12 cells against glutamate-induced cytotoxicity.Treatment with 100 μmol/L Dex significantly increased the cell viability to (86.6±2.2)％ of that of the control cells (P＜0.01) and decreased LDH release to 1.4±0.1 folds of the control level (P＜0.01).In PC12 cells exposed to glutamate,Dex pretreatment significantly reduced MDA content (P＜0.01),enhanced SOD activity (P＜0.01),inhibited ROS overproduction (P＜0.01),reduced intracellular Ca2 + level (P＜0.01) and maintained a stable MMP (P＜0.01).Conclusion Dexmedetomidine can protect PC12 cells against glutamate-induced injury possibly in relation with its anti-oxidative activity,inhibitory effect on intracellular calcium overload and protective effect of the mitochondria.

Objective To investigate the protective effects of dexmedetomidine (Dex) against glutamate-induced cytotoxicity in PC12 cells and its mechanism.Methods PC12 cells were treated with varying concentrations of dexmedetomidine 1 h before exposure to a high concentration of glutamate.The cell viability was measured by MTT assay,and LDH release,MDA content and SOD activity were measured.The level of ROS was tested by DCFH-DA staining and flow cytometry.The level of intracellular Ca2+ was detected by Fluo-8 staining and flow cytometry,and the mitochondrial membrane potential (MMP) was determined with JC-1 staining and flow cytometry.Results Within the concentration range of 0.01 to 100 μrnol/L,Dex dose-dependently protected PC12 cells against glutamate-induced cytotoxicity.Treatment with 100 μmol/L Dex significantly increased the cell viability to (86.6±2.2)％ of that of the control cells (P＜0.01) and decreased LDH release to 1.4±0.1 folds of the control level (P＜0.01).In PC12 cells exposed to glutamate,Dex pretreatment significantly reduced MDA content (P＜0.01),enhanced SOD activity (P＜0.01),inhibited ROS overproduction (P＜0.01),reduced intracellular Ca2 + level (P＜0.01) and maintained a stable MMP (P＜0.01).Conclusion Dexmedetomidine can protect PC12 cells against glutamate-induced injury possibly in relation with its anti-oxidative activity,inhibitory effect on intracellular calcium overload and protective effect of the mitochondria.