It is important in clinical practice to identify the types of serum free light chain (FLC),especially to measure the concentration of serum FLC.The serum FLC assay in combination with other serum protein analysis are very valuable in the diagnosis,monitor,and response evaluation of patients with plasma cell disorders(PCD).The methods progress of the measurement of serum FLC and clinical application in diagnosis and evaluation of treatment are reviewed.

Objective To discuss the feasibility of open heart operation on beating in the congenital heart diseases.Method This kind of operation was put to use in 181 cases of the congenitalheart diseases in order to observe the effects of myocardial protection, prevention from air embolism,et al.Results Operation field exposure was clear enough to finish the manipulation. All but one case was uneventiful postoperatively,especially without air embolism. Conclusion Open heart operation on beating with slight hypothermia is highly feasible in the common congenital heart diseases.

Objective To explore the application of integrating 64-slice CT image with three-dimensional electroanatomic mapping(Carto-Merge) in guiding catheter ablation of atrial fibrillation(AF).Methods Fifteen patients with drug-refractory AF received catheter ablation of AF.64-slice CT scan was performee 1-3 days prior to the ablation procedures.Using a novel software package,the left atrium(LA)with PVs was segmented and extracted for image registration with a combination of landmark registration and surface registration.Results The integration of the CT image into the electroanatomic mapping system was performed successfully in all patients with an error of 2.11?0.82 mm.Thirty pairs of PVs were electrically isolated after circumferential rediogrequency pulmorary rein ablation.The mean procedure time was 170.51?38.47 minutes.Cardiac tamponade occurred in one patient.All the fifteen patients were free of AF recurrence after 3 months of follow up including the 2 cases of persistent AF who required antiarrhythmic drugs.No thromboembolic events or stenosis were observed.Conclusion Integration of 64-slice CT image into the CARTO system successfully performed in patients undergoing catheter ablation of AF and enhance the ablation success rate.

Objective To investigate the mRNA expression of UPA and MMP-9 in gastric carcinoma and their correlation with histological type, growth-type, differentiation, vessel invasion, metastasis and prognosis. MethodsIn situ hybridization was used to detect the mRNA expression of UPA and MMP-9. ResultsIn situ hybridization revealed that among 105 cases, the positive rates of UPA mRNA and MMP-9 mRNA were both 58.1%. There was no significant relationship between UPA mRNA and histological type( r _ s = 0.123, P =0.210)and differentiation ( r _ s =0.102, P =0.298)of the tumor. However, there was a significant difference between growth-type( r _ s =0.344, P =0.001),tumor invasion depth( r _ s =0.296, P =0.002),vessel invasion( r _ s =0.198, P =0.042),lymph node( r _ s =0.332, P =0.001)and distant metastasis( r _ s =0.530, P =0.001);there was no significant relationship between MMP-9 mRNA staining and histological type( r _ s =0.143, P =0.145)and differentiation( r _ s =0.102, P =0.298)of the tumor. However, there was a statistically significant difference between growth-type( r _ s =0.267, P =0.006),tumor invasion depth ( r _ s =0.335, P =0.001)、vessel invasion( r _ s =0.209, P =0.032),lymph node( r _ s =0.343, P =0.001)and distant metastasis( r _ s =0.468, P =0.001);There was a positive relationship between UPA mRNA and MMP-9 mRNA expression( r _ s =0.237, P =0.015). The mean survival time in cases with positive UPA mRNA and MMP-9 mRNA expression were significantly shorter than that of cases with negative expression. ConclusionThe mRNA expression of UPA and MMP-9 can predict the invasion and metastasis of gastric carcinoma, They can be used as markers of prognosis of gastric carcinoma in clinical practice.

Objective To investigate the FDG PET-CT image characteristics of bone metastases from lung cancer and the clinical value of 18F-fluorodeoxyglucose(FDG)PET-CT for diagnosis to bone metastases from lung cancer.Methods 32 cases of bone metastasis from lung cancer examined by FDG PET-CT had been studied.All of them were proved by pathology after operation or biopsy.Their FDG PET-CT diagnosis were analyzed by comparing with CT diagnosis. Results All of 115 lesions of 32 cases showed intense uptake of 18F-FDG. SUV mean was 7.47±3.48. 115 lesions located in 42 pieces of bones. Most importantly.16 lesions of occult bone metastases of 12 cases were found.The most related bone were ribs(26/115,22.61%),thoracic vertebral(21/115,18.26%),iliac bone(18/115,15.65%)and lumbar vertebral(16/115,13.91%).96 lesions(83.48%)showed lytic type on CT images,1 lesion(0.87%)showed sclerotic type,and 2 lesions(1.74%)showed mixture type.Conclusion The FDG PET-CT can early detect bone metastases from lung cancer.show their exact location,and have superiority in the screen of bone metastases from lung cancer.

Objective To observe the safety and efficacy of rocuronium rapid sequence induction in patient undergoing laparoscopic cholecystectomy(LC).Methods 100 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups(n =50):control group(group C)and rocuronium rapid sequence induction group (group R).Conventional induction of anesthesia was used in group C,rocuronium rapid sequence induction was used in group R and assisted ventilation was not implemented in the induction process.Oxygen saturation(SpO2 ),partial pressure of oxygen(PaO2 ),carbon dioxide partial pressure(PaO2 ),pH were recored at the condition of breathing air (T0 ),breathing pure oxygen 5 minutes(T1 ),after intubation(T2 )and mechanical ventilation five minutes(T3 ).The grade of the exposure in operation field,the operative time,indwelling of gastric suction tube,the time of no ventilation in group R were recorded,too.Results Compared to T1 time point,PaO2 and pH in group R decreased,but PaCO2 was significantly higher at T2 time point(P <0.05);PaO2 and pH in group R were lower,but PaCO2 was significantly higher than group C at T2 time point(P <0.05).After 5 minutes mechanical ventilation,the PaCO2 and pH in two groups were restored to the preoperative level(P >0.05),but SpO2 and PaO2 were higher than preoperative at every time point(P <0.05).The incidence of Indwelling gastric suction tube is higher in group C than in group R,the grade of exposure in the operation field were better in group R than in group C(P <0.05).Conclusion Application of rocuronium rapid sequence induction technique in laparoscopic cholecystectomy can improve the operative conditions and field,it can be safely used in clinical anesthesia.

In the process of responding to public health emergencies,the conflicts between the principles of management and ethics are constantly revealed.Combining with a unit's practical experiences of participating in several major public health emergencies,this paper put forward that it should take into account both the rescue and notification to achieve the unity of effective rescue and informed consent;take into account both the enforcement and obedience to achieve the unity of the interest of groups and individuals;take into account both the equality and priority to achieve the unity of urgency priority and equal opportunity;take into account both the rescuing and suf-fering to achieve the unity of interest between the rescuers and the victims,and thus to provide references for the reasonable solution of the ethical conflicts in the process of responding to public health emergencies.

Purpose:To study the expression of uPA, uPAR ,PAI 1 in 3 nasopharyngeal carcinoma cell lines CEN 2Z,CEN 2Z H5,CEN 2Z H5 9,with different ability to metastasize through lymph.Methods:RT PCR was used to detect expression of uPA,uPAR,PAI 1 at levels of mRNA.Results:mRNA expression of uPA,uPAR was the highest in CNE 2Z H5 9,whereas the lowest in CNE 2Z;mRNA expression of PAI 1was detected in CNE 2Z and CNE 2Z H5, but revealed no differences,but not in CNE 2Z H5 9.Conclusions:uPA?uPAR may promote the metastasis and invasion of NPC,whereas PAI 1 maybe inhibit it

Objective To evaluate modified laparoscopic hepatic hemangioma extraction methods during laparoscopic hepatectomy.Methods From May 2009 to June 2013, 25 hepatic hemangioma patients were admitted for laparoscopic hepatectomy.Patients were divided into modified laparoscopic group with modified laparoscopic hepatic hemangioma extraction methods (MLH, n =11) and traditional laparoscopic group (TLH, n =14).Perioperative clinical parameters were compared between the two groups.Results Operative time (148.6 ± 18.0) min, time to removal of the HCH (15.7 ±4.6) min, visual analog scale pain score on the first postoperative day (2.3 ± 0.9), time to off-bed activity (2.5 ± 0.8) d, and postoperative hospital stay (8.5 ± 2.6)d in the MLH group were all less than those in the TLH group [(163.9±13.2)min, (33.9±3.1)min, (3.4±0.9), (3.1±0.8)d, (10.6±1.9)d] (t=-2.451,t =-11.800, t =-2.931, t =-2.156, t =-2.338,P ＜ 0.05).There were one in the MLH group and two cases in the TLH group developing postoperative complications (P =1.000).Conclusions Modified laparoscopic hepatic hemangioma extraction methods during laparoscopic hepatectomy for hepatic hemangioma is safe, feasible and of good therapeutic effect.

Objective To investigate the short-term therapeutic effect of warfarin in preventing portal vein thrombosis (PVT) after modified laparoscopic splenectomy combined with pericardial devascularization.Methods The retrospective cohort study was used to analyze the clinical data of 32 patients with cirrhotic portal hypertension who were admitted to the Clinical Medical College of Yangzhou University between January 2014 and August 2014.The characteristics of warfarin and aspirin regimens were introduced to the patients before operation for choosing postoperative therapeutic regimen.Based on the decisions, 17 and 15 patients receiving warfarin regimen and aspirin regimen were divided into the warfarin group and the aspirin group, respectively.All the patients underwent successful modified laparoscopic splenectomy and pericardial devascularization with intraoperative autologous blood salvage.The treatments were as follows : from postoperative day 3, patients in the warfarin group received 2.5 mg of oral warfarin once daily with titration of the dose to maintain a target international normalized ratio (INR) of 2.0-3.0 for 1 year;patients in the aspirin group received 100 mg aspirin enteric coated tablets for 1 year;and both groups received 50 mg of oral dipyridamole three times daily for 3 months and subcutaneous injection of 4 100 U of low-molecular-weight heparin (LMWH) once daily for 5 days.Blood cell analysis, liver function, coagulation function and Doppler ultrasound screening for the occurrence of PVT were performed at the first and third months.Postoperative electronic gastroscopy was performed at 3 months postoperatively for observing the change of the esophageal and gastric-fundus varices.The patients were followed up till February 2015.The incidences of PVT and the level of INR at the first week, the first month and the third month after operation were observed.Measurement data with normal distribution were presented as (x) ± s and analyzed by t test, and measurement data with skewed distribution were presented as M(range) and analyzed by the rank-sum test.Comparison of the mean INR at different time points between the 2 groups was analyzed by the repeated measures ANOVA.Comparison of count data was analyzed by the Fisher's Exact Probility.Results There were no gastrointestinal hemorrhage or perioperative death in the 2 groups.(1) The overall incidences of PVT at postoperative week 1 were 9/17 and 6/15 in the warfarin and the aspirin groups, respectively, with no significant difference (P ＞ 0.05).However, the overall incidences of PVT at postoperative month 1 and 3 were 7/17 and 3/17 in the warfarin group, which was significantly different from 12/15 and 12/15 in the aspirin group (P ＜ 0.05).(2)The incidences of main portal vein thrombosis (MPVT) at postoperative week 1 and postoperative month 1 were 5/17 and 6/17 in the warfarin group, 4/15 and 5/15 in the aspirin group, showing no significant difference (P ＞ 0.05).The incidence of MPVT at postoperative month 3 was 3/17 in the warfarin group, which was significantly different from 9/15 in the aspirin group (P ＜ 0.05).(3) The INR was changed from 1.30 ± 0.17 before operation to 1.55 ± 0.38 at postoperative month 3 in the warfarin group, and from 1.33 ±0.14 before operation to 1.21 ±0.11 at postoperative month 3 in the aspirin group, showing significant difference in the changing trend between the 2 groups (F =713.908, P ＜ 0.05).(4) All the 32 patients were followed up for a median time of 7 months (range, 3-11 months).The results of electronic gastroscopy at postoperative month 3 showed that the esophageal and gastric-fundus varices were obviously improved or disappeared.Conclusion Warfarin in preventing PVT after modified laparoscopic splenectomy combined with pericardial devascularization is safe and feasible, with a good short-term outcome.