The conflicts among medical doctors,patients,medical administration,and health insurance corporations are becoming more and more serious.Additionally,novel medical techniques and methods are unprecedented challenges during the clinical activities for thoracic tumors.Here we emphasize that medical doctors who specialize in thoracic tumors should be proficient at managing these special and complex disorders.In order to effectively prevent and deal with a variety of ethical conflicts,all clinical practice should strictly abide by the principles of evidence-based medicine,and medical doctors should be held responsible for their patients from both technical and moral aspects.

Objective To evaluate economic benefits and clinical effects of internal fixation treatment of severe rib fracture so as to provide objective basis for improving medical treatment for rib fracture.Methods A retrospective review was made on clinical data of 50 patients with severe rib fracture hospitalized from January 2009 to April 2014.With varied treatment modalities,the patients were assigned to operative group (n =13) and non-operative group (n =37).Variables were recorded including length of stay,total hospital charges,length of ventilatory support,off-bed time,duration of antibiotic use and incidence of complications and used to perform cost-efficiency analysis.Results Between operative and non-operative groups,length of hospital stay was (25.9 ± 8.2) days vs (35.4 ± 7.0) days,total hospital charges were (121 676.2 ± 10 991.1) yuan vs (148 724.5 ± 21 254.3) yuan,length of ventilatory support was (7.9 ± 2.8) days vs (14.1 ± 3.3) days,off-bed time was (14.3 ± 4.9) days vs (26.1 ± 6.5) days,duration of antibiotic use was (12.4 ± 3.3) days vs (21.2 ± 6.2) days and complications occurred in 2 cases vs 13 cases respectively.The findings were length of ventilatory support,off-bed time and duration of antibiotic use differed significantly between the two groups (P ＜ 0.05).Cost-effectiveness ratios based on subjective and objective measures were superior in operative group (1 962.52 and 3 925.03) over those in non-operative group (1 931.48 and 3 718.10),suggesting operative treatment could yield higher economic returns.Conclusion Internal fixation can accelerate bone healing in patients with severer rib fracture and cut down medical expense,which should be promoted in medical treatment.

Objective To establish a paraspinal neural pathway of quadriceps femoris by end-to-end anastomoses between the spinal ventral root after spinal cord injury(SCI) in rats. Methods Twenty-fourweek old SD rats, with the weight of 120 g to 150 g, were included. The left side was the experimental side, while the right side served as a control. Electrostimulating of L1-L5 ventral root was done respectively to decide the predominant nerve of quadriceps femoris. The lumbar 1 ventral root was reveal to little innervation of quadriceps femoris, and the lumbar 3 ventral root was predominant innervation. End-to-end anastomosis between the left L1 and L3 ventral root was done. After axona regeneration, the new paraspinal neural pathway of quadriceps femoris was established. At 6 months postoperatively, the early function of the new pathway was observed by electrophysiological examinations, hindlimb locomotion and BBB (basso, beattie and bresnahan)scale at 1,3,7, 14,21,28 d after SCI. Results Sixteen rats survived for 6 months after operation and only ten rats got good results because of tissue adhesion postoperatively. Single stimuli (2.5 mA,0.2 ms, 1 Hz) of the left anastomoses nerve resulted in action potential recorded from the left quadriceps femoris before and after the spinal cord hemisection horizontally between L2 segmental levels. The amplitudes of the action potentials were (7.63 ± 1.86) mV and (6.00 ± 1.92)mV, respectively, and there was no significant difference (P ＞ 0.05). The left quadriceps femoris contraction was initiated by single stimuli (2.5mA, 0.2 ms, 1 Hz) of the left anastomoses nerve. After paraplegia, when the right L3 ventral root was stimulated, the amplitude of the action potential was (15.87 ± 1.16) mV. Locomotion of the left hindlimb was partially restored after spinal cord hemisection while creeping and climbing. According to BBB scale, there was significant difference at 1, 3, 7 d, and little difference at 14, 21, 28 d after SCI. Conclusion Spinal ventral roots cross-ananstomosis to reconstruct the paraspinal pathway of quadriceps femoris after SCI is efficient reinnervation of hindlamb muscles in a rat model and may have potential in clinical application.

A new strain of Streptomyces regensis was isolated from soil to produce a novel antibiotic AGPM possessing a strong antitumor activity In order to study on the metabolic path of the novel antibiotic AGPM, the protein patterns from the strain of Streptomyces regensis at different culture period were analyzed by using two eimensional polyacrylamide gel electrophoresis Comparing with sample from growth phase, seventeen new protein spots were found in that from antibiotic production phase The results demonstrated that the special proteins might be related with the antibiotic AGPM biosynthesis from Streptomyces regensis

Objective To evaluate the clinical effects of memory alloy embracing fixators in fixation of the rib fractures and investigate the related surgical indications and surgical techniques.Methods Retrospectively review was conducted on the clinical data of 30 patients with rib fractures treated with memory alloy embracing fixators from October 2010 to April 2011 at General Hospital of Guangzhou Military Command.The number of memory alloy embracing fixators used in operation,the number of fixed positions,and operation time were recorded.The pain scores before and after operation were comparatively studied.Operation efficacy and complications were analyzed.Results Of the 30 patients,the total operation time,number of fixators,and number of fixed ribs were (111.9±48.0) minutes,4.3±2.1 and 3.5±1.3,respectively.Meanwhile,the difference between pre-operative and post-operative pain scores was significant (6.93±0.88) points vs (4.04±0.62) points,P＜0.05).The ambulation perlod was (4.6±1.9) days and length of hospital stay was (27.2±10.8) days.Incisional and thoracic wall hematoma was detected in three patients and pulmonary infection in six post-operatively but none presented intractable chest pain,foreign body rejection or wound infection.Conclusion Memory alloy embracing fixators for rib fractures is reliable,easy,and effective in alleviating pain,improving lung function,reducing the frequency of ventilator use and preventing complications like lung infection.

The incidence of non-small cell lung cancer (NSCLC) is the highest among malignant tumors. StagesⅡtoⅢA patients are potentially treatable. Perioperative chemotherapy is the standard treatment for NSCLC; however, in patients with the EGFR mutation, neoadjuvant or adjuvant targeted therapy can improve disease-free survival (DFS). Despite this, the survival benefit is not clear. Postop-erative adjuvant radiotherapy can enhance survival in patients with stageⅢA (N2) NSCLC. Durvalumab maintenance therapy, after concurrent chemoradiotherapy, has become the new standard for patients with locally advanced and unresectable NSCLC. Immuno-therapy requires additional investigation in patients with driver gene mutations, as does the combination of immunotherapy plus che-motherapy. Notably, anti-angiogenesis therapy has failed as a postoperative adjuvant therapy.

BACKGROUNDRRM1 may be a prognostic factor in non-small cell lung cancer (NSCLC). The aim of this study is to evaluate RRM1 expression and prognosis in NSCLC by the means of tissue microarray.

METHODSA total of 417 paraffin-embedded specimens of NSCLC from Lung Cancer Study Center in Guangdong Provincial People's Hospital were collected and tissue microarray was constructed. RRM1 expression was detected by SP method and its correlation with prognosis was evaluated.

RESULTSNo statistic difference was found in RRM1 expression in different gender, age, tumor site, histology, differentiation, T stage, N stage, M stage and pTNM stage groups (P > 0.05). Univariate analysis showed that RRM1 was not an independent prognostic factor (P > 0.05). At the multivariate analysis, differentiation and N stage were considered independent prognostic factors.

CONCLUSIONSRRM1 expression detected by immunohistology is not an independent prognostic factor in NSCLC. TNM stage is still the best prognostic factor up to now.

Epigenetic changes are closely related to carcinogenesis, tumor progression and prognosis, which have a considerable potential in assisting the precision and minimally invasive management of cancers. The progress of detection techniques for DNA methylation, hydroxymethylation and histone modification has promoted the research works of liquid biopsy targeting epigenetic markers, and recently, important progress has been made in tumor location, early diagnosis, clinical staging, evaluation of treatment response, monitoring of recurrence and prognostic prediction of solid tumors.

The biological role of N 6-methyladenine (m 6A) methylation modification has been gradually identified, and it has shown increasing value in tumor. In recent years, with the accumulated explore of epigenetics in RNA modification, many studies have reported that m 6A methylation modification contributes to development and progression of lung cancer. m 6A-related modified regulator has potential application value as a clinical target for diagnosis and treatment of lung cancer.

Liquid biopsy is a kind of emerging pathological detection technique, which has shown certain value in the diagnosis and treatment of lung cancer. Detections of circulating tumor cells, circulating tumor DNA, DNA methylation, microRNA, exosomes and tumor educated platelets in patients′ body fluids can be used for the early diagnosis and predicting the progress of lung cancer. At recent, the application of liquid biopsy still has some shortcomings. However, with the continuous development of detection technology, it may become an effective auxiliary or alternative method for imaging examination such as CT in the near future, and will provide a new direction for the diagnosis and treatment of lung cancer.