Optimization of perioperative treatment strategies for locally advanced esophageal squamous cell carcinoma from the perspective of tumor heterogeneity / 中华胃肠外科杂志

Recent advances in multimodality treatment offer excellent opportunities to rethink the paradigm of perioperative management for locally advanced esophageal squamous cell carcinoma. One treatment clearly doesn't fit all in terms of a broad disease spectrum. Individualized treatment of local control of bulky primary tumor burden (advanced T stage) or systemic control of nodal metastatic tumor burden (advanced N stage) is essential. Given that clinically applicable predictive biomarkers are still awaited, therapy selection guided by diverse phenotypes of tumor burden (T vs. N) is promising. Potential challenges regarding the use of immunotherapy may also boost this novel strategy in the future.

Hotspots and prospects of esophageal cancer research in China / 中华胃肠外科杂志

Esophageal cancer is a malignant tumor with a high incidence in China. At pesent, advanced esophageal cancer patients are still frequently encountered. The primary treatment for resectable advanced esophageal cancer is surgery-based multimodality therapy, including preoperative neoadjuvant therapy, such as chemotherapy, chemoradiotherapy or chemotherapy plus immunotherapy, followed by radical esophagectomy with thoraco-abdominal two-field or cervico-thoraco-abdominal three-field lymphadenectomy via minimally invasive approach or thoracotomy. In addition, adjuvant chemotherapy, radiotherapy, or chemoradiotherapy, or immunotherapy may also be administered if suggested by postoperative pathological results. Although the treatment outcome of esophageal cancer has improved significantly in China, many clinical issues remain controversial. In this article, we summarize the current hotspots and important issues of esophageal cancer in China, including prevention and early diagnosis, treatment selection for early esophageal cancer, surgical approach selection, lymphadenectomy method, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and nutritional support treatment.

Effects of long working hours exposure on occupational stress and depression symptoms in couriers in Zhejiang Province / 中华劳动卫生职业病杂志

Objective: To understand the current situation of long working hours exposure of couriers in Zhejiang Province, and to analyze the influence of long working hours exposure levels on their occupational stress and depression symptoms, and provide a basis for promoting the physical and mental health of couriers. Methods: From September to December 2021 , 1159 couriers from Zhejiang Express Transport Companies were selected as respondents by cluster sampling, and their basic information were collected. The occupational stress and depression symptoms of the couriers were assessed using the Core Occupational Stress Scale (COSS) and the Patient Health Questionnaire-9 (PHQ-9). The effects of long work hours (>48 h per week) on the occupational stress and depression symptoms of the couriers were analyzed. Results: The average age of 1159 courier in Zhejiang Province was (33.24±8.42) years, the average weekly working hours were (63.21±18.77) h, and 75.15% (871/1159) were long-term workers. The detection rates of occupational stress and depression symptoms in courier were 32.44% (376/1159) and 32.53% (377/1159), respectively. There were significant differences in the detection rates of occupational stress and depression symptoms among couriers with different ages, educational background, marital status, monthly average income, length of service, position or post, shift status, drinking status, and average weekly working hours (P <0.05). The adjusted logistic regression analysis showed that, after adjusting for the influence of confounding factors such as age, educational background, marital status, monthly average income, length of service, position or post, shift status and drinking status, compared with the weekly working hours ≤48 h, weekly working hours of 63-77 h, 78-92 h, ≥93 h were the risk factors for occupational stress (OR=1.547, 95%CI: 1.019-2.350; OR=1.886, 95%CI: 1.184-3.006; OR=2.338, 95%CI: 1.188-4.062) and depression symptoms (OR=1.897, 95%CI: 1.258-2.860; OR=2.041, 95%CI: 1.290-3.230; OR=4.978, 95%CI: 2.551-9.715) of couriers (P<0.05) . Conclusion: Long working hours could increase the risk of occupational stress and depression symptoms among couriers. It is necessary to arrange working hours reasonably to reduce the occurrence of occupational stress and depression symptoms of couriers.

Laparoscopic surgery contributes to a decrease in short-term complications in surgical ulcerative colitis patients during 2008–2017: a multicenter retrospective study in China

Background/Aims@#The aim of this study was to analyze the chronological changes in postoperative complications in surgical ulcerative colitis patients over the past decade in China and to investigate the potential parameters that contributed to the changes. @*Methods@#Ulcerative colitis patients who underwent surgery during 2008–2017 were retrospectively enrolled from 13 hospitals in China. Postoperative complications were compared among different operation years. Risk factors for complications were identified by logistic regression analysis. @*Results@#A total of 446 surgical ulcerative colitis patients were analyzed. Fewer short-term complications (24.8% vs. 41.0%, P=0.001) and more laparoscopic surgeries (66.4% vs. 25.0%, P<0.001) were found among patients who received surgery during 2014–2017 than 2008–2013. Logistic regression suggested that independent protective factors against short-term complications were a higher preoperative body mass index (odds ratio [OR], 0.870; 95% confidence interval [CI], 0.785–0.964; P=0.008), laparoscopic surgery (OR, 0.391; 95% CI, 0.217–0.705; P=0.002) and elective surgery (OR, 0.213; 95% CI, 0.067–0.675; P=0.009). The chronological decrease in short-term complications was associated with an increase in laparoscopic surgery. @*Conclusions@#Our data revealed a downward trend of short-term postoperative complications among surgical ulcerative colitis patients in China during the past decade, which may be due to the promotion of minimally invasive techniques among Chinese surgeons.

Impact of fatty liver on long-term outcomes in chronic hepatitis B: a systematic review and matched analysis of individual patient data meta-analysis

Background/Aims@#Chronic hepatitis B (CHB) and fatty liver (FL) often co-exist, but natural history data of this dual condition (CHB-FL) are sparse. Via a systematic review, conventional meta-analysis (MA) and individual patient-level data MA (IPDMA), we compared liver-related outcomes and mortality between CHB-FL and CHB-no FL patients. @*Methods@#We searched 4 databases from inception to December 2021 and pooled study-level estimates using a random- effects model for conventional MA. For IPDMA, we evaluated outcomes after balancing the two study groups with inverse probability treatment weighting (IPTW) on age, sex, cirrhosis, diabetes, ALT, HBeAg, HBV DNA, and antiviral treatment. @*Results@#We screened 2,157 articles and included 19 eligible studies (17,955 patients: 11,908 CHB-no FL; 6,047 CHB-FL) in conventional MA, which found severe heterogeneity (I2=88–95%) and no significant differences in HCC, cirrhosis, mortality, or HBsAg seroclearance incidence (P=0.27–0.93). IPDMA included 13,262 patients: 8,625 CHB-no FL and 4,637 CHB-FL patients who differed in several characteristics. The IPTW cohort included 6,955 CHB-no FL and 3,346 CHB-FL well-matched patients. CHB-FL patients (vs. CHB-no FL) had significantly lower HCC, cirrhosis, mortality and higher HBsAg seroclearance incidence (all p≤0.002), with consistent results in subgroups. CHB-FL diagnosed by liver biopsy had a higher 10-year cumulative HCC incidence than CHB-FL diagnosed with non-invasive methods (63.6% vs. 4.3%, p<0.0001). @*Conclusions@#IPDMA data with well-matched CHB patient groups showed that FL (vs. no FL) was associated with significantly lower HCC, cirrhosis, and mortality risk and higher HBsAg seroclearance probability.

The value of the planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of esophageal squamous cell carcinoma / 中华肿瘤杂志

Objective@#The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non-radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors.@*Methods@#We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy (33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single-institution database.The survival rates were calculated by Kaplan-Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model.@*Results@#The median follow-up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease-free survival (DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3-year OS were 75.5%, 57.4%, 27.3% (P<0.001) and 3-year DFS were 72.0%, 44.7%, 17.6% (P<0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3-year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7% of the negative group (both P<0.001). The 3-year OS and DFS of pathologic stage Ⅰ, Ⅱ, ⅢA, ⅢB and Ⅵ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3% (P<0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3% (P<0.001), respectively.The operation-related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS (P<0.05 for all).@*Conclusions@#The planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.

The clinical and pathological features, biomarker characteristics and prognosis analysis of lung adenosquamous carcinoma / 中华肿瘤杂志

Objective@#Adenosquamous carcinoma of lung is an uncommon subtype with more aggressive behavior and poor prognosis than adenocarcinoma and squamous cell carcinoma. This study was aimed to investigate the clinicopathological characteristics and prognostic factors of lung adenosquamous carcinoma.@*Methods@#The pathological features and follow-up data of 133 patients were collected and the prognostic factors of these patients were retrospectively analyzed.@*Results@#Among the 133 patients, 81 cases (60.9%) smoked. Among the 62 patients whose percentage of histological components were identified, 45 cases had >50% adenocarcinoma components, and 17 cases had >50% squamous cell carcinoma components. 55 patients had lymph node metastasis at the first visit. All patients accepted at least one test of tumor driven gene mutation, and the results showed that the mutation rate of EGFR was 50.8% (67/132), the mutation rate of K-ras was 8.6% (11/128), the ALK-positive rate was 4.2% (2/48). The gender, smoking status, and the proportion of pathological components were the main influence factors of EGFR mutation status. The median overall survival was 28 months, the rates of 1-year, 3-year, and 5-year survival were 72.9%, 23.3%, and 9.0%, respectively. EGFR tyrosine kinase inhibitors (TKIs) treatment was an independent risk factor for prognose of these patients (P=0.024).@*Conclusions@#Lung adenosquamous carcinoma is a rare subtype with high malignancy and poor prognosis. Early diagnosis and driven-mutation-based individualized therapy may improve the survival of patients with lung adenosquamous carcinoma.

Key technology of lymph node dissection along recurrent laryngeal nerve and its associated complication prevention in patients with thoracic esophageal cancer / 中华肿瘤杂志

Esophageal cancer is one of the most prevalent cancers in China. Lymph node metastasis is one of the most important prognostic factors and severely affect the long-term survival after surgical treatment. Therefore, systemic two-field lymph node dissection including thoracic and abdominal draining nodes of the esophagus during surgery is essential in order to improve the long-term survival for the patients with thoracic esophageal cancer, and it is also the basis for precise staging and postoperative adjuvant treatment regimen- making. As reported in the literature, lymph node metastases along bilateral recurrent laryngeal nerve was the highest, therefore, the lymph node dissection along bilateral recurrent laryngeal nerve is the most important manipulation during esophagectomies, however, it is also the most technically difficult procedure during operation. It usually results in postoperative complications especially the respiratory complications due to paralysis of recurrent laryngeal nerves caused by lymph node dissection. Therefore, the gain and loss of lymph node dissection along bilateral recurrent laryngeal nerve has been a disputed and entangle topic for thoracic surgeons, and the purpose of this paper is to summarize author′s experience and the key technology to prevent the associated complications in lymph node dissection along recurrent laryngeal nerve during esophagectomies for the patients with thoracic esophageal cancer.

Response of growth and photosynthetic characteristics of Polygonatum cyrtonema to shading conditions / 中国中药杂志

The purpose of this experiment was to study the effects of different shading conditions on the growth,physiological characteristics and biomass allocation of Polygonatum cyrtonema,which offered a theoretical basis for its cultivation.Different light environments(100%,80%,60% and 35% light transmittance) were simulated with shading treatments.Growth and photosynthetic indexes of P.cyrtonema were measured and the variances were analyzed.The results show that shading decreased superoxide anion radical(O-·2)production rate and hydrogen peroxide(H_2O_2) accumulation,kept the activity of SOD,POD and CAT enzyme at a high level.Furthermore,The content of chlorophyll a and chlorophyll b,net photosynthetic rate(Pn),stomatal conductance(Gs),transpiration rate(Tr),maximal photochemical efficiency of photosystem Ⅱ(Fv/Fm),photochemical quenching index(q P) and effective quantum yield of photosystem II(ΦPSⅡ) of P.cyrtonema were increased while the intercellular CO2 concentration(Ci),Foand NPQ were decreased by shading.Shading is beneficial to P.cyrtonema growth,can increase the total biomass P.cyrtonema.The allocation proportion of biomass on the aerial portion of P.cyrtonema increased but underground parts decreased with increasing shading conditions.In this study,P.cyrtonema can grow well in shading conditions,shading is beneficial to the formation of the yield and quality of the rhizomes of P.cyrtonema,especially in 65% light transmittance.

Comparison of lung cancer surgery in China, 2005 vs. 2015 / 中华肿瘤杂志

Objective@#To study the impact of the advance of the times and technological progress on the surgical treatment of lung cancer.@*Methods@#The data of patients with non-small cell lung cancer treated by thoracic surgery at Cancer Hospital of Chinese Academy of Medical Sciences from 2005 to 2015 were retrospectively analyzed. The population distribution, operation methods and treatment results were analyzed retrospectively.@*Results@#510 patients (in 2005) and 1 235 (in 2015) non-small cell lung cancer patients were included in this study. The proportions of male patients (79.0% vs. 55.8%), smoking (52.9% vs. 30.1%), squamous cell carcinoma (50.2% vs. 22.4%) and video-assisted thoracoscopic surgery (VATS) (0 vs. 61.1%), stage Ⅰ (15.2% vs. 36.8%), the number of lymph node dissection (21.8 vs. 16.6), intraoperative blood transfusion rate (9.6% vs. 1.9%), palliative resection rate (7.5% vs. 2.0%), the average length of stay (10.8 d vs. 7.6 d) were significantly changed. There was no significant difference in the average age of patients and operation time.@*Conclusion@#There was a significant change in the distribution of population and surgical techniques in patients undergoing lung cancer surgery in last ten years.

Relationship between human papillomavirus infection and prognosis of lung cancer:A meta-analysis / 实用肿瘤学杂志

Objective The objective of this study was to explore the association between human papillomavirus( HPV) and prognosis of lung cancer by meta-analysis. Methods The PubMed,Embase and Cochrane literature databases studies were searched using a combination of subject terms and free words. As of October 2018,a total of 123 related documents were obtained. After screen-ing the literature according to inclusion and exclusion criteria,the basic information of the study,HPV detection methods,lung cancer patients,hazard ratio(HR)values and 95% confidence interval(CI)were extracted from each study. The meta-analysis of random effects models was used to evaluate the correlation between HPV infection and prognosis in patients with lung cancer. Heterogeneity was assessed using the Q test and I2statistics,and publication bias was tested using Egger′s linear regression test and Begg′s rank cor-relation test. Results The study finally included 11 articles(9 in Asia,2 in Europe and US),and 1439 patients with lung cancer. Meta-analysis using a random-effects model showed no significant association between HPV infection and prognosis of lung cancer (HR=0. 90,95% CI:0. 71~1. 13). A stratified analysis of lung cancer pathological subtypes showed that the prognosis of patients with HPV-infected lung adenocarcinoma was significantly better than that in patients without HPV-infected lung adenocarcinoma (HR=0. 65,95% CI:0. 49~0. 85). Sensitivity analysis was performed by sequentially removing the included studies,and the results were not statistically significant. The results of Egger′s test(P=0. 708)and Begg′s test(P=0. 784)suggest that there is no publica-tion bias in this study. Conclusion HPV infection may be related to the prognostic of patients with lung adenocarcinoma. More basic and clinical studies are needed to further explore the association between HPV infection and lung adenocarcinoma as well as the corre-sponding mechanisms in the future.

Coagulation Properties for Whole Blood Stored at 4℃ / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To study the coagulation properties the refrigerated whole blood stored at 4℃.</p><p><b>METHODS</b>Ten units of whole blood were obtained from healthy volunteer donors and stored at 4±2℃ for 21 days. Samples were collected on the day after donation and on days 2, 4, 6, 8, 10, 14 and 21 for delection including complete blood count, electrolyte, APTT, PT, Fg, blood coagulation factors, and thromboelastography(TEG).</p><p><b>RESULTS</b>The levels of Hb, WBC, Plt, sodium and potassium in each sample accorded with standard of storing whole blood. The level of Hb, WBC, Plt and Na decreased along with prolonging of storage time, while the K level increased along with prolonging of stored time, APTT and PT prolonged along with prolonging of thored time, PT>17 min at d 21, the Fg level change was no-obvious, The level of factor Ⅴ and Ⅷ decreased more than 50 % of baseline on d 6 and 4 respectively; the levels of factor Ⅱ, Ⅶ, Ⅸ, Ⅹ, Ⅺ, Ⅻ showed decreasing trend, but their levels were less than 40 % of baseline values at d 21. TEG test showed that no abnormalily of R value was found, the abnormal valnes of K and Angle were observed at d 21, the abnormal value of MA was observed at d 14.</p><p><b>CONCLUSION</b>The whole blood stored for 10 days possesses normal coagulation function showing important significance for treatment of hemorrhage from war injury and surgical openation of heart and chest.</p>

Effects of N and Zn interaction on growth, yield and active components of Agastache rugosa / 中国中药杂志

The study is aimed to explore the effect of combination use of nitrogen(N) and zinc(Zn) fertilizers on the growth, yield and the effective components of Agastache rugosa. A. rugosa was grown under two N application rate (120, 300 kg·hm⁻²) and five Zn levels (0, 20, 50, 100，150 kg·hm⁻²) under field condition. The effect of the treatments on the physiological indicators, distribution of nitrogen and zinc and volatile oil components of A. rugosa were studied. The results showed that the combination use of N and Zn could significantly affect the growth and development, yield and volatile oil components of A. rugosa. Under the test conditions, the highest yield of Agastaches Herba was obtained when 50 kg·hm⁻² of Zn fertilizer was applied with high N application rate of 300 kg·hm⁻². Under the same N application rate, the increase of Zn production was positively correlated with the amount of Zn application in a certain concentration range, but excessive Zn application led to the decrease of yield. With the increase of N application level, the content of Zn also significantly increased. The combination use of N and Zn increased the yield of Agastaches Herba. High level of N application was beneficial to the absorption and accumulation of N and Zn of A. rugosa. Zn fertilizer could also promote the absorption and accumulation of N of A. rugosa. The interaction between N and Zn had significant influence on the main chemical constituents of the volatile oil of A. rugosa. Among the volatile oil chemical constituents of A. rugosa the content of pulegone (34.56%-53.91%) and piperonyl methyl ether (18.86%-42.27%) were much higher. Under the same N application rate, different Zn application rates also had significant effects on the main chemical components of volatile oil.

Effect of Thoracic Surgeons on Lung Cancer Patients' Survival / 中国肺癌杂志

BACKGROUND@#Surgeons are the direct decision-makers and performers in the surgical treatment of patients with lung cancer. Whether the differences among doctors affect the survival of patients is unclear. This study analyzed the five-year survival rates of different thoracic surgeries in patients undergoing surgery to assess the physician's impact and impact.@*METHODS@#A retrospective analysis of five years between 2002-2007 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, for surgical treatment of lung cancer patients. According to different surgeons grouping doctors to compare the basic information of patients, surgical methods, short-term results and long-term survival differences.@*RESULTS@#A total of 712 patients treated by 11 experienced thoracic surgeons were included in this study. The patients have nosignificant difference with gender, age, smoking, pathological type between groups. There were significant differences in clinical staging, surgery type, operation time, blood transfusion rate, number of lymph node dissection, palliative resection rate, postoperative complications and perioperative mortality. There was a significant difference in five-year survival rates among patients treated by different doctors. This difference can be seen in all clinical stage analyzes with consistency. In the multivariate analysis, it was suggested that surgeon was an independent factor influencing the prognosis of patients.@*CONCLUSIONS@#Thoracic surgeon has a significant effect on the therapeutic effect of lung cancer patients.

Effects of fish oil lipid emulsion on risk of infection in patients with Crohn's disease after enterectomy: a prospective study / 中华消化外科杂志

Objective To explore the effects of fish oil lipid emulsion on risk of infection in patients with Crohn's disease (CD) after enterectomy.Methods The prospective study was conducted.The clinical data of 70 patients with CD who planned to receive enterectomy in the Nanfang Hospital of South Medical University between June 2015 and May 2017 were collected.All the patients were allocated into the fish oil group and control group by random number table method,and then underwent enterectomy by the same doctors' team.Patients in the fish oil group received daily intravenous infusion of 100ml 10％ fish oil lipid emulsion from day 1 to 5 postoperatively or longer) based on conventional treatment [combined other parenteral nutrition (PN) were selected according to patients' conditions];patients in the control group received conventional treatment (intravenous infusion of PN were selected according to patients' conditions).Observation indicators:(1) postoperative infection situations between groups;(2) risk of postoperative infection and nutrition-related indexes between groups;(3) comparison of duration of postoperative hospital stay between groups.Measurement data with normal distribution were represented as-x ±s.The comparisons between groups were evaluated with the independent-sample t test and repeated measures data were analyzed by the repeated measures ANOVA.The comparisons of count data were analyzed using the chi-square test or Fisher exact probability.Odds ratio and 95％ confidence interval (CI) for incidence of complications were calculated.Results Sixty-five patients were screened for eligibility,including 33 in the fish oil group and 32 in the control group.(1) Postoperative infection situations between groups:18 patients in the 2 groups were complicated with postoperative infection.Abdominal infection,wound infection,anastomotic fistula,pulmonary infection and wound infection combined with intestinal fistula were detected in 7,4,4,2 and 1 patients,respectively.Incidence of postoperative infection in the fish oil group and control group were respectively 15.2％(5/33) and 40.6％(13/32),with a statistically significant difference between groups (x2 =5.265,OR=0.261,95％CI:0.080-0.853,P＜0.05).(2) Risk of postoperative infection and nutrition-related indexes between groups:numbers of white blood cell (WBC) and centriole cell and level of hemoglobin (Hb) from day 1 to 5 post-operatively were respectively from (12.7±2.5) × 109/L,(10.7±2.2)×109/L,(103±17) g/L to (9.8±4.1) ×109/L,(7.5±4.1)×109/L,(101±13)g,/L in the fish oil group and from (12.3±2.5) × 109/L,(10.1±2.3) ×109/L,(106±16) g/L to (11.8±5.1) ×109/L,(9.6±5.1)× 109/L,(100±14) g/L in the control group,showing no statistically significant difference in changing trend of above indexes between groups (F =1.316,0.930,0.181,P＞0.05).The levels of procalcitonin,C-reactive protein and albumin (Alb) from day 1 to 5 postoperatively were respectively from (1.92± 1.41) ng/mL,(30± 10) mg/L,(30.0±4.1) g/L to (1.00±0.96) ng/mL,(30±27)mg/L,(34.1±4.3)g/L in the fish oil group and from (2.15±1.16)ng/mL,(26±7)mg/L,(31.1±3.9) g/L to (2.02± 1.86) ng/mL,(58± 56) mg/L,(28.5± 2.6) g/L in the control group,showing statistically significant differences in changing trend of above indexes between groups (F=5.053,6.056,6.709,P＞0.05).(3) Comparison of duration of postoperative hospital stay between groups:duration of postoperative hospital stay in the fish oil group and control group were respectively (9±4)days and (12±6) days,with an average shortened time of 3 days,showing a statistically significant difference between groups (t =-2.443,P ＜ 0.05).Conclusion Intravenous infusion of fish oil lipid emulsion could reduce risk of postoperative infection in patients with CD after enterectomy,and also improve postoperatively patients' nutritional status and shorten duration of hospital stay.

Clinical effect of neoadjuvant chemo-radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy / 中华消化外科杂志

Objective To explore the clinical effect of neoadjuvant chemo-radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy for esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 111 esophageal cancer patients who underwent neoadjuvant chemo-radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy in the Cancer Hospital of Chinese Academy of Medical Sciences between January 2010 and December 2016 were collected.Among 111 patients,68 with interval time between neoadjuvant chemo-radiation and thoracoscopic and laparoscopic three-incision esophagectomy ＜ 8 weeks were allocated into the ＜ 8 weeks group and 43 with interval time between neoadjuvant chemo-radiation and thoracoscopic and laparoscopic three-incision esophagectomy ≥8 weeks were allocated into the ≥8 weeks group.Patients underwent preoperative radiotherapy and chemotherapy with TP regimen,and then underwent selective thoracoscopic and laparoscopic three-incision esophagectomy.Observation indicators:(1) neoadjuvant chemo-radiation situations;(2) surgical and postoperative situations;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Count data were analyzed using the chi-square test or Fisher exact probability.Comparison of ranked data was done by the nonparametric test.Results (1) Neoadjuvant chemo-radiation situations:all the patients underwent neoadjuvant chemo-radiation,without severe adverse reaction.Number of patients with complete remission based on oncopathology were 34 in the ＜8 weeks group and 15 in the ≥ 8 weeks group,with no statistically significant difference between the 2 groups (x2=2.441,P＞0.05).(2) Surgical and postoperative situations:all the patients underwent successful thoracoscopic and laparoscopic three-incision esophagectomy,with negative surgical margins.Operation time,volume of intraoperative blood loss,number of lymph node dissected,time of postoperative intrathoracic drainagetube removal,time of postoperative neck drainage-tube removal,hoarseness,upper gastrointestinal hemorrhage,anastomotic fistula,respiratory complication,pleural effusion and empyema,cardiovascular complication,incision abnormal healing,death within postoperative 30 days and duration of hospital stay were (354±103)minutes,(400± 76)mL,19±4,(11±4)days,(4.9±1.6)days,5,1,12,3,6,5,8,0,(19± 17) days in the ＜ 8 weeks group and (343±92) minutes,(392±51)mL,19±3,(12±6)days,(4.5±1.0)days,2,0,7,5,3,4,3,2,(18± 11) days in the ≥ 8 weeks group,respectively,with no statistically significant difference between the 2 groups (t =1.080,0.569,0.326,1.223,1.286,x2=0.029,0.035,1.114,0.000,0.000,0.246,t=0.315,P＞ 0.05).(3) Follow-up:90 of 111 patients were followed up for 3-82 months,with a median time of 25 months,including 55 in the ＜8 weeks group and 35 in the ≥8 weeks group.During follow-up,death and tumor recurrence were detected in 9,11 patients in the ＜8 weeks group and 6,11 patients in the ≥ 8 weeks group,respectively.Conclusion Neoadjuvant chemo-radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy is safe and effective,and it doesn't increase the perioperative risks based on preoperative 8-week interval time.

Analysis of the risk factors for postoperative cervical anastomotic leakage after McKeown's esophagectomy / 中华肿瘤杂志

Objective@#To analyze risk factors of anastomotic leakage after McKeown'sesophagectomy.@*Methods@#The clinical data of 635 esophageal cancer patients, who underwent McKeown's esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences from January 2012 to December 2015, were retrospectively analyzed. The risk factors of cervical anastomotic leakage were identified through analysis of medical history, surgical procedure, tumor characteristics and vascular calcification.@*Results@#Among all the 635 patients, anastomotic leakage occurred in 111 (17.5%)patients. Univariate analysis showed that the American Society of Anesthesiologists (ASA) risk class, prior thoracic surgery, upper digestive tract ulcer, COPD, hypertension, peripheral vascular disease, renal insufficiency, FEV1% predicted, DLCO% predicted, duration of surgery and calcification of descending aorta, celiac trunk and left postceliac arteries were associated with a statistically significant increase in risk of cervical anastomotic leakage (P<0.05 for all). Logistic regression analysis showed that ASA risk class, peripheral vascular disease, renal insufficiency and calcification of descending aorta and celiac trunk were independent risk factors of cervical anastomotic leakage after McKeown's esophagectomy (P<0.05 for all).@*Conclusions@#ASA risk class, peripheral vascular disease, renal insufficiency, calcification of descending aorta and celiac trunk are independent risk factors of cervical esophageal anastomotic leakage after McKeown's esophagectomy.

Application of newly developed hemostatic apparatus for US army TCCC:XSTAT 30 / 医疗卫生装备

Objective To explore the effect of newly developed XSTAT 30 hemostatic apparatus for US army TCCC. Methods The characteristics and application effects of XSTAT 30 were described from the aspects of design, indication and contraindication, operation and precautions, application safety and etc. Results In tactical echelons XSTAT 30 could be used for the hemostasis of penetrating fragment injuries at groin, armpit and etc. Conclusion XSTAT 30 behaves well in the hemostasis at the junction sites, and is worthy referencing for designing likely devices of the PLA.

Clinical efficacy of preoperative three-dimensional radiotherapy with or without concurrent chemotherapy for esophageal carcinoma / 中华放射肿瘤学杂志

[ Abstract] Objective To investigate the clinical efficacy of preoperative three-dimensional radiotherapy (3DRT) with or without concurrent chemotherapy for esophageal carcinoma.Methods We retrospectively analyzed 103 esophageal carcinoma patients who received preoperative 3DRT with or without concurrent chemotherapy from 2004 to 2014 in Cancer Hospital CAMS.The median radiation dose was 40 Gy, and the TP or PF regimen was adopted for concurrent chemotherapy if needed.The overall survival (OS) and disease-free survival ( DFS) were calculated by the Kaplan-Meier method, and the survival difference and univariate prognostic analyses were performed by the log-rank test.The Cox proportional hazards model was used for multivariate prognostic analysis.Results The number of patients followed at 3-years was 54.The 3-year OS and DFS rates were 61.1% and 54.9%, respectively, for all patients.There were no significant differences between the 3DRT and concurrent chemoradiotherapy (CCRT) groups as to OS (P=0.876) and DFS (P=0.521).The rates of complete, partial, and minimal pathologic responses of the primary tumor were 48.0%, 40.2%, and 11.8%, respectively.There were significant differences in OS and DFS between the complete, partial, and minimal pathologic response groups (P=0.037 and 0.003). No significant difference in pathologic response rate was found between the 3DRT and CCRT groups (P=0.953).The lymph node metastasis rate was 26.5%, and this rate for the complete, partial, and minimal pathologic response groups was 14%, 30%, and 67%, respectively, with a significant difference between the three groups (P=0.001).The OS and DFS were significantly higher in patients without lymph node metastasis than in those with lymph node metastasis (P=0.034 and 0.020).The surgery-related mortality was 7.8% in all patients.Compared with the 3DRT group, the CCRT group had significantly higher incidence rates of leukopenia (P=0.002), neutropenia (P=0.023), radiation esophagitis (P=0.008), and radiation esophagitis ( P=0.023).Pathologic response of the primary tumor and weight loss before treatment were independent prognostic factors for OS and DFS (P=0.030,0.024 and P=0.003,0.042). Conclusions Preoperative 3DRT alone or with concurrent chemotherapy can result in a relatively high complete pathologic response rate, hence increasing the survival rate.Further randomized clinical trials are needed to confirm whether preoperative CCRT is better than 3DRT in improving survival without increasing the incidence of adverse reactions.

Clinical value of postoperative radiotherapy for node-positive middle thoracic esophageal squamous cell carcinoma and modification of target volume / 中华放射肿瘤学杂志

Objective To analyze the clinical value of postoperative radiotherapy for node-positive middle thoracic esophageal squamous cell carcinoma ( TESCC ) and to modify the target volume .Methods A total of 286 patients with node-positive middle TESCC underwent radical surgery in Cancer Hospital, Chinese Academy of Medical Sciences, from 2004 to 2009.In addition, 90 of these patients received postoperative intensity-modulated radiotherapy.The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis.The Cox model was used for multivariate prognostic analysis.The chi-square test was used for comparing the recurrence between patients receiving different treatment modalities.Results The 5-year overall survival ( OS) rates of the surgery alone ( S) group and surgery plus postoperative radiotherapy ( S+R) group were 22.9%and 37.8%, respectively, and the median OS times were 23.2 and 34.7 months, respectively ( P=0.003) .For patients with 1 or 2 lymph node metastases (LNMs), the 5-year OS rates of the S group and S+R group were 27.3%and 44.8%, respectively ( P=0.017);for patients with more than 2 LNMs, the 5-year OS rates of the S group and S+R group were 16.7%and 25.0%, respectively (P=0.043).The peritoneal lymph node metastasis rates of N1 , N2 , and N3 patients in the S group were 2.9%, 10.9%, and 20.0%, respectively ( P=0.024) .The S+R group had a significantly lower mediastinal lymph node metastasis rate than the S group ( for patients with 1 or 2 LMNs:8.0%vs.35.3%, P=0.003;for patients with more than 2 LNMs, 10.0%vs.42.3%, P=0.001) , and had a prolonged recurrence time compared with the S group ( 25.1 vs.10.7 months, P=0.000) .However, for patients with more than 2 LNMs, the S+R group had a significantly higher hematogenous metastasis rate than the S group (46.7%vs.26.1%, P=0.039).Conclusions Patients with node-positive middle TESCC could benefit from postoperative radiotherapy.The target volume can be reduced for patients with 1 or 2 LNMs.Prospective studies are needed to examine whether it is more appropriate to reduce the radiotherapy dose than to reduce the target volume for patients with more than 2 LNMs.A high hematogenous metastasis rate warrants chemotherapy as an additional regimen.