Systematic analysis of prophages carried by Porphyromonas gingivalis.

To systematically investigate the prophages carrying in Porphyromonas gingivalis (P. gingivalis) strains, analyze potential antibiotic resistance genes (ARGs) and virulence genes in these prophages. We collected 90 whole genome sequences of P. gingivalis from NCBI and utilized the Prophage Hunter online software to predict prophages; Comprehensive antibiotic research database (CARD) and virulence factors database (VFDB) were adopted to analyze the ARGs and virulence factors (VFs) carried by the prophages. Sixty-nine prophages were identified among 24/90 P. gingivalis strains, including 17 active prophages (18.9%) and 52 ambiguous prophages (57.8%). The proportion of prophages carried by each P. gingivalis genome ranged from 0.5% to 6.7%. A total of 188 antibiotic resistance genes belonging to 25 phenotypes and 46 different families with six mechanisms of antibiotic resistance were identified in the 17 active prophages. Three active prophages encoded 4 virulence genes belonging to type III and type VI secretion systems. The potential hosts of these virulence genes included Escherichia coli, Shigella sonnei, Salmonella typhi, and Klebsiella pneumoniae. In conclusion, 26.7% P. gingivalis strains carry prophages, while the proportion of prophage genes in the P. gingivalis genome is relatively low. In addition, approximately 39.7% of the P. gingivalis prophage genes have ARGs identified, mainly against streptogramin, peptides, and aminoglycosides. Only a few prophages carry virulence genes. Prophages may play an important role in the acquisition, dissemination of antibiotic resistance genes, and pathogenicity evolution in P. gingivalis.

[Hotspots and prospects of esophageal cancer research in China].

Esophageal cancer is a malignant tumor with a high incidence in China. At pesent, advanced esophageal cancer patients are still frequently encountered. The primary treatment for resectable advanced esophageal cancer is surgery-based multimodality therapy, including preoperative neoadjuvant therapy, such as chemotherapy, chemoradiotherapy or chemotherapy plus immunotherapy, followed by radical esophagectomy with thoraco-abdominal two-field or cervico-thoraco-abdominal three-field lymphadenectomy via minimally invasive approach or thoracotomy. In addition, adjuvant chemotherapy, radiotherapy, or chemoradiotherapy, or immunotherapy may also be administered if suggested by postoperative pathological results. Although the treatment outcome of esophageal cancer has improved significantly in China, many clinical issues remain controversial. In this article, we summarize the current hotspots and important issues of esophageal cancer in China, including prevention and early diagnosis, treatment selection for early esophageal cancer, surgical approach selection, lymphadenectomy method, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and nutritional support treatment.

[Investigation of occupational hazard of 750 kV extra high voltage substations].

Objective: To understand the current status of major occupational hazards in 750 kV extra high voltage (EHV) substations. Methods: In July 2019, through investigating and detecting the sulfur hexafluoride, power frequency electric field and noise occupational hazards of 750 kV EHV substations in substation 1, substation 2, substation 3, substation 4, substation 5, substation 6 and substation 7, the exposure intensity of the sulfur hexafluoride, power frequency electric field and noise intensity that the operators are exposed to during the inspection process were analyzed. Results: The qualified rate of 358 sulfur hexafluoride test results was 100.0% of the seven 750 kV EHV substations. The qualified rate of 8 h time-weighted average of the power frequency electric field of those 750 kV EHV substations contacted by operators was 100.0%. Among the 847 power frequency electric field detection points, the exceeding standard rate of power frequency electric field was 64.3%, and the differences in the power frequency electric field detection exceeding standard rates of different substations and inspection areas were statistically significant (χ2=87.52, 50.86, P<0.01) . The highest exceeding standard rate of power frequency electric field was the circuit breaker inspection area (94.4%, 34/36) . The noise intensity test results of the seven EHV substations were 41.1-79.7 dB (A) , and the qualified rate was 100.0%. Conclusion: The sulfur hexafluoride, power frequency electric field and noise that the operators contacted in 750 kV EHV substations meet the requirements of occupational exposure limits. The inspection areas of main transformers, capacitors, reactors, bus bars and switches have high power frequency electric field radiation, should be select equipment iand give priority to robot inspection, and reasonably adjust the inspection time to reduce the intensity level of substation operators' exposure to power frequency electric field.

[The possibility of neoadjuvant chemotherapy course adjustment for delayed operation of patients with esophageal cancer in special period].

Objective: To investigate the effect of the neoadjuvant chemotherapy course adjustment on the patients with esophageal cancer underwent delayed operation. Methods: The clinical data of patients with esophageal cancer treated in Cancer Hospital, Chinese Academy of Medical Sciences from 2019-2020, who underwent neoadjuvant chemotherapy strategy adjustment (multiple course chemotherapy group) or not (control group), were retrospectively studied. The clinical pathological characteristics and postoperative complication of these two group were compared and analyzed. Results: The cases who underwent the interval between chemotherapy and operation more than 4 weeks in multiple course chemotherapy group and control group were 17 and 6, with significant difference (P<0.05). The average operative blood loss of these two groups were 88.6 ml and 46.1 ml, the average postoperative hospital stays were 14.7 days and 10.0 days, with significant difference (P<0.05). The incidence rate of postoperative complication in the multiple course chemotherapy group was 40.9% (9/22), not significantly different from 31.8% (7/22) of control group (P>0.05). There were no death within postoperative 7 days and 30 days in both groups. Cases with apparent tumor regression [tumor regression grade (TRG) 1 to 3] in multiple course chemotherapy group were 14, with marginal tumor regression (TRG 4 to 5) were 8, while there were 7 and 15 in the control group, respectively, with significant difference (P<0.05). After multiple neoadjuvant chemotherapy, the imaging examination of patients indicated an almost total tumor degradation and the postoperative pathology showed no residual malignant tumor tissue was observed. Conclusions: Increased neoadjuvant chemotherapy course for patients with locally advanced esophageal cancer can obtain more obvious tumor degradation response. Neoadjuvant chemotherapy adjustment according to the operation schedule is recommended.

[Progress in diagnosis and treatment of lung adenocarcinomas imaging manifesting as radiological part-solid nodule].

The incidence and mortality of lung cancer ranked the first in China. China had 787, 000 new cases of lung cancer in 2015, and a majority of these patients with advanced lung cancer. With the development and popularization of high-resolution computed tomography, more and more early-stage lung adenocarcinomas are found in screening. The imaging finding of early-stage lung adenocarcinomas often manifests as part solid nodule (PSN) containing ground glass opacity (GGO). Although the imaging manifestation of the nodules can't accurately predict the pathologic type of nodules, the parts of solid nodule and GGO still have some pathologic indications, and the prognostic evaluation effect of the maximum diameter of PSN is superior to that of the whole nodule. With the development of the molecular radiography and molecular pathology, the relationship of imaging manifestation of the PSN and metastasis were focused on. Some PSNs with special nature are more active and rapidly progressed than the pure GGOs. While compared to the pure solid nodules, the aggressiveness of PSNs are insufficient, with lower metastatic rates of lymph node and better prognoses. Currently, international acknowledge recommends to take active intervention measure for PSNs which are highly suspected to be malignant. We focus on the diagnosis and treatment of PSNs, systemically depict their staging, follow-up, surgical treatment, gene detection and immunotherapy.

[Anatomical partial lobectomy for the treatment of 3 336 cases of patients with lung nodule].

Objective: To explore the feasibility, safety and effectiveness of anatomical partial lobectomy. Methods: The clinical data of 3 336 patients with lung nodules underwent anatomical partial lobectomy in our center from November 2013 to November 2019 were retrospectively analyzed. We set the safety margin distance according to the imaging feature of the lesion. The surgeons then anatomically detached the major vessels and bronchus in this region, resected the targeted lung tissue along the plane, and completed the resection of anatomical pulmonary lobe and clean and sampling of systemic lymph nodules. Results: A total of 668 cases were multiple nodules and 2 668 cases were solitary pulmonary nodules. According to the postoperative pathological results, 283 cases were benign, 1 197 cases were preinvasive lesions (including 38 cases of atypical adenomatous hyperplasia, 445 cases of adenocarcinoma in situ and 714 cases of minimally invasive adenocarcinoma), 1 713 cases were invasive adenocarcinoma, 73 cases were non-adenocarcinoma and 70 cases were metastatic carcinoma. Among 1 786 invasive primary lung cancers, 11 cases received preoperative neoadjuvant chemotherapy, and their postoperative pathologic diagnoses were stage ypIA. Other 1 775 cases who did not receive postoperative neoadjuvant treatment included 1 587 cases in stage ⅠA, 112 cases in stage ⅠB, 3 cases in stage ⅡA, 18 cases in stage ⅡB, 37 cases in stage ⅢA, 9 cases in stage ⅢB, 9 cases in stage Ⅳ. The average operation time was (127.3±55.3) minutes, and the mean postoperative hospital stay was (4.8±2.4) days. The incidence rate of complications (grade>2) was 1.1%(38/3 336), and no death occurred during 30 days after operation. Conclusion: Anatomic partial lobectomy has good clinical applicability, safety and effectiveness, which is worthy of clinical application and recommendation.

[Treatment and prognostic analysis of patients with primary esophageal small-cell carcinoma].

Objective: The study aimed to analyze the clinicopathological features, treatment, and prognosis factors of primary esophageal small-cell carcinoma (PESC). Methods: The clinical records and follow-up data of 100 patients with PESC were collected, and the clinicopathological features and treatments were examined. Log-rank test and Cox regression model were performed to identify the independent prognostic factors. Results: Progressive dysphagia, weight loss, and abdominal pain were the most common initial symptoms in the 100 patients with PESC. The primary tumor site mainly occurred in the middle of the chest (51%, 51/100), and the ulcer type was the most common under gastroscope (31%, 31/100). One or more positive markers of epithelial origin were present in all of the enrolled patients. At the time of diagnosis, 80 cases had limited disease (LD) and 20 cases had extensive disease (ED). The 1-, 3-, and 5-year survival rates of PESC patients were 57.0%, 18.0%, and 11.0%, respectively, with a median survival time (MST) of 13.8 months. In all PESC patients, multivariate Cox regression analysis indicated that the significant prognostic factors included the lesion length (OR=2.661, P<0.001), TNM staging (OR=1.464, P=0.016), and treatment methods (OR=0.333, P<0.001). Besides, in patients with LD, the lesion length (OR=2.638, P=0.001) and treatment methods (OR=0.285, P<0.001) were independent prognostic factors. The MST of patients in surgery + chemotherapy group (21.6 months) was longer than that of the surgery only group (8.3 months, P=0.021), while patients in surgery+ chemotherapy+ radiotherapy group were also associated with a longer MST than the chemotherapy + radiotherapy group (31.0 months, 9.8 months, respectively; P<0.001). Conclusions: PESC is a rare esophageal malignant tumor with poor prognosis. Our findings reveal that the lesion length, TNM staging, and treatment method are independent prognostic factors for PESC patients. Moreover, surgery-based comprehensive treatments may prolong the survival of patients with LD.

[Clinical analysis of mediastinal lymph node dissection through sternotomy approach in the treatment of papillary thyroid carcinoma with mediastinal lymph node metastasis].

Objective: To investigate the rule of mediastinal lymph node metastasis of papillary thyroid carcinoma and the application of therapeutic mediastinal lymph node dissection through the sternotomy approach in the treatment of mediastinal lymph node metastasis of papillary thyroid carcinoma. Methods: All cases of papillary thyroid carcinoma with mediastinal lymph node metastasis treated through sternotomy cooperated by thoracic surgeons and head and neck surgeons from January 2006 to January 2017 in Cancer Hospital of Chinese Academy of Medical Sciences were included in this study. The distribution, metastasis rate, metastasis degree, surgical method, surgical complications and postoperative survival of patients with mediastinal lymph node metastasis were retrospectively analyzed. Results: A total of 31 patients (16 males and 15 females) with papillary thyroid cancer with mediastinal lymph node metastasis, with a median age of 46 (19-65) years, were enrolled in the group. Partial upper sternotomy was used in 28 cases, and total sternotomy was used in 3 cases. The mediastinal lymph nodes of papillary thyroid carcinoma metastasized farthest to the station 6, and the lymph node metastasis rate of each group from high to low was: 2R (61%), 1R (39%), 3A (39%), 1L (16%), 2L (10%), 4R (10%), 5 (3%) and 6 (3%). No metastasis was observed in station 3P, 4L and 7. In addition, the degree of lymph node metastasis at station 2R was the highest, reaching 35% (77/219). Extra-nodal invasion of mediastinal metastatic lymph nodes in thyroid papillary carcinoma is common (23%), easily fuses into masses (23%) and invades peripheral vascular nerves (26%). Up to 29% of blood transfusions are required during or after surgery due to oozing or bleeding (9/31). The 1-, 3-, 5-and 10-year survival rates of patients undergoing surgical treatment were 94%, 94%, 87% and 81%, respectively. Conclusion: Papillary thyroid carcinoma can metastasize to almost all mediastinal lymph nodes except station 3P, 4L and 7. Radical mediastinal lymph node dissection through sternotomy is an effective method for the treatment of mediastinal lymph node metastasis of thyroid papillary carcinoma.

[The clinical characteristics and surgical management of ciliated muconodular papillary tumor].

Objective: To investigate the clinical characteristics and surgical management based on the clinical manifestation, pathological feature and the medical imaging finding of ciliated muconodular papillary tumor (CMPT). Methods: The data of clinical manifestation, pathological feature and the medical imaging finding of 15 patients with CMPT who received surgical treatment from January 2017 to April 2019 were collected and retrospectively analyzed. Results: CMPT generally occurred in the elderly people. Most of the diameter of the tumor was less than 1 cm, while the diameters of other 3 patient were 1~2 cm. The computed tomography (CT) scan of 9 patients displayed solid nodule, while 4 displayed ground glass opacity (GGO), and other 2 showed no significant abnormal. Thirteen patients received minimally invasive video-assisted thoracoscopic surgery (VATS), the other 2 received open surgery. Eight patients received lobectomy, 3 received thoracoscopic anatomical partial-lobectomy, 4 received wedge resection. The frozen section diagnostic results of 8 patients were adenocarcinoma, including 3 mucinous adenocarcinoma. Other 5 patients were diagnosed as CMPT and 2 were reported as infection nodule. During the perioperative period, 2 patients occurred cardiac arrhythmia, 1 occurred pulmonary infection. None of the patients had local recurrence or distant metastasis during the follow-up. Conclusions: CMPT usually presents as solitary peripheral lung nodules without obvious symptoms. Most CMPTs are incidentally detected by routine CT scan. Some of the cases are accompanied by primary lung cancer probably. Surgical treatment is the major therapy for CMPT. The imaging feature of CT scam usually shows a solid nodule or a GGO locates in peripheral pulmonary. Frozen section diagnosis for CMPTs can be easily confused with adenocarcinoma or mucinous adenocarcinoma.

An evaluation of direct PCR assays for the detection and quantification of Porphyromonas gingivalis.

Porphyromonas gingivalis has been linked to the development and progression of oesophageal squamous cell carcinoma (ESCC), and is considered to be a high-risk factor for ESCC. Currently, the commonly used methods for P. gingivalis detection are culture or DNA extraction-based, which are either time and labour intensive especially for high-throughput applications. We aimed to establish and evaluate a rapid and sensitive direct quantitative polymerase chain reaction (qPCR) protocol for the detection of P. gingivalis without DNA extraction which is suitable for large-scale epidemiological studies. Paired gingival swab samples from 192 subjects undergoing general medical examinations were analysed using two direct and one extraction-based qPCR assays for P. gingivalis. Tris-EDTA buffer-based direct qPCR (TE-direct qPCR), lysis-based direct qPCR (lysis-direct qPCR) and DNA extraction-based qPCR (kit-qPCR) were used, respectively, in 192, 132 and 60 of these samples for quantification of P. gingivalis. The sensitivity and specificity of TE-direct qPCR was 95.24% and 100% compared with lysis-direct qPCR, which was 100% and 97.30% when compared with kit-qPCR; TE-direct qPCR had an almost perfect agreement with lysis-direct qPCR (κ = 0.954) and kit-qPCR (κ = 0.965). Moreover, the assay time used for TE-direct qPCR was 1.5 h. In conclusion, the TE-direct qPCR assay is a simple and efficient method for the quantification of oral P. gingivalis and showed high sensitivity and specificity compared with routine qPCR.

[Epidemiological characteristic and current status of surgical treatment for esophageal cancer by analysis of national registry database].

Objective: To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China. Methods: A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014. Results: Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively. Conclusions: The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.

[The influence of TP53 mutation on the therapeutic effect of EGFR tyrosine kinase inhibitor and prognosis of EGFR mutant non-small cell lung cancer patients].

Gene mutations can impair the sensitivity of cancer cells to targeted drugs, and lead to individual differences of clinical therapeutic effects. Epidermal growth factor receptor (EGFR) mutation plays an important role in therapeutic decision-making. Furthermore, some co-existing gene mutations, such as TP53 mutation, can also affect the therapeutic effect and prognosis of patients. Whether EGFR mutation combined with TP53 mutation affects the sensitivity of lung cancer cells to tyrosine kinase inhibitor (TKI) and long-term prognosis of non-small cell lung cancer (NSCLC) patients is still unknown and has attracted more attentions. However, in the current clinical practice, TP53 mutation is not a key factor of therapeutic decision-making, so further studies are needed to clarify the impact of TP53 mutation (including each subtype) on the potential benefits of EGFR-targeted therapy of NSCLC.

Analysis of a registry database for esophageal cancer from high-volume centers in China.

Esophageal cancer has a high incidence among malignancies in China, but a comprehensive picture of the status of its surgical management in China has hitherto not been available. A nationwide database has recently been established to address this issue. METHOD: A National Database was setup through a network platform, and data was collected from 70 high-volume centers (>100 esophagectomies/per year) across China. Data was entered between January 2009 and December 2014, and was analyzed in June 2015 after a minimal follow-up of 6 months for all patients. 8181 patients with complete data who received surgery for primary esophageal cancer on the Database were included in the analysis. RESULT: In this series, there were 6052 males and 2129 females, with a mean age of 60.5 years (range: 22-90 years). The pathology in 95.5% of patients was squamous cell carcinoma. The pathological stage distribution was 1.2% in stage 0, 2.5% in Ia, 11.5% in Ib, 14.8% in IIa, 36.1% in IIb, 19.3% in IIIa, 8.3% in IIIb, 6.2% in IIIc. 1800 patients (22.0%) with locally advanced disease received preoperative neoadjuvant therapy and 3592 patients (43.9%) underwent postoperative adjuvant chemotherapy and/or radiotherapy. The esophagectomies were performed through left thoracotomy approach in 5870 cases (72.6%), through right chest approach in 2215 cases (27.4%) including right thoracotomy (21.3%) and VATS (6.1%). The 30-day postoperative mortality rate was 0.6% (43 patients), and the overall postoperative complication rate was 11.6% (951 patients). The 1-, 3-, and 5-year overall survival rates were 82.6%, 61.6%, and 52.9%, respectively. CONCLUSION: This National Registry Database from high-volume centers provides a comprehensive picture of surgical management for esophageal cancer in China for the first time. Squamous cell carcinoma predominates, but there is heterogeneity with respect to the surgical approach and perioperative oncologic management. Overall, surgical mortality and morbidity rates are low, and good survival rates have been achieved due to improvement of surgical treatment technology in recent years.

[The value of the planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of esophageal squamous cell carcinoma].

Objective: The role of planned neoadjuvant radiotherapy or chemoradiotherapy in the non-radical resection of esophageal squamous cell carcinoma was unclear. The study aimed to evaluate their therapeutic effect and analyze the prognostic factors. Methods: We retrospectively analyzed the clinical data of locally advanced esophageal squamous cell carcinoma who received neoadjuvant radio therapy (33 patients) and concurrent chemoradiotherapy (119 patients) from January 2004 to December 2016 in our single-institution database.The survival rates were calculated by Kaplan-Meier method. The prognostic factors were analyzed by using Log rank test and Cox proportional hazards model. Results: The median follow-up was 29.8 months. One hundred and one patients survived more than 3 years. The rates of overall survival (OS) and disease-free survival (DFS) at 3 years were 63.9% and 55.6%, respectively.The rates of complete, partial and minimal pathological response of the primary tumor were 50.3%, 38.4%, 11.3%, the corresponding 3-year OS were 75.5%, 57.4%, 27.3% (P<0.001) and 3-year DFS were 72.0%, 44.7%, 17.6% (P<0.001), respectively.The postoperative lymph node metastasis rate was 27.0%. The 3-year OS and DFS of the lymph node positive group was 45.6% and 32.8%, significantly lower than 70.8% and 63.7% of the negative group (both P<0.001). The 3-year OS and DFS of pathologic stage Ⅰ, Ⅱ, ⅢA, ⅢB and Ⅵ A were 76.2%, 57.4%, 64.7%, 35.0%, 33.3% (P<0.001) and 70.1%, 49.3%, 41.2%, 22.1%, 33.3% (P<0.001), respectively.The operation-related mortality was 3.3%. Multivariate analysis showed that chest pain, postoperative respiratory failure, pathological differentiation, more than 15 lymph node dissection and ypTNM stage were the independent prognostic factors of OS (P<0.05 for all). Conclusions: The planned neoadjuvant radiotherapy or chemoradiotherapy for the non-radical resection of advanced esophageal squamous cell carcinoma could result in favorable survival. The chest pain, postoperative respiratory failure, pathological differentiation, the number of lymph node resection and ypTNM stage are the independent prognostic factors of the prognosis of these patients.

[Key technology of lymph node dissection along recurrent laryngeal nerve and its associated complication prevention in patients with thoracic esophageal cancer].

Esophageal cancer is one of the most prevalent cancers in China. Lymph node metastasis is one of the most important prognostic factors and severely affect the long-term survival after surgical treatment. Therefore, systemic two-field lymph node dissection including thoracic and abdominal draining nodes of the esophagus during surgery is essential in order to improve the long-term survival for the patients with thoracic esophageal cancer, and it is also the basis for precise staging and postoperative adjuvant treatment regimen- making. As reported in the literature, lymph node metastases along bilateral recurrent laryngeal nerve was the highest, therefore, the lymph node dissection along bilateral recurrent laryngeal nerve is the most important manipulation during esophagectomies, however, it is also the most technically difficult procedure during operation. It usually results in postoperative complications especially the respiratory complications due to paralysis of recurrent laryngeal nerves caused by lymph node dissection. Therefore, the gain and loss of lymph node dissection along bilateral recurrent laryngeal nerve has been a disputed and entangle topic for thoracic surgeons, and the purpose of this paper is to summarize author's experience and the key technology to prevent the associated complications in lymph node dissection along recurrent laryngeal nerve during esophagectomies for the patients with thoracic esophageal cancer.

[Comparison of lung cancer surgery in China, 2005 vs. 2015].

Objective: To study the impact of the advance of the times and technological progress on the surgical treatment of lung cancer. Methods: The data of patients with non-small cell lung cancer treated by thoracic surgery at Cancer Hospital of Chinese Academy of Medical Sciences from 2005 to 2015 were retrospectively analyzed. The population distribution, operation methods and treatment results were analyzed retrospectively. Results: 510 patients (in 2005) and 1 235 (in 2015) non-small cell lung cancer patients were included in this study. The proportions of male patients (79.0% vs. 55.8%), smoking (52.9% vs. 30.1%), squamous cell carcinoma (50.2% vs. 22.4%) and video-assisted thoracoscopic surgery (VATS) (0 vs. 61.1%), stage Ⅰ (15.2% vs. 36.8%), the number of lymph node dissection (21.8 vs. 16.6), intraoperative blood transfusion rate (9.6% vs. 1.9%), palliative resection rate (7.5% vs. 2.0%), the average length of stay (10.8 d vs. 7.6 d) were significantly changed. There was no significant difference in the average age of patients and operation time. Conclusion: There was a significant change in the distribution of population and surgical techniques in patients undergoing lung cancer surgery in last ten years.

[Analysis of the risk factors for postoperative cervical anastomotic leakage after McKeown's esophagectomy].

Objective: To analyze risk factors of anastomotic leakage after McKeown'sesophagectomy. Methods: The clinical data of 635 esophageal cancer patients, who underwent McKeown's esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences from January 2012 to December 2015, were retrospectively analyzed. The risk factors of cervical anastomotic leakage were identified through analysis of medical history, surgical procedure, tumor characteristics and vascular calcification. Results: Among all the 635 patients, anastomotic leakage occurred in 111 (17.5%)patients. Univariate analysis showed that the American Society of Anesthesiologists (ASA) risk class, prior thoracic surgery, upper digestive tract ulcer, COPD, hypertension, peripheral vascular disease, renal insufficiency, FEV1% predicted, DLCO% predicted, duration of surgery and calcification of descending aorta, celiac trunk and left postceliac arteries were associated with a statistically significant increase in risk of cervical anastomotic leakage (P<0.05 for all). Logistic regression analysis showed that ASA risk class, peripheral vascular disease, renal insufficiency and calcification of descending aorta and celiac trunk were independent risk factors of cervical anastomotic leakage after McKeown's esophagectomy (P<0.05 for all). Conclusions: ASA risk class, peripheral vascular disease, renal insufficiency, calcification of descending aorta and celiac trunk are independent risk factors of cervical esophageal anastomotic leakage after McKeown's esophagectomy.

[Analysis of prognostic factors for patients with stageâ b non-small cell lung cancer after operation].

Objective: To study the prognostic factors for patients with stage ⅠB non-small cell lung cancer (NSCLC) after radical operation (R0). Methods: The clinical data of 458 patients who underwent radical resection for NSCLC and were pathologically diagnosed with stage ⅠB lung cancer from January 2009 to December 2010, were reviewed retrospectively. Those cases include 269 male patients and 189 female, aged between 28 and 88, with a median age of 61 years. The Kaplan-Meier method and Log rank test were used for univariate survival analysis and the Cox proportional hazards model for multivariate survival analysis. Results: Among these 458 cases, 66 patients were dead and the 5-year survival rate was 85.6%.The results of the univariate analysis showed that the age ≥65 years, elevated preoperative CEA, preoperative FEV1%pred<70%, vascular carcinoma embolus, and low tumor differentiation were associated with poor prognosis of patients(P<0.05). The results of the multivariate analysis showed that elevated preoperative CEA, preoperative FEV1%pred<70% and low tumor differentiation were connected with poor prognosis of patients (P<0.05). Conclusions: Elevated preoperative CEA, preoperative FEV1%pred<70% and low tumor differentiation are independent risk factors which influence prognosis and survival rate of patients with stage ⅠB NSCLC, among which those with poorly differentiated tumor could benefit from postoperative chemotherapy.

[Gastric pull-up reconstruction after pharyngoesphagectomy for advanced hypopharyngeal or cervical esophageal squamous cell carcinoma].

Objective: To analyze the clinical results of gastric pull-up reconstruction following total pharyngoesophagectomy. Methods: A total of 90 patients with hypopharyngeal or cervical esophageal cancinoma who underwent gatric pull-up reconstruction after pharyngoesophagectomy between June 2006 and June 2015 were reviewed retrospectively. Clinical data were analyzed. Rates of survival, recurrence and complicates were calculated with SPSS software. Results: Of 90 patients, 8 patients had hypopharyngeal cancinoma invading cervical esophagus, 51 patients had cervical esophageal carcinoma, and 31 patients had hypophageal and esophageal multiple parimary carcinomas. Forty patients were treated with surgery alone, 29 patients with planned surgery, and 21 patients with salvage surgery. After follow up of 6-104 months with a median of 22 months, 54 patients died and the total 3-year survival rate was 36.3%. Seventeen patients developed local recurrences and 10 patients cervical or mediastinal lymph node metastasis (LNM). The 3-year survival rates of patients with and without recurrence or LNM were respectively 5.9%, and 45.7% (χ2=11.564, P=0.001). Twenty-three patients developed distant metastasis. The 3-year survival rate of patients with and without distant metastasis were respectively 22.9% and 41.8% (χ2=4.534, P=0.033). Multivariate analysis showed local recurrence and distant metastasis as predictors for poor survival. The rates of perioperative mortality and anastomotic fistula were 3.3% (3/90) and 13.3%(12/90), respectively. Conclusions: Gastric pull-up reconstruction is a relatively safe and effective method for esophageal reconstruction after removal of hypopharyngeal or cervical esophageal carcinoma. Some patients could achieve good survival with low mortality and acceptable morbidity after multidisciplinary treatments.

[Survival after surgical treatment of bilateral synchronous multiple primary non-small cell lung cancers].

OBJECTIVE: To explore the clinical characteristics of patients with bilateral synchronous multiple primary non-small cell lung cancer (NSCLC) and identify the prognostic indicators associated with survival. METHODS: From January 2010 to December 2014, clinicopathological data of 96 patients with bilateral synchronous multiple primary NSCLC, who met the modified Martini-Melamed criteria and underwent radical surgical resection, were retrospectively reviewed. Survival was estimated using the Kaplan-Meier method, and the clinical parameters associated with survival were analyzed using a log-rank test. Cox proportional hazards regression models were used to identify the risk factors for this cancer. RESULTS: Of the 96 patients, two patients who died of severe postoperative complications were excluded, and 94 patients were analyzed. Of the 94 cases, a two-stage operation was performed in 93 patients, while a single-stage bilateral surgery was performed in only one patient using video-assisted thoracic surgery (VATS). 79 patients had 2 tumors and the other 15 patients had 3 or more tumors. There were 82 patients with synchronous tumors located in different lobes and 12 patients had at least two tumors located in the same lobe. Seventy-six patients were found to have multiple lung adenocarcinoma and 12 patients had multiple squamous cell carcinoma (SCCs). Five patients had adenocarcinoma and SCC, and one patient had adenocarcinoma and adenosquamous carcinoma simultaneously. Univariate analysis showed that the large maximum tumor diameter, highest pT stage and lymph node involvement were associated with an unfavorable DFS (P<0.01 for all), while female gender, small maximum tumor diameter, early highest pT stage and pN0 were associated with a better overall survival (OS). Multivariate analysis showed that highest pT stage and lymph node metastasis were independent prognostic factors for DFS and OS. Patients with a lower highest pT stage and negative lymph node metastasis had longer DFS and OS (P<0.05 for both). CONCLUSIONS: The diagnosis for patients with bilateral synchronous multiple primary NSCLCs should be made very carefully. Two stage surgical treatment is safe, reasonable and effective for patients with bilateral synchronous multiple primary NSCLCs in a relatively early stage. The highest pT stage and pN status are important predictors for long-term survival. Adequate pulmonary tissue resection with complete resection of multiple nodules and systematic lymphadenectomy are suggested.