Objective To investigate the formation mechanism of string beads sign in peripheral small cell lung cancer (SCLC) and evaluate the significance of it in differential diagnosis among SCLC,peripheral lung adenocarcinoma and peripheral lung squa-mous cell carcinoma.Methods 78 cases of SCLC,69 cases of peripheral lung adenocarcinoma and 33 cases of peripheral lung squa-mous cell carcinoma,confirmed pathologically were included in this study.The positive rates of string beads sign,mediastinal lymph node metastasis and mediastinal lymph nodes larger than primary lung lesions were calculated and analyzed in these three groups.Results 10 out of SCLC cases (12.8%)have string beads sign,in which all mediastinal lymph nodes were larger than lung lesions.Mediasti-nal lymph node metastases were observed in 63(80.8%)of 78 cases,and 42 (53.8%)cases had larger mediastinal lymph nodes than lung lesions.No string beads sign was observed in patients with peripheral solid lung adenocarcinomas,but 25 of 69 cases (36.2%) have mediastinal lymph node metastasis and 2 cases (2.9%)had larger mediastinal lymph nodes than lung lesions.13 cases(39.4%) of 33 patients with peripheral lung squamous cell carcinomas had mediastinal lymph node metastasis,and 6 cases (16.7%)had larger mediastinal lymph nodes than lung lesions.The statistical results showed the positive rate of string beads sign was not significantly different between peripheral SCLC group and peripheral lung squamous cell carcinoma group,but that of mediastinal lymph node and larger mediastinal lymph nodes than lung lesions were statistically different among these three groups.Conclusion To some extent, string beads sign on CT could reflect the biologic character of SCLC.It played an important role in differential diagnosis of peripheral SCLC,peripheral lung adenocarcinoma and periph-eral lung squamous cell carcinoma,but it should be combined with mediastinal lymph node size.

Objective To assess the therapeutic effect of imaging-guided pulsed-radiofrequency stimulation of medial branch of lumbar spinal nerve in treating lumbar facet joint syndrome. Methods A total of 48 patients with clinically-diagnosed lumbar facet syndrome were randomly divided into group A (anti-inflammatory and analgesic group, n=26) and group B (pulsed-radiofrequency group, n=22). The patients of group A received oral meloxicam dispersible tablets , while the patients of group B were treated with DSA-guided pulsed-radiofrequency stimulation of dorsal medial branch of lumbar spinal nerve corresponding to the diseased lumbar facet. Using visual analogue scale (VSA) the severity of pain at the time of admission, discharge and 6 month after discharge was separately evaluated , and the therapeutic effect was assessed based on the improvement of VSA score. Results The VAS scores of group A and group B at the time of discharge and 6 months after discharge were significantly lower than those determined at the time of admission (P<0.01). At the time of discharge, the VSA score of group B was significantly lower than that of group A (P<0.05). Six months after discharge, the VAS score of group B was significantly lower than that of group A (P<0.05). The total effective rates at 6 months after di scharge of group A and group B were 46.5% and 87.6% respectively;the excellent effect rates of group A and group B were 26.4% and 76.2% respectively. Both the total effective rate and excellent effect rate of group B were significantly higher than those of group A (P<0.01). Conclusion Imaging-guided pulsed-radiofrequency stimulation of dorsal medial branch of lumbar spinal nerve can effectively relieve chronic lower back pain caused by lumbar facet joint syndrome , and its therapeutic effect is superior to oral anti-inflammatory and analgesic medication.

Objective To evaluate the efficacy of fluoroscopy-guided intercostal nerve radiofrequency coagulation in treating postherpetic neuralgia. Methods A total of 40 patients with postherpetic neuralgia (VAS ≥ 4.0) were randomly and equally divided into two groups. Patients in group A (control group) were treated with gabapentin, amitriptyline and oxycodone, while patients in group B (study group) were treated with intercostal nerve radiofrequency coagulation together with the same medicines used in group A. VAS score and oxycodone dosage were determined before the treatment and one, 7, 30, 90 and 180 days after the treatment. The side effects and complications during the treatment were recorded. The results were analyzed and compared between the two groups. Results The VAS scores of patients in group A and group B before the treatment and one, 7, 30, 90 and 180 days after the treatment were (8.2 ± 1.6) vs (8.1 ± 1.1), (6.1 ± 1.7) vs (4.5 ± 1.2), (4.2 ± 1.4) vs (2.7 ± 1.4), (3.6 ± 1.1) vs (2.3 ± 1.3), (3.3 ± 1.3) vs (1.6 ± 0.9), and (2.7 ± 1.2) vs (1.3 ± 1.0), respectively (P<0.05 in all), while the oxycodone dosages in group A and group B were (28.5 ± 5.4) mg vs (28.7 ± 5.8) mg, (35.2 ± 8.5) mg vs (17.3 ± 5.4) mg, (1.6 ± 8.5) mg vs (12.3 ± 3.8) mg, (18.6 ± 4.4) mg vs (5.1 ± 1.7) mg, (10.4 ± 2.3) mg vs (5.6 ± 1.1) mg, and (8.4 ± 1.6)mg vs (4.0 ± 1.1)mg, respectively (P < 0.05 in all). The drug side effects in group B were obviously very mild, and no serious complications occurred. Conclusion Fluoroscopy-guided intercostal nerve radiofrequency coagulation can rapidly relieve the pain in patients with postherpetic neuralgia, and reduce the oxycodone dosage and the occurrence of drug-related side effects as well. Therefore this technique is a safe and effective method for postherpetic neuralgia.

Objective To study the effects of metformin on proliferation and apoptosis of oral squamous cells so as to create a new path for the treatment of oral carcinoma.Methods CAL27 cells were treated with different dosage of metformin(5,10,20 mmol/L)for 24,48, and 72 hours.The number of apoptosis was detected by flow cytometry and TUNEL.The autophagic vacuole was detected by immunofluores-cence.The expression of hallmark of apoptosis and autophagy was detected by Western blot.Results Metformin could induce apoptosis in CAL27 cells.The CL-PARP and Bcl-2 expression significantly increased.In line with the apoptosis,metformin can trigger autophagy in CAL27 cells.The expression of LC3,Beclin-1 and GFP-LC3 positive autophagosomes were increased by metformin.Metformin inhibit the expression of STAT3 and mTOR signaling pathways at the same time might be the possible reasons of the autophagy.And inhibited autophagy could en-hance metformin induced Caspase-3 activity in CAL27 cells.Conclusion Inactivation of STAT3 and mTOR pathway contributes to metform-in-induced autophagy.Inhibited autophagy could enhance metformin induced apoptosis in oral squamous cell carcinoma.

Objective To discuss the blood flow charateristics of normal Couinaud’s hepatic segments by using whole-liver perfu-sion with multi-slice spiral computed tomography (MSCT).Methods 73 patients underwent whole-liver perfusion enhanced CT scans for detection of gastric or pancreas cancer,and some were excluded including metastatic liver tumors in 7,multiple liver cysts (>3 cm in diameter)in 6,cirrhosis in 6,liver operation or splenecormy in 3,intra-hepatic bile duct dilation in 1,and excessive motion artifacts in 4.The final 46 patients with normal liver were included,and the perfusion parameters of liver segments were measured for estimating blood-dynamics condition.Results The hepatic arterial perfusion (HAP)in segment 3 was significantly higher than that in segment 6,7 and 8 (P <0.05),and the HAP in segment 4 was significantly higher than that in segment 7 (P <0.05).The hepatic perfusion index (HPI)in segment 3 was significantly higher than that in segment 7 (P <0.05).All normal liver were classi-fied into two groups (group A:<60 years,group B:≥60 years),and no significant correlation between age groups was found.How-ever,the perfusion parameter values in group A were higher than those in group B.No significant correlation was found between gen-ders.Conclusion Our results suggest that differences exist in normal hepatic parenchyma between liver segments.MSCT whole-liver perfusion imaging can more comprehensively response hemodynamic changes in liver,and provids the imaging basis for clinical evaluation of liver disease.

Objective To observe the effect of spleen-strengthening and kidney-reinforcing method on leukopenia in patients with malignant tumor after chemotherapy.Methods Seventy-one patients with malignant tumor were randomly allocated to Group A(n=37) and Group B (n=34).Group A was treated with spleen-strengthening and kidney-reinforcing herbal medicine and chemotherapy and Group B with chemotherapy only. The treatment course lasted 28 days.Blood routine examination was carried out before chemotherapy and on 7 th,9 th,12 th,15 th,18 th and 21 st day of chemotherapy.Results In Group A,5 cases of leukopenia were found, 3 in degree Ⅰ, 1 in degree Ⅱ and 1 in degree Ⅲ,the incidence being 13.5%; In Group B,25 cases of leukopenia were found, 3 in degree Ⅰ,13 in degree Ⅱ,8 in degree Ⅲ and 1 in degree Ⅳ, the incidence being 73.5%. There was significant difference between the two groups (P

PBL is a new teaching method.Applying it to the teching of distribution of bacterias can fully display students'subjective initiative and have good teaching effect ant at the same time build the new model of PBL in medical education.

Objective To study the distance of MRI in the practice of correct diagnosed meningioma.Methods 152 cases which have been diagnosed meningioma from MRI scan compared to operation and pathology.16 cases which do not fit the diagnosis from them were analysed.Results There were 10 cases which were misdiagnosed other tumour(6.5%).Other tumour misdiagnosed meningioma were 6 cases(4%).The general misdiagnostic rate was 10.5%.Conclusion Because of complexity in histological structural,equipment function and scan technology,it is inevitable to misdiagnose.If we can pay more attention to the typical character and study the plain film and medical history taking carefully,we could increase correct diagnostic rate of meningioma.

Objective To evaluate the clinical value of microvascular anastomotic devices in free anterolateral thigh flap in the recon-struction of oral carcinoma defects.Methods From September 2013 to September 2014,52 patients with oral cancer were treated by func-tional neck cleaning,primary tumors resection,and free anterolateral thigh flap in the reconstruction.Of which 27 patients received free of femoral anterolateral flap to repair veins by using microsurgical line end to end anastomosis.And 25 pieces of microvascular anastomotic ad-vices were applied in 25 patients with oral carcinoma defects.The length of anastomosis time,flap survival rate,and complications were recor-ded.Results In 52 patients,microvascular anastomotic devices were applied in 25 veins with shorter anastomosis time,(6.3 ±1.9)min vs. (12.3 ±1.4)min,and the difference was significant(P =0.001).The flap survival rate and vascular anastomosis patency rate was 100%.No intra-and post-operative complications such as blood leak,stapling,excessive tension and tear,thrombosis in flap vein crisis associated with microvascular anastomotic devices were observed.Twenty-seven patients with 40 root vein received manual microsurgical anastomosis,2 of them showed vein crisis.Conclusion The microvascular anastomotic devices used in repairing the soft tissue defects by anterolateral thigh flap with venous anastomosis for patients of oral cancer after surgery has the advantage of higher quality,shorter time and less complications.

Objective To explore detection value of vacuum sealing drainage in osteomyelitis of sternum after cardio-thoracic surgery operation.Methods 132 cases of osteomyelitis of sternum after cardio-thoracic surgery operation were randomly divided into two groups(research group and control group).The research group had 72 cases)and the control group had 60 cases.The control group was treated with conventional treatment.The research group was treated with vacuum sealing drainage.The average healing time and clinical therapeutic effect of the two groups were observed.Results The patients'age and the sternum of osteomyelitis was significantly related,with OR=1.153 and P＜0.05.After treatment,the average healing time of the research group was(3.1±0.8)months.The average healing time of the control group was(7.2±1.5)months.The average healing time of the two groups had significant difference(P＜0.05).Conclusion Vacuum sealing drainage in osteomyelitis of sternum after cardio-thoracic surgery operation has sure curative effect.It can change chronic wounds for acute tissue effectively,shorten the healing time.It has high application value in the first phase of treatment and the second phase of repair.