Objective To discuss the efficacy and safety of different second-line chemotherapies in small cell lung cancer chemotherapy.Methods 170 patients with small cell lung cancer who were failure to first -line treatment were chosen,they were randomly divided into observation group and control group.The control group was given paclitaxel plus cisplatin second-line chemotherapy,the observation group used the irinotecan joint cisplatin second-line chemotherapy.The effect of the two groups was recorded.Results The effective rate of the observation group was 45.88%,which of the control group was 25.88%,the difference between the two groups was statistically significant (χ2 =7.389,P<0.05).The median survival time,total survival time,median disease-free survival time, Karnofsky score,pain score of the observation group were (10.32 ±2.41)months,(7.89 ±1.88)months,(7.54 ± 1.78)months,(83.23 ±6.89)points,(2.37 ±1.07)points,which of the control group were (7.45 ±1.03)months, (3.16 ±0.79)months,(3.89 ±0.68)months,(69.97 ±2.33)points,(4.81 ±2.13)points,the differences between the two groups were statistically significant (t =10.095,21.384,17.660,21.384,17.660,all P<0.05).In the observation group,nausea and vomiting occurred in 5 cases,thrombocytopenia in 3 cases,anemia in 1 case,leukopenia in 7 cases,hypodynamia in 12 cases.In the control group,nausea and vomiting occurred in 16 cases,thrombocytopenia in 11 cases,6 cases of anemia,leukopenia in 18 patients,hypodynamia in 26 cases,the differences between the two groups were statistically significant(χ2 =6.574,4.981,4.722,4.981,4.722,all P <0.05).Conclusion The second-line chemotherapy regimens with irinotecan used in small cell lung cancer patients can improve the treatment effect,adverse reaction mild,prolong patients'survival,it is worth popularizing in clinical.

Purpose:To evaluate the Application of Ultrasound Guided Mammotome Minimallay Invasive Biopsy System in diagnosis and treatment of breast masses. Methods:68 breast lesions in 42 patients were performed by Ultrasound Guided Mammotome Minimallay Invasive Biopsy System in order to evaluateits diagnostic and therapeutic ifficacy. Results:40 lesions were diagnosed as fibroadenoma , 19 lesions as fibroadenomatoid hyperplasia, 7 lesions as breast adenosis,2 lesions diagnosed as galactocele in operation but fibre and fat tissue after operation by pathology. 67 lesions were excised by mammotome system. 1 lesion was stopped duete hmorrage,1 case had serious hematoma. 1 case had machine failure but was resolved. The excision times were on the average 28 in every lesion,the lengh of incision is only 3mm,and the duration of operation was 30 minutes. No evidence of recurrence was found by physical examination and the ultrasound evaluation during the follow up 1~6 monthes. Conclusions:Ultrasound guided mammotome minimallay invasive biopsy system excision for benign breast mass was complete and the postoperative breast appearance was satisfactory.

Objective To explore the surgical skill, safety, and cosmetic outcomes of complete endoscopic subcutaneous mastectomy and immediate reconstruction with implants for breast cancer. Methods From August 2004 to September 2007, 31 women with breast cancer received complete endoscopic subcutaneous mastectomy and immediate reconstruction with implants in our hospital after neoadjuvant chemotherapy. The operation spaces were established by insufflating carbon dioxide after lipolysis and liposuction in the subcutaneous stratum and retromammary space. Subcutaneous mastectomy was carried out under a complete endoscope, sentinel lymph node biopsy or axillary lymph node dissection, and immediate reconstruction with implants were carried out via axillary small incision. Results The operations were completed in all of the 31 cases. Sentinel lymph node biopsy was performed on 15 cases (including supplemental axillary lymph node dissection in 8), and immediate axillary lymph node dissection was done in 16 cases. No cancer infiltration on tumor surface or into the nipple basement was observed in frozen sections during the operation. In one patient, the nipple was partly necrotic. No other complications were found in this series. Three months after the operation, cosmetic results were good in 22 cases (71.0%), average in 7 (22.6%), and poor in 2 (6.4%). The patients were followed for 3 months to 3 years (over 1 year in 15 patients), during which no one had metastasis or recurrence of the tumor. Conclusions Complete endoscopic subcutaneous mastectomy combined with immediate reconstruction with implants is less traumatic and safe with few complications and good cosmetic result. The method is a good choice for patients with early-stage breast cancer.

Objective To improve the existing folded grid tent and enhance the efficiency of medical support.Methods The simple pulley and handling dolly were developed,and the skeleton rod was strengthened.Results The improved folded grid tent was easy to carry,transport and handle,and the skeleton rod was solid enough.Conclusion The improved folded grid tent is gifted with an enhanced support efficiency and a longer service time.

Penicillin expandase, also known as deacetoxycephalosporin C synthase (DAOCS), is an essential enzyme involved in cephalosporin C biosynthesis. To evaluate the catalytic behaviors of penicillin expandase under high penicillin G concentration and to identify mutants suitable for industrial applications, the specific activities of wild-type DAOCS and several mutants with increased activities toward penicillin G were determined by HPLC under high penicillin G concentrations. Their specific activity profiles were compared with theoretical predictions by different catalytic dynamics models. We evaluated the specific activities of wild-type DAOCS and previous reported high-activity mutants H4, H5, H6 and H7 at concentrations ranging from 5.6 to 500 mmol/L penicillin G. The specific activities of wild-type DAOCS and mutant H4 increased as penicillin G concentration increased, but decreased when concentrations of substrate go above 200 mmol/L. Other mutants H5, H6 and H7 showed more complex behaviors under high concentration of penicillin G. Among all tested enzymes, mutant H6 showed the highest activity when concentration of penicillin G is above 100 mmol/L. Our results revealed that the substrate inhibition to wild-type DAOCS' by penicillin G is noncompetitive. Other DAOCS mutants showed more complex trends in their specific activities at high concentration of penicillin G (>100 mmol/L), indicating more complex substrate inhibition mechanism might exist. The substrate inhibition and activity of DAOCS mutants at high penicillin G concentration provide important insight to help select proper mutants for industrial application.
Catalysis ; Intramolecular Transferases ; genetics ; Mutation ; Penicillin G ; pharmacology ; Penicillin-Binding Proteins ; genetics ; Streptomyces ; enzymology ; genetics

In the study,nematode-trapping fungus-Arthrobotrys oligospora was firstly cultivated in Sabouraud dextrose broth medium containing 0.05％ of agar,then transferred to the corn meal agar medium.A.oligospora conidiospores was eluted from the media in different time and lyophilized after being counted,then the resuscitation of lyophilized spores was also observed,in oder to evaluate their nematicidal dosage and nematode-trapping efficacy in vitro.The results of the study were as follows:by observing the germination rate,growth rate and nematode-trapping rate of lyophilized spores from A.oligospora.The maximum germination rate of lyophilized A.oligospora conidiospores was 79.5％ on the 4 th day after inoculation,and the average growth rate was 3.4 mm/d;the maximum nematode-trapping rate was 95.8％ on the 7 th day after larvae were added on the media,and the average nematode-trapping rate was 74.0％.Compared with the control groups,the differences were both no significant (P＞0.1)in average growth and nematode-trapping rate.The results show that the freeze-dried preparation materials was accessible and simple,with good resuscitation.After further optimization it will display the prospect of industrialization application.

Objective To detect the excision repair cross-complementing gene 1 (ERCC1) and thymidylate of the acid synthase (TS) in non-small cell lung cancer (NSCLC) and its adjacent tissue,and investigate the relationship of the expression of ERCC1 and TS with the clinical characteristics of NSCLC and prognosis for NSCLC individual therapy to provide experimental basis.Methods The protein expression levels of ERCC1 and TS in 50 cases of postoperative NSCLC cancer and adjacent tissue were detected by immunohistochemical method and the relationship among the expression of ERCC1,TS,and overall survival of patients with NSCLC Phase (OS),disease progression time (TTP),the median OS,and median TTP was analyzed.Results (1)There was an obvious difference between the expression of ERCC1,TS in cancer and paraneoplastic tissue of NSCLC,which had statistically significance (64.00％ vs 20.00％,x2 =19.87,P ＜ 0.01 ;48.00％ vs 24.00％,x2 =6.25,P ＜ 0.05) ; (2)The continued investigation in the patients who received postoperative cisplatin or carboplatin chemotherapy showed that the 0S of negative expression of ERCC1 was significantly longer than the positive one (19.10 vs 10.00 months;x2 =8.133,P =0.002),so was median TTP (15.30 vs 9.00 months; x2 =7.410,P =0.003).The median 0S of the negative expression of TS,was significantly longer than the positive one (17.80 vs 11.00 months,x2 =7.001,P =0.008),so was median TTP (11.40 vs 6.80 months; x2 =5.884,P =0.026).Conclusions ERCC1 and TS protein may become sensitive predictors of platinum chemosensitivity for NSCLC patients ; the detection of combined with ERCC1 and TS would contribute to the selection of individualized treatment programs for NSCLC.

Objective To explore surgical approach for internal mammary node biopsy in patients with breast cancer. Methods Modified radical mastectomy and incised intercostal muscles for internal mammary node biopsy was performed on 113 patients. The distance from the internal mammary artery to the lateral sternal border, and the intercostal distance between the two costal cartilage were measured. Anatomical location and maximal diameter of the excised nodes were recorded. Results The internal mammary artery runs through intercostal space along the lateral sternal border. The distance from the internal mammary artery to the lateral sternal border was (10. 9?4. 5) mm, (11.6?2.9) mm, (9.6?3.6) mm and (4.5?3.5) mm in the first, second, third and fourth intercostal space, respectively. The distance between the two costal cartilage was (14. 2?4. 1) mm, (16. 2?4. 2) mm, (13. 9?4. 3) mm and (9.9?3. 6) mm in the first,second, third and fourth intercostal space, respectively. Two hundred and seventy-nine internal mammary nodes were excised from 113 patients. The anatomical location of the internal mammary nodes which embedded in the fatty tissue surrounding internal mammary artery were 41. 2% at the medial side, 51. 6% at the lateral side and 7. 2% in an anterior plane to the internal mammary artery. Metastases in the internal mammary node were detected in 26 patients. The lymph nodes metastasis were detected only in the internal mammary nodes in 5 cases. Conclusion Internal mammary node biopsy via intercostal space is a feasible, minimally traumatic, low-risk procedure.

Objective:To investigate the short-term efficacy of totally laparoscopic distal gastrectomy (TLDG) after endoscopic submucosal dissection (ESD) versus direct TLDG for early gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 623 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2014 to December 2019 were collected. There were 405 males and 218 females, aged from 26 to 86 years, with a median age of 62 years. Of 623 patients, 25 cases undergoing TLDG after ESD were divided into ESD+TLDG group and 598 cases undergoing TLDG directly were divided into TLDG group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations of TLDG; (3) stratification analysis of the ESD+TLDG group. The propensity score matching was conducted by 1∶2 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range) and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 75 of 623 patients had successful matching, including 25 in the ESD+TLDG group and 50 in the TLDG group. Before propensity score matching, the body mass index (BMI), cases with tumor diameter ≤20 mm, 21 to 30 mm or>30 mm, cases with tumor classified as stage Ⅰ, stage Ⅱ or stage Ⅲ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1, 0 of the ESD+TLDG group, respectively, versus (24.3±2.7)kg/m 2, 238, 125, 235, 312, 126, 160 of the TLDG group, showing significant differences in the above indicators between the two groups ( t=2.744, Z=?2.834, ?4.209, P<0.05). After propensity score matching, the BMI, cases with tumor diameter ≤20 mm, 21 to 30 mm or >30 mm, cases with tumor classified as stage Ⅰ or stage Ⅱ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1 of the ESD+TLDG group, versus (23.6±2.9)kg/m 2, 29, 12, 9, 48, 2 of the TLDG group, showing no significant difference between the two groups ( t=1.542, Z=?0.597, 0.000, P>0.05). (2) Intraoperative and postoperative situations of TLDG: after propensity score matching, the operation time and time to postoperative drainage tube removal were 180 minutes(range, 124 to 289 minutes) and 6 days(range, 4 to 13 days) of the ESD+TLDG group,respectively,versus 170 minutes(range, 106 to 250 minutes) and 6 days (range, 4 to 9 days) of the TLDG group, showing significant differences between the two groups ( Z=-2.396, -3.039, P<0.05). Cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL, the number of lymph node dissected, duration of postoperative hospital stay, cases with perioperative complications as incision fat liquefaction, delayed gastric emptying, anastomotic bleeding or pulmonary infection were 7, 9, 9,34(range, 16 to 58), 8 days(range, 6 to 31 days), 1, 1, 0, 0 of the ESD+TLDG group,respectively,versus 18, 26, 6, 39 (range, 22 to 68), 8 days (range, 6 to 29 days), 0, 0, 1, 1 of the TLDG group, showing no significant difference between the two groups ( Z=-1.703, -1.958, -1.139, χ2=0.033, P>0.05). Cases with anastomotic bleeding were recovered after hemostasis under endoscopy and cases with other perioperative complications were recovered after conservative treatment. (3) Stratification analysis of the ESD+TLDG group. ① For 5 cases undergoing TLDG ≤14 days after ESD and 20 cases undergoing TLDG >14 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 170 to 289 minutes), 0, 3, 2, 36(range, 9 to 57), 7 days(range, 5 to 9 days), 8 days(range, 7 to 9 days), 1 and 180 minutes (range, 124 to 253 minutes), 8, 6, 6, 34(range, 8 to 78), 6 days(range, 4 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.536, ?1.993, ?0.238, ?0.932, ?0.589, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ② For 13 cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss as <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 145 to 289 minutes), 2, 6, 5, 34(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 11 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 3, 3, 34(range, 16 to 78), 6 days(range, 5 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing a significant difference in the operation time of TLDG between the two groups ( Z=?2.241, P<0.05), while showing no significant difference in the volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay between the two groups ( Z=?1.471, ?0.163, ?0.084, ?0.194, P>0.05) and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ③ For 15 cases undergoing TLDG ≤28 days after ESD and 10 cases undergoing TLDG >28 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 190 minutes (range, 145 to 289 minutes), 2, 7, 6, 33(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 31 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 2, 2, 37(range, 16 to 78), 6 days (range, 5 to 13 days), 8 days(range, 6 to 14 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.619, ?2.000, ?0.667, ?0.370, ?0.057, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). Conclusions:Compared with cases undergoing TLDG directly, the operation time to TLDG and time to drainage tube removal after TLDG for cases undergoing ESD+TLDG are prolonged, but there is no difference in the short-term efficacy. For cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, there is a significant difference in the operation time of TLDG.

Objective To explore effects of endoscopic subtotal thyroidectomy on nodular goiter and its clinical significance.Methods From Jun.2004 to Dec.2009,72 patients with nodular goiter underwent endoscopic subtotal thyroidectomy in Southwest Hospital.Of the 72 cases,22 cases had left-side nodule,31 cases had right-side nodule and 19 cases had bilateral nodules.Single thyroid nodule occurred in 41 cases and multiple nodules in 31 cases.The total number of nodules was 113.The average nodule size was 2.8 cm(ranging from 0.4 to 6.3 cm).Results Of the 72 cases,19 patients underwent bilateral subtotal thyroidectomy and the mean operative time was 97 min(ranging from 80 to 150 min).53 patients underwent unilateral subtotal thyroidectomy and the mean operative time was 65 min(ranging from 25 to 120 min).The mean intraoperative blood loss was 45 ml (ranging from 5 to 120 ml).Of the 72 cases,68 cases were given cervical plexus block regional anesthesia and among them 66 cases(97%)acquired good anesthesia.Temporary hoarse voice occurred in 2 cases and postoperative bleeding occurred in the subcutaneous tunnel of breast in 2 cases.Patients were followed up from 3 to 5years and the cosmetic result was satisfactory.The postoperative review half year later showed that unilateral nodule recurred in 1 case and the recurrence rate was 1.4%.Conclusions Endoscopic subtotal thyroidectomy through anterior chest wall or breast approach under local anesthesia is a safe and effective treatment in nodular goiter.In the process of dissecting thyroid,blunt maneuver and proper use of ultrasonic knife instead of clamping thyroid nodules directly are recommended in order to reduce intraoperative blood loss and enhance safe practice.