Non-small cell lung cancer(NSCLC)is now regarded as the most common cause of cancer-related mortality in China.Despite continuous efforts to improve the therapeutic response,the overall five-year survival rate for NSCLC is still less than 15%.Now we have known that the growth of neoplastic tumors is maintained exclusively by a small subpopulation called "cancer stem cells" which posseses ability of self-renew and differentiation.It has been widely accepted that cancer stem cells are chemoresistant and radioresistant.Therefore,a major challenge in treating this and other cancers is the intrinsic resistance to conventional therapies demonstrated by the stem/progenitor cell that is responsible for the sustained growth,survival,and invasion of the tumor.Identifying these stem cells in non-small cell lung cancer and defining the biologic processes necessary for their existence are paramount in developing new clinical approaches with the goal of preventing disease recurrence.This review summarizes our update understandings of the cellular and molecular mechanisms operating within the putative cancer-initiating cells at the core of non-small cell lung cancer.

OBJECTIVE:To observe the effects of parecoxib preemptive analgesia combined with postoperative epidural analgesia on hip replacement and immune function. METHODS:Totally 86 patients undergoing unilateral hip replacement selected from Xining Third People's Hospital during Jan. 2014-Jun. 2016 were divided into observation group and control group according to random num-ber table,with 43 cases in each group. Two groups underwent unilateral hip replacement under spinal epidural anesthesia. Observation group was given Parecoxib sodium for injection 40 mg intravenously 30 min before the end of surgery. Control group was given con-stant volume of normal saline intravenously. Both groups were given epidural analgesia pump(Ropivacaine hydrochloride injection 150 mg+Ondansetron hydrochloride injection 16 mg+Dezocine injection 10 mg,added into normal saline to 100 mL)after surgery with dripping speed of 2 mL/h and patient-controlled time of 15 min. The hemodynamic indexes,analgesic effect,T lymphocyte subsets and NK cells levels were compared between 2 groups at different time points as well as the occurrence of ADR after surgery. RE-SULTS:Two patients of observation group and one patient of control group withdrew from the study. Before surgery,there was no sta-tistical significance in MAP and HR between 2 groups(P>0.05);12,24 h after surgery,MAP and HR of control group were signifi-cantly increased and higher than observation group,with statistical significance(P<0.05). There was no statistical significance in MAP and HR of observation group at different time points compared to before treatment;there was no statistical significance in MAP and HR between 2 groups immediately after surgery,48 h after surgery(P>0.05). There was no statistical significance in VAS score between 2 groups immediately after surgery(P>0.05);6,12,24,48 h after surgery,VAS scores of observation group were signifi-cantly lower than those of control group,with statistical significance(P<0.05). There was no statistical significance in CD3+,CD4+, CD4+/CD8+and NK cells levels between 2 groups before surgery(P>0.05). CD3+,CD4+and NK cells levels of 2 groups immediately after surgery,CD3+,CD4+,CD4+/CD8+ and NK cells levels of 2 groups at 12,24 h after surgery,CD3+and CD4+of control group at 48 h after surgery all changed significantly;CD3+,CD4+,CD4+/CD8+and NK cells levels of observation group at 12,24 h after sur-gery were significantly higher than those of control group,with statistical significantly(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:The parecoxib preemptive analgesia combined with postopera-tive epidural analgesia shows good analgesic effect for hip replacement patients,keeps their hemodynamics stable and protects immune function to certain extent with good safety.

Objective To investigate the early diagnostic value of serum neuron‐specific enolase(NSE) in neonaal hypoxic‐is‐chemic encephalopathy(HIE) .Methods Eighty full term neonates with HIE in the neonatology department of our hospital from January 2013 to June 2014 were selected as the observation group and contemporaneous 30 full term neonates without perinatal as‐phyxia as the control group .Serum NSE was detected within 24 h after birth and after 2‐week comprehensive treatment(mainly in‐cluding 10 d ganglioside therapy) .The neonatal patients were divided into the mild HIE in 18 cases ,moderate HIE in 48 cases and severe HIE 14 cases according to the HIE severity .The control group was performed the serum NSE detection within postnatal 24 h .Results The serum NSE level in the mild ,moderate and severe HIE groups was significantly higher than that in the control group(P<0 .05) .The re‐detected results of serum NSE after 2‐week comprehensive treatment in the mild ,moderate and severe HIE groups were significantly decreased when compared with those at admission ,the differences were statistically significant(P<0 .05) .Conclusion Serum NSE is a sensitive biochemical indicator for early diagnosing neonatal HIE ,and also reflect the severity of neonatal HIE .

Objective To design a new type of field operation instrument for easy to spread a rescue surgery rapidly in field first -aid at the present stage. Methods The traditional field operation instrument set is innovated in its composition, structure and function. The packing instrument procedure can be omitted. The new field operation instrument set is made of four different operation instrument boxes, two of which can be put into a standard field medical case. Results It is designed to be convenient to have a rescue surgery rapidly and to be washed, sterilized, conveyed and kept in aseptic storage. Conclusion The new field operation instrument case has such advantages as compactness, reasonable allocation and function completed, so it can be used easily.

This paper aims to discuss the use and management of operation instrument in treatment of the wounded on the sea by using the new type of field operation instrument set so as to improve the rescue ability on the sea. The operation set has a new structure and is designed reasonably. It is easy to be washed and disinfected. It can be packed sterilizedly for a long time and deployed rapidly. All of the operation instrument is fixed in the box to prevent it from falling when it is used on the sea and it is convenient to count and arrange. The new type of field operation instrument set is fit for rescuing the wounded on the sea. It is convenient to be used, sterilized, stored and carried.

Objective To explore the clinical characteristics,management and pregnancy outcome in patients with ovarian tumor and ovarian tumor like condition complicated with pregnancy.Methods The clinical data of 248 patients with ovarian tumor and ovarian tumor like condition eomplicated with pregnancy who treated,operated and pathology conducted from January 2003 to December 2009 was analyzed retrospectively.Results Among of 248 patients,8 patients were found by pelrioscopy,184 patients were found by sonography.The rate of ovarian tumor and ovarian tumor like condition during pregnancy was 0.49％ (248/50 652),about 52.82％(131/248)were diagnosed as benign tumor,most of them were ovarian mature teratoma(22.18％,55/248).About 45.56％(113/248)were diagnosed as ovarian tumor like condition,most of them were ovarian chocolatecyst(23.79％,59/248).Four patients(1.61％,4/248)were ovarian malignant tumor.Two hundred and sixteen received operation,term birth was in 164 patients,premature birth was in 19 patients,miscarriage was in 33 patients.Conclusions Pelvioscopy and sonogaraphy are principally important in the diagnosis and detection of ovarian tumor during pregnancy.Pregnancy complicated with ovarian tumor or ovarian tumor like condition should be treated by tumor resection.Suitable surgery intervention during second trimester is safe.

Objective To analyze the risk factors for postoperative stricture after endoscopic submucosal dissection (ESD) for early stage esophageal cancer.Methods The data of 362 patients with early esophageal cancer treated by ESD from January 2007 to February 2012 were reviewed to investigate the risk factors of postoperative stricture.Results Esophageal stricture after ESD occurred in 42 patients (11.6％)with a mean time from ESD to stricture of (58.5 ± 12.3) days.The rates of mild,median and severe stricture were 16.7％ (7/42),38.1％ (16/42) and 45.2％ (19/42),respectively.Multivariate analysis revealed that lesion range ＞ 3/4 esophageal circumference (odds ration [OR]:44.2 ; 95％ confidence interval [CI]:4.4-443.6) and tumor invasion beyond m2 (OR:14.2; 95 ％ CI:2.7-74.2) were independent risk factors.Stricture level was related to lesion's circumferential extension (relational coefficient (φ) =0.47,P ＜ 0.05) and tumor invasion depth (relational coefficient (φ) =0.647,P ＜ 0.05).Conclusion Circumferential extension and invasion depth of early esophageal cancer were independent risk factors for post-ESD esophageal stricture and related with the degree of stricture.

Objective To investigate the effects of Pseudomonas aeruginosa vaccine (PA) on proliferation and invasiveness of the hepatocellular carcinoma cell line MHCC97L with metastatic potential. Methods Proliferation, growth curve, plate efficiency, flow cytometry, transwell invasion assay, cell motility assay, scarification test, vascular endothelial growth factor (VEGF) and matrix metalloproteinase-2 (MMP2) protein activity were evaluated after cells were treated with PA at various concentrations. Results PA can inhibit the proliferation and plate efficiency of MHCC97L cell markedly in a dose-dependent manner. The IC50 of cells treated with PA for 48 h and 72 h was 3.1 ×108/ml and 1.9 × 108/ml, respectively. The doubling time increased and plate efficiency decreased gradually when cells treated with 0.5 × 108/ml, 1 × 108/ml and 2 × 108/ml PA (P＜0.01). PA could induce cell cycle arrest at the G1 phase in a dose-dependent manner by flow cytometric analysis. The average amount of invading cell per field in cell invasion assay and motility assay were 4. 8 ± 1.3 and 8. 8±2.2 when cells treated with 1× 108/ml PA, which was significantly lower than that of control group (8. 6±2. 1 and 15. 6±1.2 ) (P＜0.01) Scarification test showed that the metastatic ability of cells treated with 1 × 108/ml PA significantly lower than that in the control group. Comparison between cells treated with 1 × 108/ml PA and control group, no remarkable difference was found regarding expression of VEGF and MMP2 in supernatant of cell culture. Conclusion PA can inhibit proliferation and plate efficiency of HCC cell line MHCC97L, which is in part mediated by the cell cycle arrest at the G1 phase. PA could inhibit invasiveness of HCC cell line MHCC97L, which is unrelated to the VEGF and MMP2 protein activity.

Objective To analyze the complications after procedure for prolapse and hemorrhoids (PPH) in treating severe mucocutaneous hemorrhoids.Methods The clinical data of 550 patients with severe mucocutaneous hemorrhoids who were admitted to the Hangzhou Hospital of Nanjing Medical University from January 2005 to December 2013 were retrospectively analyzed.All the patients were treated by PPH or PPH + external hemorrhoids resection.The postoperative complications were recorded and assessed.Patients were followed up via outpatient examination and telephone interview till June 2014.Results Operation was successfully carried out on all the 550 patients.The operation time and duration of hospital stay were (15 ± 10)minutes and (4.2 ± 1.8)days,respectively.A total of 445 patients were followed up for 6-60 months,with the median time of 28 months.The overall incidence of complications was 14.61％ (65/445).Forty-five patients were complicated with anal pain,12 with hemorrhoid recurrence,7 with bleeding,5 with dysporia,4 with anastomotic stenosis and 2 with rectal and perianal infection.Of the 12 patients with hemorrhoids recurrence,5 was alleviated by medication and 7 received PPH for the second time.Of the 4 patients with anastomotic stricture,the condition of 2 patients were alleviated by anus dilatation,and the condition of 1 patient was alleviated by balloon dilatation under enteroscope,1 patient received circular incision of the stricture because of severe stricture and failed of conservative treatment.Of the 2 patients with rectal and perianal infection,1 was alleviated by intravenous and local medication,and the other patient who was complicated with anal fistula was alleviated by surgery.The condition of other patients was improved after symptomatic treatment.Conclusions PPH is effective and safe for the treatment of severe mucocutaneous hemorrhoids.The main complication is anal pain,and it could be cured or alleviated by symptomatic treatment.