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Due to the particularity of tumor location, the surgery of esophagogastric junc-tion(EGJ) carcinoma needs to meet the safety of negative tumor margin, lymph node dissection and digestive tract reconstruction at the same time, which attracted more and more attention of esopha-gogastric surgeons. The current Siewert and Nishi classifications are based on the tumor epicenter, which is difficult to be accurately evaluated and measured before and during operation, and also lack of significance in determining the surgical methods and approach and lymph node dissection. The authors systematically analyze the limitations of Siewert and Nishi classification, discuss the relationship between esophageal invasion length and mediastinal lymph node metastasis and the role of esophageal invasion length on selection of surgical approach, and propose a modified classi-fication based on esophageal invasion length, including (1) malignant tumors with the upper or lower edge of tumor involving the zone of EGJ are defined as EGJ carcinoma; (2) EGJ carcinoma with the upper edge of tumor located 3.0 cm above the EGJ is classified as type Ⅰ; (3) EGJ carcinoma with the upper edge of tumor located 0?3.0 cm above the EGJ is classified as type Ⅱ; (4) EGJ carcinoma with the upper edge of tumor located 0?2.0 cm below the EGJ is classified as type Ⅲ.
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Objective To investigate the relationship between plasma activin A (ACTA),B－type natriuretic peptide(BNP),growth differentiation factor －15 (GDF－15) and interleukin－6 ( IL－6) levels and heart failure. Methods From January 2017 to December 2018,80 patients with acute heart failure admitted to Lishui Central Hospitalwere selected as observation group.According to NYHA cardiac function classification , 23 patients were classified as grade II,30 patients were classified as grade Ⅲand 27 patients were classified as grade Ⅳ.Another 60 healthy people were selected as control group from January 2017 to December 2018.The left ventricular end －diastolic diameter(LVEDD) and left ventricular ejection fraction (LVEF) were measured by Doppler echocardiography ,and the levels of ACTA, BNP, GDF －15 and IL －6 were measured by ELISA.Results The plasma ACTA [(2.43 ± 0.54)ng／mL],BNP[(219.31 ±34.25)ng／L],GDF－15[(854.31 ±46.57)ng／L],IL－6[(183.25 ±39.89)ng／L] in the observation group were significantly higher than those in the control group [(0.32 ±0.10) ng／mL,(16.74 ± 3.89)ng／L,(467.52 ±60.91)ng／L,(40.31 ±6.57) ng／L]( t＝29.859,45.553,42.591,27.455,all P＜0.05). The LVEDD[(65.73 ±5.38) mm] in the observation group was higher than that in the control group [(47.83 ± 4.31)mm],while the LVEF[(39.82 ±3.56)%]was lower than that in the control group [(64.32 ±4.16)%]( t＝21.170,37.475,all P＜0.05).The ACTA [(3.98 ±0.58) ng／mL],BNP[(304.21 ±41.30) ng／L],GDF－15 [(989.83 ±50.38) ng／L],IL－6[(249.81 ±45.61) ng／L] in grad Ⅳ group were lower than those in grade Ⅱgroup[(1.17 ±0.21)ng／mL,(135.42 ±23.98)ng／L,(735.24 ±41.87)ng／L,(120.74 ±33.45)ng／L] and gradeⅢgroup[(2.41 ±0.52)ng／mL,(217.27 ±35.46)ng／L,(861.32 ±53.46) ng／L,(185.42 ±42.31) ng／L] ( F＝8.391,23.154,17.849,14.568,all P＜0.05).The plasma levels of ACTA,BNP,GDF－15 and IL－6 in gradeⅢgroup were lower than those in gradeⅡgroup (t＝10.764,9.517,9.322,6.025,all P＜0.05).The LVEDD[(72.31 ± 5.91) mm] in grade Ⅳ group was higher than that in grade Ⅱ group [(58.98 ±4.64) mm] and grade Ⅲ group [(66.01 ±5.48) mm], and the LVEF [( 29.97 ±3.36)%] was lower than that in grade Ⅱ group [(51.54 ± 3.27)%]and gradeⅢgroup[(40.35 ±3.81)%],the differences were statistically significant (F＝12.415,9.829, all P＜0.05).The LVEDD in grade Ⅲgroup was higher than that in grade Ⅱgroup,and the LVEF was lower than that in gradeⅡgroup,the differences were statistically significant ( t ＝4.176,10.856,all P＜0.05).Conclusion The levels of ACTA,BNP,GDF－15 and IL－6 in plasma are increased in patients with acute heart failure ,and are closely related to the progress of the disease.They can be used as diagnostic and prognostic indicators of acute heart failure.
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Objective To investigate the reliability of MRI classification and clinical significance of deep gray matter injury(DGMI)in children with cerebral palsy(CP).Methods We made a retrospective assessment of 14 children with gross motor function classification system(GMFCS),manual ability classification system(MACS)and MRI classification system of deep gray matter injury.Based on T2WI,two radiologists worked independently and graded MRI pictures according to three-grading system and four-grading system.To evaluate the reliability of different grading systems,intra-observer and inter-observer agreements were tested by Kappa test.Spearman correlation analysis was performed to analyze the MRI classification system with GMFCS and MACS.Results The Kappa value of the intro-observer and inter-observe agreement of three-grading system was 0.873 and 0.873,respectively (P＜0.001).The Kappa value of the intro-observer and inter-observe agreement of four-grading system was 0.901 and 0.611(P＜0.001).Three-grading system had no significant correlation with GMFCS(r=0.053,P＞0.05)or MACS(r=0.128,P＞0.05).Four-grading system had a significant positive correlation with GMFCS(r=0.605, P＜0.05)and MACS(r=0.779,P＜0.05).Conclusion In the two grading systems,four-grading system is a more repeatable approach for detecting deep gray matter,gross motor function and manual function injuries in children with cerebral palsy.
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Exit-site infection(ESI) is a troublesome catheter related complication of CAPD that may lead to peritonitis and require catheter removal, ESI is variably defined and classified. The rate of ESI and the outcome of treatment are also variably reported in literature. We conducted a retrospective study of 58 episodes of ESI(40 patients) between August 1997 and February 1999, and evaluated the episodes and types of ESI, organism isolated from ESI and their sensitivity, outcome of ESI, number and reason for catheter loss, and the current modality. The mean age was 48.9+/-11.5 years(31-70) and the male to female ratio was 22:18. The mean duration of CAPD before ESI was 34.1+/-29.6 months (1.5-114.2), and diabetic nephropathy was the cause of ESRD in 17.5% of cases. The types of catheter were two-cuff, coiled Tenckhoff in 17 patients, two-cuff, coiled swan-neck in 10 patients, two-cuff, straight swan-neck in 10 patients, and two-cuff, straight Tenckhoff in 3 patients. According to Twardowski's classification, acute infection in 33 patients and chronic infection in 25 patients were noted. Causative organisms of ESI were S. aureus, S. epidermidis, Pseudomonas, and E. cali in diminishing order of frequency. S. aureus was the most common organism in acute infection, and S. epidermidis was the most common organism in chronie infection. The mean duration of CAPD before ESI was 27.6+/-27.2 months in acute infection, and 42.8+/-30.8 in chronic infection (p<0.05). The duration of antibiotic treatment was 19.9+/-14.4 days in acute infection, and 42.7+/-27.2 days in chronic infection(p<0.05). In acute infection, peritonitis developed in 2 patients and 1 catheter was removed. In chronic infection, peritonitis developed in 1 patient and the catheter was removed. Three patients had the external cuff shaved due to persistent ESI which was unresponsive to antibiotics and local care. By the end of the study, 36 patients(90%) were still on CAPD, 2 patients(5%) had transferred to hemodialysis, and 2 patients(5%) had died. The cause of death was peritonitis in 1 patient, and cachexia in the other patient. In conclusion, exit-site infection responded relatively well to conservative treatment. However, exit-site infection is one of the major causes of catheter failure in CAPD. Therefore, careful exit-site care and examinations are needed.