Carcinoma of the esophagus is one of the common malignant tumors, and surgical treatment is still the main method for the treatment of esophageal cancer. With the development of thoracoscopic and laparoscopic instruments, minimally invasive esophagectomy is more and more widely used in the treatment of esophageal cancer. At present, minimally invasive esophagectomy mainly includes thoracoscopic and laparoscopic esophagectomy, mediastinoscopic esophagectomy, robot assisted esophagectomy, etc. At present, there are many studies on the comparison between minimally invasive esophagectomy and open esophagectomy. Although it is not clear which minimally invasive surgical method is more superior, each method may be superior to open esophagectomy in terms of blood loss, pulmonary complications and hospital stay. No matter what method is used, surgeons must be trained in a structured system to improve the level of experience required for independent operation. Ultimately, with the implementation of experienced doctors, the minimally invasive method in esophagectomy is superior to open esophagectomy in technically feasible cancer cases.

Primary pulmonary mucinous adenocarcinoma is a subtype of lung adenocarcinoma, and its epidemiology is similar to other pulmonary adenocarcinoma. Because of its low incidence rate, the survival data of patients with pulmonary mucinous adenocarcinoma are few and often contradictory. KRAS mutations often occur in pulmonary mucinous adenocarcinoma, but EGFR mutations are rare. The expression of PD-L1 in pulmonary mucinous adenocarcinoma is very low. Patients with early pulmonary mucinous adenocarcinoma can benefit from surgery. Lobectomy is still the standard operation at present, but sub lobectomy may also be effective for early pulmonary mucinous adenocarcinoma. Other treatment options include platinum based dual drug chemotherapy, targeted therapy targeting driving genes, and the recent rise of immunotherapy. Future new targets and corresponding treatments should require more research to confirm.

Background::The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement (TAVR) for symptomatic severe aortic stenosis (AS), and the impact of sizing strategies and related procedural outcomes.Methods::Patients with severe AS who underwent TAVR were consecutively enrolled from 2012 to 2019. The anatomy and morphology of the aortic root were assessed. "Downsize" strategy was preformed when patients had complex morphology. The clinical outcomes of patients who performed downsize strategy were compared with those received annular sizing strategy. The primary outcome was device success rate, and secondary outcomes included Valve Academic Research Consortium-3 clinical outcomes variables based on 1-year follow-up.Results::A total of 293 patients were enrolled. Among them, 95 patients (32.4%) had bicuspid aortic valve. The calcium volume (Hounsfield Unit-850) of aortic root was 449.90 (243.15-782.15) mm 3. Calcium is distributed mostly on the leaflet level. Downsize strategy was performed in 204 patients (69.6%). Compared with the patients who performed annular sizing strategy, those received downsize strategy achieved a similar device success rate (82.0% [73] vs. 83.3% [170], P= 0.79). Aortic valve gradients (downsize strategy group vs. annular sizing group, 11.28 mmHg vs. 11.88 mmHg, P = 0.64) and percentages of patients with moderate or severe paravalvular regurgitation 2.0% (4/204) vs. 4.5% (4/89), P = 0.21) were similar in the two groups at 30 days after TAVR. These echocardiographic results were sustainable for one year. Conclusions::Chinese TAVR patients have more prevalent bicuspid morphology and large calcium volume of aortic root. Calcium is distributed mostly on the leaflet level. Compare with annular sizing strategy, downsize strategy provided a non-inferior device success rate and transcatheter heart valve hemodynamic performance in self-expanding TAVR procedure.

Objective:To explore the clinical effects of endoscopic sinuvertebral nerves neurotomy for discogenic low back pain.Methods:Based on the anatomical research of sinuvertebral nerves, a total of 40 patients, including 9 males and 21 females aged 35±10 (24-55) years, with single-segment discogenic low back pain were treated with endoscopic sinuvertebral nerves neurotomy in our hospital from July 2018 to February 2019. The operating section included 4 cases of L 3,4 (10.0%, 4/40), 31 cases of L 4, 5 (77.5%, 31/40), and 5 cases of L 5S 1 (12.5%, 5/40). The preoperative visual analogue scale (VAS) score was 4.5±0.9 with the preoperative Oswestry disability index (ODI) score 49.7%±14.0%. For diagnostic nerves block, lidocaine (0.1-0.3 ml of 0.05 g/L) was successfully injected into the intersection of the lateral edge of the bilateral pedicle projection and the upper edge of the intervertebral disc projection. The initial segment of the sinuvertebral nerves was destroyed by a radiofrequency blade or a nerve dissector after bilateral percutaneous transforaminal endoscopic. All cases were followed up at 1, 3, 6 and 12 months after surgery, observing the changes in VAS and ODI. Results:Filamentous lumbar sinuvertebral nerve was observed under endoscope with its main trunk tranversed into the spinal canal against the intervertebral disc. The deputy trunk crossed at the posterolateral edge of the intervertebral disc and entered the intervertebral disc or the posterior edge of the vertebral body. By moving along with postcentral branches of spinal artery, the main trunk of sinuvertebral nerve was with tension and was capable of moving with the nerve root. In spite of moving the working channel along the main trunk of the sinuvertebral nerve laterally, the starting point of the sinuvertebral nerve at the ventral ganglion could be observed. All 40 patients successfully completed the sinuvertebral nerve destruction. The VAS was reduced to 1.7±0.9, 1.3±0.9, 1.2±0.8, 1.3±0.7 at 1, 3, 6 and 12 months after sugery respectively, which were significantly lower than those at pre-operation ( F=116.7, P=0.00). The improvement rate of VAS in 40 cases was 68.9%± 17.1% (33.3%-100.0%) at 12 months after operation. The VAS score in 6 cases was higher at 12 months after surgery than that preoperatively ( t=4.2, P=0.48), namely 1 case of L 3, 4, 2 cases of L 4, 5, and 3 cases of L 5S 1. In all cases, the ODI was reduced to 18.3%±5.2%, 14.5%±4.3%, 13.6%±3.7%, 12.8%±3.0% points at 1, 3, 6 and 12 months after surgery respectively, which were significantly lower than those before surgery ( F=237.7, P=0.00). The improvement rate of ODI was 72.0%±11.6% (33.3%-88.9%) at 12 months after surgery in all cases. Conclusion:The destruction of sinuvertebral nerve after transforaminal endoscope could improve the pain and function in patients with discogenic low back pain at L 3,4 and L 4, 5 segments within 12 months. For patients with discogenic low back pain at L 5S 1 segment, the clinical effects could be better within 6 months.

Objective: To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal digital artery. Methods: From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected. The radial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed. Results: The distal 1/3 segment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface. The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries. The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6±0.4 cm and the diameter was 0.2±0.1 mm. Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches. Conclusion The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue defect on the thumb and purlicue.

Twenty-one protostane-type triterpenoids with diverse structures, including nine new compounds (-), were isolated from the of Linn. Structurally, alisolides A‒F (-), composed of an oxole group coupled to a five-membered ring, represent unusual C-17 spirost protostane-type triterpenoids. Alisolide H () is a novel triterpenoid with an unreported endoperoxide bridge. Alisolide I () represents the first example of 23,24-acetal triterpenoid. Their structures were elucidated based on spectroscopic analysis, wherein the absolute configurations of ‒, were further confirmed by the Mo(OAc)-induced ECD method. Furthermore, all isolates were evaluated for their inhibitory effects on LPS-induced NO production in Caco-2 cells, and all the compounds showed remarkable inhibitory activities, with IC values in the range of 0.76-38.20 μmol/L.

To provide the anatomical information for auricle replantation. Methods From March, 2016 to March, 2019, a total of 25 fresh adult cadaveric head were used, 20 of these specimens were perfused with plastic and eroded to be vascular cast mold, 5 specimens perfused with red latex for anatomy, then observed the origin, course, diameter and arteries anastomose between branches of the posterior auricular artery (PAA) and superfi-cial temporal artery (STA). Results The main blood supply to the auricle were auricle branches of PAA and STA. The auricle branches of PAA and STA both divided into superior, intermedius and inferior branches, and distributed in the auricle posterior surface and anterior surface, respectively.The auricle branches of PAA running across ear car-tilage, distributed in the anterior surface, and anastomosed with auricle branches of STA. The diameters of these branches at the initiating portion were 0.2-0.8 mm. Eighty percent of blood supply to earlobe was from the inferior branches of PAA, and 20% from the STA. Conclusion The auricle branches of PAA played an important role to the auricle replantation.The auricle branches of PAA should be the firstly selected vessle in operation, and the auricle branches of STA be the second choice.

Objective To study the levels of serum cytokines in schizophrenic patients and their changes in antipsychotic medica-tion treatment .Methods The levels of serum cytokines including IL-10 ,IL-6 ,IL-13 ,IL-4 ,IFN ,TNF-α,IL-1a and IL-1RA were de-tected in 34 healthy adults and 53 schizophrenia patients by adopting the flow fluorescence method .Results The serum levels of IL-6 ,IL10 and TNF-αbefore treatment in schizophrenic patients were significantly higher than those in the control group (P<0 .05) . After treatment ,the levels of serum IL-1a ,IL-6 and TNF-α in schizophrenic patients were significantly lower than those before treatment(P<0 .05) .Conclusion Serum IL-6 and TNF-α levels are correlated with the disease condition of schizophrenia .IL-10 plays a role in early anti-inflammation of schizophrenia .

OBJECTIVETo evaluate the impact of primary site, NIH risk and imatinib treatment on the prognosis of patients with gastrointestinal stromal tumors(GIST).

METHODSClinicopathological data of 156 adult patients with GIST treated by imatinib in the Cancer Institute and Hospital of Tianjin Medical University from January 2006 to December 2010 were retrospectively analyzed. According to NIH risk classification, 30 patients were at moderate risk and 126 at high risk. Sixty-seven patients had advanced GIST. Prognosis of patients with different primary tumor site, different NIH risk and different treatment was compared respectively.

RESULTSImatinib therapy was well tolerated in all the patients. Eighty-nine cases received radical operation and adjuvant imatinib treatment. Among 67 advanced GIST cases, 26 received radical operation and adjuvant imatinib treatment, 27 received palliative operation and adjuvant imatinib treatment, and 14 received simple adjuvant imatinib treatment without operation. All the patients had routine follow-up, ranging from 9 to 56(median 27) months. The overall survival (OS) rate was 96% in 1-year, 86% in 2-year, and 71% in 3-year. The OS rate was 95% in 1-year, 77% in 2-year, and 65% in 3-year for patients at high risk, and all 100% in 1-, 2-, 3-year for patients at moderate risk, the differences was statistically significant (P=0.001). The OS rate was 97% in 1-year, 90% in 2-year, and 84% in 3-year for patients with gastric GIST, and 95% in 1-year, 69% in 2-year, and 52% in 3-year for patients with non-gastric GIST, the difference was significant(P=0.000). The OS rate was 98% in 1-year, 95% in 2-year, and 90% in 3-year for patients undergoing radical resection and adjuvant imatinib therapy. For 67 advanced GIST patients with imatinib therapy, none had complete remission, 41 had part remission, 15 had stable disease, indicating 56 advanced GIST cases(83.6%) obtaining clinical benefit. The OS rate was 91% in 1-year, 58% in 2-year, and 43% in 3-year.

CONCLUSIONSThe prognosis of high, and non-gastric and advanced GIST patients is poor. Radical resection combined with early imatinib treatment can improve the prognosis of GIST patients.

Antineoplastic Agents ; therapeutic use ; Benzamides ; therapeutic use ; Combined Modality Therapy ; Follow-Up Studies ; Gastrointestinal Neoplasms ; drug therapy ; pathology ; Gastrointestinal Stromal Tumors ; drug therapy ; Humans ; Imatinib Mesylate ; Piperazines ; therapeutic use ; Prognosis ; Pyrimidines ; therapeutic use ; Retrospective Studies ; Survival Rate

Objective To evaluate the impact of primary site, NIH risk and imatinib treatment on the prognosis of patients with gastrointestinal stromal tumors (GIST). Methods Clinicopathological data of 156 adult patients with GIST treated by imatinib in the Cancer Institute and Hospital of Tianjin Medical University from January 2006 to December 2010 were retrospectively analyzed. According to NIH risk classification, 30 patients were at moderate risk and 126 at high risk. Sixty-seven patients had advanced GIST. Prognosis of patients with different primary tumor site , different NIH risk and different treatment was compared respectively. Results Imatinib therapy was well tolerated in all the patients. Eighty-nine cases received radical operation and adjuvant imatinib treatment. Among 67 advanced GIST cases, 26 received radical operation and adjuvant imatinib treatment, 27 received palliative operation and adjuvant imatinib treatment, and 14 received simple adjuvant imatinib treatment without operation. All the patients had routine follow-up, ranging from 9 to 56 (median 27) months. The overall survival (OS) rate was 96% in 1-year, 86% in 2-year, and 71% in 3-year. The OS rate was 95% in 1-year, 77% in 2-year, and 65% in 3-year for patients at high risk, and all 100% in 1-, 2-, 3-year for patients at moderate risk, the differences was statistically significant (P=0.001). The OS rate was 97%in 1-year, 90% in 2-year, and 84% in 3-year for patients with gastric GIST, and 95% in 1-year, 69%in 2-year, and 52%in 3-year for patients with non-gastric GIST, the difference was significant(P=0.000). The OS rate was 98% in 1-year, 95% in 2-year, and 90% in 3-year for patients undergoing radical resection and adjuvant imatinib therapy. For 67 advanced GIST patients with imatinib therapy , none had complete remission, 41 had part remission, 15 had stable disease, indicating 56 advanced GIST cases (83.6%) obtaining clinical benefit. The OS rate was 91% in 1-year, 58% in 2-year, and 43% in 3-year. Conclusions The prognosis of high, and non-gastric and advanced GIST patients is poor. Radical resection combined with early imatinib treatment can improve the prognosis of GIST patients.