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Esophagectomy and lymph node dissection are the cornerstones for the treatment of esophageal cancer. Upper mediastinal lymph node dissection is of great value for accurate staging and improving the prognosis of patients. Lymph node dissection along the left recurrent laryngeal nerve is the most challenging procedures in esophageal surgery, and there has been no relevant consensus on the scope and boundary of lymph node dissection. In recent years, with the application of endoscopic technology, especially robotic surgery system in esophagectomy, and the introduction of the concept of superior mediastinal microdissection, the authors have proposed the border of lymph node dissection along the left recurrent laryngeal nerve, so as to achieve precise, radical and standardized dissection. Combined with their own experiences, the authors elaborate on the anatomic boundary, extent and technique of lymph node dissection along the left recurrent laryngeal nerve.
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Objective:To explore the influence of family function on the psychological resilience of mothers of premature infants.Method:Totally 2 836 mothers of premature infants who met the inclusion criteria were investigated with general information questionnaire, family APGAR index (APGAR) and Connor-Davidson resilience scale (CD-RISC) in three third-class A general hospitals and two specialty hospitals in Ningxia.SPSS 23.0 software was used for statistical analysis.Pearson correlation was used to analyze the relationship between psychological resilience and family function of preterm mothers.Hierarchical regression was used to analyze the impact of family function on psychological resilience of preterm mothers.Results:Total score of resilience scale in mothers of premature infants was (68.38±16.59) and the total score of family function was (9.07±1.53). There were 1 550 cases with good family function and 1 286 cases with family dysfunction.The total score of psychological elasticity and the score of all dimensions in the group with good family function were higher than those in the group with family dysfunction( P<0.05). The total score of psychological elasticity ( r=0.771, P<0.01) and self-improvement ( r=0.410, P<0.05), tenacity ( r=0.492, P<0.01), optimism( r=0.438, P<0.05) were positively correlated with family function.Stratified regression analysis showed that cooperation( β=1.016) and intimacy( β=0.389) were the important influencing factors of preterm mothers' psychological resilience ( P<0.05). Conclusion:Psychological resilience of mothers of premature infants is closely related to their family function.Good family function can help mothers of premature infants improve their psychological resilience and promote their mental health.
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Objective To investigate the effects of early essential newborn care (EENC) on body temperature and short-term clinical outcomes of vaginally born preterm infants at 1 h after birth. Methods This was a prospective case-control study. A total of 97 premature infants, who were born vaginally between 34-37 weeks in the Obstetrics Department of General Hospital of Ningxia Medical University from January 1 to December 31, 2017 and admitted to the neonatal intensive care unit were enrolled as intervention group. Another 103 premature infants, who were born vaginally in the Obstetrics Department of Yinchuan Maternal and Child Health Hospital at the same period were enrolled as control group. EENC-based treatment and management were implemented to infants in the intervention group, such as thorough drying immediately, 30 min skin-to-skin contact immediately and delayed cord clamping after birth, etc., while those in the control group were managed based on routine protocol. Chi-square test was used to compare the incidence of hypothermia, hypoglycemia and hypoxemia between the two groups at 1 h after birth. The general condition and the time of colostrum secretion were compared by two independent sample t-test. Multivariate logistic regression was used to analyze the risk factors of hypothermia. Results At last, 96 participants in the intervention group and 102 in the control group were analyzed. Compared with the control group, the intervention group showed lower incidence of hypothermia [17.7% (17/96) vs 37.3% (38/102), χ2=9.418, P=0.002], hypoglycemia [9.4% (9/96) vs 19.6% (20/102), χ2=4.142, P=0.042] and hypoxemia [14.6% (14/96) vs 28.4% (29/102), χ2=5.578, P=0.018] at 1 h after birth and earlier colostrum secretion [(18.3±2.4) vs (31.4±3.5) min, t=32.463, P<0.001]. Multivariate logistic regression analysis showed that birth weight <2 500 g ( OR=2.483, 95% CI : 1.731-3.234, P=0.025), gestational age<36 weeks (OR=1.899, 95%CI : 1.325-2.472, P=0.012), room temperature between 22-24℃in the delivery ward (OR=2.465, 95% CI: 1.279-4.754, P=0.007), no-skin contact (OR=2.958, 95%CI: 1.435-4.481, P=0.023) and rapid and simple drying ( OR=2.467, 95% CI : 1.285-4.736, P=0.006) were the risk factors for hypothermia in premature infants. Conclusions EENC can reduce the incidence of hypothermia, hypoglycemia and hypoxemia in premature infants at 1 h after birth and may be helpful for early colostrum secretion.
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Objective: To study the the expression and significance of MAPK8 gene in oral squamous cell carcinoma (OSCC) .Methods: 17 cases of oral normal tissues and 42 of OSCC tissues were collected. The relative expression of MAPK8 mRNA was detected by Real-Time PCR, the expression of MAPK8 protein was detected by immunohistochemical SP method. Results: Over expression of MAPK8 mRNA and protein was observed in OSCC (P ＜ 0. 05), the expression was correlated with the differentiation (P ＜ 0. 05) and clinical stage (P ＜ 0. 05) of the lesion, but not with the age (P＞ 0. 05) and gender (P＞ 0. 05) . Conclusion: MAPK8 gene may play an important role in the development of OSCC.
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Objective The surgical approaches and extent of lymph node dissection for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction(AEG) are controversial.The present study was aimed to investigate the application of right thansthoracic Ivor-Lewis(IL),left transthoracic(LTT),and left thoracoabdominal(LTA) approach in Siewert type Ⅱ AEG.Methods The data of 196 patients with Siewert type Ⅱ AEG received surgical resection in our cancer center between January 2014 and April 2016 was retrospectively analyzed.Finally,136 patients met the inclusion criteria were enrolled in the study and divided into the IL(47 cases),LTT(51 cases),and LTA group(38 cases).Clinical and short-term treatment effects were compared among the three groups.Results The patients with weight loss,diabetes,and heart disease increased in the LTT group (P =0.054,P =0.075,and P =0.063,respectively).Operation time was significantly longest in the IL group (P =0.000),but the amount of bleeding and tumor size did not significantly differ among the three groups (P =0.176 and P =0.228,respectively).The IL group had the significantly longest proximal surgical margin (P =0.000) and most number of total (P =0.000) and thoracic lymph nodes(P =0.000) dissected.Both the IL and LTA groups had more abdominal lymph nodes dissected than the LTT group(P =0.000).In general,the IL and LTT group had the highest dissection rates of every station of thoracic (P ＜ 0.05) and lower mediastinal lymph nodes (P ＜ 0.05),respectively.The dissection rate of the paracardial,left gastric artery,and gastric lesser curvature lymph nodes did not differ significantly among the three groups(P ＞ 0.05),but the dissection rate of the hepatic artery,splenic artery,and celiac trunk lymph nodes was significantly highest in the IL group (P ＜0.05).Postoperative hospital stay,perioperative complications,and mortality did not differ significantly among the three groups(P ＞ 0.05).Conclusion Compared with the traditional left transthoracic approach,the Ivor-Lewis approach did not increase the perioperative mortality and complication rates in Siewert type Ⅱ AEG,but obtained satisfactory length of the proximal surgical margin,and was better than left transthoracic approach in thoracic and abdominal lymph node dissection.However,the advantages of Ivor-Lewis procedure requires further follow-up and validation through prospective randomized controlled trials.
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The expression of calcium binding protein S100A8 in 30 controls of normal oral tissue and 35 cases of OSCC was detected by immunohistochemical staining and Western blot respectively. The positive expression of S100A8 protein in OSCC and the controls was 68. 5％ and 36. 7％ respectively(P ＜ 0. 05). S100A8 may play a role in the development of OSCC.
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Objective:To investigate the expression of insulin-like growth factor binding protein 3 (IGFBP-3) in salivary pleomorphic adenoma(SPA).Methods:The expression of IGFBP-3 protein in 40 cases of SPA(group SPA),40 of normal glandular tissue(group N) and 10 of salivary gland malignant tumor(group CA) was detected by Western blot.The expression of IGFBP-3 mRNA in 50 cases of SPA,50 of salivary gland normal tissue and 10 of CA was detected by qRT-PCR.Results:The expression(A value) of IGFBP-3 protein in group N,SPA and CA was 8.54 ± 3.95,4.78 ± 2.07,3.63 ± 2.27 respectively.The expression ration of IGFBP-3 mRNA of group N vs SPA or CA,P ＜ 0.05;SPA vs CA,P ＞ 0.05 (SPA/N was 0.654 ± 0.387,CA/N:0.452 ± 0.229) respectively,but showed no significance difference between SPA and the CA groups(P ＞ 0.05).Difference of IGFBP-3 mRNA expression was observed with different envelope infiltration of SPA (P ＜ 0.05),no significant difference was observed in different age,gender or relapse groups.Conclusion:IGFBP-3 Low expression of IGFBP-3 in pleomorphic adenomas may reduce the antagonism of IGF-1R,causing the proliferation of tumor cells and promote tumor formation.
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Objective@#To evaluate the lymph node metastasis (LNM) pattern and related prognostic factors for T1 esophageal cancer.@*Methods@#Clinical data of 143 cases of pT1 esophageal cancer patients (120 male and 23 female patients with median age of 60 years) who underwent esophagectomy and lymph node resection during January 2011 and July 2016 at the Department of Esophageal Cancer of Tianjin Medical University Cancer Institute and Hospital were reviewed, including 50 cases of T1a patients and 93 cases of T1b patients. The LNM pattern was analyzed and the prognostic factors related to LNM were assessed by χ2 test and Logistic regression analysis.@*Results@#Of 143 patients, 25 patients had LNM. The LNM rates were 17.5% for pT1 tumors, 16.0%(8/50) for pT1a tumors, and 22.6%(21/93) for T1b tumors. Of 25 patients with LNM, one patient had cervical metastasis, 15 patients with thoracic metastasis, and 17 patients with abdominal metastasis. The relatively highest LNM sites were laryngeal recurrent nerve (8 cases), left gastric artery (8 cases), right and left cardiac (6 cases) and thoracic paraesophageal (5 cases). Logistic regression analysis showed that the depth of tumor infiltration (OR=4.641, 95%CI: 1.279 to 16.836, P=0.020), tumor size (OR=5.301, 95%CI: 1.779 to 15.792, P=0.003), tumor location (OR=3.238, 95% CI: 1.248 to 8.401, P=0.016), and tumor differentiation (OR=5.301, 95%CI: 1.719 to 16.347, P=0.004) were independent prognostic factors related to LNM for T1 esophageal cancer. Tumor size (OR=4.117, 95% CI: 1.228 to 13.806, P=0.022) was an independent risk factor related to thoracic LNM, and the vessel invasion (OR=6.058, 95% CI: 1.228 to 29.876, P=0.027) and tumor location (OR=8.113, 95% CI: 1.785-36.872, P=0.007) were independent prognostic factors related to abdominal LNM.@*Conclusions@#T1 esophageal cancer has a relatively high LNM rate, and the depth of tumor infiltration, tumor size, tumor location and tumor differentiation are correlated with LNM. The LNM risk and extent must be considered comprehensively in decision-making of a better surgical treatment and lymph node resection strategy.
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Objective@#To compare the extent of lymphadenectomy and postoperative complications between Ivor-Lewis procedure and left sided thoracotomy in patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG).@*Methods@#The clinical data of 101 patients with Siewert type Ⅱ EG who received surgical treatment between January 2014 and September 2015 in the Department of Esophageal Cancer, Tianjin Medical University Cancer Hospital were analyzed retrospectively. These patients were divided into Ivor-Lewis group (IL, n=38) and left- sided thoracotomy group (LT, n=63) according to the operation mode. The number and extent of dissected lymph nodes and postoperative complications were compared between the two groups.@*Results@#The surgical blood loss, length of postoperative stay, anastomotic leakage, pulmonary infection, respiratory failure and complications of incision of the two groups showed no significant differences (P>0.05 of all). The operation time of IL group was 200 min, significantly longer than the LT group (120 min, P<0.05). The number of resected lymph nodes in the IL and LT groups were (20±9) and (13±7), respectively, with a statistically significant difference (P<0.001). Significantly more thoracic lymph nodes (7±5) were harvested in the IL group than in the LT group (2±2, P<0.001), and the number of resected abdominal lymph nodes in the IL and LT groups were (13±8) and (11±7), with a non-significant difference (P=0.157). As regarding the lymph node dissection rate, the IL approach was obviously better than the LT approach in the following lymph node stations: superior mediastinal nodes, subcarinal nodes, left hilar nodes, right hilar nodes, middle thoracic paraesophageal nodes, lower thoracic paraesophageal nodes, lymph nodes along the common hepatic artery, and lymph nodes along the splenic artery(P<0.05 for all).@*Conclusions@#The Ivor-Lewis procedure achieves better thoracic and abdominal lymph node dissection, and does not cause more postoperative complications than the left-sided thoracotomy in patients with Siewert type Ⅱ AEG. However, these findings need to be confirmed by large-scale randomized clinical trial in the future.
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<p><b>OBJECTIVE</b>To investigate the regularity of lymph node metastasis in cardiac carcinoma and its risk factors.</p><p><b>METHOD</b>Complete clinicopathological data of 768 cardiac carcinoma patients undergoing radical resection and lymph node dissection were collected. A retrospective cohort study was performed to analyze the distribution of lymph node metastasis (lymph node metastasis rate=number of patients with lymph node metastasis/number of patients with lymph node dissection; lymph node metastasis frequency=number of metastatic lymph node/number of total resected lymph node) and the influence of clinicopathological factors on lymph node metastasis.</p><p><b>RESULTS</b>Of the 768 patients, 599 were male and 169 were female, with mean age of 61(28 to 85) years. According to gastric cancer staging criteria from the American Joint Cancer Association (AJCC) 7th edition in 2010, there was 256 cases in N0 stage, 171 cases in N1 stage, 181 cases in N2 stage, 160 cases in N3 phase; 18 cases in T1 stage, 30 cases in T2 stage, 9 cases in T3 stage, 711 cases in T4 stage. Borrmann type I( was found in 61 cases, type II( in 306 cases, type III( in 358 cases, type IIII( in 43 cases. The histological type was adenocarcinoma in 738 cases and signet ring cell carcinoma in 30 cases. A total of 9 183 lymph nodes were resected during operation for 768 patients with mean 12(0 to 57) nodes per case, while 510 patients were found to have 2 889 metastatic nodes; the lymph node metastasis rate was 66.4%(510/768), and lymph node metastasis frequency was 31.5%(2 889/9 183). Besides, 483 patients were found to have 2 759 metastatic lymph nodes and 8 246 resected lymph nodes in abdominal cavity with lymph node metastasis rate of 62.9%(483/768) and lymph node metastasis frequency of 33.5% (2 759/8 246); 57 patients were found to have 130 metastatic lymph nodes and 937 resected lymph nodes in thoracic cavity with lymph node metastasis rate of 7.4%(57/768) and lymph node metastasis frequency of 13.9%(130/937). Stations with the higher lymph node metastasis rate included paracardiac (left cardia: 38.8%, right cardia: 39.9%), lesser curvature of stomach(41.9%), left gastric artery (46%) and posterior pancreatic (38.5%). A total of 361 patients had resected lymph node number ≥12 during operation, while other 407 patients had number <12. Univariate analysis showed that Borrmann type, depth of tumor invasion and resected lymph node number were associated with lymph node metastasis. Lymph node metastasis rates of Borrmann type I(, II(, III( and IIII( patients were 55.7% (34/61), 62.7% (192/306), 73.7% (264/358) and 51.2%(22/43) respectively, and the difference was statistically significant (χ=18.115, P=0.000). Lymph node metastasis rates of T1, T2, T3, T4 stage patients were 0%(0/18), 30%(9/30), 100%(9/9) and 69.5%(494/711) respectively, and the difference was statistically significant (χ=63.971, P=0.000). Lymph node metastasis rate of patients with resected lymph node number ≥12 was 79.5%(287/361), which was significantly higher than 55.3%(225/407) of those with resected lymph node number <12(χ=50.496, P=0.000). Multivariate analysis revealed that higher T stage (OR=2.326, 95%CI: 1.758 to 3.078, P=0.000) and resected lymph node number ≥12(OR=2.998, 95%CI: 2.142 to 4.195, P=0.000) were independent risk factors of lymph node metastasis.</p><p><b>CONCLUSIONS</b>The lymph node metastasis rate of cardiac carcinoma is quite high. The metastasis occurs mainly in the surrounding of cardia, the small curvature of the stomach, the left artery of stomach and posterior pancreatic. The depth of tumor invasion and the number of lymph node dissection are independent risk factors of lymph node metastasis.</p>
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<p><b>OBJECTIVE</b>To compare the treatment outcomes of neoadjuvant chemoradiotherapy (NCRT) combined with operation and operation alone for esophageal cancer.</p><p><b>METHODS</b>Randomized controlled trials(RCTs), comparing the treatment outcomes of NCRT combined with operation to operation alone for esophageal cancer, published from January 1990 to December 2015 were searched from PubMed, Web of Science, and other English-language databases. STATA 10.0 software was used to analyze short-term efficacy (R0 resection rate, positive lymph node ratio, postoperative complications and mortality) and long-term outcomes (overall survival rate and local recurrence rate). The publication bias was evaluated by funnel plot and Egger test.</p><p><b>RESULTS</b>A total of 12 RCTs, including 1 872 esophageal cancer patients, were included in the meta-analysis, with 939 cases in NCRT combined with operation group and 943 cases in operation alone group. Meta-analysis of short-term efficacy showed that, as compared to operation alone group, NCRT combined with operation group had higher R0 resection rate (RR=1.19, 95%CI:1.08 to 1.32, P=0.015), lower positive lymph node rate (RR=0.55, 95%CI:0.49 to 0.63, P=0.001), but higher postoperative mortality (RR=1.63, 95%CI:1.09 to 2.45, P=0.018). Postoperative complications were similar between the two groups(RR=1.04, 95%CI:0.91 to 1.18, P=0.558). Meta-analysis of long-term outcomes showed that, as compared to operation alone group, NCRT combined with operation group had lower local recurrence rate (RR=0.50, 95%CI:0.39 to 0.64, P=0.000), and higher overall survival rate (HR=0.75, 95%CI:0.66 to 0.84, P=0.001). Subgroup analysis according to pathological types showed that both squamous cell carcinoma and adenocarcinoma patients in NCRT combined with operation group had higher overall survival rates compared to those in operation alone group (HR=0.80, 95%CI:0.69 to 0.93, P=0.003; HR=0.78, 95%CI:0.70 to 0.88, P=0.003).</p><p><b>CONCLUSIONS</b>NCRT can decrease the staging of esophageal cancer, elevate the R0 resection rate, and ameliorate local recurrence without increasing postoperative complications. Meanwhile NCRT can improve overall survival of esophageal cancer patients even with squamous cell carcinoma and adenocarcinoma.</p>
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Objective:To used the internationally accepted methods of CT quality assurance for testing their quality, to maintain the normal operation of CT scanner and guarantee the quality of photographic image.Methods: Toshiba Activion 16 row CT, set the scanning conditions: tube voltage 120 kv, 310 mas exposure, scan time is 0.33 s, scanning layer thickness: 10 mm, 5 mm, 1.5 mm, view(FOV) 150 mm×150 mm, 512 x 512 reconstruction matrix. We measured the following performance parameters for CT spatial resolution, low contrast resolution,uniformity and noise with Catphan500 phantom made by the phantom laboratory of U.S.A.Results: The spatial resolution, low contrast resolution, uniformity and noise of the CT are all in line with the requirements. Obtained by detecting the X-ray dose, pixel, the thickness of the above parameters are affected, but also the interaction between the above parameters simultaneously.Conclusion: By detecting the spatial resolution, low contrast resolution of medical image, we can effectively guarantee system performance, maintaining optimal image quality.
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42 cases of OSCC and 20 of healthy tissues were studied to detect the expression of NIMA-related Kinase 2(NEK2)mRNA by Real-time PCR.Over expression of NEK2 mRNA was observed in OSCC (z =-6.328,P 0.05),age (z =-0.365,P >0.05)and gender (z =-3.450,P >0.05).NEK2 gene may be involved in the develop-ment of OSCC.
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<p><b>OBJECTIVE</b>To compare the perioperative complications and the stress response between thoracoscopic esophagectomy and open esophagectomy in patients with esophageal cancer.</p><p><b>METHODS</b>Clinicopathologic data of 154 patients with esophageal cancer undergoing thoracoscopic esophagectomy (thoracoscope group) and 113 undergoing open procedure(open group) in the Tianjin Medical University Cancer Institute and Hospital from October 2012 to September 2014 were analyzed retrospectively. The incidence of perioperative complications and the change of stress response index in patients without complications were compared between two groups.</p><p><b>RESULTS</b>The total complication rate in thoracoscope and open group was 33.8% and 38.1%(P = 0.470) respectively. Compared with open group, incidence of ligation of thoracic duct(2.6% vs. 14.2%), recurrent laryngeal nerve paralysis (16.9% vs. 28.3%), chylothorax (0 vs. 4.4%), atelectasis (1.3% vs. 7.1%), pleural effusion (0.6% vs. 6.2%) and acute respiratory distress(0.6% vs. 6.2%) were obviously decreased in thoracoscope group(all P<0.05). No significant differences were observed in other complications (all P>0.05). Thirty-two cases and 24 cases without complication and with complete test data in thoracoscope and open group were selected for the detection of stress response index. There were no significant differences in white blood cell count, and the levels of cortisol, thyroxine (FT3 and FT4) and C-reactive protein between two groups at the same time points (before operation, 1, 3 and 6 days after operation) (all P>0.05).</p><p><b>CONCLUSION</b>Thoracoscopic esophagectomy has some obvious advantages associated with less pulmonary complications, lower morbidity of injury in thoracic duct and recurrent laryngeal nerve, while no significant difference of stress response is found in patients without complication between thoracoscope group and open group.</p>
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Humans , Esophageal Neoplasms , General Surgery , Esophagectomy , Ligation , Postoperative Complications , Retrospective Studies , ThoracoscopyABSTRACT
<p><b>OBJECTIVE</b>To study the impact of preoperative fasting plasma glucose(FPG) on postoperative morbidity and outcome following surgical resection of esophageal squamous cell carcinoma (ESCC), and to analyze the risk factor of postoperative complication in ESCC.</p><p><b>METHODS</b>Clinicopathological data of 314 ESCC patients undergoing esophagectomy in our center between January 2011 and December 2012 were retrospectively collected. Patients were divided into two groups according to their preoperative FBG: normal FPG group (FPG<6.1 mmol/L, 252 cases) and high FBG group (FPG≥6.1 mmol/L, 62 cases, including 14 diabetes cases). Clinicopathological data and postoperative morbidity were analyzed and compared between two groups. Multivariate logistic regression analysis was used to evaluate risk factors for postoperative complications.</p><p><b>RESULTS</b>There were 278 male and 36 female patients with a median age of 59 years (range 42-83 years). As compared to normal FPG group, high FBG group had higher ratio of female [22.6%(14/62) vs. 8.7%(22/252), P=0.000], older median age (66 years vs. 59 years, P=0.010), lower ratio of smoking and alcohol drinking [48.4%(30/62) vs. 73.8%(186/252), 38.7%(24/62) vs. 69.0%(174/252), both P=0.000], higher ratio of comorbid diabetes and hypertension [51.6%(32/62) vs. 15.1%(38/252), 16.1%(10/62) vs. 1.6%(4/252), both P=0.000]. Pathology results showed 206 patients in normal FPG group (81.7%, 206/252) were moderate-poor differentiation, which was obviously lower than 93.5%(58/62) in high FPG group(P=0.023). Patients of two groups completed their operations successfully. Perioperative overall complication morbidity was 24.2%(76/314), and the most common was lung lesions (24 cases of pneumonia, 10 cases of respiratory failure), then was anastomotic leakage (28 cases) and incision infection (18 cases). Differences in overall and other complication morbidity were not significant between two groups (all P>0.05). Multivariate logistic regression analysis revealed that operation time was an independent risk factor of postoperative complications (P=0.047), anastomosis site was an independent risk factor of anastomotic leakage (P=0.036), and FPG was not a risk factor of postoperative complications(respectively, P=0.683, P=0.836, P=0.784, P=0.637).</p><p><b>CONCLUSIONS</b>Preoperative control of FBG does not increase the postoperative complication morbidity. Shortening operation time and choosing appropriate surgical procedure are important to decrease postoperative complications.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Alcohol Drinking , Anastomotic Leak , Blood Glucose , Physiology , Carcinoma, Squamous Cell , General Surgery , Comorbidity , Diabetes Complications , Epidemiology , Diabetes Mellitus , Esophageal Neoplasms , General Surgery , Esophagectomy , Hypertension , Operative Time , Pneumonia , Epidemiology , Postoperative Complications , Epidemiology , Respiratory Insufficiency , Epidemiology , Retrospective Studies , Risk Factors , Smoking , Surgical Wound Infection , Epidemiology , Treatment OutcomeABSTRACT
The expression of DNA methyltranferase 1 (DNMT1 )mRNA and protein in 20 controls of normal oral mucosa tissue and 43 cases of oral squamous cell carcinoma(OSCC)was detected by Real-Time PCR and immunohistochemical staining and Western blot respectively. DNMTl mRNA CT values in OSCC and the controls were 0.958 6 ±0.986 6 and 0.459 5 ±0.525 8 respectively(Z =-2.028,P <0.05), The positive expression of DNMT1 protein in OSCC and the controls was 87% and 25% respectively(P <0.05).DNMT1 may play a role in the development of OSCC.
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Objective To analyze the differences in paraoperative morbidity and lymph node dissection between thoracoscopic esophagectomy and open procedure.Methods From October 2012 to April 2014,207 patients with esophageal cancer underwent surgery.125 patients underwent video-assisted esophagectomy,and 82 underwent open procedure.In the minimally invasive group,there were 109 thoracoscopic cases and 16 thoracolaparoscopic cases.Results There were significant differences between the thoracoscope group and the open group in atelectasis(0.8％ vs.7.3％,P ＜ 0.05),pleural effusion (0 vs.4.9％,P ＜ 0.05),acute respiratory distress (0 vs.6.1％,P ＜ 0.05),ligation of thoracic duct (3.2％ vs.15.9 ％,P ＜ 0.05),recurrent laryngeal nerve paralysis (19.2％ vs.32.9％,P ＜ 0.05),c hylothorax (0 vs.4.9％,P ＜ 0.05),number of lymphonode along the right recurrent laryngeal nerve lymphatic chains[1.91 ± 0.73 vs.1.12 ± 0.81,P ＜ 0.05)] and achievement ratio(97.6％ vs.89.0％,P ＜0.05) and number of lymphonode along the left recurrent laryngeal nerve lymphatic chains (0.93 ± 0.71 vs.1.76 ± 0.84,P ＜ 0.05) and achievement ratio(52％ vs.76.8％,P ＜ 0.05).No significant differences were observed in pneumonia,anastomotic leak,thoracic abscess,esophago-tracheal fistula,re-laparotomy,re-thoracotomy,wound infection,arrhythmia,cardia failure,renal failure,hepatic inadequacy,cerbral infarction,and mortality(P ＞ 0.05).There were also no significant differences in number of lymphonode and achievement ratio of periesophagel lymph nodes,subcarinal lymph nodes and hilar lymph nodes (all P ＞ 0.05).Conclusion The thoracoscopic esophagectomy has some obvious advantage associated with less pulmonary complications,lower injury of thoracic duct and recurrent laryngeal nerve,more lymphonode and higher achievement ratio along the right recurrent laryngeal nerve lymphatic chains.But it has still a larger space for improvement of lymphadenectomy along the left recurrent laryngeal nerve lymphatic chains.
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<p><b>OBJECTIVE</b>To analyze the pattern and the clinicopathologic risk factors of lymph node metastasis (LNM) in pN1 stage esophageal squamous cell carcinoma.</p><p><b>METHODS</b>Clinical data of 181 patients (154 male and 27 female patients, aging from 38 to 84 years) who underwent esophagectomy during January 2005 and December 2008 were reviewed, including 69 cases through left thoracotomy and 112 cases through right thoracotomy. All patients underwent systematic lymphadenectomy. The risk factors related to lymph node metastasis were analyzed by χ² test and Logistic regression analysis.</p><p><b>RESULTS</b>The relatively highest LNM site were middle and lower thoracic paraesophageal (38.4%), right and left cardiac (35.3%) and the left gastric artery (38.8%). The LNM of middle and lower thoracic paraesophageal was correlated with T stage (χ² =11.754, P=0.009). A correlation was also found among the LNM of upper mediastinum and the location of tumor (P=0.039). The T stage (χ² =8.694, P=0.034) and TNM stage (χ² =6.906, P=0.032) were the risk factors of the LNM of middle and lower mediastinum. The risk factors of the LNM of abdomen were the location of tumor, the length of tumor, T stage and TNM stage (χ² =5.713 to 16.749, P>0.05). Multivariate analysis showed that the location of tumor is the independent risk factors for the abdominal lymph node metastasis.</p><p><b>CONCLUSIONS</b>The relatively highest LNM sites are correlated with the location of tumor, T stage, the length of tumor and TNM stage. According to the risk factors of LNM, the relatively highest LNM sites should be mainly swept.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Abdomen , Abdominal Cavity , Carcinoma, Squamous Cell , Pathology , General Surgery , Esophageal Neoplasms , Pathology , General Surgery , Esophagectomy , Lymph Node Excision , Lymph Nodes , Lymphatic Metastasis , Mediastinum , Multivariate Analysis , Neoplasm Staging , Risk Factors , ThoracotomyABSTRACT
<p><b>OBJECTIVE</b>To preliminarily investigate the expression and clinical significance of leptin and adiponectin in esophageal squamous cell carcinoma (ESCC).</p><p><b>METHODS</b>The expression of leptin and adiponectin in ESCC and normal esophageal mucosal tissue was detected by immunohistochemical staining with tissue microarray. The correlation between leptin, adiponectin and clinicalpathological features was statistically analyzed.</p><p><b>RESULTS</b>The expression of leptin was significantly upregulated in the ESCC than in the normal esophageal mucosa tissue [65.6% (80/122) versus 27.5% (11/40), P < 0.001]. Expression of leptin was significantly correlated with lymph node involvement and advanced tumor stage (P = 0.009 and P = 0.043, respectively). Expression of adiponectin was significantly down-regulated in ESCC compared with that in normal esophageal mucosal tissue [22.1% (27/122) versus 47.5% (19/40), P = 0.002]. Expression of adiponectin was significantly correlated with lymph node involvement (P = 0.020). Correlation analysis showed a positive correlation between the expression of leptin and lymph node metastasis and TNM stage (r = 0.235 and r = 0.183, respectively), and a negative correlation between the expression of adiponectin and lymph node metastasis (r = -0.229). There was no significant correlation between the expressions of leptin and adiponectin (P > 0.05), and between the body mass index and the expression of leptin and adiponectin, and lymph node metastasis (P > 0.05 for all).</p><p><b>CONCLUSIONS</b>An imbalanced expression of adipocytokines exits in ESCC. The expression of leptin and adiponectin is correlated with lymph node metastasis and/or tumor stage. Therefore, imbalanced expression of leptin and adiponectin may have a potential role in the carcinogenesis and disease progression of ESCC.</p>
Subject(s)
Adiponectin , Metabolism , Carcinoma, Squamous Cell , Metabolism , Down-Regulation , Esophageal Neoplasms , Metabolism , Leptin , Metabolism , Lymphatic Metastasis , Neoplasm Staging , Up-RegulationABSTRACT
Objective:We aimed to investigate the effect of neo-adjuvant chemotherapy on postoperative cognitive dysfunction (POCD) in elderly patients who underwent one-lung ventilation (OLV) surgery. Methods:A total of 90 esophageal carcinoma patients aged 60 years old or older were included. These patients were scheduled for esophagectomy, including two or three-field lymphadenec-tomy, and were randomly divided into two groups based on the American Society of Anesthesiologists status (Ⅰ or Ⅱ) and the Tu-mor-Node-Metastasis (TNM) classification stage (ⅡorⅢ), as follows:the neo-adjuvant chemotherapy group (Group N:n=45) that re-ceived preoperative neo-adjuvant chemotherapy;and the control group (Group C:n=45) that did not receive chemotherapy. The neuro-psychological test was performed 1 d before and 7 d after surgery to evaluate the changes in cognitive function. The incidence of POCD was also determined via the Z-value method in the two groups. Results:A total of 44 patients in Group N and 41 patients in Group C completed the neuropsychological tests. No statistical differences were observed in the demographics, TNM stage, and the intra-and post-operative clinical data between the groups. POCD was observed in 21 of the patients in Group N (47.7%) and 11 of the patients in Group C (26.8%), and the differences were significant (χ2=3.949, P=0.047). Conclusion:Neo-adjuvant chemotherapy can aggravate the impairment of cognitive function in the elderly patients undergoing OLV surgery and can significantly increase the incidence of POCD.