Objective 　To evaluate the role of surgical resection on synchronous multiple pulmonary nodules identified difficultly in clinics. Methods 　The clinical data of 97 patients with synchronous multiple pulmonary nodules who received surgical resection between 2012 and 2019 in Hunan Cancer Hospital were retrospectively analyzed. There were 72 males and 25 females, aged 58.1卤9.0 years. Among these patients, there were 78 patients with ipsilateral and 19 patients with bilateral pulmonary nodules. Clinicopathological parameters between main nodules and secondary nodules were evaluated. Perioperative morbidity was also assessed. Results 　The operation was successfully completed on all patients for the ipsilateral and bilateral lesions. Totally, 71.1% of mian lesions was mostly removed by lobectomy, and the completion rate of video-assisted thoracoscopic surgery (VATS) was 69.1% (67/97); 80.4% of secondary lesions were mostly removed by wedge resection, and the completion rate of VATS was 71.1% (69/97). The incidence of grade 3 or higher complications after unilateral or bilateral surgery was 12.8% and 5.3%, respectively. Postoperative pathology confirmed that the main lesions were malignant in 65 patients (67.0%), mainly adenocarcinoma (63.1%), of which 43.1%were in the stage Ⅰ; 32 patients were benign, mainly tuberculoma (56.3%). There were 29 patients of malignant secondary lesions, 67 benign, and 1 both benign and malignant; the pathological agreement rate of primary and secondary lesions was 54.6% (lung cancer metastases in the lung and all the benign). When the primary lesion was malignant with its diameters of <3 cm, 3-<5 cm, 5-7 cm, >7 cm, the metastatic rate of secondary lesions was 42.5%, 15.8%, 20.0%, 0, respectively. When the primary lesion was malignant with lymph node metastasis, the probability of the secondary lesion being a metastatic tumor was higher than that without lymph node metastasis (46.7% vs. 30.0%, P>0.05). When the primary lesion was malignant and the primary and secondary lesions were located in the same lobe, the secondary lesions were more likely to metastasize (54.5%), while when they were located on different lobes on the same side or different sides, the secondary lesions were more likely to be benign (58.1%, 72.7%), and the possibility of metastasis was small ( 32.6%, 9.1%). When the primary lesion was benign and clinical differential diagnosis was difficult, the secondary lesion was benign. Conclusion    For synchronous multiple pulmonary nodules, the diameter of the primary lesion is large, the metastatic rate of secondary lesions tends to decrease. In ipsilateral synchronous multiple pulmonary nodules, especially with node metastasis, the risk of metastatic nodule increases. Bilateral surgical resection does not significantly increase the perioperative morbidity.

Objective To evaluate the learning curve of video-assisted thoracoscopic sleeve lobectomy in patients with central lung cancer.Methods A total of 86 consecutive patients with resected central lung cancer in the second department of thoracic surgery of Hunan Cancer Hospital between Apirl 2016 and July 2018 were retrospectively enrolled.Video-assisted tho-racoscopic tracheoplasty with sleeve resection and lobectomy were performed in 56 patients, video-assisted thoracoscopic tra-cheoplasty with wedge resection and lobectomy were performed in 20 patients, and 10 patients transit to thoracotomy.Surgical parameter of patients who underwent video-assisted thoracoscopic sleeve lobectomy were investigated to assess the learning curve, including operation duration, bleeding volume, amount of lymph nodes examined(medianstinal and intrapulmonary). Lowess smoothing method was performed to fit curve to evaluate the variation tendency of surgical parameters .Cut-off point, as well as the confidence interval, were identified using piecewise regression analysis.Results Surgical duration tend to be stable (almost 200 min) when the cumulative case amount of video-assisted thoracoscopic sleeve lobectomy reach 40.Surgical bleed-ing tend to be stable( almost 200 ml) when the cumulative case amount of video-assisted thoracoscopic sleeve lobectomy reach 20.There is no significant correlation between the amount of lymph node harvest and surgical volume .Conclusion The cut-off point for video-assisted thoracoscopic sleeve lobectomy is approximately 40 cases.

In recent years, immune therapy for the treatment of cancer has made remarkable progress. The monoclonal antibodies of programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) have shown considerable responses and good tolerance in the treatment of non-small cell lung cancer (NSCLC). In this review, we summarized the current clinical status and future direction of PD-1/PD-L1 in NSCLC.

Objective To observe the effect of yin-yang acupuncture in association with respiratory reducing-reinforcing needling manipulations on the gait cycle in patients with post-stroke hemiplegia. Methods Sixty patients with ischemic stroke were randomized into a treatment group and a control group, 30 each. The control group was intervened by conventional medication, while based on which the treatment group was additionally given yin-yang acupuncture in association with respiratory reducing-reinforcing needling manipulations. The kinematic time parameters were evaluated before intervention and after 28-day treatment. Results After intervention, the stance phase of the affected side and the healthy side, ambulation cycle, swinging phase of the affected side and the healthy side, and the stance phase of both limbs in the treatment group were significantly different from that in the control group(P＜0.05). Conclusion Yin-yang acupuncture in association with respiration reducing-reinforcing needling manipulations can effectively improve the gait cycle and ambulation function of the patients with post-stroke hemiplegia.

OBJECTIVETo compare the shear bond strength(SBS) of cast Co-Cr alloys and selective laser melting(SLM) Co-Cr alloys with those of dental porcelain.

METHODSA dental porcelain (Vita) was applied on cast and SLM Co-Cr alloy specimens (n = 10). SBS test was conducted, and fracture mode analysis was determined. Student's t-test by SPSS 13.0 software was employed to analyze the data.

RESULTSThe SLM Co-Cr alloy specimens had lower SBS values than the cast Co-Cr alloy specimens (P > 0.05). The metal-porcelain bond strength value of the cast group was (33.11 +/- 4.98) MPa, and that of the SLM group was (30.94 +/- 5.98) MPa. The specimens in both test groups exhibited mixed failure.

CONCLUSIONThe metal-porcelain system processed by SLM exhibit a bond strength that is similar to that of the cast group. This system also display a high precision.

Objective: To observe the effect of reinforcing and reducing manipulation by breathing on yin and yang meridian points for motor function of knee joints in patients with ischemic stroke. ＜br> Methods: A total of 60 ischemic stroke cases were randomly allocated into an observation group and a control group, 30 in each group. Other than basic and conventional rehabilitation therapies, cases in the observation group were treated with reinforcing and reducing manipulation on yin and yang meridians points for a period of 8 weeks; whereas cases in the control group only received the same basic and conventional rehabilitation therapy as that in the observation group. Then the knee joint energy, support moment and shaking moment were compared between the two groups before treatment, and after 4-week and 8-week treatment respectively. ＜br> Results: Before treatment, there were no between-group significant differences in knee joint energy, support moment and shaking moment (all P>0.05). After treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved (P＜0.05). After 8 weeks of treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved than that of 4-week treatment (P＜0.05). In addition, there were between-group statistical significances in comparing knee joint energy, support moment and shaking moment after 4 and 8 weeks of treatment (P＜0.05). ＜br> Conclusion: Reinforcing and reducing manipulation by breathing on yin and yang meridian points can increase the knee joint support and shaking force and moment in stroke patients and improve their walking ability.

Objective To observe the change of extension-flexion arc of ankle in hemiplegia due to ischemic stroke after yin-yang acupuncture associated with respiration needling manipulations.Method Sixty ischemic stroke patients were divided into a control group and a treatment group by random number table, 30 in each group. The control group was intervened by basic treatment, while the treatment group was by yin-yang acupuncture associated with respiration needling manipulations in addition to the basic treatment. Before intervention and 28 d after intervention, the Lokomat gait analysis system was adopted to observe the change of the extension-flexion arc of ankle respectively under motorial and stationary states.Result When heel was grounded, the flexion angle, the maximum extension-flexion arc value, and motility of ankle joint of the treatment group were statistically different from those of the control group (P＜0.05).Conclusion Yin-yang acupuncture associated with respiration needling manipulations can effectively improve the movement and the walk function of hemiplegia due to ischemic stroke.

OBJECTIVE ToobservetheprotectiveeffectandmechanismofCompoundGinkgo biloba(CGB)againstalcohol-inducedliverinjury.METHODS MiceweregivenCGB0.125,0.25and 0.75 g·kg -1 ,Ginkgo biloba extract (GBE)0.1 25 g·kg -1 and bifendate(Bif)0.1 5 g·kg -1 for 8 weeks, respectively.At the end of 4th week the mice were given wine by gavage (56% V/V,0.01 L·kg -1 ), and (56% V/V,0.016 L·kg -1 )at the end of the 8th week.The serum was obtained to measure alanine transaminase (GPT),aspartate aminotransaminase (GOT),mitochondrial aspartate aminotransferase (mGOT)and tumor necrosis factor-α(TNF-α).Liver histopathology was revealed by HE staining.The protein expression of cytochrome P450 (CYP)2E1 ,NF-E2-related factor 2 (Nrf2)and TNF-αin the liverwasanalyzedbyWesternblotting.RESULTS Comparedwithnormalcontrolgroup,theactivitiesof GOT and mGOT were increased in model group (P<0.01 ).Compared with model group,CGB 0.25 and 0.75 g·kg -1 groups and Bif 0.1 5 g·kg -1 group significantly decreased the activity of GOT and mGOT in serum (P<0.05,P<0.01 ),while there was no significant difference between these groups in serum GPT activity (P>0.05).Fatty degeneration and neutrophil infiltration were significantly ameliora-ted in CGB 0.25 and 0.75 g·kg -1 groups.Preliminary mechanism research showed CGB not only increased the protein expression of Nrf2 with a positive dose-effect relationship (r=0.942,P<0.01 ), but reduced the protein expression of hepatic CYP2 E1 and the level of TNF-αin hepatic tissue with a negative dose-effect relationship (r=-0.987,P<0.05;r=-0.940,P<0.05).In addition.The level ofTNF-αwasalsosignificantlydecreasedintheserum(P<0.05,P<0.01).CONCLUSION CGB may protect the liver fro m acute alcoholic injury and the mechanis m may be that it increases the protein expression of Nrf2,restrains the protein expression of hepatic CYP2E1 and TNF-αand reduces the TNF-αlevel in the serum.

This study was aimed to investigate the therapeutic effect of yin-yang meridian acupuncture by reinforc-ing-reducing with patient's respiration on lower limb function among post-stroke patients. A total of 100 stroke pa-tients were enrolled and randomly divided into two groups, which were the control group and the treatment group, with 50 cases in each group. Basic treatment was given in the control group with no related rehabilitation treatment. Basic treatment was given in the treatment group combined with yin-yang meridian acupuncture by reinforcing-re-ducing with patient's respiration. All patients were assessed with kinematics time parameters at the beginning of the treatment and 28 days after the treatment on muscle strength, muscular tension and the change of joint movement of hip joint and knee joint among patients. The results showed that compared with the control group, there was significant difference in treatment group on muscle strength, muscular tension and the change of joint movement of the hip joint and knee joint 28 days after the treatment (P < 0.01). It was concluded that yin-yang meridian acupuncture by reinforcing-reducing with patient's respiration can effectively increase the muscle strength, reduce muscular tension, and improve the change of joint movement, in order to increase the lower limb movement func-tion among stroke patients.

Objective To compare the shear bond strength(SBS) of cast Co-Cr alloys and selective laser melting(SLM) Co-Cr alloys with those of dental porcelain. Methods A dental porcelain (Vita) was applied on cast and SLM Co-Cr alloy specimens(n=10). SBS test was conducted, and fracture mode analysis was determined. Student’s t-test by SPSS 13.0 soft- ware was employed to analyze the data. Results The SLM Co-Cr alloy specimens had lower SBS values than the cast Co-Cr alloy specimens (P>0.05). The metal-porcelain bond strength value of the cast group was (33.11±4.98) MPa, and that of the SLM group was (30.94±5.98) MPa. The specimens in both test groups exhibited mixed failure. Conclusion The metal-porcelain system processed by SLM exhibit a bond strength that is similar to that of the cast group. This system also display a high precision.