Objective To investigate the effects of different levels of intra-abdominal pressure ( IAP) on respiration and hemodynamics in a porcine model of acute lung injury( ALI) .Methods A total of 8 domestic swine received mechanical ventilation. Following baseline observations, oleic acid 0. 1mL/kg in 20mL of normal saline was infused via internal jugular vein. Using a nitrogen gas pneumoperitongum, the IAP increased from0 to 15 and 25mmHg, and the groups were named IAP0 , IAP15 and IAP25 , respectively. During the experimental period, hemodynamic parameters including heart rate ( HR) , cardiac output ( CO) , mean arterial pressure( MAP) , central venous pressure( CVP) , intrathoracic blood volume index( ITBVI) and so on were obtained by using thermodilution technique of pulse induced continuous cardiac output( PiCCO) . The esophageal pressure( Pes) was dynamicly monitored by the esophageal catheter. Results Pes and peak airway pressure( Ppeak) increased and static lung compliance( Cstat) decreased significantly in IAP15 and IAP25 groups compared with IAP0 group( all P lt;0. 01) . Transpulmonary pressure( Ptp) showed a downward trend( P gt;0. 05) . PO2 and oxygenation index showed a downward trend while PCO2 showed a upward trend ( P gt;0. 05) . HR and CVP increased significantly, cardiac index( CI) and ITBV index decreased significantly ( all P lt;0. 05) ,MAP didn′t change significantly( P gt;0. 05) . The changes in Pes were negatively correlated with the changes in CI( r = - 0. 648, P = 0. 01) . Conclusion In the porcine model of ALI, Pes increases because of a rise in IAP which decreased pulmonary compliance and CI.
Abstract: Objective To investigate the expression of inhibitor of apoptosis gene Livin and its relationship with expression of P53,Bcl-2 in esophageal carcinoma tissues. Methods The expression of Livin messenger ribonucleic acid (mRNA) in 36 esophageal carcinoma tissues and 18 paracancerous tissues were measured by reverse transcriptionpolymerase chain reaction (RT-PCR) combined with silver staining technique. The expression of Livin, P53 and Bcl-2 proteins were detected by immunohistochemical method (streptavidin-peroxidase). Results RT-PCR results: Livin mRNA positive expression of esophageal carcinoma tissues was more evident than that of paracancerous tissues, the expression of both variants was simultaneous basically. Immunohistochemical results: the Livin protein positive expression rate of esophageal carcinoma tissues was higher evidently than that of paracancerous tissues(Plt;0.01). Livin protein positive expression rate of external coat of esophagus invaded by carcinoma was higher than that of tunica muscularis esophagi invaded by carcinoma(Plt;0.05); Livin protein positive expression rate of lymph node metastasis was higher than that of normal lymph node (Plt;0.05). The expression of Livin protein was not related to the expression of P53 protein（χ2=1.00,P=0.505）,but it was positively related to the expression of Bcl-2 protein（χ2=10.60，P=0.003）. Conclusion Aberrant expression of Livin may be a new target for diagnosis and gene treatment of esophageal carcinoma.The aberrant expression of Livinand apoptosis related gene Bcl-2 may play synergetic roles in process of carcinogenesis of esophageal carcinoma.
ObjectiveTo evaluate the effect on complication after esophagectomy by comparing the different methods of anastomosis (cervical versus thoracic anastomosis). MethodsWe searched the following databases including PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang database to identify randomized controlled trials (RCTs) of cervical versus thoracic anastomosis for esophagectomy patients from establishment of each database to October 30, 2014. Quality of the included RCT was evaluated. Meta-analysis was conducted by using RevMan 5.2 software. ResultsWe finally identified 4 RCTs involving 267 patients. In terms of the postoperative complication, the incidence of anastomotic leakage (RR=3.83, 95%CI 1.70 to 8.63, P=0.001) with cervical anastomosis was significantly higher than that of the patients with thoracic anastomosis. However, there was no statistical difference in incidence of anastomotic stricture (RR=1.04, 95%CI 0.62 to 1.76, P=0.87), pulmonary complication (RR=0.73, 95%CI 0.27 to 1.91, P=0.52), and mortality (RR=0.89, 95%CI 0.40 to 1.97, P=0.77) between cervical and thoracic anastomosis. ConclusionCompared with thoracic anastomosis, the method of cervical anastomosis is associated with a higher incidence of anastomotic leakage. But there are many unclear factors about anastomotic stricture, pulmonary complication and mortality, further measurement should be taken.
Conduit failure and conduit airway fistula are rare complications after esophagectomy, however they can be catastrophic resulting in high mortality. Survivors can expect a prolonged hospital course with multiple interventions and an extended period of time prior to being able to resume oral nutrition. High index of suspicion can aid in early diagnosis. Conduit failure usually requires a period of proximal esophageal diversion and staged reconstruction. Conduit airway fistulas may be amenable to endoscopic repair but this has a high failure rate and many patients will require surgical repair with closure of the fistula and interposition of vascularized tissue to minimize recurrence.
Objective To show the changes of coagulation function in patients with esophageal carcinoma, and to explore the clinical significance of the changes. Methods We retrospectively analyzed the clinical data of 202 patients(as a trial group, 114 males, 88 females, aged from 36 to 69 years, median age at 49 years) with esophageal carcinoma confirmed by pathological examination in Gansu Provincial Hospital from January 2010 through May 2014. The prothrombin time (PT), prothrombin time activity (PTA), international activated partial thromboplastin time (APTT), fibrinogen (Fib), D-Dimer, and platelet count, pathological type, TNM stage, gender were recorded. Eighty patients (38 males, 42 females, with aged of 39 to 71 years, median age of 51 years) without cancer were selected as a control group. Results Compared with the control group, coagulation parameters including PT, APTT, PLT, Fib, TT, D-Dimer were statistically higher in the trial group (P<0.05). Higher Fib level was found in the squamous cell esophageal carcinoma patients than adenocarcinoma cell esophageal carcinoma patients (P<0.05). Fib increased significantly (P<0.05) and APTT shorten (P<0.05) in the patients at stage Ⅲ and stage Ⅳ compared with those of patients at stage Ⅰ and stage Ⅱ. Fib and D-Dimer levels increased (P<0.05) in N1-3 patients compared with those of N0 patients. There was no statistical difference in gender or age (P>0.05) between the two groups. Conclusion Most of the patients with esophageal carcinoma have abnormal changes of coagulation and fibrinolysis system. Patients with squamous subtype and/or lymph node metastasis at advanced stages of esophageal carcinoma are prone to thrombophilia. So monitoring the coagulation parameters of cancer patients can be used as an effective measure to prevent blood clot.
China is a country with a high incidence of esophageal cancer. Most patients are already in the locally advanced stage when first diagnosed. Preoperative neoadjuvant therapy followed by surgery has become the standard treatment mode for them. Closely related to prognosis, the evaluation of tumor response is essential. Response evaluation criteria in solid tumors is the gold standard to evaluate tumor response, but the lesions must meet the measurement standards. Tumor regression grading (TRG) systems are designed to classify regressive changes after neoadjuvant treatment based on histopathological results to reveal prognostic information. Concentrating on pathologic assessment of esophageal cancer following neoadjuvant therapy, this article reviews histopathological changes, commonly used TRG systems and current debate.
ObjectiveTo study the gastric function of vagus-preserved patients after esophagectomy, and to evaluate the significance of keeping vagus and the value of gastric tube with vagal-sparing esophagectomy. MethodsWe retrospectively analyzed clinical data of 15 patients in West China Hospital between June 2012 and January 2014. They were divided into two groups. There were 8 patients with 6 males and 2 females with average age of 57 years ranging from 44 to 77 years, in a gastric pull-up group with vagal-sparing esophagectomy. There were 7 patients with 6 males and 1 female at average age of 60 years ranging from 50 to 70 years in a gastric tube group with vagal-sparing esophagectomy. We chose 8 patients with 7 males and 1 female at average age of 62 years ranging from 47 to 69 years as a control group with a classical esophagectomy and a gastric pull-up. Then we evaluated the function of the vagal nerves and gastric reservoir after vagal-sparing esophagectomy. ResultsAll 23 surgeries were successfully performed. In subjective symptom, diarrhea was rare in the vagal-sparing esophagectomy patients and statistically more common in patients with a standard esophagectomy. Dumping and early satisfaction situation were similar among 3 groups. The 60 minutes gastric emptying rate was much better in the vagal-sparing group than that in the control group. And the esophageal manometry of the vagal-sparing group was statistically hihger than that in the control group. The gastroscope showed that the incidence of reflux esophagitis in the vagal-sparing group was statistically lower than that of the control group. There was no statistic difference in weight in the vagus-preserved group before and after the surgery while the weight decreased statistically in the control group. ConclusionsFor both esophageal replacement and gastric tube, preserving the vagus can reduce the functional dyspepsia after esophagectomy.
ObjectiveTo explore the effects and molecular mechanisms of histone methylase G9a inhibitor BIX-01294 on apoptosis in esophageal squamous cell carcinoma (ESCC).MethodsMTT assay and Colony-forming Units were adopted to determine the effects of BIX-01294 on the growth and proliferation of ESCC cell lines EC109 and KYSE150. Flow cytometry was used to analyze the apoptosis status of ESCC cells after the treatment of BIX-01294. The effects of BIX-01294 treatment on the expressions of G9a catalytic product H3K9me2, DNA double-strand break (DSB) markers, and apoptosis-related proteins were detected by Western blotting.ResultsBIX-01294 inhibited the growth of EC109 and KYSE150 cells in a dose-dependent manner (P<0.05), and BIX-01294 with the inhibitory concentration 50% (IC50) significantly inhibited the formation of colony (P<0.05). After 24 hours treatment of BIX-01294 (IC50), the apoptosis rate of EC109 cells increased from 11.5%±2.1% to 42.5%±5.4%, and KYSE150 cells from 7.5%±0.9% to 49.2%±5.2% (P<0.05). The expression level of the G9a catalytic product, H3K9me2, significantly decreased (P<0.05); while the expression of the DSB marker γH2AX was dramatically enhanced (P<0.05). We also found that the mitochondrial apoptosis pathway was activated and the expression levels of cleaved caspase3 and cleaved PARP were significantly elevated (P<0.05).ConclusionBIX-01294, the inhibitor of methyltransferase G9a, prompted apoptosis in ESCC cells by inducing DSB damage and activating mitochondrial apoptosis pathway.
Abstract:Objective To investigate the clinicopathological features and prognostic aspect of basaloid squamous carcinoma （BSC）. Methods From July 2000 to May 2003, the clinical data of 1 257 documented cases that underwent potentially curative resection on esophageal carcinoma in our department were retrospectively analysed, and 18 cases of BSC （BSC group） were detected. And 54 cases of typical squamous carcinoma of esophagus（ESC） were randomly selected as control （ESC group）, to analyse the clinicopathological and prognostic parameters of BSC patients. Results The age of BSC group patients was higher than that of ESC group （61. 56 ± 7. 62 years vs. 56.11± 10. 58 years; t=-2. 012,P=0. 048）, and the ratio of T4 stage was much higher than that in ESC group （27.8% vs. 5.6%;x2= 6. 750, P= 0. 020）. The follow-up showed that, comparing with ESC group, the ratio of metastasis was higher（62.5% vs. 25.0%, P=0. 047）, and mean survival time（P〈0.05） was significantly shorter in patients of BSC group after curative resection. There were no statisticaly differences in patient gender （P = 0. 494）, or ratio of recurrence （P=0. 887） between two groups. Conclusion The BSC is a rare carcinoma involving esophagus, which occurs in elder patients. Both invasiveness and metastasis of BSC are more usual than those of typical ESC.
ObjectiveTo investigate the high risk factors for perioperative atrial fibrillation (AF) and its effect on the postoperative short term outcome in esophageal carcinoma patients. MethodsSixty three patients with AF after esophagectomy (AF group) and 126 patients without AF after esophagectomy in control group were analyzed by χ 2, and logistic regression, and compare with patient the postoperative mortality and duration hospitalization in two groups.ResultsThe rates of age above 65 (χ 2=7.02, P lt;0.01), male sex (χ 2=4.06, P lt;0.05), history of cardiac disease (χ 2=6 03, P lt;0.05), history of chronic obstructive pulmonary disease (COPD, χ 2=29.14, P lt;0 01), postoperative thoracic gastric dilatation ( P lt;0.01), and postoperative lower oxygen saturation ( P lt;0.01) in AF group were significantly higher than those in control group. No significant relevance was found between history of diabetes or hypertension, choice of operative approach, site of stoma and postoperative AF. 1 in 15 AF patients regain sinus rhythm after remove the pathological factors, and the others resumed after antiarrhythmic drug therapy. The postoperative hospitalization time was 10.65±0.87 d in patients developing AF group and 9.98±0.96 d in control group ( P gt;0.05). No difference was observed between two groups with regard to mortality ( P gt;0.05).ConclusionAF occurs more frequently after esophagectomy in aged and male sex. Other factors contributing to AF are history of cardiac disease, COPD and lower oxygen saturation. And in this study, early occurrence of AF after operation for esophageal carcinoma does not show any negative impact on mortality or on postoperative duration hospitalization.