• Pseudomonas aeruginosa
• drug resistance
• the isolation sites

• Humans
• Pseudomonas aeruginosa/drug effects
• Pseudomonas aeruginosa/isolation & purification
• Male
• Gastrointestinal Diseases/microbiology
• Female
• Middle Aged
• Aged
• Drug Resistance, Bacterial
• Anti-Bacterial Agents/pharmacology
• Pseudomonas Infections/microbiology
• Microbial Sensitivity Tests
• Adult
• Aged, 80 and over

• esophageal cancer
• infectious complication
• peritumoral fibrosis
• preoperative therapy

• Humans
• Interleukin-6/therapeutic use
• Esophageal Neoplasms/surgery
• Esophageal Neoplasms/pathology
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Inflammation
• Pleural Effusion
• Retrospective Studies
• Treatment Outcome

• acute lung injury
• epidural anesthesia
• inflammatory response
• lung cancer surgery
• one-lung ventilation
• remifentanil analgesia

The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer.

Patients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy.

Sixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements).

Although further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer.

This trial was registered in the UMIN Clinical Trial Registry (UMIN000017565 14/05/2015).

• Esophageal cancer
• Esophagectomy
• Minimally invasive esophagectomy
• Robot-assisted esophagectomy

• C-reactive protein
• Cancer progression
• Esophageal cancer
• Prognosis
• Prognostic nutritional index

This study aims to investigate the causes of death in patients with esophageal cancer (EC) and report reliable and accurate estimates of adjusted conditional overall survival (COS).

We retrieved data on patients aged 18 years or older who were diagnosed with EC between 1975 and 2016 from the Surveillance Epidemiology End Results (SEER) registry. We estimated COS by using an inverse probability weighting method to adjust for the available covariates. Linear trends were analyzed via a weighted linear regression.

A total of 40,142 confirmed patients were included in the final analysis. Of these, 20,971 were diagnosed with esophageal squamous cell carcinoma, and 19,171 were diagnosed with esophageal adenocarcinoma. EC was the leading cause of death, followed by heart disease (5.2%), stomach cancer (3.2%), and other diseases (2.9%). Five-year adjusted COS, given that patients had already survived 36 months was improved from 0.50 to 0.87 (P_Difference<0.001) in comparison with the 5-year conventional overall survival. As the survival time increased from 0 to 48 months, the 5-year adjusted COS improved significantly. The adjusted conditional EC-specific survival also showed similar trends.

For patients with EC who had survived over time, the 5-year adjusted COS and the conditional EC-specific survival improved dramatically. Other causes of death in EC patients should also be considered.

• Causes of death
• adjusted conditional survival
• esophageal cancer (EC)

• Esophageal cancer
• Outcome skeletal muscle volume
• Postoperative pneumonia
• Sarcopenia

• Ivor Lewis
• epidural
• esophagectomy
• outcomes
• regional anesthesia

• Cancer metastasis
• Non–small cell lung cancer
• Pneumonia
• Toll-like receptors

• Cortisol
• Music
• Perioperative patient care
• Stress response
• Surgery

• CI, confidence of interval
• CRP, C-reactive protein
• Complications
• EC, Esophageal cancer
• Esophageal cancer
• Esophagectomy
• Hyperbilirubinemia
• Infection
• LN, lymph node
• MIE, Minimally invasive transthoracic esophagectomy
• OE, open transthoracic esophagectomy
• OR, odds ratio
• PICs, postoperative infectious complications
• T-bil, total bilirubin
• THE, Transhiatal esophagectomy
• TNM, tumor-node-metastasis
• UICC, International Union Against Cancer
• WBC, white blood cell

• bacteria
• detection
• esophageal cancer
• esophagectomy
• pneumonia

• C-reactive protein
• Esophageal cancer
• Surgical stress

Increasing numbers of refractory or severe, even fatal, cases of Mycoplasma pneumoniae infections have been reported in recent years. Excessive inflammatory responses play a vital role in the pathogenesis of refractory M. pneumoniae pneumonia (RMPP). HMGB1 is an actively secreted cytokine produced by macrophages and other inflammatory cells that participates in various infectious diseases. The present study aimed to explore the role and clinical significance of HMGB1 in children with RMPP and the potential mechanism of HMGB1 expression.

Four hundred and fifty-two children diagnosed with M. pneumoniae pneumonia, including 108 children with RMPP, were enrolled from January 2013 to December 2015 at the Children’s Hospital of Soochow University. HMGB1, TNF-α, and IL-6 in peripheral blood from RMPP and non-RMPP (NRMPP) cases were detected by real-time PCR and ELISA. Lipid-associated membrane proteins (LAMPs) were extracted from live M. pneumoniae and prepared at different concentrations for stimulation of THP-1 cells. After coculture with LAMPs, HMGB1, TNF-α, IL-6, RAGE, TLR2, and TLR4 in THP-1 cells were detected by real-time PCR.

Occurrences of cough, fever, and abnormal lung signs were more frequent in RMPP cases compared with NRMPP cases (all p < 0.05). Children with RMPP had longer hospital stays than children with NRMPP (p < 0.05). Different distributions of lymphocytes were noted between RMPP and NRMPP cases. HMGB1, TNF-α, and IL-6 levels were significantly higher in RMPP cases compared with NRMPP cases (all p < 0.05). HMGB1 had good diagnostic ability to differentiate RMPP with AUC of 0.876, sensitivity of 0.833, and specificity of 0.824 compared with TNF-α and IL-6. HMGB1 expression in THP-1 cells was increased by stimulation with 10 μg/ml LAMPs. TLR2 expression was increased after stimulation with 6 μg/ml LAMPs. HMGB1 level was positively associated with TNF-α, IL-6, and TLR2 levels.

HMGB1 is a good diagnostic biomarker for differentiating RMPP and NRMPP. LAMPs from M. pneumoniae may induce HMGB1 expression in immune cells through the TLR2 pathway. Further in vitro and in vivo studies are needed for the development of a new treatment strategy to inhibit the HMGB1 pathway, thereby preventing the inflammation in RMPP.

• HMGB1
• Lipid-associated membrane proteins (LAMPs)
• M. Pneumoniae pneumonia
• RMPP

• enteral nutrition
• esophageal cancer
• long-term morbidity from pneumonia
• presarcopenia

• Aged
• Body Mass Index
• Esophageal Neoplasms/surgery
• Esophagectomy/adverse effects
• Esophagectomy/methods
• Female
• Humans
• Incidence
• Japan/epidemiology
• Male
• Muscle, Skeletal/pathology
• Muscular Atrophy/epidemiology
• Muscular Atrophy/etiology
• Muscular Atrophy/pathology
• Pneumonia/diagnosis
• Pneumonia/epidemiology
• Pneumonia/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/pathology
• Retrospective Studies

• Esophageal cancer
• Pneumonia
• Postoperative complications

Postoperative pneumonia (PP) is one of the common complications following esophagectomy and associated with poor short- and long-term outcomes. Sevoflurane and propofol, which have inflammatory-modulating effects, are common used general anesthetics. This study aimed to compare the effects of anesthesia with sevoflurane and propofol on the development of PP after esophageal surgery for cancer.

The electronic medical records of patients who underwent elective esophagectomy between July 2013 and July 2016 were reviewed. We conducted univariate and multivariate logistics analysis and propensity score matching analysis to compare the effect of sevoflurane and propofol on the incidence of PP and to identify the risk factors for PP after esophagectomy.

Overall, the incidence of postoperative pneumonia was 9.5%. There was no significant difference in the rates of PP between sevoflurane group and propofol group either before or after propensity score matching (9.6% vs 8.0%, P = 0.606; 7.7% vs 6.4%, P = 0.754, respectively). Univariate and multivariate analysis revealed that alcohol use (OR 1.513; 95% CI 1.062–2.156), surgical procedure (Sweet: referent; Ivor-Lewis: OR 1.993; 95% CI 1.190–3.337; Three-incision: OR 1.878; 95% CI 1.296–2.722) and surgeon experience (high-volume: referent; low-volume: OR 1.525; 95% CI 1.090–2.135) were significant risk factors of postoperative pneumonia.

Sevoflurane did not differ from propofol in terms of affecting the risk of PP development after esophagectomy.

• Esophagectomy
• Pneumonia
• Propofol
• Sevoflurane

• gram-positive bacteria
• lung cancer
• metastasis
• pneumonia
• toll-like receptors

• acute lung injury
• acute respiratory distress syndrome
• esophagectomy
• pathophysiology
• postoperative complications

This randomized controlled trial aimed to evaluate whether the serum procalcitonin (PCT) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma.

A total of 293 consecutive patients with suspected asthma attacks from February 2005 to July 2010 participated in this study. 225 patients completed the study. Serum PCT levels, and other inflammatory biomarkers of all patients were measured. In addition to the standard treatment, the control group received antibiotics according to the attending physicians’ discretions, while the patients in the PCT group were treated with antibiotics according to serum PCT concentrations. Antibiotics usage was strongly discouraged when the PCT concentration was below 0.1 μg/L; discouraged when the PCT concentration was between 0.1 μg/L and 0.25 μg/L; or encouraged when the PCT concentration was above 0.25 μg/L. The primary endpoint was the determination of antibiotics usage. The second endpoints included the diagnostic accuracy of PCT and other laboratory biomarkers the effectiveness of asthma control, secondary ED visits, hospital re-admissions, repeated needs for steroids or dosage increase, needs for antibiotics, WBC count, PCT levels and FEV1%.

At baseline, two groups were identical regarding clinical, laboratory and symptom score. Probability of the antibiotics usage in the PCT group (46.1%) was lower than that in the control group (74.8%) (χ² = 21.97, p < 0.001. RR = 0.561, 95% CI 0.441-0.713). PCT and IL-6 showed good diagnostic significance for bacterial asthma (r = 0.705, p = 0.003). The degrees of asthma control in patients were categorized to three levels and were comparable between the two groups at the six weeks follow-up period (χ² = 1.62, p = 0.45). There were no significant difference regarding other secondary outcomes (p > 0.05).

The serum PCT concentration can be used to effectively determine whether the acute asthma patients have bacterial infections in the respiratory tract, and to guide the use of antibiotics in the treatment of acute asthma exacerbations, which may substantially reduce unnecessary antibiotic use without compromising the therapeutic outcomes.

ICTRP ChiCTR-TRC-12002534

• Acute lung injury
• Acute respiratory distress syndrome
• Complications
• Esophagectomy
• Pneumonia

• Esophagectomy/adverse effects
• Esophagectomy/mortality
• Health Status
• Humans
• Lung Diseases/etiology
• Lung Diseases/mortality
• Lung Diseases/prevention & control
• Postoperative Care
• Preoperative Care
• Treatment Outcome