Purpose:To investigate the relationship between involved extent of lymph node parenchyma and prognosis of patients with stageⅢ non-small-cell lung cancer (NSCLC) and define the appropriate surgical indications for the patients. Methods:From 1988 to 1998,one hundred and sixteen patients with NSCLC underwent systematic lymph node dissection and were diagnosed to have metastasis in mediastinal lymph node (N_(2) disease), whose clinical data were reviewed. According to the clinical and pathologic characteristics of the involved mediastinal lymph node, the patients were divided into subgroups. Survival rates were calculated and survival curves were prepared by Kaplan-Meier method. Survival differences among the subgroups were compared by Log-Rank test. Results:Involved extent of lymph node parenchyma had an important effect on the prognosis. In N_(2) disease with extra-capsular metastasis and intact capsule, 5-year survival rates were 9.8% and 18.8%, respectively. The survival difference between extra-capsular metastasis subgroup and inner-capsular metastasis subgroup was of statistical significance (P

Purpose:To explore the rational operative approach in patients with carcinoma of the middle third of the esophagus by T and N status as determined by preoperative CT scan. Methods:87 cases with carcinoma of the middle third of the esophagus chosen for the operative approach by CT findings entered the observational group, 118 cases with carcinoma of the middle third of the esophagus who were not scanned by CT were put into the control group. The observational group adopted different operative approaches by the relationship between the primary tumour and the aorta,and the relationship between the primary tumour and the azygos vein,and by the metastasis of regional lymph nodes. The operative approaches were chosen as follows:if the aorta was not involved, the operative approaches were chosen by the metastastatic status of the regional lymph nodes; left thoracoabdominal approaches were chosen,if the aorta was involved,and Ivor-Lewis operation was involved if the azygos vein was involved.The control group adopted the Ivor-Lewis operation. The rate of resection between two groups and the difference in positivity rates of the resected regional lymph node were analysed by chi-square test and T test. Results:Sensitivity of N staging by CT scan was 74.7%(65/87), and specificity of N staging was 60%(39/65). Sensitivity of diagnosis of the aorta involved by tumour by CT scan was 21.8%(19/87), and specificity was (26.3%)(5/19). The rate of resection in the observational group was 92%, and the rate of resection in the control group was'81.4%. Both were markedly different,P

BACKGROUND:Improper angle of prosthesis placement often induces acetabular cup impact, and limits the scope of activity of artificial hip joint, and cannot meet the requirement of daily life. At present, the angle of acetabular cup instal ation remains controversial during total hip arthroplasty. Moreover, there is lack of targeted guide for the acetabular cup instal ation during hip arthroplasty with different head-neck ratios. OBJECTIVE:To explore the safe range of the artificial acetabular cup instal ation angle for different head-neck ratios. METHODS:In accordance with the calculation formula of range of internal rotation and external rotation, abduction and adduction, flexion and extension after total hip replacement, interpretation of dynamical variety law of acetabular abduction and anteversion, and deriving inequalities depending on Widmer’s standard of artificial hip joint normal activities range:(1) external rotation range was at least 40°, and internal rotation range was at least 80°. (2) Abduction range was at least 50°, and adduction range was at least 50°. (3) Anteflexion range was at least 130°, and extension range was at least 40°. The safety scope of artificial hip joint instal ation angle at different head-neck ratios was determined by solving the above three groups of inequality. RESULTS AND CONCLUSION:The safe range of the artificial acetabular cup instal ation angle for different head-neck ratios was different. To meet the normal hip joint activities, the head-neck ratios of artificial hip should be greater than 22/12. Artificial hip joint activities gradual y increase with the enlargement of head neck ratios. With enlarging the head-neck ratios, the acetabular cup instal ation safety angle scope of abduction and anteversin gradual y increases and the extreme of abduction increases gradual y, then with anteversion increasing gradual y, the abduction upper extreme of the security scope gradual y decrease and lower extreme of the security scope gradual y increase, tending to 45° symmetrical y. When anteversion is the biggest, the abduction should be 45°.

BACKGROUND:Long-term use of corticosteroids (hereinafter referred to as hormone) after renal transplantation could obviously lead to adverse reactions. Immunosuppressive regimen with less and no hormone has been a hot focus in the study of renal transplantation al over the world. However, reduction or withdrawal of hormones has a certain risk. At present, there is no unified scheme. Because urine protein can be immediately detected after tubular injury, to monitor urine protein can find the renal dysfunction after transplantation in recipients undergoing renal transplantation, which can gain time for clinical therapy. OBJECTIVE:To discuss the influence of hormone (prednisone) removal on the occurrence of urine protein in recipients undergoing renal transplantation. METHODS:A total of 35 recipients undergoing renal transplantation after removal of prednisone received immunosuppressive regimen of cyclosporine A or tacrolimus+mycophenolate mofetil bivalent. Initial dose of prednisone was 30 mg/d, and then gradual y reduced by 5 mg per week, and withdrawn at 1 month after renal transplantation. There were 16 cases in cyclosporine A group and 19 cases in tacrolimus group. Urine protein was measured and quantified at 3, 6, 12 and 24 months after renal transplantation and 3, 6 and 12 months after addition of prednisone in both groups. Simultaneously, serum creatinine, fasting glucose, body mass increases, the rate of acute rejection, infection, patient/graft survival at 2 years after renal transplantation and urine protein at 24 hours before and after adding hormone were recorded. RESULTS AND CONCLUSION:For the two groups, urineα1-microglobulin started to rise after 6 months of removal of prednisone. Urinary microalbumin, urinaryα1-microglobulin, and urinary transferrin ascended obviously at 12 months. Urinary protein was positive in five cases of cyclosporine A group and in three cases of tacrolimus group. At 24 months, urinary microalbumin, urinaryα1-microglobulin, urinary transferrin and urinary IgG ascended obviously. Urinary protein was positive in cyclosporine A group with 11 cases and in tacrolimus group with 10 cases. 24-hour urinary protein quantity was more than 1 g in every case. On this base, we made the patients to take more prednisone for 6 months, so urineα1-microglobulin and urinary microalbumin began to descend. Each group had one case of positive urinary protein turning to negative. Twelve months after the adjustment of the prednisone, urinary microalbumin, urinaryα1-microglobulin, and urinary transferrin descended respectively. Positive urinary protein turned into negative:in cyclosporine A group with two cases and in tacrolimus group with three cases. 24-hour urinary protein quantity was around 0.7 g. Two years after renal transplantation, serum creatinine and acute rejection rates were higher in the cyclosporine A group than in the tacrolimus group (P<0.05). No significant difference in fasting glucose, body mass increase, infections, and patient/graft survival was detectable between both groups. Results suggested that removal of prednisone greatly affected urine protein in recipients undergoing renal transplantation. In particular, at 2 years after renal transplantation, urinary microalbumin, urinaryα1-microglobulin, urinary transferrin and urinary IgG ascended obviously, and the security needs further research.

Objective To observe the efficacy and safety of high-dose amiodarone administered by continuously intravenous infusion for cardioversion of paroxysmal atrial fibrillation.Methods From 2008 to 2010,109 patients suffered from paroxysmal atrial fibrillation were treated with high-dose arniodarone (125 mg/h) administered by continuously intravenous infusion.Before cardioversion,patients were treated with low molecular weight heparin anticoagulant therapy,Laboratory tests on FT3,FT4,TSH,serum ions,etc,and coloured Doppler ultrasound imaging of heart,and ECG and blood pressure monitoring were carried out.Amiodarone hydrochloride injectio of 150 mg was mixed with sodium chloride 50 mL homogeneously,and then infused continuously by micro-pump in a rate of 41 mL/h until resume of sinus rhythm or infusion was kept up to 24 h.After successful cardioversion,as appropriate,the intravenous amiodarone was maintained in a rate of 0.5-1.0 mg/min for 6-12 h joined with oral amiodarone dosing,and the total dose was limited up to 3000 mg.Results A cohort of 104 (95.4％) patients had the restoration of sinus rhythm after cardioversion.The mean dose of amiodarone for cardioversion was (774.52 t 700.53) mg,and time required for cardioversion was (6.3 ± 5.55) hours.Conclusions The patients with paroxysmal atrial fibrillation are given high-dose amiodarone (125 mg/h) continuously intravenous infusion therapy and have high cardioversion success rate,less complications and side effects,as well as other advantages at the basic hospital.The method above has broad application prospects.

Objective To evaluate the effectiveness of free highly active antiretroviral therapy (HAART) in adult infected with human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) patients in Dehong area. Methods Clinical data of 1039 adult HIV/AIDS patients from five counties/cities in Dehong area who initiated HAART during the period from July 1st 2004 to June 30th 2008 were retrospectively analyzed to examine their virological and immunological responses to HAART. Data were analyzed by Chi-squared test or F test. Results Among the 1039 HIV/AIDS cases, 611 were males and 428 were females. The mean age was (37.0±9.9) years and the mean treatment duration was (22. 41 ± 12. 69) months. Complete viral suppression (HIV viral load＜50 copy/mL) was achieved in 781 cases (75. 17%). The percentage of patients achieving complete viral suppression rates were 76.95%, 76.49%, 70.65% and 77. 73% in patients treated for 6-12,13-24, 25-36 and more than 37 months, respectively (x2=8.646, P=0.194). The meanCD4+ T cell counts were (164.93±118.05) × 106/L at baseline, and (330.85±201.73) × 106/L, (356.24±205.49) × 106/L, (434.53±250.65) × 106/L and (396.31±202.62) × 106/L in patients treated for 6- 12, 13-24, 25-36 and more than 37 months, respectively. CD4- T cell counts were significantly different in patients treated for 6-12 and 13-24 months (F= 19. 423 , P＜0. 01). Successful immune reconstitution was achieved in 927 ( 90.88 % ) cases. Seven hundred and seventeen (70.29% ) cases achieved both virological suppression and immunological reconstitution with HAART, whereas 40 cases (3. 92%) failed to achieve both virological and immunological responses. Conclusion HIV/AIDS patients in Dehong area show good virological and immunological responses to HAART.

Objective To analyze the effect of long-term anti-viral treatment in children with acquired immune deficiency syndrome (AIDS) and investigate the factors affecting the treatment efficacy and growth and development of the children, so as to provide reference for improving the efficacy of antiviral drugs.Methods Children with AIDS receiving anti-retroviral treatment during 2004 to 2016 were retrospectively enrolled.The height, weight and CD4+ T cell counts were recorded every half year and the measurement of HIV RNA load was recorded on an annual basis.The CD4+ T cell counts and viral inhibition rates for the children who were under the treatment in the first year, 1~<5 years, 5~<10 years, and ≥10 years were compared.And their growth and development were also assessed.Treatment efficacy and growth and development of the children were compared between those who raised by social organization and by family.Children who raised by family were further divided into two groups: high-income and low-income groups.All categorical data were analyzed using chi-square test and those non-normal distribution were compared by rank-sumtest.Results After comparison between the children who have received anti-virus treatment for 1 to 5 years (including 5 year) and those for 5 to 10 year (including 10 years), the baseline CD4+ T cell counts were 436.5(265, 728)cells/μL and 334 (102, 535)cells/μL, respectively with the statistically significant difference (Z=-2.619, P<0.01).The last measured CD4+ T cell counts were 779 (622, 1 024)cells/μL and 720 (640, 977)cells/μL, respectively with no statistical significance (Z=-0.708, P>0.05);and viral inhibition rates were 92.9% and 97.6%, respectively with no statistical significance (χ2=1.071, P>0.05).The viral inhibition rate for the children receiving the treatment for 1 year was 85.7%, while that for whose treatment lasted for more than 10 years was 100.0%.A total of 5 cases developed drug-resistance (2 cases treated for 1 to 5 years and 3 cases for 5 to 10 years), and the virus replication was completely inhibited after switching to Lopinavir/ritonavir (LPV/r).The drug compliance was more than 95.0%.64.8% of children met the standard height, while 68.5% met the standard body mass.The baseline and last measured CD4+ T cell counts showed no significant differences between family-raised and social organization-raised children (Z=-1.159 and -0.523, respectively, both P>0.05).The children from high-income families had no significant differences compared with those from low-income ones in terms of the baseline and last measured CD4+ T cell counts (Z=-0.019 and -0.776, respectively, both P>0.05).Conclusions The long-term anti-retroviral treatment can effectively elevate the CD4+ T cell counts, inhibit viral replication and ensure drug compliance, which may promote the growth and development of children.However, approximately 30% children are still lower than the normal standards in terms of height and body mass.The drug-taking observer plays a central role on treatment effect.Most of the children′s family suffer from poor economic conditions.

Objective To screen the active tuberculosis patients among HIV infected patients,and investigate the diagnostic methods for active tuberculosis among TB/HIV co-infected patients.Methods From August 2006 to March 2007,660 HIV/AIDS patients were enrolled.The study was conducted at 4 authorized hospitals for AIDS in Nanning and Liuzhou.Chest X-ray(CXR),acid-fast stain test of sputum smear and fast culture were applied if CD+4 T cell counts were below 350 cells/mm3 or the patients at least have one suspected symptom.Result The CD<;+>4 T cell count in 76.1% (502/660) of the patients was less than 200 cells/mm3.TB/HIV coinfection was found in 22.9% (151/660) of the HIV patients.Among them,74.8% (113/151) of them were pulmonary TB patients.One third of them were extra-pulmonary TB patients,and 68.1% of them involved lymph node.In 264 patients with negative sputum smear test and CXR,20.1% (53/264) of them showed positive results in fast culture tests.In addition,the non-tuberculosis mycobacterium (NTM) infection accounted for 38.5% culture positive cases.Conclusions The TB/HIV coinfection rate is 22.8%.Liquid rapid culture of sputum plays an import role in diagnosing of active tuberculosis among HIV patients.There are considerable proportions of NTM or extra-pulmonary TB coinfection in HIV patients.

Objective To study the detection rate of pathogens from sputum , blood, and bronchoalveolar lavage fluid ( BALF ) samples in acquired immunodeficiency syndrome ( AIDS ) patients complicated with pulmonary infection.Methods Seventy-three hospitalized AIDS patients complicated with pulmonary infection in Beijing Ditan Hospital , Capital Medical University were enrolled from February 2018 to September 2018.Blood, sputum and BALF samples were collected.Blood samples were cultured to detect anaerobic bacteria, aerobic bacteria, fungi and mycobacteria.Antigen agglutination method was applied in blood samples to detect cryptococcus neoformans.The sputum samples were tested for Mycobacterium tuberculosis by acid-fast staining and were cultured to detect bacteria and fungi.The sputum samples were observed under microscope for sporotrichosis and fungal spores.The BALF samples were cultured to detect bacteria and fungi. The BALF samples were tested for Mycobacterium tuberculosis by polymerase chain reaction amplification and acid-fast staining.Pneumocystis were detected in BALF samples by methenamine silver staining method .The BALF samples were observed under a microscope for sporotrichosis and fungal spores .The detection rate of pathogens from blood, sputum and BALF samples were compared.Chi-square test was conducted for statistical analysis.Results In 73 AIDS patients complicated with pulmonary infection , the pathogen detection rates in blood, sputum and BALF samples were 8 (11.0%), 23 ( 31.5%) and 48 (65.8%), respectively.The difference was statistically significant ( F ＝48.513, P ＜0.01 ).The detection rate in BALF samples was significantly higher than that in blood or sputum samples ( χ2 ＝43.349 and 17.136, respectively, both P＜0.01).The detection rate in sputum samples was significantly higher than that in blood (χ2 ＝9.215, P＜0.05). The highest detection rates of pathogens in blood , sputum and BALF samples were Talaromyces marneffei 4.1%(3), viridans group streptococci 16.4%(12) and 35.6%(26), respectively.Conclusions The detection rate of pathogens in BALF samples from AIDS patients complicated with pulmonary infection is the highest , followed by sputum and blood samples.

Objective:Sirtuins family is involved in the regulation of many biological events in the cells of the body. As one of the important members, SIRT1 may participate in the formation and development of colorectal cancer. We detected the expression of SIRT1 in colorectal cancer and adjacent normal mucosa to explore its role and significance in the pathogenesis of colorectal cancer.Methods:One hundred and twenty surgical specimens of patients from Xinhua Hospital Affiliated to Dalian University who were hospitalized for colorectal cancer from January 2018 to July 2018 were selected as experimental group. The normal mucosa tissues more than 10 cm away from the tumor focus were taken as the control group. The expression of SIRT1 in colorectal cancer and normal mucosa was detected by immunohistochemistry SP method and Western blot. The different expression of SIRT1 in different organs of digestive tract and parts of human system was compared with Expression Atlas Database. The relationship between SIRT1 expression and clinical pathological data was analyzed to explore the role and significance of SIRT1 in colorectal cancer.Results:SIRT1 protein was mainly expressed in the tumor cell nucleus. The positive staining was brownish yellow, and it was highly expressed in rectal cancer; Sirt1 expression was positively correlated with the depth of tumor invasion, differentiation and tumor size, and the difference was statistically significant ( P<0.05); SIRT1 was highly expressed in human digestive tract, but there was no significant difference in the expression of SIRT1 in various organs of digestive tract; Sirt1 may function through the PI3K-AKT signaling pathway in colorectal cancer. Conclusions:SIRT1 plays the role of oncogene in the development of colorectal cancer, and increasing expression of SIRT1 promotes the development of colorectal cancer. SIRT1 may be a marker of early diagnosis of colorectal cancer, which is of great significance.