Paracancerous tissues (PCTs) were previously considered benign regions, but recent findings reveal genomic instability in these areas. Smoking and alcohol consumption are closely associated with esophageal cancer (EC) development. This study explored the interplay between the Hippo pathway and pyroptosis in EC, PCTs, and distal normal tissues (DNTs). We used molecular epidemiological methods to analyze the effects of smoking and alcohol on these pathways. We found that key genes in both pathways were more altered in smokers and/or drinkers compared to non-smokers and non-drinkers. Additionally, we observed changes in some genes and proteins in PCTs, while the Hippo pathway and pyroptosis had not yet been influenced. We applied 4.0% alcohol combined with various concentrations of cigarette smoke extract (CSE) to PCTs cultured in vitro to observe carcinogenesis and changes in these pathways. Verteporfin, as an inhibitor of YAP, was also used in vitro culture experiments to observe its effects on cellular carcinogenesis. Among 56 EC patients, 41 had a history of smoking and/or alcohol consumption in this study. Compared to DNTs, Hippo pathway genes (Lats1, Yap, and Taz) and pyroptosis genes (Nlrp3, Asc, Gsdmd, and Caspase-1) were altered in 49 EC tissues, while changes of Lats1, Nlrp3, and Asc were observed in 47 PCTs. Additionally, 4.0% alcohol combined with 3.2%, 4.0%, and 5.8% CSE, respectively, not only induced cellular heterogeneity and even cancerous transformation, but also suppressed the Hippo pathway and pyroptosis in the PCTs cultured in vitro. Furthermore, in vitro, 9 μM verteporfin inhibited cellular heterogeneity/carcinogenesis in PCTs induced by 4.0% alcohol combined with 5.8% CSE through inhibiting YAP and promoting pyroptosis. It is speculated that the downregulation of YAP could prevent smoking- and alcohol-induced carcinogenesis in esophageal PCTs by promoting pyroptosis, which may offer new insights for the treatment of esophageal squamous carcinoma.

Background:The management of esophageal anastomotic fistula continues to be a significant clinical challenge in the field of esophageal surgery. With rapid advances in material science, selecting appropriate biomaterials to enhance anastomotic healing and reduce the incidence of anastomotic fistula has emerged as a promising strategy to address the issues. The aim of this study was to investigate the prevention of anastomotic fistula by reinforcing the anastomosis with suitable biomaterial patches. Methods:Forty large, healthy adult New Zealand white rabbits were randomized into the experimental group (n=20) and the control group (n=20). An animal model of cervical esophageal anastomosis was established using the esophagectomy anastomosis method. The esophageal anastomoses of the rabbits in the experimental group were completely covered with hydrogel biomaterial patches loaded with basic fibroblast growth factor (bFGF) intraoperatively. Four weeks after surgery, the incidence of anastomotic fistula was observed, and tissue samples were obtained from the esophageal anastomosis site for histologic and immunofluorescent detection. Results:An animal model of cervical esophageal incision and anastomosis was successfully established in rabbits, and the incidence of anastomotic fistula in the experimental group was lower than that in the control group at the end of the experiment (1/18 versus 7/19; P<0.05). The esophageal anastomosis tensile test showed that the anastomosis in the experimental group had higher mechanical strength than that in the control group (6.49±0.17 versus 6.33±0.12 N; P<0.05). Histological examination of the anastomotic specimens showed that the tissue layers of the esophageal anastomoses in the experimental group were clear, and fibroblast proliferation and collagen fiber secretion were greater than those in the control group. Immunofluorescence showed that fibroblast proliferation was significantly increased in the perianastomotic tissues of the experimental group compared to that of the control group. Conclusions:The application of hyaluronic acid methacrylate (HAMA) hydrogel biomaterial patches loaded with bFGF in esophageal surgery improved the mechanical strength of the esophageal anastomosis, facilitated fibroblast proliferation and collagen secretion, and could promote the growth of the tissues around the esophageal anastomosis. It may thus serve as a novel therapeutic approach for reducing the incidence of anastomotic fistula in esophageal cancer.

Background:Recently, minimally invasive surgical modalities have become the mainstream approach for the treatment of esophageal cancer, but the incidence rate of anastomotic leak (AL) has not significantly decreased. Compared to intrathoracic anastomoses, cervical anastomotic leaks (CALs) occur at a higher rate. However, there is still a lack of consensus regarding the local management for CALs. In recent years, we have innovated an irrigation and drainage technique for patients with CALs. The aim of this article is to investigate the therapeutic effect of this novel technique. Methods:The current study was designed as a retrospective study. Patients with CALs in Shanghai Changzheng Hospital were included consecutively. Data regarding healing time (HT), frequency of dressing changes (DC), post-operative hospital stay, mortality, morbidity, as well as laboratory indicators, such as white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) were recorded. Results:The current study included a total of 53 patients with CALs. Among them, 26 patients received conventional DC treatment (DC group), while 27 patients were treated with irrigation and drainage treatment (IDT) group. IDT significantly expedited the HT of CALs (45 vs. 22 days, P<0.01), reduced the frequency of DC (2.6 vs. 1.5 times/day, P<0.01), shortened the length of post-operative hospital stay (76.5 vs. 43 days, P<0.01), and decreased the mortality rate of patients (15.4% vs. 0%, P<0.05). Additionally, the incidence of sepsis (23.1% vs. 3.7%, P<0.05) and pneumonia (30.8% vs. 7.4%, P<0.05) significantly decreased in the IDT group. Laboratory tests indicated that IDT significantly reduced the CRP and IL-6 levels on the 3rd and 7th days of treatment. Conclusions:The irrigation and drainage technique is an effective treatment for CALs and merits broad implementation within clinical practice.

56岁男性患者，体检发现胸骨占位3个月。2021年8月13日于上海长征医院胸外微创中心行混合现实技术胸骨肿瘤精准切除术，手术过程顺利，术后病理示(胸骨)软骨肉瘤。术后4天出院。现随访9个月余，患者胸廓及上肢活动好，未见复发及转移。

混合现实(MR)技术是继虚拟现实(VR)、增强现实(AR)技术之后出现的新型数字全息影像技术,将现实世界与虚拟世界融合在一起,形成的一种新的可视化环境.目前MR技术已被应用于各种领域,但在医学领域中的应用尚处于探索阶段.随着数字时代的迅猛发展,MR技术和医学的结合前景无限,相信未来MR技术会在医学培训、疾病诊断、医患沟通、临床诊疗等方面带来颠覆性的变化.本文将MR技术在医学中的应用进行综述.

目的 讨论充气纵隔镜联合腹腔镜在治疗食管癌的短期随访结果.方法 回顾性分析2017年1月至2019年1月于我院接受微创食管癌根治术102例食管癌患者的临床资料.根据手术方法的不同将患者分为两组,胸腔镜组[A组,59例,其中男53例、女6例,年龄45～ 75 (63.3±7.6)岁]、单孔充气纵隔镜组[B组,43例,男35例、女8例,年龄50～ 82(66.7±6.7)岁].比较两组短期随访结果.结果 A组患者肺部感染11例(18.64％),与B组(2例,4.65％)差异有统计学意义(P＜0.05).而其它吻合口瘘等术后并发症,两组差异无统计学意义(P＞0.05).A组术后6个月、1年、2年生存率分别为96.61％、89.83％、73.33％,B组术后6个月、1年、2年生存率分别为95.35％、93.02％、79.17％,两组术后短期生存率差异无统计学意义(P＞0.05).结论 在治疗食管癌方面,充气纵隔镜联合腹腔镜术后肺部感染发生率低于传统胸腔镜联合腹腔镜手术,其它术后并发症无明显区别.两组术后短期生存率无明显差异.充气纵隔镜食管癌根治术是一种比较安全的手术方式,具有不错的短期疗效,长期疗效有待进一步检验.

目的 探讨3D单孔充气式纵隔镜联合腹腔镜食管癌根治术的安全性和有效性.方法 回顾性分析2018年6月至2019年6月我科收治的28例实施单孔充气式纵隔镜联合腹腔镜食管癌根治术的食管鳞状细胞癌患者的临床资料,其中男25例、女3例,年龄51 ～ 76岁.根据手术方法不同,将患者分为两组,即3D纵隔镜组(3D组,10例)和2D纵隔镜组(2D组,18例).比较两组近期疗效.结果 3D组手术时间明显短于2D组(P=0.017)、清扫淋巴结数目多于2D组(P=0.005)、出血量少于2D组(P=0.015),差异均有统计学意义.两组在主刀医师眩晕感及视觉重影方面差异无统计学意义(P＞0.05).两组在颈部引流管置管时问、术后住院时间、肺部感染、心律失常、吻合口瘘、喉返神经损伤等方面差异无统计学意义(P＞0.05).结论 3D充气式纵隔镜联合腹腔镜食管癌根治术优化了2D操作,实践中是安全、可行的,可以作为未来的一种术式去尝试.

目的 探讨裸眼3D胸腔镜在微创食管癌根治术中的安全性及有效性.方法 回顾性分析2018年10月至2019年4月于我院接受微创食管癌根治术的65例食管癌患者的临床资料,其中男50例、女15例,年龄47～72岁.根据手术方法将患者分为两组,即裸眼3D胸腔镜组(A组,30例)、传统2D胸腔镜组(B组,35例).比较两组临床效果.结果 A组手术时间明显短于B组(P＜0.05),A组清扫淋巴结数目多于B组(P＜0.05),术后第1～3 d胸腔引流量A组多于B组,差异有统计学意义(P＜0.05),术后第4～5d胸腔引流量差异无统计学意义(P＞0.05),术后胸腔引流管置管时间A组长于B组,差异有统计学意义(P＜0.05);两组在术后住院时间、肺部感染、心律失常、吻合口瘘、喉返神经损伤等方面差异无统计学意义(P＞0.05).结论 应用裸眼3D胸腔镜实施微创食管癌根治术是一种安全、有效的手术方式,与传统的2D胸腔镜微创手术相比,其在术中的安全性更高,清扫淋巴结更加彻底,手术效率更高,值得推广.

目的 介绍混合现实技术在肺结节术前和术中的应用.方法 以l例两肺多发结节的49岁女性患者最终行单孔胸腔镜下左肺下叶背段切除及左肺上叶楔形切除术为例.利用Mimics医学图像后处理软件,根据患者术前胸部CT影像DICOM数据重建患者肺部影像.将三维重建的影像数据导入HoloLens眼镜,在混合现实技术辅助下进行术前讨论制定手术方式、和患者进行术前谈话,同时在术中利用混合现实技术实时导航辅助手术.结果 混合现实技术清晰预显示血管、气管、病灶等重要解剖结构以及相互位置关系.在混合现实技术辅助下手术进行顺利,总手术时间49 min,精准背段切除时间27 min,术中出血量约39 mL.患者术后恢复良好顺利出院.结论 混合现实技术在肺结节术前及术中有一定的应用价值,该技术的不断成熟和在临床工作中进一步应用将为胸外科发展带来新方向的同时也提供更广阔的前景.

目的 探讨3D胸腔镜在单孔肺叶切除术中的安全性及有效性.方法 回顾性分析2018年9月至2019年5月于我院接受胸腔镜单孔肺叶切除术248例肺癌患者的临床资料.根据手术方法的不同将患者分为两组:3D胸腔镜组[76例,其中男52例、女24例,平均年龄(58.59±7.62)岁]和2D胸腔镜组[172例,其中男102例、女70例,平均年龄(57.75±8.59)岁].分析患者临床病理资料、淋巴结清扫情况、手术并发症、术后住院时间等.结果 3D胸腔镜组手术时间明显短于2D胸腔镜组(P＜0.05),清扫淋巴结数目多于2D胸腔镜组(P＜0.05),术后第1d胸腔引流量多于2D胸腔镜组(P＜0.05).两组术后带管时间,术后住院时间,肺部感染、心律失常、支气管胸膜瘘、喉返神经损伤等发生率差异无统计学意义(P＞0.05).结论 与传统的2D胸腔镜微创手术相比,应用3D胸腔镜行单孔肺叶切除术术中安全性更高、清扫淋巴结更加彻底、手术效率更高,值得推广.

2019年12月以来,湖北省武汉市陆续出现2019新型冠状病毒（2019-nCoV,SARS-CoV-2）感染病例,疫情持续蔓延,全国其他地区也相继发现了此类病例。新型冠状病毒肺炎疫情给胸外科临床实践带来了巨大挑战。门诊需要加强对磨玻璃影及肺内斑块影病例的鉴别诊断。疫情期间严格控制手术指征,推迟择期手术;拟行限期手术患者,需隔离2周且核酸检测阴性后,方可开展手术;在疫区拟行急诊手术患者,术前应注意排查是否合并新型冠状病毒感染,必要时行核酸检测;拟行急诊手术患者,必要时术前应开展核酸检测,术中按三级防护处理。严格开展手术消毒隔离措施。在术后患者中,积极排查合并新型冠状病毒感染患者。在新型冠状病毒感染患者抢救过程中,需要注意预防、治疗相关并发症,包括机械通气相关性气胸或纵隔气肿以及气管插管后损伤。

临床资料 患者,男,30岁,右肺中叶外侧段结节,大小约5.5 mm,见图1.纳入标准:术前胸部CT提示怀疑早期肺癌,且肺结节大小在≤1 cm,术前吲哚菁绿(indocyanine green,ICG)皮试阴性,无肝肾功能不全.排除标准:既往ICG过敏,对碘化物过敏,甲状腺疾病,肾脏或肾脏的过敏素质肝功能衰竭,怀孕或哺乳期.本研究经我院伦理委员会批准,患者家属术前签署手术知情同意书.近红外荧光成像系统使用easyScopy NIR/ICG医用荧光内窥镜摄像系统(上海逸思医疗科技有限公司),可在白光模式和近红外光模式下自由切换.注射用ICG为25 mg/支(卫材(辽宁)制药有限公司).

BACKGROUND:Magnolol has shown anti-cancer activity against a variety of cancers, such as liver, breast, lung and colon cancer. However, the role of magnolol in esophagus cancer cells is unknown. METHODS:In this study, esophagus cancer cell lines including TE-1, Eca-109 and KYSE-150 were used to evaluate the cytotoxic effect of magnolol on cell proliferation, apoptosis and migration. RESULTS:We found that magnolol inhibits cellular proliferation of all three cell lines in a time- and dose-dependent manner; 20 µM magnolol markedly inhibited the migration ability of KYSE-150 cell which was accompanied with a decreased expression of MMP-2. Treatment with 100 µM magnolol significantly increased KYSE-150 cell apoptosis. We found that cleaved caspase-3, cleaved capsese-9 and Bax protein expression was increased and Bcl-2 protein expression was decreased after magnolol treatment. In addition, Magnolol had no effect on JNK but induced the phosphorylation of p38 and ERK1/2 in a concentration-dependent manner, suggesting the involvement of these kinases in the initiation of the apoptosis process. Finally, magnolol treatment significantly suppressed KYSE-150 tumor cell growth in nude mouse xenograft models. CONCLUSIONS:The results of this study provide a basis for the understanding and development of magnolol as a potential novel drug for esophagus cancer.

患者男,63岁。因贲门癌入院。完善相关检查后行经左胸近端胃大部切除+胃食管主动脉弓下吻合术,手术顺利。术后第7天开始进食,进食后患者无不适主诉,无发热、腹痛、腹胀等不适。术后第12天患者出现腹胀、腹痛等不适,无恶心、呕吐,体温38.3℃,但仍有排气排便,排出大便后腹胀有所缓解。术后第13天行消化道造影及胸腹部CT检查示,吻合口愈合良好,未见造影剂溢出;空肠、结肠胀气,升结肠处可见同心圆结构,考虑肠套叠可能;予以肠镜检查可见结肠黏膜多处糜烂,颜色红润,未见明显套叠,予以疏通后

Objective To evaluate the efficacy and safety of single negative pressure drainage tube after thoracoscopic esophagectomy surgery. Methods From January 2014 to January 2017, 83 patients with esophageal cancer admitted to the Second Affiliated Hospital of Naval Medical University were selected and divided into two groups according to the different drainage tubes used during the operation: negative-pressure drainage tube group which included 40 cases and conventional drainage tube group which included 43 cases. Pleural effusion, dropsy, subcutaneous emphysema, total volume of thoracic drainage, drainage tube duration, postoperative hospital stay, postoperative stitch removal time of drainage tube, incision healing rate, relevant complications, incision VAS pain scores and other indicators were compared. Results Baseline data and postoperative pleural effusion, dropsy, subcutaneous emphysema, defective rate of incision healing, average hospital stay time, duration of drainage tube, and incidence of relative complications were not statistically significant between the two groups (P>0.05). Compared to negative-pressure drainage tube group, for patients in conventional group, the thoracic drainage volume was significantly decreased; the scar reaction rate was significantly reduced; the stitch-removal time was significantly shortened; and the VAS pain score was significantly reduced. The differences were statistically significant (P<0.05). Conclusions Single negative pressure drainage tube is safe and effective after thoracoscopic radical resection of esophageal carcinoma, and it has the same clinical effect as conventional 28F thoracic duct and it is helpful for patients to recover quickly after operation. Key words: Thoracoscopic; Esophageal carcinoma; Negative pressure drainage tube

Severe tracheal stenosis,which commonly results from tumor of trachea,tracheal trauma,congenital deformity constitutes a threaten for patient life,thus it needs for tracheal resection and reconstruction.For defects less than 5 cm,it can be repaired by direct end-to-end anastomosis.But for large area (more than 6 cm),it needs numerous different types of materials and techniques.These alternatives include allograft transplantation,autologous tissue transplantation,tissue engineering materials,and so on.In recent years,due to the rapid development of surgical techniques,the tracheal surgery has considerable development.In this paper,we will discuss tracheal allograft transplantation and tissue engineering trachea in tracheal replacement research progress.

Shp2 (Src-homology 2 domain-containing phosphatase 2) was originally reported as an oncogene in kinds of solid tumors and hematologic malignancies. However, recent studies indicated that Shp2 may act as tumor suppressors in several tumor types. We investigated the function of Shp2 in esophageal squamous cell cancer (ESCC). The expression level of Shp2 was analyzed in tumor tissues in comparison with adjacent normal tissues of ESCC patients by immunohistochemistry and Western blot. Shp2 was knocked down by Short hairpin RNA to evaluate its function in ESCC cell lines. The relationship between Shp2 and p-Stat3 (signal transducer and activator of transcription 3) in human ESCC tissues was statistically examined. A significant low expression of Shp2 was found in ESCC tissues. Low expression of Shp2 was related to poorer overall survival in patients from The Cancer Genome Atlas (TCGA) dataset. Knockdown of Shp2 increased the growth of ESCC cell lines both in vivo and vitro. Activation of Stat3 (p-Stat3) was induced by Shp2 depletion. Expression of p-Stat3 was negatively correlated with Shp2 expression in ESCC tissues. Furthermore, knockdown of Shp2 attenuated cisplatin-sensitivity of ESCC cells. Shp2 might suppress the proliferation of ESCC by dephosphorylation of p-Stat3 and represents a novel research field for targeted therapy.

胆碱激酶α隶属于胆碱激酶蛋白家族,是CDP-胆碱通路的关键酶.在多种人类肿瘤组织中均发现有胆碱激酶α表达升高,如乳腺癌、结直肠癌、前列腺癌、肺癌等.研究已证实胆碱激酶α与多种肿瘤相关通路存在交互作用.由于其在肿瘤组织中的高表达和异常激活,胆碱激酶α可能是有助于肿瘤诊断的生物标记物,并有望成为肿瘤治疗的新靶点.本文从胆碱激酶α在肿瘤中的生物功能及其在肿瘤诊断及预后评估、肿瘤靶向治疗中的作用等方面综述了胆碱激酶α在肿瘤中的作用.

普外科急诊实习是医学生加强理论联系实际、培养逻辑思维和应急处理能力的重要途径,长征医院普外科借助微信辅助CBL(Case-Basedkarning)及TBL(Team-Based Learning)教学法在普外科急诊实习带教中进行实践,调动了学生的学习兴趣和积极性,锻炼了学生沟通能力及团队协作意识,提高了学生逻辑思维能力和解决问题能力,取得了较好的教学效果.

信息化高技术局部战争对基层军医战伤外科能力提出新的要求.为强化战伤外科培训效果,应明确教学目标,注重师资培养,打造全功能的训练平台,构建多媒介教学资源体系,进而建立“理论精讲-案例研讨-模拟教学-野外实训-战伤研究”相结合的培训新模式,以促进基层军医战伤外科水平的有效提升.