Objective To investigate the mechanism of anireflux procedures in treating sliding hiatal hernia and the effectiveness of the method of cardia position by clock to evaluate the outcome of antireflux procedures. Methods From 1992 to 2008, 136 patients with sliding hiatal hernia underwent transabdominal antireflux surgery: 27 patients received Nissen procedure and 109 recieved floppy Nissen operation. Results There is no postoperative death. Within one month after operation, in the Nissen group, 2 patients developed severe dysphagia and 1 had regurgitation; in the floppy Nissen group, 9 patients had regurgitation, and 3 had dysphagia. During the over-2-year follow-up period, 2 patients developed severe dysphagia,1 had nausea and 2 had significant reflux in the Nissen group. While 3 patients recturred, 2 had dysphagia and 7 had significant reflux in the floppy Nissen group. The effective rates of the Nissen group and the floppy Nissen group were 81.5% and 88.1%, respectively. There was no significant difference in postoperative tests between two groups ( P ＞ 0.05 ). Tests of cardia position by o'clock showed that cardia positions of 80. 1% patients before surgery were located at sites between 10 and 11 o'clock and those of 91.7% after surgery being at 9 o' clock or less. Conclusions The Niseen and the floppy Nissen fundoplication can reach good long-term results in treatment of sliding hiatus hernia. Mechanism of these antireflux procedures include, by fundoplication, increasing esophageal sphincter pressure, prolonging the sphincter length, deepening His angle and prolonging abdominal esophagus, etc. Among them, the last one, descending the cardia position to 9 o'clock or less is vital to antireflux.The test of cardia position by o'clock is practically important to reach the successful result.

[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Numerous studies showed that changes in serum pepsinogen( PG)and gastrin-17( G-17)levels can reflect histological condition of gastric mucosa,that can be served as serological biopsy of gastric fundic glandular mucosa. The decrease of serum PGⅠ level and PGⅠ/ PGⅡ ratio(PGR)as well as increase of G-17 denotes a high risk of gastric cancer. Helicobacter pylori(Hp)infection can cause chronic active gastritis,and the progress of inflammation can lead to atrophy and intestinal metaplasia of mucosa. This article reviewed the diagnostic value of serum PG,G-17 and Hp antibody for atrophic gastritis and gastric cancer.

Objective To study the apoptotic effect of brazilein on human lung cancer A549 cells and endoplasmic reticulum stress .Methods The cytotoxic activity was tested by MTT assay in A549 cells .The flow cytometry was used to detect apoptosis . Western blotting was performed to detect GRP78 and cyto c protein expression .Results The IC50 values of brazilein against A549 cells was (5 .36 ± 0 .62)μmol/L .After treatment with 0 ,5 ,10 and 20 μmol/L brazilein for 48 h ,the percent of apoptosis was (1 .15 ± 0 .32)% ,(19 .61 ± 4 .52)% ,(30 .18 ± 6 .35)% and (39 .48 ± 7 .44)% respectively .There was significant difference among the different treatment (P< 0 .05) .Compared with control group ,the protein expression of GRP78 and cytosolic cyto c was in‐creased after 5 ,10 and 20 μmol/L brazilein treated for 48 h .Conclusion Brazilein induced apoptosis in human lung cancer A549 cells though endoplasmic reticulum stress pathway .

Objective To investigate the feasibility and safety of minimally-invasive video-assisted parathyroidectomy ( MIVAP) for parathyroid adenoma ( PA) . Methods Clinical data of 14 patients with primary hyperparathyroidism ( PHPT) caused by PA between April 2011 and September 2014 in our hospital were analyzed retrospectively.Coexistent thyroid lesions were found in 6 patients.With preoperative definite diagnosis and localization, we performed parathyroidectomy and local excision or lobectomy of the thyroid gland.All the patients were confirmed by intra-operative fast frozen section pathological examination and postoperative pathological immunohistochemistry.Intra-and post-operative parathyroid hormone monitoring was conducted.Hoarseness, choking cough, and active bleeding were observed. Results All the procedures were accomplished successfully, without intra-operative abnormal blood loss or conversion to conventional operation.The operative time was 35-60 min ( mean, 50 min);the intra-operative blood loss was 1.7-32.0 g (mean, 9.75 g).Neither transient nor everlasting injury to recurrent laryngeal nerve or superior laryngeal nerve happened.No hemorrhage was observed.All the patients were followed up for 2-43 months ( mean, 16 months) , during which there was no recurrence. Conclusion MIVAP with thyroidectomy is feasible and safe for PA and coexistent benign thyroid lesions, on the basis of pre-operative adequate diagnosis and proper localization and intra-operative parathyroid hormone monitoring.

Objective To investigate the feasibility and safety of three-dimensional video-assisted thyroidectomy (3D VAT). Methods During January to April of 2014, 10 cases with unilateral or bilateral thyroid benign diseases , thyroid cancer, or parathyroid lesions were enrolled .The 3D VAT was carried out by using a 10-mm 3D stereoscopic endoscope .Local excision or lobectomy was performed via a 2-4 cm curve skin incision one finger above the sternal notch .In two patients , lobotomy combined with systematic lymphadenectomy was performed when papillary thyroid microcarcinoma was identified during operation . Results All the procedures were accomplished successfully under 3D video-assisted system, without intra-operative abnormal blood loss or conversion to conventional thyroidectomy .The operative time was 30-90 min (61.8 ±22.4 min);the intra-operative blood loss was 1.3-93.0 g (median, 5.2 g).All the patients were followed up for 1-4 months.Neither intra-nor post-operative complications about recurrent laryngeal nerve , superior laryngeal nerve , or parathyroid were observed . Conclusions Preliminary impression emerging from this study seems to suggest that 3D VAT is safe and effective.Compared with 2D surgery, a good perception of depth and easy recognition of anatomic structures are noticeable .

Objective To investigate the availability and mechanism of recombinant adenovirus vector expressing wild type p53 in gene therapy of prostate cancer. Methods Prostate cancer cell line PC3M was cultivated and recombinant adenovirus vector expressing wild type p53 was added to the media. Then the levels of proliferation and apoptosis were detected and changes of bax were exa mined . Results AdCMVp53 is effectively transfected to the cells. The transfecting ratio is 95%. In the cells transfected with AdCMVp53, the level of proliferation decreased. Tested by BrdU, the absorbance rate decreased from 1.454 in the control group to 0.496 in the experimental group( P

Education to medical postgraduates is relatively special. Their study and research work have something to do with their clinical practice. Based on their technical training for thoracic surgery,postgraduates were demanded to follow up and instruct their patients on postoperative recovery from surgery. In this way,these postgraduates were trained not only in clinical practice but also in other aspects,such as communication techniques,how to take care of patients,professional moral education. Instruction to outpatients is helpful to cultivate post-graduates and promote their abilities in self-thinking,self-acknowledging,initiative,creation,and so on. Instruction to outpatients is an important way to bring up excellent medical postgraduates.

ObjectiveTo investigate the clinical application value of enzyme-linked immunosorbent assay (ELISA) and time-resolved fluorescence analysis(TRFIA) and latex immune chromatography (GICA) in detecting hepatitis B serum markers.MethodsOne hundred and forty-five suspected patients of hepatitis B were detected serum markers of hepatitis B by ELISA,TRFIA and GICA method,and the results were compared and analyzed.ResultsWhen TRFIA method was as gold standard,the positive coincidence rate of ELISA and GICA method in HBsAg,HBeAb,HBcAb was 71％ (57/80),45％ (36/80),and in HBsAb,HBeAb,HBcAb was 33％( 1/3),0 (0/3),and there were significant differences between two methods (P＜0.05 ) ; the others were no significant differences (P ＞ 0.05 ).There was significant difference in the sensitivity of HBsAg between ELISA method and GICA method (P ＜ 0.05 ),but there was no significant difference in HBsAb,HBeAg,HBeAb,HBcAb(P ＞ 0.05 ).There was no significant difference in the specificity of HBsAg,HBsAb,HBsAg,HBeAb and HBcAb between ELISA method and GICA method (P ＞0.05).There was significant difference in HBsAg among three methods(P ＜0.05),but there was no significant difference between ELISA method and TRFIA method (P＞0.05),and there was significant difference between GICA method and TRFIA method (P＜0.05).There was no significant difference in HBsAb,HBeAg,HBeAb and HBcAb among three methods (P ＞ 0.05 ); there was significant difference in both HBsAb and HBeAb positive among three methods (P ＜ 0.05),and there was significant difference between ELISA method,GICA method and TRFIA method (P＜ 0.05).ConclusionTRFIA method has supreme measuring range,sensitivity and specificity supreme,but the price is higher;ELISA method is in the intermediate level of three methods and price is cheap,and it as well as TRFIA is suitable for the batch detection; GICA accuracy is low,but quick and simple,it is more suitable for the complement of the first two methods.

Objective To investigate the feasibility of differentiation between prostate cancer and prostatitis by using metabolic ratios provided by 3D 1H Magnetic Resonance Spectroscopic Imaging (MRSI). Methods Metabolic changes were evaluated in 42 voxels with prostate cancer and 30 voxels with prostatitis in the peripheral zone using MRSI. The results were based on the pathologic findings by biopsy. The (choline + creatine)/Citrate (CC/C) ratio and the changes of choline and citrate levels were evaluated in each voxel with cancer or prostatitis, t test was used to determine the power of the CC/C ratio in differentiation between prostate cancer and prostatitis. Results The CC/C ratio for cancer voxels (1.28±0.41) was significantly different from the ratio in the voxles with prostatitis (1.03±0.40), t=6.45, P<0.05, due to greatly increased choline level in the cancer voxels. When CC/C ratio of 0.8 was taken as the criteria for the diagnois of prostate cancer, the sensitivity, specificity and accuracy were 65.5%, 71.4% and 66.7%, respectively. Positive predictive value(PPV)and negative predictive value(NPV) were 90.5% and 33.3%, respectively. The CC/C ratio was higher than 0.86 in 66.7% voxels with prostatitis (20 voxels of total 30 voxels), which mostly depended on the level of choline. When citrate level was used as an auxiliary index to evaluate prostatitis (Cit/norm, Cit≥0.75), the misdiagnosis rate of prostate cancer was reduced to 26.6%(8 voxels of total 30 voxels). Conclusions The metabolic ratio of CC/C can be used to differentiate prostate cancer from prostatitis. The misdiagnosis rate is reduced when citrate is not or slightly decreased relative to normal citrate level (Cit/norm, Cit≥0.75).