For advanced lung cancer,multimodality treatment is the main stream.Patients with locally advanced disease may have long-term survival rate with radiation therapy combined with chemotherapy.Patients with advanced metastatic disease may achieve improved survival and palliation of symptoms with chemotherapy.Here we reviewed the recent development in treatment for advanced non-small cell lung cancer.

Objective: To investigate the influencing factors for social alienation among the elderly patients with type 2 diabetes mellitus (T2DM), so as to provide insights into formulating targeted intervention measures. Methods: T2DM patients aged 60 years and older were selected from Hangzhou First People's Hospital from January to October 2023. Their demographics, diabetes complications were collected using questionnaire surveys, social support level was evaluated using the Social Support Scale, and the stigma was evaluated using the Chinese version of the Type 2 Diabetes Stigma Assessment Scale, and the social alienation was assessed using General Alienation Scale. Factors affecting the social alienation were identified among the elderly patients with T2DM using a multiple linear regression model. Results: A total of 316 elderly patients with T2DM were investigated, including 171 males (54.11%) and 145 females (45.89%), and had a mean age of (69.75±8.12) years. The level of social support was mainly medium, with 162 cases accounted for 51.27%. The average stigma scores were (61.87±12.50) points, and average social alienation scores were (42.09±6.33) points. Multiple linear regression analysis identified educational level (high school/junior college, β'=-0.159; college and above, β'=-0.301), marital status (married persons, β'=-0.236), monthly household income (3 000 Yuan and more, β'=-0.175), diabetes complications (β'=0.192), social support level (medium, β'=-0.210; high, β'=-0.352) and stigma score (β'=0.283) as factors affecting the social alienation among the elderly patients with T2DM. Conclusion The social alienation among the elderly patients with T2DM are associated with educational level, marital status, family income, diabetes complications, social support level and stigma.

Objective To study the relationship between PDD and the polymorphism of apolipoprotein E(apoE) gene,to inquire the etiological basis of PDD.Methods 11 Patients with PDD 40 patients with PD without dementtia and 52 unrelated controls were collected to detect the genotype of apoE gene by PCR－ RFLP. Results There was no difference in the apoE allele frequencies and genotype distribution in PDD group,PD without dementia group and control group(P >0.05). Conclusion There is no relationship between the polymorphism of apoEgene and the onset of PDD.The pathogenesis of PDD differs from that of AD.

Objective To investigate the effect of bortezomib on proliferation and apoptosis of pancreatic cancer cell lines BxPC3,SW1990 and explore possible mechanisms of bortezomib's killing effect on cancer cells.Methods BxPC3,SW1990 cells were treated by using 1,10,50,100,500 nmol/L and 1,10 μmol/L of bortezomib,and cells without bortezomib treatment were considered as control group.The cell proliferation was determined by MTF assay,and apoptosis was determined by flow cytometry.Bak,Bax,Bcl2,Bcl-xl,survivin mRNA expressions were measured by RT-PCR,and Western blot was applied to determine the expressions of pro-caspase-3,cleaved-caspase-3,Bax,Bcl-2,surviving protein.Results When bortezomib concentration was higher than 50 nmol/L,it inhibited the proliferation of two cell lines in a dose and time-dependent manner.And with the same treatment the rate of proliferation inhibition of BxPC3 cells by bortezomib was greater than that of SW1990 cells,and the difference between the two cell lines was statistically significant (P ＜0.05).Apoptosis rates in the groups of BxPC-3 and SW1990 cells treated by 100 nmol/L bortezomib were (22.56 ± 4.23) ％ and (12.71 ± 2.23) ％,which were significantly higher than those in control group (2.15 ± 0.47) ％ and (2.32 ± 0.54) ％,P ＜ 0.05).In addition,apoptosis rate of BxPC3 cells was significantly higher than that of SW1990 cells (P＜0.05).Bak mRNA expression of BxPC3 and SW1990 cells after 100 nmol/L bortezomib treatment were not significantly changed,but the expression of Bax mRNA and protein was significantly increased (P ＜0.05).Bcl-2 mRNA and protein,as well as Bcl-xl mRNA expressions was significantly decreased (P ＜0.05).The expression of survivin mRNA and protein in BxPC3 cells were decreased,but were increased in SW1990 cells(P ＜0.05).The expression of pro-caspase-3 protein in the two cell lines was decreased,while the expression of cleaved-caspase-3 protein was increased (P ＜0.05).Conclusions Bortezomib can inhibit the proliferation of pancreatic cancer cell Iines BxPC-3 and SW1990 and induce apoptosis,and the effect on BxPC3 cells is more than that on SW1990 cells.The mechanism may depend on activation of the mitochondrial pathway of apoptosis,and be related to survivin-involved drug-resistance.

BACKGROUND:Lumbar spinal stenosis can result in lumbar nerve root pain and other symptoms or even disability, which seriously impacts people’s quality of life. Interbody fusion is the main clinical treatment. Studies have shown that an interspinous fusion cage is prone to have hairline fractures and loss of implant; therefore, biomechanical properties and biocompatibility of the interbody fusion cage at L4/5need to be studied.
OBJECTIVE:To analyze the stability of the interspinous fusion cage at L4/5, and to explore the biomechanical properties and biocompatibility of adjacent segments.
METHODS: Ten adult fresh frozen spine specimens were selected and divided into normal group and model group, with five specimens in each group. The specimens were numbered and placed in a special fixture. The interspinous fusion cage, made in Zhengzhou Cast Medical Instrument Co., Ltd., China, was implantedin vivo and fixed using a cage fixator made of Ti6AL-4V ELI.
RESULTS AND CONCLUSION:Artificial vertebral bodies had less strain changes than the normal vertebrae in different implantation positions in terms of central compression, anteflexion, rear protraction, lateroflexion (P < 0.05). During vertebral displacement under the maximum load of 500 N, the linear displacement and angular displacement in anteflexion, rear protraction, left lateral flexion, levorotation were decreased significantly in the model group than the normal group (P < 0.05). These findings indicate that the interspinous fusion cage can maximaly preserve the range of motion of the injured vertebral body, maintain the stability of the segment, and reduce the stress of the intervertebral disc.

Purpose:To study the effectiveness and safety o f first-line chemotherapy with GEM-Cis 3-week regimen in routine care of Chin ese patients with advanced NSCLC. Methods:Gem-Cis 3-week regimen was used as first line chemoth erapy to treat stage Ⅲb/Ⅳ NSCLC patients, measurements of effectiveness includ ed clinical benefit and significant clinical response (SCR), and side events of GEM-Cis in the treatment of stage Ⅲb/IV NSCLC. Results:221 patients with cytological or pathological confirmed stage Ⅲb or IV NSCLC were enrolled, 209 eligible for effectiveness and safety analysis. Median age 58 years (range, 29 to 79 years); males: females, 67.5%∶ 32.5%; stage Ⅳ: ⅢB, 52.5%∶47.8 %; KPS

A 2-month-old baby girl developed universal keratotic plaques soon after birth. Physical examination revealed well-defined, dark erythematous, keratotic plaques with thick scales and mild infiltration at the periorbital, perioral, perianal and vulvar regions, as well as deep fissures of both hands and feet covered with thick yellowish crusts. Another case was a 24-year-old female, the mother of the baby, who presented with hyperkeratotic plaques at perioral and perianal regions, congenital alopecia universalis, mutilation of fingers and toes with massive thick keratotic yellow crusts and scales. Histopathology of skin lesions from the gluteal region of the baby showed psoriasiform hyperplasia of the epidermis, slight inflammatory infiltration of dermal papillae and superficial dermal perivascular regions. Immunohistochemistry demonstrated the positive staining for acidic keratin (AE1) in the prickle cell layer and granular layer and for CK10 in the upper prickle cell layer and granular layer. Electron microscopy showed increased cell space and decreased tonofilament. Both the baby girl and her mother were diagnosed with Olmsted syndrome.

Objective To observe the pathological change of visceral pleura in patients with chronic obstructive pulmonary disease (COPD), and to discuss the relationship between the changes and COPD airflow limitation. Methods A total of 70 patients received the pulmonary lobectomy or partial resection because of lung tumor in Tianjin Chest Hospital from May 2014 to August 2015 were selected in this study. According to the results of pulmonary function test, the patients were divided into COPD group [forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC) <70%,n=40] and control group (FEV1/FVC≥70%,n=30). The lung tissues, which was not the lesion areas, were used to make tissue sections. The Elastica Van Gieson (EVG) method was used to stain the sections. The thickness of visceral pleural and the proportion of elastic fibers in visceral pleural were observed and calculated under a microscope in the two groups. Results The specimens were derived from upper and middle lobes in 22 cases of COPD group, and from lower lobe in 18 cases. Specimens were derived from upper and middle lobes in 17 cases of control group, and from lower lobe in 13 cases. There were no statistical differences in sampling sites between two groups (χ2=0.019,P>0.05). The visceral pleural thickness and the proportion of elastic fibers in visceral pleural were significantly thinner in COPD group than those of control group ( P<0.01). In both COPD group and control group, visceral pleural thickness was significantly thinner in upper and middle lobes than that of lower lobe (P<0.05), but the proportion of elastic fibers in visceral pleural of upper, middle lobes showed no statistical difference compared with that of the lower lobe (P>0.05). Conclusion The thinner visceral pleural and the reduction of elastic fibers in visceral pleural are one of the causes of expiratory airflow limitation in COPD patients.

Emotional and cognitive disorders (EACD),such as depression and anxiety,have become very common in today′s society,seriously affecting human lives and health. Neural plasticity can reflect the anti-stress ability of the nervous system to the internal and external stimulation,and is capable of dynamic changes in structure or function to adapt to environmental changes,as is often manifested in the process of compensation and repair of nerve injuries. EACD is often accompanied by macroscopic and cellular morphological changes in brain tissues and functions. Thus,studies on the mechanisms of neural plasticity will contribute to the treatment of EACD. In this paper ,the role of neural plasticity in the active components of Chinese herbal medicine(ACCHM) is reviewed. The effects of ACCHM on 5-hydroxytryptamine(5-HT)system,and the antioxidant activities and neurotrophic effects of ACCHM are described. ACCHM can affect neural plasticity,playing a neuroprotective role by improving 5-HT levels,reducing oxidative stress in brain cells,and increasing the expression of brain derived neurotrophic factor(BDNF). In summary,one ACCHM could affect neural plasticity through one or more mechanisms. There are interactions between different mechanisms of the same ACCHM. Different ACCHM can play a synergistic effect on the enhancement of neural plasticity because of their different mechanisms.

Objective To compare the influence of tracheotomy after two wet fluid on airway and provide the basis for clinical treatment and care. Methods A total of 30 patients with severe brain injury stay neurosurgery tracheotomy were divided into 0.45% sodium chloride group and ambroxol hydrochloride group with 15 cases each by random digits table method, two airway humidification liquid (0.45%sodium chloride,0.9% sodium chloride + ambroxol hydrochloride) were each instilled in the trachea inner sleeve. Blood gas analysis was performed and the levels of serum lung surface active substances related protein-A (SP-A protein), interleukin-6, interleukin-8, tumor necrosis factor-alpha(TNF-α) were measured by enzyme linked immunosorbent assay (ELISA) before 1 d and after 3,7,14 d of tracheotomy. Results There were significant differences in arterial blood oxygen partial pressure, arterial carbon dioxide partial pressure, oxygenation index after 14 d of tracheotomy between ambroxol hydrochloride group and 0.45% sodium chloride group:(110.72±26.75) mmHg(1 mmHg=0.133 kPa) vs.(89.39±21.98) mmHg, (30.44±6.75) mmHg vs. (35.12±7.28) mmHg, 333.23±80.56 vs. 270.93±77.21, t=29.49,-8.63,7.44, P<0.01.There were significant differences in the levels of serum SP-A protein, interleukin -6, interleukin -8, TNF-α after 14 d of tracheotomy between ambroxol hydrochloride group and 0.45% sodium chloride group:(191.34 ±1.21) ng/L vs. (61.92 ±12.0) ng/L, (2.62 ±0.23) ng/L vs. (5.42 ±0.16) ng/L, (124.56 ±2.10) ng/L vs. (185.91 ±1.48) ng/L, (31.32±1.38) ng/L vs.(69.13±1.16) ng/L, t=75.72,-13.51,-23.89,-20.97, P<0.01. Conclusions The airway humidification effect of ambroxol hydrochloride group is better than 0.45%sodium chloride group, it can improve the wetting effect, and better protect the lung tissue, reduce the incidence of lung infection, make it an ideal airway humidification liquid.