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.

This study investigates the expression and functional significance of mitochondrial ribosomal protein S12 (MRPS12) within NSCLC pathogenesis. The Cancer Genome Atlas dataset reveals a significant association between MRPS12 overexpression and unfavorable clinical outcomes in NSCLC patients. Single-cell RNA sequencing data unequivocally confirm MRPS12 overexpression across diverse NSCLC cancer cell populations. MRPS12 is also upregulated in locally-treated NSCLC tissues. shRNA-mediated gene silencing or CRISPR-Cas9-mediated gene knockout (KO) of MRPS12 impaired mitochondrial function, resulting in a reduction in oxygen consumption rate, marked declines of complex I activity and ATP levels, mitochondrial membrane depolarization, and an increase in reactive oxygen species production in NSCLC cells. Moreover, MRPS12 silencing or knockout attenuated cell viability, proliferation, and migratory capacity, while inducing apoptotic cell death in various NSCLC cell types. Conversely, ectopic MRPS12 overexpression conferred a pro-tumorigenic phenotype to NSCLC cells. In vivo studies demonstrated that MRPS12 silencing markedly inhibited the growth of subcutaneous xenografts derived from primary NSCLC cells in nude mice. The MRPS12-silenced NSCLC xenografts exhibited decreased ATP levels, elevated oxidative injury, diminished proliferation, inhibited Akt-mTOR activation and an increase in apoptosis. These findings support the important role of MRPS12 in supporting mitochondrial function and driving the malignant progression of NSCLC.

INTRODUCTION:The soft tissue of the heel is weak, and calcaneal bone defects occur easily post-infection, resulting in the inability of paediatric patients to walk normally. Calcaneal reconstruction is challenging. We aimed to evaluate the methodology and clinical effects of the Ilizarov technique in the treatment of calcaneal infectious bone defects. METHODS:We retrospectively analyzed the cases of 12 children with infectious calcaneal bone defects treated by the Ilizarov technique in our center from January 2018 to August 2022.Stump lengthening of the calcaneus was performed in nine cases. Due to severe calcaneus infection the calcaneus was removed, and talus lengthening was performed in three children. Two children were treated with drug-loaded spacer bone cement to control peripheral soft tissue infection before bone elongation could be performed, while the other ten cases underwent bone lengthening at one stage after radical debridement. Pain, foot function, self-care ability and hind foot function were evaluated using a Visual Analogue Scale (VAS), the Maryland Foot Score, Activity of Daily Living scale, and the American Orthopaedic Foot and Ankle Society retro ankle foot score. RESULTS:In this cohort of 12 children, the time for bone lengthening ranged from 32 to 64 days (mean 41.75 ± 10.09 days), and the distance of bone lengthening was between 2.6 cm and 5.4 cm (mean 3.57 ± 0.86 cm). The inflammation indicators CRP, ESR, and IL-6 were significantly reduced after radical debridement (15.72 ± 3.09 vs 6.04 ± 1.28, 25.20 ± 2.72 vs 15.11 ± 1.56, 16.39 ± 3.75 vs 2.99 ± 1.08, respectively; p < 0.01). Bone reconstruction effectively reduced pain in the affected limb and significantly improved foot function, self-care ability, and hind foot function in these children. In four cases, external fixators were removed and an Achilles tendon lengthening operation was performed to further reconstruct calcaneal bone function. After surgical treatment, all the children in this cohort were able to return to normal life. CONCLUSION:The Ilizarov technique for treating large infectious calcaneal bone defects and bone lengthening can effectively reconstruct the function of the calcaneal bone without significantly affecting the ankle joint.

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.

Background:Esophageal malignancies have a high morbidity rate worldwide, and minimally invasive surgery has emerged as the primary approach for treating esophageal cancer. In recent years, there has been increasing discussion about the potential of employing inflatable mediastinoscopic and laparoscopic approaches as an option for esophagectomy. Building on the primary modification of the inflatable mediastinoscopic technique, we introduced a secondary modification to further minimize surgical trauma.Methods:We conducted a retrospective analysis of patients who underwent inflatable mediastinoscopy combined with laparoscopic esophagectomy at the Second Affiliated Hospital of Naval Medical University from March 2020 to March 2023. The patients were allocated to the following two groups: the traditional (primary modification) group, and the secondary modification group. Operation times, intraoperative bleeding, and postoperative complications were compared between the groups.Results:The procedure was successfully performed in all patients, and conversion to open surgery was not required in any case. There were no statistically significant differences in the surgical operation time, intraoperative bleeding, number of dissected lymph nodes, and rate of postoperative anastomotic leakage between the two groups. However, a statistically significant difference was observed in the length of the mobilized esophagus between the two groups. The mobilization of esophagus to the level of diaphragmatic hiatus via the cervical incision was successfully achieved in more patients in the secondary modification group than the primary modification group.Conclusions:Inflatable mediastinoscopy combined with single-incision plus one-port laparoscopic esophagectomy is a safe and effective surgical procedure. The use of a 5-mm flexible endoscope, ultra-long five-leaf forceps, and LigaSure Maryland forceps facilitates esophageal mobilization and lymph node dissection through a single cervical incision.

OBJECTIVES:In recent years, with the advancement of sublobar resection, a safe, painless method for locating peripheral pulmonary nodules was needed. Previously, an alternative method of arterial watershed localization was introduced to remedy the shortcomings of preoperative computed tomography (CT)-guided localization or other methods for locating pulmonary nodules, but its technical limitations were discovered during clinical applications. Therefore, we developed a technique to localize non-subpleural nodules using basin analysis of the target vein and validated its feasibility and safety. METHODS:We performed a retrospective analysis of surgical cases of pulmonary nodules smaller than 2 cm in our centre. The vein watershed locational method (V-WALM) was compared with CT-guided percutaneous puncture localization wedge dissection in terms of success rate, the mean duration of the operation, mean volume of intraoperative bleeding and median postoperative stay, mean postoperative drainage and mean drainage tube indwelling time. RESULTS:V-WALM and CT-guided localization were used for localized resection of pulmonary nodules in 50 patients. The localization success rates were 94.0% for V-WALM and 90.0% for CT-guided localization, respectively, with no statistical difference noted. In addition, no statistical difference in patient population distribution between the 2 groups was noted. The operating time was 95.5 ± 26.4 min for V-WALM and 94.3 ± 37.5 min for CT-guided localization, with no statistical difference. Neither were there statistical differences in intraoperative bleeding, postoperative drainage and drainage tube indwelling time. The lymph node sampling rate of V-WALM was 48.0%, which was much higher than the 24% noted in the CT-guided localization group. CONCLUSIONS:The results of this study demonstrate that V-WALM is a safe and feasible intraoperative localization method for peripheral lung nodules. It provides a high-precision, fast and minimally invasive approach to intraoperative localization.

The challenges posed by delayed atrophic healing and nonunion stand as formidable obstacles in osteoporotic fracture treatment. The processes of type H angiogenesis and osteogenesis emerge as pivotal mechanisms during bone regeneration. Notably, the preconditioning of adipose-derived stem cell (ADSC) exosomes under hypoxic conditions has garnered attention for its potential to augment the secretion and functionality of these exosomes. In the present investigation, we embarked upon a comprehensive elucidation of the underlying mechanisms of hypo-ADSC-Exos within the milieu of osteoporotic bone regeneration. Our findings revealed that hypo-ADSC-Exos harboured a preeminent miRNA, namely, miR-21-5p, which emerged as the principal orchestrator of angiogenic effects. Through in vitro experiments, we demonstrated the capacity of hypo-ADSC-Exos to stimulate the proliferation, migration, and angiogenic potential of human umbilical vein endothelial cells (HUVECs) via the mediation of miR-21-5p. The inhibition of miR-21-5p effectively attenuated the proangiogenic effects mediated by hypo-ADSC-Exos. Mechanistically, our investigation revealed that exosomal miR-21-5p emanating from hypo-ADSCs exerts its regulatory influence by targeting sprouly1 (SPRY1) within HUVECs, thereby facilitating the activation of the PI3K/AKT signalling pathway. Notably, knockdown of SPRY1 in HUVECs was found to potentiate PI3K/AKT activation and, concomitantly, HUVEC proliferation, migration, and angiogenesis. The culminating stage of our study involved a compelling in vivo demonstration wherein GelMA loaded with hypo-ADSC-Exos was validated to substantially enhance local type H angiogenesis and concomitant bone regeneration. This enhancement was unequivocally attributed to the exosomal modulation of SPRY1. In summary, our investigation offers a pioneering perspective on the potential utility of hypo-ADSC-Exos as readily available for osteoporotic fracture treatment.

Abstract To explore the safety and feasibility of wireless thoracoscope in thoracic surgery. A retrospective analysis was made of all the clinical data of 90 patients with thoracoscope lung resection, from April to August 2021, Shanghai changzheng hospital thoracic minimally invasive center. Compared the thoracoscope preparation time, picture resolution, picture delay, surgeon comfort level, assistant comfort level between the wireless thoracoscope group and wired thoracoscope group. The thoracoscopic preparation time of the wireless thoracoscope group was significantly shorter than that of the wired group (26.66 ± 6.04 vs 62.14 ± 10.07, p < 0.0001). Comfort level of the surgeon (4.64 ± 0.48 vs 3.77 ± 0.42, p < 0.001) and the comfort level of the assistant (4.85 ± 0.36 vs 3.88 ± 0.32, p < 0.001) of the wireless thoracoscope group were higher than that of the wired thoracoscope group. There were no statistically significant differences in video sharpness (4.64 ± 0.48 vs 4.74 ± 0.44, p = 0.31). Although there was one case picture delay in wireless group, it was caused by low power which could be dealt with by a good charge before surgery. The wireless thoracoscope has the advantages of short preparation time, high comfort for the surgeon and the assistant, no less than the wired thoracoscope in picture resolution and picture delay. Wireless connection is more convenient and portability, which is worthy of further application in clinical practice.

Background:With the popularity of high-resolution computed tomography (HRCT), more and more pulmonary nodules are being discovered. Video-assisted thoracoscopic surgery (VATS) has become the first choice for surgical treatment of pulmonary nodules. The use of accurate preoperative localization is crucial for successful resection in VATS. At present, there are many kinds of preoperative localization methods, but there are certain disadvantages. This study aimed to evaluate the feasibility and safety of mixed reality (MR)-guided pulmonary nodules localization, which is a new method that can benefit patients to a greater extent.Methods:By constructing an animal model of pulmonary nodules localization, 28 cases of pulmonary nodules were located by MR-guided localization. We recorded the localization accuracy, localization time, insertion attempts, and incidence of complications related to localization under MR-guidance.Results:All 28 nodules were successfully located: the deviation of MR-guided localization was 5.71±2.59 mm, localization time was 8.07±1.44 min, and insertion attempts was 1. A pneumothorax and localizer dislodgement occurred in 1 case, respectively.Conclusions:Since preoperative localization is critical for VATS resection of pulmonary nodules, we investigated a new localization method. As indicated by our study, MR-guided localization of pulmonary nodules is feasible and safe, which is worthy of further research and promotion. We have also registered corresponding clinical trials to further investigate and help to improve our understanding of this technique.

Objective To investigate the safety and efficacy of glasses-free three-dimensional (3D) thoracoscopic surgery in minimally invasive esophagectomy (MIE). Methods The clinical data of 98 patients, including 81 men and 17 women aged 45–77 years, with esophageal squamous cell carcinoma who underwent minimally invasive thoracoscopic esophagectomy from January 2017 to December 2019 [3 years, with clinical follow-up time: 1 year~4 years (2017.01–2020.12)] were retrospectively analyzed. Patients were divided into two groups according to different surgical methods including a glasses-free 3D thoracoscopic group (G-3D group: 38 patients) and a two-dimesional (2D) thoracoscopic group (2D group: 60 patients). The clinical outcome of the two groups were compared. Results The operation time of the thoracoscopic part in the G-3D group was significantly shorter than that in the 2D group (P<0.05). The total number of lymph node dissection in the G-3D group was more than that in the 2D group (P<0.05). The thoracic indwelling time, postoperative hospital stay, severe pulmonary infection, arrhythmia, anastomotic leakage, chylothorax, and recurrent laryngeal nerve injury were not significantly different between the two groups (P>0.05). There was also no significant difference between the two groups on the progression-free survival (P>0.05). Conclusion Glasses-free 3D thoracoscopic surgery for esophageal cancer is a safe and effective surgical procedure. Compared with 2D thoracoscopic MIE, glasses-free 3D thoracoscopic MIE for esophageal cancer has higher safety, more lymph node dissection, and higher operation efficiency through the optimized surgical operations. We believe that glasses-free 3D thoracoscopy for MIE is worthy of clinical promotion.

目的:分析中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、白介素-6(IL-6)与急性非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)有无合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者之间的相关性及临床诊断价值.方法:选取NSTEMI患者215名,分为A组(合并T2DM,n=96)及B组(未合并T2DM,n=119).应用回归分析确定NSTEMI合并T2DM患者的危险因素,应用ROC曲线评估NLR及IL-6的诊断价值.结果:A组的NLR、IL-6数值均高于B组,在矫正相关混杂因子后其诊断价值不变.结论:NLR、IL-6是NSTEMI合并T2DM患者的危险因素,具有临床诊断价值.

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。

Background:With uniportal video-assisted thoracoscopic surgery (VATS) becoming mainstream, how to make the incision cosmetic has attracted much attention. This study aimed to introduce a new traceless method for cosmetic closure of the incision and a special procedure for chest tube fixation after uniportal VATS and to evaluate the feasibility, effectiveness, and safety of this new technique.Methods:In this retrospective study, a total of 258 consecutive patients who underwent uniportal VATS were included. Among them, 127 patients were treated with a conventional method, and 131 patients were treated with a new method.Results:Patients in the new method group had a significantly less incidence of subcutaneous emphysema after the chest tube was removed. The incidence of pneumothorax after the chest tube was removed and fat liquefaction of chest incision was not significantly different between the two groups. No differences in the incidence of pneumothorax after chest tube removal and fat liquefaction of postsurgical incision were found between the two groups. Additionally, there was also no significant difference in follow-up items.Conclusions:Taken together, our results showed that this new method for minimally invasive incision closure and chest tube fixation after uniportal VATS was as feasible, effective, and safe as the conventional one but more cosmetic.

Background:Atherosclerosis is the most common cause of cardiovascular disease, accompanied by high mortality and poor prognosis. Low-density lipoprotein (LDL) and its oxidized form oxidized low-density lipoprotein (oxLDL) play an important role in atherosclerosis. This article will explore the role of the lncRNA COLCA1 (colorectal cancer associated 1)/hsa-miR-371a-5p/SPP1 (secreted phosphoprotein 1) pathway in oxLDL in causing human coronary artery endothelial cells (HCAECs) inflammation and related biological function changes.Methods:OxLDL was used to stimulate HCAECs. The inflammatory response and biological function changes of HCAECs were analyzed, total RNA-seq was performed on HCAECs before and after stimulation, and RT-Qpcr (real-time quantitative PCR) was used to verify the differential genes. Interference of the expression of COLCA1 in HCAECs was performed by siRNA interference technology to verify the role of COLCA1 in the biological function changes of HCAECs after oxLDL stimulation, and further prove that COLCA1 affects SPP1 through hsa-miR-371a-5p.Results:OxLDL can affect the oxidative stress response of HCAECs, which in turn affects the apoptosis and wound healing ability of HCAECs. COLCA1 and SPP1 were highly expressed after oxLDL stimulation, while hsa-miR-371a-5p was the opposite. After COLCA1 interference, the oxidative stress level of HCAECs stimulated by oxLDL decreased, the apoptosis level also significantly decreased, and the wound healing ability was enhanced. After simultaneous COLCA1 interference and recovery of the expression of hsa-miR-371a-5p, these improved functions disappeared. The dual-luciferase assay confirmed that hsa-miR-371a-5p and COLCA1, hsa-miR-371a-5p and SPP1 has binding targets.Conclusions:OxLDL can up-regulate the expression of COLCA1 in HCAECs, which in turn affects the intracellular COLCA1/hsa-miR-371a-5p/SPP1 pathway to regulate the level of oxidative stress in cells. This in turn affects the level of apoptosis and wound healing ability, which causes cells to produce a continuous inflammatory response.

Repair of large bone defects represents a major challenge for orthopedic surgeons. The newly formed microvessels inside grafts play a crucial role in successful bone tissue engineering. Previously, an active role for mesenchymal stem cell (MSC)-derived exosomes in blood vessel development and progression was suggested in the repair of multiple tissues. However, the reports on the application of MSC-derived exosomes in the repair of large bone defects are sparse. In this study, we encapsulated umbilical MSC-derived exosomes (uMSCEXOs) in hyaluronic acid hydrogel (HA-Gel) and combined them with customized nanohydroxyapatite/poly-ε-caprolactone (nHP) scaffolds to repair cranial defects in rats. Imaging and histological evaluation indicated that the uMSCEXOs/Gel/nHP composites markedly enhanced bone regeneration in vivo, and the uMSCEXOs might play a key role in this process. Moreover, the in vitro results demonstrated that uMSCEXOs promoted the proliferation, migration, and angiogenic differentiation of endothelial progenitor cells (EPCs) but did not significantly affect the osteogenic differentiation of BMSCs. Importantly, mechanistic studies revealed that exosomal miR-21 was the potential intercellular messenger that promoted angiogenesis by upregulating the NOTCH1/DLL4 pathway. In conclusion, our findings exhibit a promising exosome-based strategy in repairing large bone defects through enhanced angiogenesis, which potentially regulated by the miR-21/NOTCH1/DLL4 signaling axis.

Background and aims: Adventitial remodeling is an important pathological process of atherosclerosis, but cues implicated in adventitial remodeling are far from fully understood. Periostin (POSTN), a matricellular protein, has been demonstrated to have multiple roles in cardiovascular diseases. The aim of the study was to explore the function of POSTN in adventitial remodeling during atherosclerosis. Methods: An atherosclerosis model was constructed based on ApoE-/- mice fed a high-fat and high-cholesterol diet. The expression of POSTN in the adventitia of mouse atherosclerotic vascular specimens was detected by immunohistochemical staining. The roles of POSTN in regulating adventitial fibroblast activation were assessed by cell contractility and activation marker α-smooth muscle actin (α-SMA) expression evaluation in adventitial fibroblasts overexpressing POSTN. In addition, we performed quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting to examine the expression of the proinflammatory chemokines transforming growth factor-β1 (TGF-β1) and monocyte chemotactic protein 1 (MCP1), as well as some extracellular matrix (ECM)-related proteins, in POSTN-overexpressing adventitial fibroblasts. Finally, the integrin-related signaling pathway was detected upon POSTN overexpression in adventitial fibroblasts. Results: POSTN was highly expressed in the adventitia of atherosclerotic aortae in the mouse atherosclerosis model and promoted the activation and contraction of adventitial fibroblasts. Meanwhile, POSTN also induced adventitial fibroblasts to express TGF-β1, monocyte chemotactic protein-1 (MCP1), and ECM-related proteins and activated the phosphorylation of focal adhesion kinase (FAK) and Src. Conclusions: Our results revealed that POSTN is elevated in adventitia during atherosclerosis and contributes to the adventitial remodeling of atherosclerosis by activating adventitial fibroblasts.

Background and objective Transcervical inflatable mediastinoscopic esophagectomy (TIME) is a novel method of minimally invasive esophagectomy (MIE) for esophageal cancer. However, whether TIME is effective and feasible as conventional MIE remains unclear. This study aimed to evaluate the efficacy of TIME by comparing it with thoracoscopic esophagectomy (TE). Methods Surgical outcomes and relapse-free survival (RFS) rates of patients with local early- or intermediate-stage thoracic esophageal squamous cell carcinoma that underwent TIME or TE from January 2017 to December 2019 were analyzed in this retrospective study. Propensity score matching was used to control the confounding factors. Results The mean operation time in TIME was shorter than that in TE (p < 0.05). Patients in the TIME group achieved postoperative ambulation earlier than those in the TE group (p < 0.05). The rate of pulmonary complications was lower in TIME than in TE (p < 0.05). The number of lymph nodes harvested during surgery and the RFS rates of two groups did not have significant differences. Conclusion TIME may be a feasible and safe method to treat local early- and intermediate-stage thoracic esophageal squamous cell carcinoma effectively and it could be a supplementary surgical method of TE for patients with poor pulmonary function or cannot undergo TE.

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.

BACKGROUND:It still remains unclear whether three-dimension (3D) video-assisted thoracoscopic surgery (VATS) for esophageal cancer is safe and reasonable. This meta-analysis aims at assessing the effectiveness and safety of 3D VATS for esophageal cancer in comparison with that of two-dimension (2D) VATS.METHODS:All the relevant data systematically analyzed in this thesis is from PubMed, Embase, The Cochrane Library, Web of Science and clinicaltrials.gov, and the time span for retrieval is from the date of the database establishment to February 2021. The research on the efficacy and safety of 3D VATS for esophageal cancer and 2D VATS is consistent with our meta-analysis. Continuous variables and dichotomy variables are compared using odds ratio, average or standard average differences with 95% confidence interval (95% CI), and P values, respectively.RESULTS:In five studies of this paper, there were 553 patients in total (3D VATS group, n=266 and 2D VATS group, n=287). Patients in the 3D group had shorter operation time [standardized mean difference (SMD) =-0.99, 95% CI: -1.66 to -0.32; P=0.004], and less bleeding (SMD =-0.88, 95% CI: -1.66 to -0.10; P=0.03) than those in the 2D group. The total amount of dissected lymph node and post-operative complications in the 2D group and the 3D group were nearly the same, showing no significant difference.DISCUSSION:The results of this meta-analysis showed that 3D VATS for esophageal cancer will be more applied and developed in the future.REGISTRATION NUMBER OF PROSPERO:CRD42021238863.