Lymph node dissection in esophageal carcinoma: Minimally invasive esophagectomy vs open surgery

AIM: To compare lymph node dissection results of minimally invasive esophagectomy(MIE) and open surgery for esophageal squamous cell carcinoma.METHODS: We retrospectively reviewed data from patients who underwent MIE or open surgery for esophageal squamous cell carcinoma from January 2011 to September 2014. Number of lymph nodes resected, positive lymph node(p N+) rate, lymph node sampling(LNS) rate and lymph node metastatic(LNM) rate were evaluated. R E S U LT S : A m o n g 4 4 7 p a t i e n t s i n c l u d e d, 1 2 3 underwent MIE and 324 underwent open surgery. The number of lymph nodes resected did not significantly differ between the MIE and open surgery groups(21.1 ± 4.3 vs 20.4 ± 3.8, respectively, P = 0.0944). The p N+ rate of stage T3 esophageal squamous cell carcinoma in the open surgery group was higher than that in the MIE group(16.3% vs 11.4%, P = 0.031), but no differences was observed for stages T1 and T2 esophageal squamous cell carcinoma. The LNS rate at left para-recurrent laryngeal nerve(RLN) site was significantly higher for open surgery than for MIE(80.2% vs 43.9%, P < 0.001), but no differences were noted at other sites. The LNM rate at left para-RLN site in the open surgery group was significantly higher than that in the MIE group, regardless of pathologic T stage. CONCLUSION: For stages T1 and T2 esophageal squamous cell carcinoma, the lymph node dissection result after MIE was comparable to that achieved by open surgery. However, the efficacy of MIE in lymphadenectomy for stage T3 esophageal squamous cell carcinoma, particularly at left para-RLN site, remains to be improved.

Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction

BACKGROUND Hemorrhoidal prolapse is a common benign disease with a high incidence.The treatment procedure for prolapse and hemorrhoids(PPH)remains an operative method used for internal hemorrhoid prolapse.Although it is related to less posoperative pain,faster recovery and shorter hospital stays,the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy(MMH).We have considered that recurrence could be due to shortage of the pulling-up effect.This issue may be overcome by using lower purse-string sutures[modified-PPH(M-PPH)].AIM To compare the therapeutic effects and the patients’satisfaction after M-PPH,PPH and MMH.METHODS This retrospective cohort study included 1163 patients(M-PPH,461;original PPH,321;MMH,381)with severe hemorrhoids(stage III/IV)who were admitted to The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from 2012 to 2014.Early postoperative complications,efficacy,postoperative anal dysfunction and patient satisfaction were compared among the three groups.Established criteria were used to assess short-and long-term postoperative complications.A visual analog scale was used to evaluate postoperative pain.Follow-up was conducted 5 years postoperatively.RESULT Length of hospital stay and operating time were significantly longer in the MMH group(8.05±2.50 d,19.98±4.21 min;P<0.0001)than in other groups.The incidence of postoperative anastomotic bleeding was significantly lower after MPPH than after PPH or MMH(1.9%,5.1%and 3.7%;n=9,16 and 14;respectively).There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH(15%,8%and 10%;n=69,30 and 32;respectively).There was a significantly lower rate of recurrence after M-PPH than after PPH(8.7%and 18.8%,n=40 and 61;P<0.0001).The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups(1.3%and 4.3%,n=5 and 20;P=0.04).Patient satisfaction was significantly greater after M-PPH than after other surgeries.CONCLUSION M-PPH has many advantages for severe hemorrhoids(Goligher stage III/IV),with a low rate of anastomotic bleeding and recurrence and a very high rate of patient satisfaction.

Analytical model of tilted driver–pickup coils for eddy current nondestructive evaluation

A driver-pickup probe possesses better sensitivity and flexibility due to individual optimization of a coil.It is fre-quently observed in an eddy current(EC)array probe.In this work,a tilted non-coaxial driver-pickup probe above a multilayered conducting plate is analytically modeled with spatial transformation for eddy current nondestructive evalua-tion.Basically,the core of the formulation is to obtain the projection of magnetic vector potential(MVP)from the driver coil onto the vector along the tilted pickup coil,which is divided into two key steps.The first step is to make a projection of MVP along the pickup coil onto a horizontal plane,and the second one is to build the relationship between the pr,ojected MVP and the MVP along the driver coil.Afterwards,an analytical model for the case of a layered plate is established with the reflection and transmission theory of electromagnetic fields.The calculated values from the resulting model indicate good agreement with those from the finite element model(FEM)and experiments,which validates the developed analytical model.

Biochar-supported nano-scale zerovalent iron activated persulfate for remediation of aromatic hydrocarbon-contaminated soil:an in-situ pilot-scale study

Biochar supported nano-scale zerovalent iron(nZVI/BC)for persulfate(PS)activation has been studied extensively for the degradation of pollutants on the lab scale,but it was rarely applied in practical soil remediation in the field.In this research,we developed a facile ball-milling method for the mass production of nZVI/BC,which was successfully applied to activate persulfate for the remediation of organic polluted soil on an in-situ pilot scale.In-situ high-pressure injection device was developed to inject nZVI/BC suspension and PS solution into the soil with a depth of 0-70 cm.The removal efficiency of target pollutants such as 2-ethylnitrobenzene(ENB,1.47-1.56 mg/kg),biphenyl(BP,0.19-0.21 mg/kg),4-(methylsulfonyl)toluene(MST,0.32-0.43 mg/kg),and 4-phenylphenol(PP,1.70-2.46 mg/kg)at different soil depths was 99.7%,99.1%,99.9%and 99.7%,respectively,after 360 days of remediation.The application of nZVI/BC significantly increased the degradation rates of contaminants by 11-322%,ascribed to its relatively higher efficiency of free radical generation than that of control groups.In addition,it was found that nZVI/BC-PS inhibited soil urease and sucrase enzyme activities by 1-61%within 55 days due to the oxidative stress for microbes induced by free radicals,while these inhibition effects disappeared with remediation time prolonged(>127 days).Our research provides a useful implementation case of remediation with nZVI/BC-PS activation and verifies its feasibility in practical contaminated soil remediation.

单纯性高度近视黄斑区视网膜敏感度与血流密度的关系

目的:观察单纯性高度近视黄斑区视网膜敏感度与血流密度的变化规律,并探讨其相关性。方法:描述性研究。收集2019年3─9月在南昌爱尔眼科医院就诊的患者及志愿者共80例(80眼),其中单纯性高度近视47例(47眼)作为高度近视组,低度近视及正视33例(33眼)作为对照组。采用光学相干断层扫描血管成像(OCTA)测量黄斑区3 mm×3 mm视网膜浅层血流密度(SVD)及深层血流密度(DVD),黄斑功能评估仪(MAIA)微视野计测量黄斑区10°视网膜敏感度(RS)。根据糖尿病视网膜病变早期干预研究将RS图划分为与血流图相对应的6个区域(颞、上、鼻、下、中、旁中区)。2组间数据比较采用独立样本t检验。RS与眼轴、等效球镜度、SVD和DVD的相关性采用Pearson相关分析。结果:与对照组相比,高度近视组RS除鼻侧外,其余各区均明显下降(均P<0.05),且高度近视组DVD总、旁中、上、下均明显降低(均P<0.05)。无论总体受检者还是高度近视组,RS与等效球镜度呈正相关(r=0.382,P<0.001;r=0.435,P=0.002)、与眼轴呈负相关(r=-0.429,P<0.001;r=-0.382,P=0.008)、与DVD呈正相关(r=0.286,P=0.010;r=0.344,P=0.018)、与SVD无相关性。高度近视组RS与SVD在中、旁中、颞及鼻区呈正相关(r=0.386,P=0.015;r=0.292,P=0.046;r=0.435,P=0.006;r=0.319,P=0.048),RS与DVD在中、旁中、上及下区呈正相关(r=0.330,P=0.040;r=0.358,P=0.025;r=0.294,P=0.045;r=0.437,P=0.005)。结论:单纯性高度近视眼RS和DVD下降,且呈现出区域性差异。RS的下降可能与DVD降低有关。

Pesticide wastewater treatment using the combination of the microbial electrolysis desalination and chemical-production cell and Fenton process

The combination of the microbial electrolysis desalination and chemical-production cell(MEDCC)and Fenton process for the pesticide wastewater treatment was investigate in this study.Real wastewater with several toxic pesticides,1633 mg/L COD,and 200 in chromaticity was used for the investigation.Results showed that desalination in the desalination chamber of MEDCC reached 78%.Organics with low molecular weights in the desalination chamber could be removed from the desalination chamber,resulting in 28%and 23%of the total COD in the acid-production and cathode chambers,respectively.The desalination in the desalination chamber and organic transfer contributed to removal of pesticides(e.g.,triadimefon),which could not be removed with other methods,and of the organics with low molecular weights.The COD in the effluent of the MEDCC combined the Fenton process was much lower than that in the perixo-coagulaiton process(<150 vs.555 mg/L).The combined method consumed much less energy and acid for the pH adjustment than that the Fenton.

Intercostal artery damage and massive hemothorax after thoracocentesis by central venous catheter： A case report

Central venous catheters （CVCs） are widely used in various puncture and drainage operations in intensive care units （ICUs） in recent years. Compared to conventional operating devices, CVC was welcomed by clinicians because of the advantages of easy use, less damage to the body and convenient fixation pro- cess. We came across a patient with severe acute pancreatitis （SAP） who developed cardiac arrest due to thoracic cavity massive bleeding 24 h after thoracoceotesis with CVC. Thoracotomy surgery was carried out immediately, which confirmed an intercostal artery injury. The patient was discharged from hospital without any neurological complications two months later. Here we report this case to remind all the emergency department and ICU physicians to pay more attention to the complication of thoracic cavity bleeding following thoracocentesis conducted by CVC.