Minimally invasive esophagectomy is the preferred treatment for esophageal cancer, which has been widely popularized and developed in clinical practice. However, anastomotic complications are still common, such as anastomotic leakage, anastomotic stenosis, and gastroesophageal reflux, which seriously affect the rapid recovery and quality of life of patients after surgery. Esophagogastrostomy is the core and difficulty of the operation. In recent years, different esophagogastric anastomosis methods and techniques have been found to reduce the incidence of anastomotic complications and improve clinical outcomes. This article will summarize the development and progress of esophagogastric anastomosis techniques at home and abroad in recent years in order to provide reference for the majority of thoracic surgeons and to promote the progress of esophagogastric anastomosis techniques.

Neoadjuvant chemoradiotherapy or chemotherapy combined with surgery for locally advanced esophageal cancer has become the standard treatment, and despite the survival benefit, most patients still experience postoperative recurrence and distant metastasis. Immune checkpoint inhibitors play an anti-tumor role by activating T cells, and immunotherapy has become one of the important strategies for first-line and second-line treatment of advanced esophageal cancer with the continuous evolution of immunotherapy models. Regarding neoadjuvant immunotherapy for esophageal cancer, a large number of studies are being carried out and explored, which are expected to inject new vitality into neoadjuvant therapy for esophageal cancer. This article reviews the current clinical studies on neoadjuvant immunotherapy for esophageal cancer.

Objective To investigate the prevalence of Cryptosporidium infection and the distribution of parasite species and genotypes among HIV-positive individuals in Jiangxi Province. Methods HIV-positive individuals' sociodemographic and clinical data were collected from three AIDS designated hospitals in Jiangxi Province from January 2022 to March 2023. Subjects' stool samples were collected, and genomic DNA was extracted from stool samples. Nested PCR assay was performed based on the small subunit ribosomal RNA (SSU rRNA) gene of Cryptosporidium, and Cryptosporidium gp60 gene was amplified in stool samples positive for the SSU rRNA gene. The second-round PCR amplification product was checked with 1.5% agarose gel electrophoresis, and the products of suspected positive amplifications were sequenced, followed by sequence alignment. The phylogenetic tree was created using the Neighbor-Joining method with the software MEGA 11.0, to characterize the species, genotypes and sub-genotypes of Cryptosporidium. Results A total of 382 HIV-positive individuals were enrolled, with two cases identified with Cryptosporidium infection (0.52% prevalence), and both cases had no abdominal pain or diarrhea. Following sequencing and sequence alignment, the gene sequences of these two Cryptosporidium isolates shared 99.76% and 99.88% similarity with the gene sequence of C. meleagridis isolates. Phylogenetic analysis based on the Cryptosporidium SSU rRNA gene sequence identified the species of these two Cryptosporidium-positive stool samples as C. meleagridis. Following nested PCR amplification of the Cryptosporidium gp60 gene, sequencing and sequence alignment, the two C. meleagridis isolates were characterized as III eA17G2R1 and III bA25G1R1a sub-genotypes, and the sub-genotype III bA25G1R1a was firstly described in humans. Conclusion The prevalence of Cryptosporidium is low among HIV-positive individuals in Jiangxi Province. The likelihood of Cryptosporidium infection cannot be neglected among HIV-positive individuals without diarrhea.

In order to explore a suitable pathway for the scientific and technological achievement transformation at prefecture-level public hospitals, in October 2020, a prefecture-level tertiary hospital carried out the " 3+ 3+ 3" mode for scientific and technological innovation and achievement transformation. A three-level management structure was established, consisting of the ministry of science and education, the working group on the transformation of scientific and technological achievements, and the leading group. Three management systems were improved and formulated, including the " measures for reimbursement and rewards of scientific and technological achievements ", the " measures for intellectual property management", and the " implementation plan for promoting the transfer and transformation of scientific and technological achievements". The management measures for the three stages of intellectual property protection, incubation of scientific and technological achievements, and transfer and transformation of achievements were improved. These measures provided organizational support, institutional support, and feasible paths for this practice. After nearly three years of practice, hospitals had reduced the number of low-quality patent applications, and the number and amount of scientific and technological achievements transformed increased from 1 achievement and 10 000 yuan in 2020 to 9 achievements and 320 000 yuan in 2022. This exploration could provide a reference for the transfer and transformation of professional scientific and technological achievements in prefecture-level public hospitals in China.

Objective:To study the safety and efficacy of laparoscopic subtotal distal pancreatectomy using the arterial first approach in treatment of patients with pancreatic neck-body cancer after neoadjuvant chemotherapy.Methods:The clinical data of patients who underwent laparoscopic subtotal distal pancreatectomy after neoadjuvant chemotherapy at the Department of Pancreatic Surgery, Hunan Provincial People's Hospital from January 2019 to June 2021 were analyzed retrospectively. Seven patients were included in this study. There were 3 males and 4 females, aged 55(46, 67) years old. The clinical data analysed included chemotherapy, preoperative, intraoperative, postoperative and follow-up data. Follow up was done by outpatient visits, or contact using wechat or telephone.Results:Five borderline staged patients were treated with the AG chemotherapy regimen (gemcitabine+ albumin-bound paclitaxel), and two patients with locally advanced stage were treated with the mFOLFIRINOX chemotherapy regimen (oxaliplatin+ irinotecan+ calcium folate+ fluorouracil). All the 7 patients underwent portal vein/superior mesenteric vein resection and reconstruction using the superior mesenteric artery priority approach. The operation time was 400(350, 440) min, and the intraoperative blood loss was 300(150, 400) ml. Postoperative complications occurred in 2 patients with grade B pancreatic fistula and refractory ascites in 1 patient each. The postoperative hospital stay was 11(10, 14) days. All 7 patients underwent R 0 resection. During a follow-up period of 9 to 33 months, 5 patients were still alive without tumor, 1 patient survived with tumor, and 1 patient had died of recurrence. Conclusion:In selected cases, laparoscopic subtotal distal pancreatectomy for pancreatic neck-body cancer after neoadjuvant chemotherapy was safe and feasible.

Objective:To study the value of metastatic positivety in lymph nodes group 8a in deciding on extended lymph node dissection in pancreaticoduodenectomy(PD) for pancreatic head cancer.Methods:A retrospective study on 165 patients with pancreatic head cancer treated with PD at the Department of Pancreas and Spleen Surgery, Hepatobiliary Hospital of Hunan Provincial People's Hospital between January 2014 to June 2019 was performed. There were 101 males and 64 females with ages ranging from 38 to 75 (median 57) years. Patients who underwent standard lymph node dissection were included in the standard group ( n=88), and extended lymph node dissection in the extended group ( n=77). These patients were further divided into 4 subgroup. Subgroup A (standard PD in patients with negative nodes in group 8a, n=61), Subgroup B (extended PD in patients with negative nodes in group 8a, n=47), Subgroup C (standard PD in patients with positive nodes in group 8a, n=27), and Subgroup D (extended PD in patients with positive nodes in group 8a, n=30). The operation time, intraoperative blood loss, postoperative survival rates, complications were compared among the groups and subgroups. Results:The operation time and intraoperative blood loss of the standard group were (456.8±30.4) min and (264.28±101.14) ml, respectively, which were significantly lower than the extended group of (507.1±45.7) min and (388.9±155.3) ml (all P<0.05). The incidence of postoperative complications in the extended group (31.2%, 24/77) was significantly higher than that in the standard group (14.8%, 13/88) ( P<0.05). When compared with subgroup B, the cumulative survival rate of patients in subgroup A was not significantly different ( P>0.05). However, the cumulative survival rate of patients in subgroup C was significantly lower than that in subgroup D ( P<0.05). The cumulative survival rate of subgroup A was also significantly better than that of subgroup C ( P<0.05). There was no significant difference in the cumulative survival rates between group B and group D ( P>0.05). Conclusions:PD with extended lymph node dissection improved the survival rates in patients with cancer of the head of the pancreas with positive lymph nodes in group 8a. For these patients, extended lymph node dissection is recommended. With negative lymph nodes in group 8a, standard lymph node dissection is recommended.

Objective:To investigate the classification and surgical management of chronic calcifying pancreatitis.Methods:The retrospective and descriptive study was conducted. The clinical data of 121 patients with chronic calcifying pancreatitis who were admitted to Hunan Provincial People′s Hospital from January 2015 to December 2019 were collected. There were 99 males and 22 females, aged from 10 to 78 years, with a median age of 43 years. The patients with type Ⅰ chronic calcifying pancreatitis underwent pancreaticoduodenectomy, duodenum-preserving pancreatic head total resection, or duodenum-preserving pancreatic head spoon-type resection respectively, and external drainage when combined with peripancreatic pseudocyst. Patients with type Ⅱ chronic calcifying pancreatitis underwent resection of pancreatic body and tail combined with splenectomy or dissection of pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis. Patients with type Ⅲ chronic calcifying pancreatitis underwent pancreaticoduodenectomy or duodenum-preserving pancreatic head spoon-type resection, and external drainage when combined with peripancreatic pseudocyst. Patients with type Ⅳ chronic calcifying pancreatitis underwent basin-type internal drainage. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the recurrence of pain or chronic pancreatitis, the data of blood glucose, the morbidity of diabetes and diarrhea after surgery up to January 2020. Measurement data with normal distribution were represented as Mean± SD and measurement data with skewed distribution were described as M (range). Count data were represented as absolute numbers. Results:(1) Surgical situations: of the 48 patients with type Ⅰ chronic calcifying pancreatitis, 15 patients underwent pancreaticoduodenectomy with the operation time of (6.8±1.9)hours and volume of intraoperative blood loss of (398±110)mL, 8 patients underwent duodenum-preserving pancreatic head total resection due to no dilation of pancreatic duct with the operation time of (3.7±0.8)hours and volume of intraoperative blood loss of (137±62)mL, 25 patients underwent duodenum-preserving pancreatic head spoon-type resection due to dilation of pancreatic duct with the operation time of (3.9±1.5)hours and volume of intraoperative blood loss of (123±58)mL. Of the 8 patients with type Ⅱchronic calcifying pancreatitis, 2 patients underwent resection of pancreatic body and tail combined with splenectomy with an average operation time of 5.1 hours and an average volume of intraoperative blood loss of 200 mL, 6 patients underwent dissection of pancreatic duct combined with pancreato-jejunum Roux-en-Y anastomosis with the operation time of (2.7±0.8)hours and volume of intraoperative blood loss of (145±39)mL. Of the 49 patients with type Ⅲ chronic calcifying pancreatitis, 4 patients were underwent pancreaticoduodenectomy with the operation time of (7.2±1.4)hours and volume of intraoperative blood loss of (415±98)mL, 45 patients underwent duodenum-preserving pancreatic head spoon-type resection due to dilation of pancreatic duct with the operation time of (4.3±1.1)hours and volume of intraoperative blood loss of (135±47)mL. Sixteen patients with type Ⅳ chronic calcifying pancreatitis underwent basin-type internal drainage with the operation time of (3.3±1.3)hours and volume of intraoperative blood loss of (150±27)mL. (2) Postoperative situations: 15 of the 48 patients with type Ⅰ chronic calcifying pancreatitis who underwent pancreaticoduodenectomy had the time to first anal flatus of (2.9±1.1)days, time to initial fluid diet intake of (3.5±1.1)days, and duration of hospital stay of (14.8±2.7)days, respectively. Of the 3 patients who had postoperative complications, 2 had gastrointestinal hemorrhage (1 case was cured after hemostasis under gastroscope and the other was cured after interventional therapy), 1 with grade A pancreatic fistula was cured after delaying the time of extubation, no biliary fistula occurred. Eight patients undergoing duodenum-preserving pancreatic head total resection had the time to first anal flatus of (2.0±0.5)days, time to initial fluid diet intake of (2.5±0.4)days, and duration of hospital stay of (9.5±2.5)days, respectively. One case with postoperative grade A pancreatic fistula was cured after delaying the time of extubation. Twenty-five patients undergoing duodenum-preserving pancreatic head spoon-type resection had the time to first anal flatus of (2.4±0.8)days, time to initial fluid diet intake of (2.5±1.3)days, and duration of hospital stay of (9.8±3.1)days, respectively. One case with postoperative gastrointestinal hemorrhage was cured after interventional therapy and 1 case with grade A pancreatic fistula was cured after delaying the time of extubation. Two of the 8 patients with type Ⅱ chronic calcifying pancreatitis who underwent resection of pancreatic body and tail combined with splenectomy had an average time to first anal flatus of 3.0 days, an average time to initial fluid diet intake of 3.5 days, and an average duration of hospital stay of 14.0 days, respectively.There was no complication during perioperative period. Six of the 8 patients with type Ⅱ chronic calcifying pancreatitis who underwent dissection of the pancreatic duct combined with pancerato-jejunum Roux-en-Y anastomosis had the time to first anal flatus of (2.5±0.5)days, time to initial fluid diet intake of (2.5±0.7)days, and duration of hospital stay of (8.5±1.5)days, respectively. Two cases with postoperative grade A pancreatic fistula were cured after delaying the time of extubation. Four of the 49 patients with type Ⅲ pancreatic duct stone who underwent pancreaticoduodenectomy had the time to first anal flatus of (3.2±0.8)days, time to initial fluid diet intake of (4.1±1.2)days, and duration of hospital stay of (15.3±2.4)days, respectively. One case with postoperative grade A pancreatic fistula was cured after delaying the time of extubation without hemorrhage or biliary fistula. Forty-five of the 49 patients with type Ⅲ chronic calcifying pancreatitis who underwent duodenum-preserving pancreatic head spoon-type resection had the time to first anal flatus of (2.5±1.6)days, time to initial fluid diet intake of (2.8±0.9)days, and duration of hospital stay of (10.1±2.8)days, respectively. One case with postoperative anastomotic bleeding was cured after reoperation. One case with grade A pancreatic fistula was cured after delaying the time of extubation and 1 case with postoperative grade B pancreatic fistula was cured after puncture-duct-douch treatment. Sixteen patients with type Ⅳ chronic calcifying pancreatitis who underwent basin-type internal drainage had the time to first anal flatus of (2.6±0.7)days, time to initial fluid diet intake of (3.3±0.5)days, and duration of hospital stay of (10.4±3.0)days respectively. One case with intraperitoneal hemorrhage which represented as small amount of dark red liquid in the drainage tube of jejunum loop was cured after puncture-duct-douch treatment with noradrenaline sodium chloride solution. (3) Follow-up: Of the 121 patients, 113 (44 of type Ⅰ, 7 of type Ⅱ, 46 of type Ⅲ, 16 of type Ⅳ) were followed up for 3-58 months, with an average time of 34 months. During the follow-up, 13 patients (5 of type Ⅰ, 1 of type Ⅱ, 6 of type Ⅲ, 1 of type Ⅳ) had the recurrence of pain or pancreatitis, 55 patients (15 of type Ⅰ, 40 of type Ⅲ) with abdominal pain were improved significantly, and 45 patients (24 of type Ⅰ, 6 of type Ⅱ, 15 of type Ⅳ) did not have abdominal pain. Of the 37 patients (13 of type Ⅰ, 2 of type Ⅱ, 17 of type Ⅲ, 5 of type Ⅳ) with diabetes , 20 (6 of type Ⅰ, 2 of type Ⅱ, 12 of type Ⅲ) had blood glucose returned to normal and 17 (7 of type Ⅰ, 5 of type Ⅲ, 5 of type Ⅳ) needed controlling blood sugar with medicine. There were 5 patients (4 of type Ⅰ, 1 of type Ⅲ) diagnosed with diabetes and 3 patients (1 of type Ⅱ, 2 of type Ⅲ) with diarrhea postoperatively. Two patients of type Ⅲ chronic calcifying pancreatitis died, including 1 died of pancreatic cancer at 18 months after pancreaticoduodenectomy and 1 died of severe acute pancreatitis at 5 months after duodenum-preserving pancreatic head spoon-type resection.Conclusions:Chronic calcifying pancreatitis is a benign disease and should be treated to preserve functional tissues. Different surgical procedures should be adopted to treat different types of calcifying pancreatitis.

Objective:To investigate the clinical effect of modified atlantooccipital decompression combined with occipitocervical internal fixation on Chiari type I malformation combined with syringomyelia and atlantoaxial dislocation.Methods:Twenty-five patients with Chiari I malformation combined with syringomyelia and atlantoaxial dislocation accepted by modified atlantooccipital decompression combined with occipitocervical internal fixation in our hospital from January 2011 to March 2019. The clinical data of these patients were retrospectively analyzed. The changes of peak velocity of cerebrospinal fluid in the dorsal part of the spinal cord, electrophysiological results, atlantodental interval (ADI) values, sizes of syringomyelia, and Chicago Chiari outcome scale (CCOS) scores before and after operation were compared.Results:The peak velocity of cerebrospinal fluid in the dorsal spinal cord after surgery ([3.25±0.47] cm/s) was statistically higher in these patients than that before surgery ([2.13±0.19] cm/s, P<0.05). As compared with the preoperative results, ADI values, sizes of syringomyelia, and proportion of patients with abnormal electrophysiological monitoring at 6 months after surgery were significantly decreased, and CCOS scores at 6 months after surgery were significantly increased ( P<0.05). There were no new nerve function damage, infection, cerebrospinal fluid leakage, paralysis, respiratory failure or death. Conclusions:Modified atlantooccipital decompression combined with occipitocervical internal fixation plays effective role in atlantooccipital decompression and atlantoaxial anatomical reduction in patients with Chiari malformation type I combined with syringomyelia and atlantoaxial dislocation. The remission rate of syringomyelia is high, the symptoms and signs improve obviously, and the postoperative complications are less.

Objective To investigate the efficacy of double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula.Methods The retrospective cohort study was adopted.The clinical data of 208 patients who underwent pancreaticojejunostomy at the Hunan Provincial People's Hospital from March 2011 to March 2015 were collected.Of 208 patients,106 patients undergoing double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy were allocated into the double-“ U” group and 102 patients undergoing Child pancreaticojejunostomy were allocated into the Child group.Observation indicators included (1) surgical effects:anastomosis time,postoperative pancreatic leakage,duration of hospital stay,(2) follow-up situations.The follow-up using telephone interview and outpatient examination was performed to detect postoperative long-term complications and recovery of patients by abdominal ultrasound or computed tomography (CT) at every 6 months postoperatively up to September 2015.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed by t test.Count data were analyzed using the chi-square test.Results (1) Surgical effects:208 patients underwent successful surgery without occurrence of death.The anastomosis time was (13.0 ± 1.5) minutes in the double-“ U” group and (20.0 ± 1.6) minutes in the Child group,with a statistically significant difference between the 2 groups (t =4.713,P ＜ 0.05).Two patients in the double-“ U” group were complicated with grade A of pancreatic leakage,including 1 of 36 patients with normal pancreatic remnant and 1 of 70 patients with fibrotic pancreatic remnant.Nine patients in the Child group were complicated with pancreatic leakage,including 6 in grade A,1 in grade B and 2 in grade C,and there were 6 of 33 patients (4 in grade A,1 in grade B,1 in grade C) with normal pancreatic remnant and 3 of 69 patients (2 in grade A,1 in grade C) with fibrotic pancreatic remnant.There were statistically significant differences in the pancreatic leakage between the 2 groups and among the patients with normal pancreatic remnant in the 2 groups (x2 =2.951,4.994,P ＜ 0.05).The duration of postoperative hospital stay was (13.5 ± 1.2)days in the double-“U” group and (15.7 ± 2.6)days in the Child group,with a statistically significant difference (t =1.011,P ＜ 0.05).No readmission in the 2 groups occurred.(2) Followup situations:91 of 106 patients in the double-“U” group were followed up for 6-54 months with a median time of 30 months.During the follow-up,8 patients were dead,12 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,4 and 4 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Eighty-eight of 102 patients in the Child group were followed up for 6-54 months with a median time of 25 months.During the follow-up,10 patients were dead,11 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,6 and 6 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Conclusion Double“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula can reduce the suture time,incidence of pancreatic leakage and duration of postoperative hospital stay,and it is especially suitable for the patients with normal pancreatic remnant.

OBJECTIVE: To explore the best time of intratympanic dexamethasone injection to treat sudden sensorineural hearing loss (SSNHL) as salvage therapy so that to improve the curative efficacy on sudden deafness at the utmost. METHOD: A total of 192 patients with SSNHL were included in this study, among whom 63 cases received the systemic steroid therapy throughout the study, while the other ones were treated with systemic steroid as initial treatment and were given intratympanic steroid administration as salvage treatment starting at different time point. The salvage treatment started on the 3rd day after the beginning of the initial treatment for 29 cases, on the 7th day for 38 cases, on the 14th day for 43 cases, and 1 month later for 19 cases. All the patients were followed up for 2 months. RESULT: The recovery rates and total effective rates showed no statistically significant difference between the patients received only systemic steroid therapy and the ones received intratympanic steroid administration on the 3rd, 7th day and 1 month later after the initial treatment. The recovery rate and total effective rate exhibited statistically significant difference between the patients received intratympanic steroid administration since the 14th day after the initial treatment and the ones received only systemic steroid therapy, with the numerical value of P 0. 037 and 0. 034, respectively. CONCLUSION (1) As an initial management plan, the curative effects. between the intratympanic steroid administration and the systemic steroid therapy were not significantly different. (2) As a salvage treatment, intratympanic steroid was a better choice for patients who have not completely recover from ISSNHL after failure of initial management with systemic steroid only. (3) The best time point of salvage treatment with intratympanic steroid was about 2 weeks after initial management with systemic steroid.
Hearing Loss, Sensorineural ; drug therapy ; Hearing Loss, Sudden ; drug therapy ; Humans ; Injection, Intratympanic ; Salvage Therapy ; Steroids ; therapeutic use ; Treatment Outcome ; Tympanic Membrane