Objectives: Antihypertensive therapy is effective to control blood pressure (BP) and to prevent cardiovascular events, but the further treatment strategies for patients who cannot achieve goal BP with low-dose monotherapy is still under dispute. Our study investigates the effects of high-dose amlodipine and valsartan and their low-dose combination on blood pressure variability (BPV) and pulse wave velocity (PWV) to provide references for clinical medication.

Materials and Methods: This study was a prospective, randomized, parallel, case-controlled trial performed in a medical center. A total of 134 outpatients newly diagnosed with essential hypertension or receiving low-dose monotherapy were enrolled and 119 completed the trial. They were randomized into amlodipine 10 mg group (n = 40), valsartan 160 mg group (n = 38) and amlodipine 5 mg + valsartan 80 mg (n = 41) in a 1:1:1 allocation ratio for a 10-week treatment. Demographic data and laboratory indicators were collected at the randomization and 10 weeks after the treatment. The 24-hour ambulatory BP and brachial-ankle PWV were also monitored.

Results: All therapies reduced systolic and diastolic BP (P < 0.05). The 24-hour systolic BPV was significantly decreased in amlodipine and combination groups (3.55 +/- 2.57, 4.11 +/- 2.20 versus 2.23 +/- 2.54 mm Hg, P < 0.05). The effects on diastolic BPV differed between different treatments. PWV was lowered by 3 antihypertensive schemes; the degree of which from strongest to weakest were valsartan, combination and amlodipine (228.87 +/- 60.41 versus 152.49 +/- 49.25 versus 99.35 +/- 35.57 cm/second, P < 0.01).

Conclusions: All further strategies can effectively control BP. The combination treatment reduces both BPV and PWV noticeably, whereas double-dose amlodipine achieves the greatest BPV decrease and valsartan is best in controlling PWV.

The purpose of the current study was to compare and investigate the effect of fixed and individual valgus correction angle (VCA) on postoperative alignment restoration. It is hypothesized that individual VCA would be more accurate than fixed VCA in postoperative limb alignment restoration.

Four hundred and fifty-two patients with 546 consecutive uncomplicated primary total knee arthroplasties performed by a single surgeon, with 302 knees that had individual VCA (group A) and 244 knees that had fixed 5A degrees VCA (group B), were enroled in this study. Preoperative and postoperative full-length standing hip-to-ankle radiographs were used to assess limb alignment. Postoperative hip-knee-ankle angle (theta), femoral component angle (alpha) and tibial component angle (beta) were measured and compared between the two groups.

Mean postoperative theta angle and alpha angle were 178.9A degrees (SD 1.3A degrees) and 89.1A degrees (SD 1.1A degrees) in the group A, whereas they were 177.8A degrees (SD 1.9A degrees) and 87.9A degrees (SD 1.5A degrees) in the group B. There were significant differences in both parameters between the two groups (p = 0.021 and 0.016, respectively). Mean postoperative beta was 89.8A degrees (SD 1.2A degrees) in the group A and 89.7A degrees (SD 1.3A degrees) in the group B, and no significant difference was detected. There were 114 (37.7 %), 221 (73.2 %) and 265 (87.7 %) knees that had restoration of mechanical axis to +/- 1A degrees, +/- 2A degrees, +/- 3A degrees of neutral, respectively, and 37 (12.3 %) outliers (>+/- 3A degrees) in the group A, whereas there were 48 (19.7 %), 122 (50.0 %) and 170 (69.7 %) knees that had restoration of mechanical axis to +/- 1A degrees, +/- 2A degrees, +/- 3A degrees of neutral, respectively, and 74 (30.3 %) outliers in the group B. Group A had a higher percentage of restoration of limb alignment and fewer outliers than those in the group B, and this difference was statistically significant (p < 0.001).

The results from the present study demonstrated that individual VCA for distal femoral resection could enhance the accuracy of postoperative limb alignment restoration compared with fixed VCA. For clinical relevance, individual VCA should be recommended for routine use in all patients in order to achieve the expected postoperative neutral limb alignment and reduce the risk of postoperative malalignment due to the planning error of a fixed VCA.

Prospective comparative study, Level II.

Statement of problem. Indirect composite resins (ICR) are promising alternatives as veneering materials for zirconia frameworks. The effects of core-to-dentin thickness ratio (C/Dtr) on the mechanical property of bilayered veneer ICR/yttria-tetragonal zirconia polycrystalline (Y-TZP) core disks have not been previously studied.

Purpose. The purpose of this in vitro study was to assess the effects of C/Dtr on the biaxial flexural strength, reliability, and fracture mode of bilayered veneer ICR/ Y-TZP core disks.

Material and methods. A total of 180 bilayered 0.6-mm-thick composite resin disks in core material and C/Dtr of 2:1, 1:1, and 1:2 were tested with either core material placed up or placed down for piston-on-3-ball biaxial flexural strength. The mean biaxial flexural strength, Weibull modulus, and fracture mode were measured to evaluate the variation trend of the biaxial flexural strength, reliability, and fracture mode of the bilayered disks with various C/Dtr. One-way analysis of variance (ANOVA) and chi-square tests were used to evaluate the variation tendency of fracture mode with the C/Dtr or material placed down during testing (alpha=.05). Light microscopy was used to identify the fracture mode.

Results. The mean biaxial flexural strength and reliability improved with the increase in C/Dtr when specimens were tested with the core material either up and down, and depended on the materials that were placed down during testing. The rates of delamination, Hertzian cone cracks, subcritical radial cracks, and number of fracture fragments partially depended on the C/Dtr and the materials that were placed down during testing.

Conclusion. The biaxial flexural strength, reliability, and fracture mode in bilayered structures of Y-TZP core and veneer ICR depend on both the C/Dtr and the material that was placed down during testing.

We cultivated human bladder smooth muscle cells (HBSMCs) under pressures of 0 or 200cm H2O pressure for 24 h, before using microarray technology to extract and analyze the different expressions of miRNAs and mRNAs in the two groups. We also predicted the target mRNA of the miDNA and performed functional forecasting. Changes in miRNA were identified by quantitative real-time polymerase chain reaction (qRT-PCR) after overexpressing miRNA by transfection. We used flow cytometry to examine HBSMC proliferation, and we used qRT-PCR and Western blot analyses to quantify the expression and activation of mRNAs and proteins. There were nine upregulated and four downregulated miRNAs involved in cell proliferation, including miR 4323, which was identified by qRT-PCR (p = 0.027). In addition, miR 4323 was shown to inhibit LYN (p = 0.031), decrease lyn kinase (p = 0.037), and promotes the phosphorylation of extracellular regulated protein kinases 1 and 2 (Erk1/2) (p = 0.004). Moreover, overexpression of miR 4323 activated the proliferation pathway regulated by Erk1/2. Then, miR 4323 was shown to stimulate the proliferation of HBSMCs, with the proliferation index improving from 30.84 +/- 4.57 to 52.13 +/- 3.41 (p = 0.001). In summary, when the miRNA miR 4323 was overexpressed under cyclic hydrodynamic pressure, LYN is decreased and the Erk1/2 signaling pathway is activated; in addition, miR 4323 is involved in HBSMC proliferation when under hydrodynamic pressure.

Background: Identifying the etiology of ischemic stroke is essential to acute management and secondary prevention. The value of liver function indicators in differentiating stroke subtypes remains to be evaluated. Methods: A total of 1333 acute ischemic stroke patients were included. Liver function indicators collected within 24 hours from stroke onset, including alanine aminotransferase, aspartate aminotransferase (AST), alkaline phosphatase, gamma-glutamyl transpeptidase (GGT), and bilirubin (BILI), were collapsed into quartiles (Q) and also dichotomized by Q1. Multivariate regression analysis was conducted to identify the independent association between liver function indicators and cardioembolic stroke (SCE). Area under the curve (AUC) of receiver operating characteristic analysis was conducted, and sensitivity (Sen), specificity (Spe), positive prospective value (PPV), and negative prospective value (NPV) were determined to evaluate the predictive value of liver function indicators for SCE. Results: AST, GGT, and BILI were associated with SCE. After adjustment, only AST was related to SCE independently. The incidence of SCE in the Q1 of AST, GGT, and BILI, particularly in the Q1 of AST, was quite low. The ability of AST, GGT, and BILI to identify SCE was poor, with low AUC, Sen, and PPV. The value of AST, GGT, and BILI in eliminating SCE from stroke subtypes was good, with high Spe and moderate NPV, and was enhanced after combining each liver function indicator. Conclusions: Results of present study demonstrated that AST, GGT, and BILI, particularly AST, had a potential to eliminate SCE from stroke subtypes, and the ability of eliminating SCE would be strengthened after combining each liver function indicator together.

Objective: Millions of children were exposed to major earthquake in China, with serious psychological and developmental consequences. To obtain accurate rate of post-disaster related disorder and identify predictors may help inform post-disaster rescue and rehabilitation efforts. The present longitudinal study explored correlations of demographic and socioeconomic characteristics of juvenile survivors of the Ya'an and Wenchuan earthquakes in China with their trajectories of post-disaster related disorder.

Methods: A total of 435 Chinese children and adolescents who survived the 2013 Ya'an earthquake were recruited from six primary, secondary and high schools in Baoxing County. All survivors were assessed at 12 months after the disaster, when a trained psychiatrist assessed mental health problems in a face-to-face structured interview, and 153 survivors were followed up at 30 months after the earthquake via telephone.

Results: The 12-month assessment indicated a post-traumatic stress disorder (PTSD) prevalence of 43.9% as well as depression (20.9%) or the criteria for both PTSD and depression (18.2%) and the other disorder (0.9%). The 30-month assessment indicated that 15.7% of subjects met the criteria for PTSD, 21.6% met the criteria for depression. No subjects met the criteria for other affective or anxiety disorders. Significant predictors of PTSD and depression were death in the family, previous earthquake experience, a poor parent child relationship and economic pressure or poverty.

Limitations: Clinical interview face to face is quite different from via telephone and the attrition rate in the longitudinal cohort is high, which would directly affect our results of the assessment.

Conclusions: PTSD and depression may be as prevalent and persistent in disaster victims in China as elsewhere, and high co-comorbidities remain poorly understood. Although many adolescents recover over time, some exhibit chronic, delayed-onset PTSD and depression, especially those with poor relationships with their parents or those living in precarious economic conditions. Family-based therapy may be needed to support child and adolescent trauma survivors in order to prevent mental illness. (C) 2016 Elsevier Inc. All rights reserved.

BACKGROUND: The para-Bombay phenotype often results from a silenced beta-D-galactoside 2-alpha-fucosyltransferase 1 (FUT1) gene (h/h) but an active FUT2 (Se/Se or Se/se) gene. We identified a para-Bombay phenotype with two novel mutations in the FUT1 gene and homozygous mutated FUT2 (se(357, 385) / se(357, 385)) genes.

STUDY DESIGN AND METHODS: Red blood cell phenotype was detected by using a standard serologic technique. The entire coding regions of the FUT1 and FUT2 genes were amplified and direct sequenced using genomic DNA.

RESULTS: No ABH substance was detected on the surface of the proband's red blood cells. Anti-A, anti-B, and anti-H were identified in serum. Genetic studies indicated that the proband's ABO genotyping was A102/O01 and that the FUT2 phenotype was se(357, 385) / se(357, 385). The sample was homozygous for two FUT1 mutations: c.958insG and c.961G> A.

CONCLUSION: Two novel FUT1 mutations have been identified in the proband's FUT1 gene. The insertion mutation in the FUT1 that caused a shift of the open reading frame and formed a termination codon early at Amino Acid Position 334 may be the main reason for H deficiency in this case.

Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy.

Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien-Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition.

Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n=2) and pancreatic neuroendocrine tumor (PNET) (n=1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450-540 minutes), the mean estimated blood loss was 266mL (range 100-400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8-24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life.

Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy.

alpha-Calcitonin gene-related peptide (alpha-CGRP) plays a significant pathophysiological role in bone development, metabolism and remodeling around dental implants. However, the half-life of alpha-CGRP in plasma is only 10 min, which affects its long-time application and an alternative approach should be developed to deliver alpha-CGRP over long periods of time. The aim of this study is to investigate whether a lentiviral alpha-CGRP overexpression vector system can express this target-gene longer at peri-implant sites, thus enhancing osseointegration. Animals were divided to the following groups: alpha-CGRP(-/-), alpha-CGRP(-/-) with lentivirus transfection and alpha-CGRP(+/+) mice. MS Spectrum imaging observations identified the successful transfection of alpha-CGRP around experimental implants inserted in the femurs at 5 days after injection. Histomorphometrical analysis indicated an increase of bone-implant contact (BIC) at 1-month healing in the transfection group. Moreover, real-time RT-PCR and western blot results of bone-related markers Runx2, Osterix, and BSP levels elevated in lentivirus-transfected mice at 21 days, compared to the untreated alpha-CGRP(-/-) mice. There was no significant difference between the transfection group and alpha-CGRP(+/+) group. Further alpha-CGRP protein detection confirmed the persistent expression of this transgene at 21 days post-operatively. These results suggest that this lentiviral vector system expresses alpha-CGRP in an effective, appropriate and sustained manner, which might have a potential application in enhancing titanium implant osseointegration. (C) 2016 Elsevier Inc. All rights reserved.

Epilepsy has been recognized as a brain network disorder. Therefore, functional MRI (fMRI)-based connectivity is an ideal technique for exploring the complex effects of epilepsy on the brain. Functional connectivity studies have provided insights into the physiopathogenesis of the epileptic network underlying focal epilepsies, genetic generalized epilepsy, and specific epileptic syndromes. An increasing number of studies have focused on the deleterious effects of epilepsy on other brain networks to help to explain cognitive deficits and psychiatric symptoms. Anti-epileptic treatment studies have yielded information about the side effects and the restoration of functional abnormalities after using the drug. Researchers who have examined predictors of surgical outcomes have suggested that there might be identifiable pre-surgical patterns of functional connectivity that are associated with a greater likelihood of positive cognitive or seizure outcomes. However, knowledge regarding the role of fMRI connectivity remains limited in clinical settings. Further validation through invasive investigations and follow-up studies is required for its reliable application in the clinical management of individual patients. (C) 2016 Published by Elsevier Ltd on behalf of British Epilepsy Association.

Objectives. The objectives of this study were to: (1) develop a bioactive multifunctional composite (BMC) via nanoparticles of amorphous calcium phosphate (NACP), 2-methacryloyloxyethyl phosphorylcholine (MPC), dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of silver (NAg); and (2) investigate the effects of combined BMC + poly (amido amine) (PAMAM) on remineralization of demineralized root dentin in a cyclic artificial saliva/lactic acid environment for the first time. Methods. Root dentin specimens were prepared and demineralized with 37% phosphoric acid for 15 s. Four groups were prepared: (1) root dentin control; (2) root dentin with BMC; (3) root dentin with PAMAM; (4) root dentin with BMC + PAMAM. Specimens were treated with a cyclic artificial saliva/lactic acid regimen for 21 days. Calcium (Ca) and phosphate (P) ion concentrations and acid neutralization were determined. The remineralized root dentin specimens were examined via hardness testing and scanning electron microscopy (SEM). Results. Mechanical properties of BMC were similar to commercial control composites (p = 0.913). BMC had excellent Ca and P ion release and acid-neutralization capability. BMC or PAMAM alone each achieved slight mineral regeneration in demineralized root dentin. The combined BMC + PAMAM induced the greatest root dentin remineralization, and increased the hardness of pre-demineralized root dentin to match that of healthy root dentin (p = 0.521). Significance. The excellent root dentin remineralization effects of BMC + PAMAM were demonstrated for the first time. BMC + PAMAM induced effective and complete root dentin remineralization in an acid challenge environment. The novel BMC + PAMAM method is promising for Class V and other restorations to remineralize and protect tooth structures.

Objective A genome-wide association study has identified several gene polymorphisms associated with loss of renal function. The effect of these variants on renal function in kidney transplant recipients receiving immunosuppressive treatment is unknown.

Materials and methods A cohort of 189 kidney transplant recipients and their living donors were recruited from West China Hospital of Sichuan University, on whom we assessed the association of five single nucleotide polymorphisms with renal function after kidney transplantation.

Results Glomerular filtration rate estimated by serum creatinine was significantly higher in recipients carrying allograft with the A allele at rs17319721 in SHROOM3 (shroom family member 3) than those in the group with the GG genotype from month 1 to month 6 after transplantation (P=0.020). Covariate adjustment analysis showed that the variant at rs17319721 in SHROOM3 was an independent risk factor for renal dysfunction after the first month after transplantation (P=0.022). The estimated glomerular filtration rate was the lowest in recipients with allograft carrying both the A allele at rs17319721 in SHROOM3 and the CC genotype at rs1045642 in ABCB1 (P<0.05).

Conclusion The genetic variants in SHROOM3 and ABCB1 in donors were associated closely with renal function after kidney transplantation. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

Epirubicin (EPI) is one of the most widely used anticarcinogens; however, serious side effects, including cardiomyopathy and congestive heart failure, limit its long-term administration. To overcome this problem, the HAIYPRH peptide ligand was used with EPI in the synthesis of a HAIYPRH-EPI conjugate. The anticancer activity and cellular uptake of the conjugate were measured and evaluated. The results of the present study indicated that the cytotoxicity of HAIYPRH-EPI was correlated with the expression of the cell surface transferrin receptor (TfR). The conjugate exerted high cytotoxicity and proapoptotic function when in an LN229 glioma cell line, which overexpresses surface TfR. It was hypothesized that transferrin (Tf) can promote cytotoxicity. Conversely, the conjugate exhibited very low cytotoxicity and proapoptotic function in a U87 glioma cell line, in which surface TfR expression was undetectable. In addition, fluorescence microscopy and flow cytometry methods were used to evaluate cellular uptake, and the results of these methods were consistent with the present hypotheses. The conjugate cellular uptake of the conjugate in LN229 cells was markedly higher compared with that in U87 cells, and it was hypothesized that Tf can enhance the uptake in LN229 cells. The cytotoxicity of HAIYPRH-EPI was dependent upon the expression of surface TfR. Considering that the majority of cancer cells have high rates of iron uptake and surface TfR is generally overexpressed on cancer cells, it was speculated by the authors that HAIYPRH-EPI may form part of an effective strategy for increasing the selectivity of EPI for cancer cells, as well as reducing its systemic toxicity. To confirm the hypothesis, the effects of HAIYPRH-EPI on non-cancerous cell lines were investigated. A future study will examine the side effects of HAIYPRH-EPI, using a suitable delivery system in an animal model.

The attenuated Japanese encephalitis virus (JEV) strain SA14-14-2 has been successfully utilized to prevent JEV infection; however, the attenuation determinants have not been fully elucidated. The envelope (E) protein of the attenuated JEV SA14-14-2 strain differs from that of the virulent parental SA14 strain at eight amino acid positions (E107, E138, E176, E177, E264, E279, E315, and E439). Here, we investigated the SA14-14-2-attenuation determinants by mutating E107, E138, E176, E177, and E279 in SA14-14-2 to their status in the parental virulent strain and tested the replication capacity, neurovirulence, neuroinvasiveness, and mortality associated with the mutated viruses in mice, as compared with those of JEV SA14-14-2 and SA14. Our findings indicated that revertant mutations at the E138 or E107 position significantly increased SA14-14-2 virulence, whereas other revertant mutations exhibited significant increases in neurovirulence only when combined with E138, E107, and other mutations. Revertant mutations at all eight positions in the E protein resulted in the highest degree of SA14-14-2 virulence, although this was still lower than that observed in SA14. These results demonstrated the critical role of the viral E protein in controlling JEV virulence and identified the amino acids at the E107 and E138 positions as the key determinants of SA14-14-2 neurovirulence.

Epileptic seizures, the most common symptom accompanying glioma, are closely associated with tumor growth and patient quality of life. However, the association between glioma and glioma-related epilepsy is poorly understood. In fact, findings related to the location of epileptogenicity have been inconsistent in previous studies. We investigated seizure foci in patients with glioma and the corresponding association between glioma-related epilepsy and the tumoral and peritumoral microenvironment. Clinical characteristics, extracellular electrophysiology, immunohistochemistry, and western blots were conducted on 12 patients with glioma; nine patients had histories of preoperative seizures while three did not. Samples from included patients were used to identify seizure foci and mTOR pathway status. Electrophysiological recordings were conducted on 36 samples (tumor, peritumoral, and normal brain tissues) from 12 patients. Interictal-like discharges (ILDs) were observed in seven of nine peritumoral tissues obtained from patients with glioma that had experienced perioperative seizures. No ILDs were observed in any other sample groups. Western blots and immunohistochemistry for mTOR pathway proteins (mTOR and S6k) suggested that the mTOR pathway was activated in peritumoral tissues of patients with seizure history, but inactivated in patients without seizure history. Our results suggest that mTOR pathway expression in peritumoral tissues is associated with tumor-related seizures, thus providing a potential target for therapeutics aimed at simultaneously controlling gliomas and seizures.

A series of 1H-thieno[2,3-c] chromen-4(2H)-one derivatives were synthesised through Knoevenagel condensation of substituted flavanones with thiazolidine-2,4-dione in ethanol in the presence of piperidine. The mechanism of the reaction was proposed. All synthesised compounds were characterised by IR, H-1 NMR, C-13 NMR, HRMS, and elemental analysis. The structure of 2-(3-chlorophenyl)1H- thieno[2,3-c] chromen-4(2H)-one was confirmed by a single crystal X-ray diffraction analysis. A preliminary antitumour screening showed that 2-(2-fluorophenyl)-1H-thieno [2,3-c] chromen-4(2H)-one had moderate to good activity against A549, BGC-823, HCT116 and MDA-MB-453 cancer cell lines, and 2-(3,4-dimethoxyphenyl)-1H-thieno[2,3-c] chromen-4(2H)-one displayed similar activity against these four kinds of cancer cells compared with the reference drug.

Interleukin-10 (IL-10)-producing B cells (B10 cells) play a critical role in the immune system balance by negatively regulating inflammatory responses. This study was conducted to determine the effect of local B10 cell induction on periodontal inflammation and bone loss in ligature-induced experimental periodontitis in vivo. Purified spleen B cells from C57BL/6J mice (8 to 10 weeks old) were cultured with CD40 ligand (CD40L) and the Toll-like receptor 9 (TLR9) agonist cytidinephosphate- guanosine oligodeoxynucleotide (CpG) to determine effective IL-10 induction in vitro. Silk ligatures (size 7-0) were tied around the mouse maxillary second molars on day 0, followed by the injection of CD40L and CpG into the palatal gingiva on days 3, 6, and 9. All the mice were sacrificed, and samples were collected on day 14. CD40L and CpG significantly increased the level of IL-10 production by B cells in vitro, although the frequencies of CD1(dhi) CD5 (+) and IL-10-producing (IL-10 (+)) CD45 (+) cells were decreased. IL-10 was predominantly produced by the CD1(dhi) CD5 (+) subpopulation of B cells. In vivo, both IL-10 mRNA expression and the number of IL-10 (+) CD45 (+) cells were significantly increased after gingival injection of CD40L and CpG. Periodontal bone loss was significantly decreased and the gingival expression of IL-1 (+), tumor necrosis factor alpha, and RANKL was significantly reduced. The number of multinucleated tartrate-resistant acid phosphatase-positive cells along the alveolar bone surface was significantly decreased after gingival injection of CD40L and CpG. This study indicates for the first time that the local induction of B10 cell activity could inhibit periodontal inflammation and bone loss.

Thoracoscopic intrathoracic esophagogastrostomy is a technically demanding operation; these technical requirements restrict the extensive application of minimally invasive Ivor Lewis esophagectomy. In an attempt to reduce the difficulty of this surgical procedure, we developed a modified anastomotic technique for thoracolaparoscopic Ivor Lewis esophagectomy. During the entirety of this modified approach, neither technically challenging operations such as intrathoracic suturing, or knotting, nor special instruments such as an OrVil system or a reversepuncture head are required. Between Octomber 2015 and January 2016, 15 consecutive patients with cancer in the distal third of the esophagus or the gastric cardia underwent this modified surgical procedure. The good short- term outcomes that were achieved suggest that the modified anastomotic technique is safe and feasible for thoracolaparoscopic Ivor Lewis esophagectomy.