Objective To systematically evaluate the diagnostic value of treadmill exercise test (TET) compared with dynamic electrocardiography (DCG). Methods Databases including Cochrane library, MEDLINE,EMbase,Google Scholar and CNKI were retrieved to collect randomized clinical trials (RCT) and controlled clinical trials(CCT)focusing on comparison of TET and DCG. After screening according to the inclusion and exclusion criteria,all articles received Jadad quality assessment,and were analyzed using Review Manager Version 5.3 software(The Cochrane Collaboration,Oxford,United Kingdom). Results 9 papers with a total of 667 patients who underwent coronary angiography(CAG),TET and DCG were eventually enrolled. Results of the present Meta?analysis were as below.(1)Sensitivity:9 trials(n = 552)suggested that the sensitivity is 80.62% in TET Group versus 72.64%in DCG Group[RR=1.11,95%CI(1.04~1.18),P=0.002]. The difference was statistically significant.(2)Specificity:7 trails(n=126)indicated that no statistical significance[RR=0.86,95%CI(0.71~1.04),P=0.11]was found in specificity when comparing TET(68/115)and DCG(87/126). Conclusion TET has higher sensitivity but similar specificity in comparison with DCG,and it turns out to be a simple and feasible inspecting method in diagnosing coronary heart disease.

With the advent of the cancer stem cell hypothesis,the field of cancer research has experienced a revolution in how we think of and approach cancer. The discovery of "tumor-initiating cell" has offered an explanation for several long-standing conundrums on why tumors behave the way they do to treatment. Despite the great amount of research that has been done in order to understand the molecular aspects of tumors,the prognosis of tumors remains dismal. The slow progress in extending the survival of patients with malignant tumors is very likely due to poor understanding of the cell of origin in these tumors.This review article discusses the progress in our understanding of tumor-initiating cell as the cell of origin in cancers. We review the different proposed mechanisms of how tumor-initiating cell may originate,the molecular mechanisms of cancer initiation and progression, and finally the clinical implications of this research.

OBJECTIVE: To investigate the situation and future trend of use of drugs in this hospital after medical re- form.METHODS:Using the principle of sequencing analysis of DUD system of drug,we analysed the data of drug consumption in our hospital during the period 1999-2000.RESULTS: The policy of medical reform has affected the component ratio of drugs used, the consumption of peroral drugs being increased.The incidence of cardiovascular diseases was high in this re- gion.CONCLUSION:Most of the drugs used after medical reform were those assigned in medical insurance,which will improve the rationality and effectiveness of medication.

Objective To explore the feasibility and advantage of the small figure-L unilateral transternal incision for the treatment of anteri or mediastinal tumor. Methods Twenty-four patients with anteri or mediastinal tumor were enrolled in the study. Under general anesthesia, after a 6 to 10 cm midline skin incision was made, a unilateral figure-L partial ste rnotomy on the side occupied by the tumor was made in the second or third interc ostals space, taking into account the tumor size and location. Tumors were resec ted with excellent exposure. Results All tumors were completely resected during the operation. In 8 cases, tumors encroached on the adjacent lu ng tissue, and lung tissue was partially resected. In 6 cases, tumors invaded th e pericardium, and the pericardium was partially removed. Mean operating time wa s 106 minutes (80~125 minutes). The mean time of hospital stay was 5 days after the operation, and there was no complication. All patients were alive with a mea n follow-up period of 14 months (3~24 months). Conclusion The figure-L unilateral mini-sternotomy is considered as an effective and useful mi nimally invasive approach for anterior mediastinal tumors.

Objective To explore differences of drug resistance of temozolomide(TMZ) on different CD133 immune prototype of glioma cells and study on the changes of their sensitivity to TMZ through increased PUMA. Methods CD133+-U87MG cells sorted by CD133 magnetic beads were cultured in serum-free stem cell medium respectively. The cells were infected with recombinant adenovirus, Ad-PUMA, diluted in cell culture medium with or without TMZ intervention.The inhibitory rate of cell proliferation was detected by MTT assay and 50 ％ inhibition concentration of TMZ was calculated. Apoptosis rates of CD133+-U87MG cells were assessed by flow cytometry (FCM) before and after intervention of exogenous PUMA and TMZ.Results The TMZ IC50 values of CD133+glioma cells were higher than that of CD133- glioma cells. There were significant differences in apoptosis rate between CD133+ glioma cell and CD133- glioma cell (all P＜0.05).Conclusion AdPUMA joint TMZ can promote glioma stem cells apoptosis, thus improve the sensitivity to chemotherapy of glioma.

Objective To observe the influence of p53-upregulated modulator of apoptosis (PUMA) on the growth of human brain glioma cell lines U251 (p53 mutant) and SHG-44 (p53 wild type),and to explore its possible mechanism.Methods Construct the adenovirus PUMA (Ad-PUMA) and vector of adenovirus (AdDsRed) which were respectively transfected into glioma cell lines U251 and SHG-44.Cells proliferation rates were measured with cell counting kit-8 (CCK-8).The apoptotic ratios were detected by flow cytometry.The expression of PUMA and apoptosis associated proteins (bcl-2,Bax) were determined with Western blot analysis.Caspase-3,Caspase-8,Caspase-9 activity were measured by Caspase activity assay kit.Results Compared with vector group and blank control group,Ad-PUMA transfected group showed strong cell proliferating inhibition effects [the inhibition rates were (50.89±4.73) ％ and (44.45±5.33) ％ respectively,P ＜0.05] and pro-apoptotic effects [apoptotic rates were (44.89±5.08) ％ and (31.67±7.32) ％,P ＜ 0.05] in different p53 glioma cell lines U251 and SHG-44.Western blot analysis showed that PUMA protein expression increased after Ad-PUMA transfection,accompanied by the reduced expression of the anti-apoptotic protein bcl-2 and the increased expression of pro-apoptotic protein Bax.The activity of Caspase testing results showed that the Caspase-3,Caspase-9 activity increased significantly,while the Caspase-8 activity changed little.Conclusion No matter how p53 phenotype,PUMA can inhibit glioma proliferation,promote apoptosis,and its mechanism may be through the mitochondrial apoptotic pathways,upregulation of Bax and inhibition of bcl-2 expression,which activated Caspase-9.Ad-PUMA is expected to become a new target for gene therapy of gliomas.

OBJECTIVE To investigate the microorganisms on the hands of nurses who are doing the intravenous infusion.METHODS Sampled the hands of nurses during the procedure of intravenous infusion randomly,and then sampled after monitoring the nurses washing their hands by the six steps hand-cleaning technique.Then cultured the samples and did the identification of bacteria.The distribution of microorganism on nurses' hands was analyzed.RESULTS During the procedure of intravenous infusion,before and after the intervention the microorganisms on the nurses' hands had evident difference and with the statistic meanings.CONCLUSIONS The handwashing compliance among nurses before working in our hospital is poor,and the hand hygiene status during the nursing procedure needs to be improved.

Objective To study the effect of sevoflurane pretreatment or aftertreatment on intrapulmonary shunt for patients with one lung ventilation(OLV)during thoracic surgical procedures .Methods 80 ASA I or II patients underwent thoracic surgery with OLV were randomly divided into four groups(n= 20 for each):(1)Propofol group(group P);(2)Sevoflurane pretreatment group(group S1);(3)Sevoflurane aftertreatment group(group S2);(3)Sevoflurane whole-treatment group(group S3) .Blood sam-ples were taken from radial artery and right atrial blood before induction of anesthesia(baseline T .0) ,before OLV(sevoflurane pre-treatment 30 min ,T1) ,after OLV 30 ,60 min and before the end of OLV(T2-T4)and after the end of OLV(T5)for measurement of blood gases and calculation of Qs/Qt .The indexs of hemodynamics and relative clinical data were recorded .Results Arterial oxy-gen pressure of the four groups for OLV significantly reduced ,when compared with double lung ventilation(P<0 .05) ,but there was no significant difference among the four groups(P>0 .05) .Intrapulmonary shunt of the four groups for OLV significantly in-creased ,when compared with double lung ventilation(P<0 .05) ,but intrapulmonary shunt of S1 ,S2 and S3 groups significantly de-creased ,when compared with P group ,and there was no significant difference for S1 ,S2 and S3 groups(P> 0 .05) .Conclusion Sevoflurane can decrease intrapulmonary shunt for patients during OLV ,but there is no significant difference for pretreatment or af-tertreatment or whole treatment and do not increase arterial oxygen pressure .

Objective To compare the effects of different opportunity internal fixation in treatment of trau-matic flail chest.Methods Clinical data of 53 cases of patients with traumatic flail chest were selected,in which 28 patients were given internal fixation treatment in 72h after injury (early surgery group),25 patients were given sur-gery after 72h(late surgery group),recovery situation(postoperative ventilation time,chest improve time,ICU stay time,extubation time,hospitalization time)of the two groups were observed,respiratory function changes and compli-cations were compared before and after treatment.Results Postoperative ventilation time,chest X -ray improvement time,ICU stay time,extubation time and hospitalization time of the early operation group were (27.4 ±4.8)h, (88.6 ±7.5)h,(3.8 ±0.7)d,(3.2 ±0.8)d,(13.2 ±5.0)d,which were significantly shorter in the late operation group of (40.7 ±5.2)h,(195.3 ±8.0)h,(5.6 ±1.4)d,(5.2 ±1.3)d,(19.8 ±6.4)d,with significant difference (t =7.389,11.204,3.837,3.916,5.261,all P <0.05 ).After treatment,PaO2 ,PaCO2 ,PaO2 /FiO2 ,RR and HR were all significantly improved (early surgery group t =12.497,6.205,4.136,7.381,14.327,all P <0.05;late sur-gery group t =11.976,5.813,4.649,6.892,14.627,all P <0.05),but the indexes between the two groups were not significantly different(t =0.126,0.013,0.002,0.010,0.215,all P >0.05 ).There was no dead case in the two groups,and the incidence of atelectasis,ARDS and thoracic deformity had no significantly different between two groups (P >0.05 ).Conclusion In treatment of traumatic flail chest,early surgical treatment can rapidly improve the respiratory and circulatory function,it can shorten the postoperative recovery time,and does not increase complica-tions.So,when conditions permit,patients should be given early surgical fixation.

Objective To compare the efficacy and adverse reactions of intensity-modulated radiation therapy (IMRT) and conventional pelvic field radiation therapy for middle and advanced cervical cancer. Methods A total of 144 patients with stageⅡB-ⅢB cervical cancer from October 2007 to September 2012 were divided into IMRT group (72 cases), and routine radiotherapy group (72 cases) by using random number table method. The IMRT group was exposed to the 6 MV-X line 7 field, a dose of 46-50 Gy for planning target volume (PTV), 54-60 Gy for gross tumor volume (GTVnd) simultaneously integrated boosted, in 25-28 fractions. The central block of lead 4 cm was changed to 4 fields irradiation, adding to 46-54 Gy for the conventional group after 30-40 Gy of the whole pelvic field. The total dose for the two groups of patients was 30-45 Gy, after completed 30 Gy in vitro exposure, to the cavity irradiation, 5-7 Gy/fraction, and synchronous cisplatin (DDP) sensitization chemotherapy was done synchronously. Results The recent complete remission, partial remission, overall survival ratio of two groups were compared respectively, and the difference was not statistically significant (P > 0.05). The difference in 1 year survival rate of IMRT group and routine radiotherapy group was not statistically significant (χ2= 1.455, P> 0.05). The difference in 3 and 5 year survival rate was statistically significant [76.4 % (55/72) vs. 59.7 % (43/72); 72.2 % (52/72) vs. 55.6 %(40/72), P< 0.05]. Acute radiotherapy major adverse reactions included the digestive system, urinary system, skin response and haematological toxicity (bone marrow suppression). The incidence and degree of skin response in IMRT group was lower than that in routine radiotherapy group (P<0.05). The adverse effects of late radiotherapy were mainly rectal, bladder, skin response and hematological toxicity (bone marrow suppression). The incidence rectal and skin response in IMRT group was lower than that in routine radiotherapy group (P< 0.05). Conclusion The IMRT can improve the survival rate of advanced cervical cancer patients for 3-5 years, reduce the adverse effects of acute and terminal radiotherapy, and improve the quality of life.