Objective: To study the effect of different pressure artificial pneumothorax on total endoscopic radical esophagectomy during and after an operation. Methods: From 2019 to 2021, 64 patients with esophageal cancer underwent video-assisted thoracoscopic surgery in the same surgical treatment group. The pressure of CO2 artificial pneumothorax was randomly divided into Group A (pressure 6 mmHg), Group B (pressure 8 mmHg), and Group C (pressure 10 mmHg). Heart rate (HR), mean arterial pressure (MAP), end-expiratory CO2 partial pressure (PETCO2), arterial blood pH and PaCO2, operation time, intraoperative blood loss, and anesthesia resuscitation time were recorded at different time points. Observe the changes in inflammatory indexes, coagulation function, and the incidence of complications in the three groups, and statistically analyze and compare the differences among the three groups of patients. Results: Sixty-four patients with esophageal cancer were included in this clinical study. There were no significant differences in gender, age, lung function, BMI, and coagulation function among the three groups (P > 0.05). There were significant differences in PETCO2, arterial pH, and PaCO2 in T2, T3, and T4 among the three groups (P , and prothrombin time in Group A was significantly different from those in Group B and C (P , and other complications (P > 0.05). Conclusion: The artificial pneumothorax with 6 mmHg pressure and 8 L/min flow rate can satisfy the operation, and its safety and postoperative recovery are also better.

BACKGROUND:Circular RNA of vimentin (circ-VIM) is a predictor for poor prognosis of acute myeloid leukemia, but we had little information on its function in esophageal cancer (EC). Here we examined the effects of circ-VIM together with sevoflurane on immune escape and multiple oncogenic activities of EC.METHODS:Bioinformatic tools, luciferase assay, and RNA immunoprecipitation were used to examine regulations between circ-VIM, miR-124-3p (miR-124), and PD-L1. CCK-8, wound healing, and Transwell assays were used to measure cell proliferation, migration, and invasion, respectively. The impacts of EC cells on cytotoxicity, proliferation, and apoptosis of CD8+ T cells were examined using LDH assay, CFSE staining, and Annexin V/PI staining, respectively. The in vivo tumorigenesis and lung metastases were assessed using xenograft model and tail vein injection of EC cells.RESULTS:Significant upregulation of circ-VIM and PD-L1 and downregulation of miR-124 were detected in EC tissues or cells. Circ-VIM sponged miR-124 and released its suppression on the downstream target PD-L1. Sevoflurane, independent of circ-VIM, also upregulated miR-124 to lower PD-L1 expression. By modulating miR-124/PD-L1 axis, silencing circ-VIM and applying sevoflurane both inhibited immune escape and multiple oncogenic activities of EC in vitro, and suppressed xenograft growth and lung metastases in vivo. The inactivation of Ras/ERK signaling pathway was involved in suppression of malignant phenotypes by silencing circ-VIM and sevoflurane treatment.CONCLUSIONS:Silencing circ-VIM and applying sevoflurane, by separately regulating miR-124/PD-L1 axis, presented synergistic effects in inhibiting immune escape and multiple malignant phenotypes of EC cells.

目的 探讨纵隔镜辅助手术治疗早期食管鳞状细胞癌的远期结局.方法 回顾性分析2005年12月～2014年12月180例早期食管鳞状细胞癌接受纵隔镜辅助食管癌切除术的临床资料,通过无进展生存期(progression-free survival,PFS)和总生存期(overall survival,OS)分析患者远期生存情况.结果 均无术后30、90 d内死亡发生.术后并发症发生率30.6％(55/180),按发生率由高到低分别为吻合口漏15.6％(28/180),肺不张7.8％(14/180),肺部感染5.0％(9/180),声带麻痹2.8％(5/180),切口裂开2.2％(4/180),肠梗阻1.1％(2/180),乳糜胸1.1％(2/180),膈疝0.6％(1/180).术后吻合口/残胃复发率10.6％(19/180),术后转移部位前2位分别为淋巴结转移率16.7％(30/180)、肺转移率5.6％(10/180).3年PFS为74.4％,OS为81.1％;5年PFS为70.6％,OS为71.7％.结论 纵隔镜辅助食管癌切除术是治疗早期食管癌的有效手段.

Objective: To analyze the relationship between micropapillary pattern (MIP) and tumor spread through air space (STAS) and postoperative survival rate in patients with lung adenocarcinoma ≤ 2 cm. Methods: Retrospective analyses were performed on clinical data of 575 patients with lung adenocarcinoma ≤ 2 cm, which were resected from 2009 to 2011. We analyzed the pathological findings on the resected specimens, with special reference to the presence/absence MIP and STAS, which have been reported to be a marker of poor prognosis of lung adenocarcinoma. Patients were divided into three according to the presence/absence of MIP and STAS: low-risk (MIP- STAS-), medium-risk (either MIP or STAS + (one plus)) and high-risk group (+/+: double plus). Endpoint was postoperative survival rate, which was compared among three groups. Results: There was no statistical difference in age, sex, and serum CEA level among three groups. In lobectomized patients, there was no statistical difference in prognosis among three groups; however, in sub-lobectomy group, patients with double + (+/+ for MIP and STAS) showed a lower survival rate than others (P Conclusion: The presence of MIP and STAS reduced the survival rate in sub-lobectomized patients.