Objective To investigate the influence of fast track surgery on stress and inflammatory re-sponse in breast cancer patients treated with modified radical mastectomy .Methods Ninety nine patients with breast cancer undergoing modified radical mastectomy were allocated randomly to fast track surgery group (46cases)and general group(53cases).The concentrations of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8,TNF-αof each group were measured before operation ,12 hour,24hour and 48hour after operation by radioim-munoassay method.Operation time,operative blood loss and hospitalization days were analyzed between the two groups,simultaneously ,the incidence of subcutaneous hydrops ,flap necrosis and upper limb edema were also de-tected.Results The concentration of serum PRA ,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-αwere no significantly differences in two groups before operation and at 48 hours after surgery(P>0.05).The concentra-tions of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-αof FTS group were significantly different between the preoperative and different time points (P<0.05).The concentration of serum PRA,Ang-Ⅱ,ALD, cortisol,IL-6,IL-8 and TNF-αof FTS group were lower than that of control group at the same time point ( P<0.05).The operative time was(158.32 ±22.47)mins in FTS group and(161.32 ±22.37)mins in control group,respectively,and there were no significant statistical differences (P>0.05).The intraoperative blood loss in the FTS group(156.98 ±17.09)ml was not significantly less than that in the control group (158.57 ±16.92) ml(P=0.644).Hospitalization days were 8.37 ±1.89 and 10.37 ±2.05 in the FTS and the control group re-spectively ,with significant difference .The incidence of upper limb edema ,subcutaneous hydrops ,flap necrosis in FTS group were not less than control group .Conclusion Fast track surgery could attenuate stress and inflamma-tory response during ,and it is safe and effective in modified radical mastectomy .

Residents(medical specialists)programmed education is an important aspect to fulfill the post-graduated medical education. It can remedy the clinical practice of young doctors,which ac-cords with the trend of international medical education .This article is to give advice for the resi-dents (medical specialists)programmed education according to the work and existing problems in our hospital.

Objective To evaluate the efficacy and safety of adding neoadjuvant chemotherapy following neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer.Methods A total of 80 patients confirmed with locally advanced rectal cancer were enrolled during January 2012 and December 2015 in Guizhou Medical University Affiliated Cancer Hospital and were randomized with the method of lottery into the experimental group and the control group.In the experimental group,40 patients received 4 cycles of FOLFOX4 after chemoradiotherapy and then had total mesorectal excision (TME).Another 4 cycles of FOLFOX4 were administered after surgery.In the control group,40 patients had TME surgery 6-8 weeks after chemoradiotherapy and received 8 cycles of FOLFOX4 as adjuvant chemotherapy.Pelvic radiotherapy dose was 50 Gy in 25 fractions,5 days per week for 5 weeks.5-Fu continuous infusion was administered throughout radiotherapy.The pCR rate,downstaging rate,R0 resection rate,local recurrence rate,distant metastasis rate,survival rate,incidence of toxicities,surgical complications and completion of treatment were observed.Results The pCR rate was 20.0％ in the experimental group and 5.0％ in the control group (x2 =4.114,P ＜ 0.05).The downstaging rate was 77.4％ in the experimental group and 55.6％ in the control group(P ＞ 0.05).No statistically significant difference was observed in R0 resection rate,3-year local recurrence rate,3-year distant metastasis rate and 3-year survival rate between the two groups (P ＞ 0.05).Patients in the experimental group had higher completion rate of 8 cycles of systemic chemotherapy (87.1％ vs.61.5％,x2 =4.985,P ＜0.05).No statistically significant difference was observed in acute toxicities and postoperative complications.Conclusions Adding systemic chemotherapy after neoadjuvant chemoradiotherapy for locally advanced rectal cancer has significantly higher pCR rate and lower toxicities and side events compared with chemoradiotherapy alone.Longer follow-up and larger scale of clinical research are needed.Trial registration Chinese clinical trial registry,ChiCTR-IPR-17010454.

Background and purpose:MicroRNA (miRNA) belongs to a class of 19 to 30 nucleotide-long, endogenous noncoding RNA expressed in eukaryotes and predominantly inhibits gene expression at the post-transcriptional level. The miRNAs play critical roles in cell proliferation and differentiation, apoptosis, metabolism, and immune regulation. This study aimed to detect the expression of miR-216a-5p in lung cancer tissues and lung cancer cell lines, and to discuss the effects of miR-216a-5p on the invasion ability of lung cancer cells and the mechanism.Methods:Quantitative real-time PCR (qRT-PCR) was used to detect the expression of miR-216a-5p in lung cancer tissues of 55 cases and 7 lung cancer cell lines. Three lung cancer cell lines of A549, 95D and H460 were transiently transfected by miR-216a-5p, and Transwell was used to detect the effects of miR-216a-5p on the invasion of lung cancer cell lines. The dual luciferase reporter plasmids containing the miR-216a-5p candidate target gene and the gene of matrix metalloproteinase 16 (MMP16) were predicted and constructed. qRT-PCR and Western blot were used to detect the changes in mRNA and protein levels of target geneMMP16 by miR-216a-5p. The interference of MMP16 by siRNA and up-regulation miR-216a-5p by transfection were compared on the invasion of lung cancer cells.Results:The miR-216a-5p expression levels were all signiifcantly reduced in 90.91% (50 of 55 patients) tumor tissues compared with corresponding adjacent normal lung tissues (P<0.05). The miR-216a-5p expression levels were only 7.00%-32.00%in 7 lung cancer cells compared with the control group (P<0.05). Up-regulation of the expression of miR-216a-5p inhibited the invasion of lung cancer cells; interference of MMP16 by siRNA, as well as up-regulating miR-216a-5p by transfection, inhibited the expression of MMP16 in lung cancer leading to inhibition of the invasion of lung cancer cells. Conclusion:miR-216a-5p can be a candidate marker in clinical diagnosis and it can inhibit the invasion of lung cancer cells by down-regulating the expression of MMP16.

Objective To analyze the common reasons for misdiagnosis of atypical pulmonary embolism (APE) ,and to im‐prove the identification of APE .Methods The risk factors ,clinical manifestations ,laboratory examinations and radiographic data of 120 cases of APE diagnosed from January 2006 to December 2013 in the department of cardiovascular medicine and respiratory medicine of Xinqiao Hospital and the Affiliated Hospital of Luzhou Medical College were studied retrospectively .Results Among those 120 cases of APE ,39 cases were misdiagnosed on admission (32 .5% ) .8 cases were misdiagnosed as acute coronary syn‐drome ,7 cases as stable angina pectoris ,7 cases as chronic cor pulmonale ,5 cases as pneumonia ,3 cases as pleural effusion ,3 cases as tuberculosis ,3 cases as asthma ,1 case as atrial septal defect ,1 case as acute heart failure ,and 1 case as cardiogenic syncope .Con‐clusion APE is easy to be misdiagnosed for its non‐specific clinical manifestation .Pulmonary enhanced CT or CTPA should be car‐ried out in time for those highly suspected patients ,in order to reduce the misdiagnosis of APE .

Objective To study the effects of oral rehydration with the solution of pyruvate-glucoseelectrolyte (PGES) by comparison with the bicarbonate-glucose-electrolyte solution (BGES) on resuscitation in rats with lethal hemorrhagic shock.Methods Sixty adult male SD rats with intra-gastric tube,and cannulation of femoral artery and vein were subjected to 45％ total blood volume loss from the femoral artery,and then randomly divided into three groups (n =20 in each group):no fluid resuscitation group (NR),oral fluid resuscitation with the PGES group (PGES) and oral fluid resuscitation with the BGES group (BGES).In NR group,the animals received no fluid replacement or any other treatment.Rats in PGES and BGES groups were infused intra-gastrically with pre-warmed PGES or BGES in volume of 2 times shed blood given at 30 min after hemorrhage and completed within 6 hours.Blood samples in each group were collected from the abdominal aorta before or at 0,1,2,4 h post hemorrhage to detect serum alanine aminotransferase (ALT),creatinine (Cr),creatine phosphate kinase isoenzyme (CK-MB) and intestinal fatty acid binding protein (iFABP).Another 84 rats randomly divided into four groups:NR group (n =24),PGES group (n =24),BGES group (n =24),and no hemorrhage group (NH group,n =12).Rats in the three hemorrhage groups were treated the same as described above,and the rats in NH group underwent the same surgical procedure without hemorrhage were served as the sham group.All these rats were observed for their 24-hour survival rates.Results The 24-hour survival rates of PGES and BGES groups were both significantly higher than the rate of NR group (11/24 vs.1/24,x2 =18.087,P ＜0.01 ; 5/24 vs.1/24,x2 =6.445,P ＜ 0.05) ; the survival rate of PGES group was also significantly higher than that of BGES group (11/24 vs.5/24,x2 =4.02,P ＜ 0.05).All levels of ALT,CK-MB,Cr and iFABP in both the NR group and two oral resuscitation groups at 1 h,2 h and 4 h post hemorrhage were significantly higher than those before the blood loss,respectively (P ＜ 0.01).These biomarkers at 2 h,4 h post hemorrhage were significantly lower in the PGES and BGES groups than those in NR group (P ＜ 0.01) ; the serum levels of ALT,CK-MB,Cr and iFABP were significantly lower in the PGES group than those in the BGES group at 2 h and 4 h post hemorrhage,respectively (P ＜ 0.05).Conclusions Present results demonstrated that the pyruvate-enriched oral re-hydration solution (ORS =PGES) was more effective in preserving the organ function and prolonging the animal survival after resuscitation of lethal hemorrhagic shock in comparison with the bicarbonate-containing ORS (BGES).The oral re-hydration solution (PGES) recommended by the World Hygiene Organization (WHO ORS) may require further improvement in oral resuscitation of shock and the PGES may be recommended as a choice of oral re-hydration salts in the treatment of lethal hemorrhagic shock when intravenous administration is not available.

Objective To investigate the protective effects of elctroacupuncture(EA)at Zusanli(ST36) points on intestinal villas damage and mucosal permeability induced by small intestine pro-inflammatory factors in rats with intestinal ischemia/reperfusion(I/R). Methods 30 Sprague-Dawley(SD)rats were randomly divided into three groups(each,n=10):intestinal I/R group(model group),intestinal I/R+EA ST36 group(EA group)and intestinal I/R+sham EA group(SEA group). Rats were subjected to superior mesenteric artery(SMA)clamping at its root part to occlude the vessel for 30 minutes,followed by reperfusion for 60 minutes to form intestinal I/R models. Rats in EA group received EA at the bilateral ST36 points(2-3 mA,2-100 Hz)for 30 minutes immediately after ischemia,those in SEA group received EA at bilateral sham points(the point was located at 0.5 cm away from ST36 point in its lateral side)with the same frequency and intensity of stimulation as EA group for 30 minutes,and those in model group received no treatment. Animals were sacrificed 60 minutes after reperfusion and segments of distal part of ileum were harvested,then the levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in intestinal tissue were measured. Histopathologic changes were viewed and graded via light microscopy. A solution of fluorescein isothiocyanate(FITC)-dextran was injected into the lumen of the segment of intestine 30 minutes after reperfusion,systemic blood was drawn via abdominal aorta puncture at 60 minutes after reperfusion,and then the level of FITC-dextran in blood was measured to determine the changes in intestinal permeability. Results Compared to the model group and SEA group,EA ST36 significantly attenuated intestine TNF-α(pg/mg:3.01±0.50 vs. 8.65±1.02,8.42±1.41,both P<0.05)and IL-6 levels(pg/mg:2.51±0.15 vs. 6.34±0.86,6.13±1.12,both P<0.05),successfully maintained low gut injury scores(1.50±0.33 vs. 3.18±0.39,3.04±0.37,both P<0.05), and significantly reduced permeability of the distal ileum and the content of FITC-dextran(μg/L:282.42±73.92 vs. 856.22±229.47,844.22±239.47,both P<0.05). However,there were no significant differences in all above variables between SEA and model group(all P>0.05). Sections of distal ileum from animals in the model group and SEA group showed no obvious difference histologically,and the pathological manifestations were villous tip necrosis, blunt-shaped and collapse. Compared to the model group and SEA group,the intestinal villous injury in animals of EA group was much milder. Conclusion In rats with intestinal I/R injury,EA ST36 points has protective effect on the gut that is possibly due to the fact it may obviously lower the levels of the pro-inflammatory factors of small intestinal tissue,alleviate mucosal insult of gut and reduce the mucosal permeability.

Objective To establish a standardized management system and process for teaching ward rounds of clinical practice,so as to improve the quality of clinical practice. Methods (1) We established the system and process for teaching ward rounds. (2) The students of 2008 grade were divided into two groups. The new system and process for teaching ward rounds was used in 71 students in the experimental group,and the primary teaching ward rounds system was used in 72 students in control group. (3) A survey concerned about students' abilities of grasping theoretical knowledge, clinical thinking, self-study, clinical operation and doctor-patient communication were investigated in both students and their tutors. Result The result showed that the abilities of grasping theoretical knowledge,clinical thinking,self-study,clinical operation and doctor-patient communication in the experimental group were enhanced much more than the control group ( <0.01) . Conclusion The standardized management system and process for teaching ward rounds of clinical practice can improve the students, comprehensive abilities and the quality of clinical practice.

Objective:To investigate the expression of Survivin and it's relationship with the expression of Bcl-2 in sinonasal inverted papilloma (SNIP).Method:Immunohistochemical method was used to determine the expression of Survivin and Bcl-2 in 30 cases of SNIP,10 cases of sinonasal squamous cell carcinoma(SCC) and 10 cases of normal inferior concha tissues.Result:Survivin was expressed in 22 of 30(73.3%)cases of SNIP,8 of 10(80.0%)cases of SCC and not expressed in 10(0%)cases of normal inferior concha tissues.Expression of Survivin was significantly higher in SNIP and SCC than in normal tissues.Bcl-2 was expressed in 9 of 10(90.0%)cases of SCC and 2 of 10(20.0%)cases of normal inferior concha tissues.Expression of Bcl-2 was significantly higher in SCC than in normal tissues.Bcl-2 was expressed in 14 of 30(46.7%)cases of SNIP,higher than normal tissues.Expression of Bcl-2 was positively related to expression of Survivin.Conclusion:Survivin may play an important role in the pathway of progression of SNIP and SCC.It may be identified as a new therapeutic target.Bcl-2 may play a synergic role with Survivin in progression of SNIP.

Objective To explore the effect of ectopic overexpression of Smac/DIABLO on the proliferation of pancreatic cancer cell line SW1990,and the sensitization to TRAIL and Gemcitabine induced apoptosis.Methods The Smac/DIABLO gene was transfected into the pancreatic cancer cell line SW1990 with the participation of Lipofectamine 2000 (SW1990/Smac).The cell line transfected with empty vector served as controls (SW1990/neo).The SW1990/neo and SW1990/Smac cells were assigned into the following treatment groups:TRAIL group,Gemcitabine group,TRAIL plus Gemcitabine group,and the control group.The SW1990 cells were treated with TRAIL and Gemcitabine in different concentrations and time.The cell growth inhibition rate (CGIR) was detected by MTT,the rate of apoptosis was measured by flow eytometry,the apoptosis morphous was observed by Heochst 33342 staining.The expressions of apoptosis-associated proteins such as Smas/DIABLO,XIAP,cytochrome C and caspase-3 were detected by Western blot.Results The cell growth of SW1990/Smac was significantly lower than growth of SW1990/ neo.The concentration of TRAIL were 200,500,1000 and 2500 ng/ml respectively.After 24 hours,the CGIR of SW1990/neo and SW1990/Smac were 11.11％,46.03％,67.08％,76.19％ and 22.11％,42.67％,56.63％,67.6％ respectively (P ＜ 0.05).The concentration of Gemcitabine were 10,20,40 and 60 μmol/L respectively.After 24 hours,the CGIR of SW1990/neo and SW1990/Smac were 15.2％,34.6％,55.16％,76.4％ and 22.65％,36.85％,55.11％,79.99％ respectively (P＜0.05).The cells of SW1990/neo and SW1990/Smac were treated by TRAIL(500 ng/ml),Gemcitabine (20 μmol/L) and combination group.The apoptosis rate were 5.64％,15.30％,27.27％ and 20.37％,23.27％,67.30％ (P ＜ 0.05) respectively.In combination group,the expressions of activators of caspase such as Smas/DIABLO,cytochrome C and caspase-3 increased significantly,while the expressions of inhibitor of apoptosis protein XIAP decreased.Conclusions Ectopic expression of Smac/DIABLO could induce the apoptosis of SW1990 cell,inhibit the cell proliferation,and enhence the sensitivity of SW1990 cell to TRAIL and Gemcitabine.The mechanism of apoptosis sensitization effect by Smac/DIABLO was associated with significant up-regulation of Smac/DIABLO,cytochrome C,down-regulation of XIAP,and the activation of caspase-3.