The essay discussed the necessity and essentiality of medical moral education to intern,in the background of market-oriented economy.To summarize ways of medical moral education to intern.

Objective:In order to improve the treatment methods of laryngotracheal atresia, several improved surgical procedures were used.Method:From 1986,the 48 patients with laryngotracheal atresia accepted surgical treatment in our hospital.Laryngo-fissure with laser cauterization of the glottis, laryngotracheal reconstruction using surgical flaps with or without particles, laryngo-tracheal reconstruction using itself′s cicatrices, tracheal end-to-end anastomosis, two-stage laryngotracheal reconstruction using aqueduct method, bronchotracheal reconstruction through the chest. Result:46/48 cases were cured breathing without tracheal cannula.Following-up survey is 1～12 years.Conclusion:The treatment of cicatriceal laryngotracheal atresia was difficult, but if the surgical methods were selected carefully according to the situation of each patient, we also can get a good result.

Objective To explore the clinical effects and safety of treatment for colorectal cancer to pulmonary metastases with percutaneous multiple electrodes radiofrequency-2000 (RF-2000) under CT-guided.Methods 26 pulmonary metastatic tumors in 11 cases were treated with RF-2000. The following extents were observed: (1) blood pressure,pulse rate and oxygen saturation during the treatment;(2)the variety of the liver function,the lung function and renal function after treatment;(3) the variety of the volume and low dense shadow of tumors after treatment;(4)the survival rate for 5 years. Results (1) The blood pressure,pulse rate and oxygen saturation were not changed during the treatment;(2) the liver function,the lung function and renal function after treatment were also not changed;(3) the volume of tumors were increased one month after treatment,three months later,23 lesions of 26 tumors were disappeared,2 decreased to more than 80% and 1 to 50%~80% in volume,and the low dense shadow within the tumors appeared as Ⅰtype (less than 50%) in one,Ⅱtype (50%~80%) in 3 and Ⅲ type (more than 80%) in 22;(4)The survival rate for 5 years was 81.82%(9/11). Conclusion The clinical effects and safety of treatment of colorectal cancer to lung metastases with percutaneous radiofrequency-2000 (RF-2000) under CT-guided is excellent.

Objective To investigate the diagnosis and treatment of congenital tracheoesophageal fistula (TEF) in adult patients. Methods The clinical data of 6 adult patients with congenital TEF who had been admitted to Tangdu Hospital from January 1990 to November 2007 were retrospectively analyzed. All patients had the symp-toms of cough when drinking and/or eating fluid and expectoration. The fistulas of the 6 patients were excised, openings were closed with sutures, and the closures were covered with pedicled pleural flaps. Results All patients were diagnosed preoperatively according to the medical history and imaging examination. All the patients were with H-type TEF. The diameters of the fistulas ranged from 0.3 cm to 1.0 cm, and their lengths ranged from 0.2 cm to 1.5 cm. The outcomes and prognoses of the patients were excellent. All patients were followed up for 5 months to 10 years, and no recurrence occured. Conclusions Congenital TEF should be considered when patients are presented with recurrent and chronic cough and pulmonary suppuration. Congenital TEF can be diagnosed accor-ding to the medical history and imaging examination. Surgical procedure for congenital TEF is safe and effective.

Objective To investigate the expressions of ABCG2 and V-ATPase in NSCLC and their expression rates in pathological classification, TNM stages and pathological grades and the expression correlation between ABCG2 and V-ATPase. Methods Expressions of ABCG2 and V-ATPase were accessed with EnVinsion immunohistochemistry in tumor samples from 92 NSCLC patients. The corresponding data was analyzed statistically. Results Expressions of ABCG2 and V -ATPase were found both in the lung adenocarcinoma and lung squamous cell cancer, and the difference between these two kinds of tumors was significant (P =0.003,0.000). ABCG2 expression was significantly different among TNM stages of lung adenocarcinoma (P=0.004) as well as among pathological grades of lung adenocarcinoma (P =0.028) and squamous cell carcinoma (P =0.000), while no significant difference was found among TNM stages of squamous cell lung carcinoma. The level of V-ATPase expression was associated with TNM stages of lung adenocarcinoma (P =0.026) and pathological grades of lung squamous cell carcinoma (P =0.002), however, among TNM stages of lung squamous cell carcinoma and pathological grades of lung adenocarcinoma, the difference was not significant. Additionally, the significant correlation was found between expression of ABCG2 and V-ATPase in all samples, adenocarcinoma and squamous cell carcinoma (P<0.001). Conclusion The significant correlation is found between expression of ABCG2 and V-ATPase, which indicate that they may co-work to participate in the mechanism of anticancer drug resistance.

Objective To evaluate the changes in the expression of CXCR3 in regulatory T cells (Tregs) in the renal tissues of mice with renal ischemia-reperfusion (I/R) injury .Methods Forty-eight SPF male C57BL/6J mice ,aged 8-12 yr ,weighing 20-25 g ,were randomly divided into 3 groups ( n=16 each ) using a random number table:sham operation group (group S) ,group I/R and CD25 monoclonal antibody PC61 group (group P) . Bilateral kidneys were exposed and their pedicles were occluded for 45 min with atraumatic mini-clamp followed by 72 h reperfusion .PC61 250 μg was injected intraperitoneally at 24 h before the model was established .Blood samples were collected from the inferior vena cava at 24 and 72 h of reperfusion (T1 ,2 ) for determination of serum blood urea nitrogen (BUN) and creatinine (Cr) concentrations .Bilateral kidneys were obtained for determination of CD4+ CD25+ Foxp3+ Treg count and CXCR3+ CD4+ CD25+ Foxp3+ Treg count in renal tissues and the pathological changes of the kidney were scored .Results Compared with group S , the serum BUN and Cr concentrations and pathological scores were significantly increased at T1 ,2 in I/R and P groups ,and the number of CD4+ CD25+ Foxp3+ Treg and CXCR3+ CD4+ CD25+ Foxp3+ Treg was increased at T2 in I/R group ( P<0.05) .Compared with group I/R ,the serum BUN and Cr concentrations and pathological scores were significantly increased at T2 ,and the number of CD4+ CD25+ Foxp3+ Treg and CXCR3+ CD4+ CD25+ Foxp3+ Treg was decreased at T2 in P group ( P<0.05 ) .Conclusion Up-regulation of CXCR3 is helpful in migration of Tregs into the renal tissues of mice with renal I/R injury .

BACKGROUNDTo study the biological effects of multi-electrode radiofrequency ablation on pulmonary tissues of rabbits.

METHODSUnder the guidance of computer tomograph, electrodes were inserted into right lungs of New Zealand white rabbits and radiofrequency was performed. The biological effects were observed through CT image and microscopy.

RESULTSCoagulative necrosis was found immediately in ablation area after the procedure. On the 7th postradiofrequency ablation day, fibrous tissues appeared in the necrotic lesions. On the 30th postradiofrequency ablation day, bronchial and alveolar epithelium began to proliferate. Within 60 to 90 days after treatments, the necrotic lesions were almost replaced by normal pulmonary tissues. In group with electrodes into the right hilum, time for treating and initial impedance were significantly different from those with electrodes into the peripheral sites of the right-lower lobes (P < 0.01, P < 0.01).

CONCLUSIONSMulti-electrode radiofrequency ablation can be safely and effectivly performed in pulmonary tissue and cause coagulative necrosis within a certain extent.

BACKGROUNDSome researches have found that the development of tumor could be encouraged by vascular endothelial growth factor (VEGF) and vasoactive intestinal peptide (VIP), but how about the mode of VIP? The aim of this study is to examine the effects of VIP on expression of VEGF mRNA in non-small cell lung cancer (NSCLC) cells.

METHODSExpression of VEGF mRNA was detected in NSCLC and small cell lung cancer (SCLC) cell lines by reverse transcriptase-polymerase chain reaction (RT-PCR) technique.

RESULTSVEGF mRNA was detected in NSCLC cell lines A549, GLC-82, H157, H460 and SCLC cell line H446. VIP could enhance the expression level of VEGF mRNA in NSCLC cell lines A549 and H157. The expression level of VEGF mRNA reached a peak at 8h and 16h after VIP administration, which was significantly higher than that at 0h (P < 0.01).

CONCLUSIONSVIP may promote the angiogenesis of lung cancer through increasing the expression and secretion of VEGF in lung cancer cells, and thus plays an important role in the pathogenesis of lung cancer.

BACKGROUNDIt has been known that vasoactive intestinal peptide (VIP) has the effect of promoting the growth of some malignant tumors, but its mechanism is not clear. The aim of this study is to use c-fos antisense oligodeoxynucleotide (ASO) to block c-fos expression and to explore whether c-fos can directly regulate VIP-induced VEGF expression in small cell lung cancer (SCLC) cells.

METHODSExpression levels of c-fos and VEGF genes were detected in SCLC cell line H446 treated with VIP by RT-PCR. After c-fos ASO was added to the H446 cells, the change of VEGF mRNA expression level was analyzed.

RESULTSAdministration of VIP resulted in increased expression of c-fos and VEGF mRNA in the H446 cells. The expression of c-fos mRNA reached the peak level at 2h and 4h after VIP treatment, which was significantly higher than that at 0h (P < 0.01). Whereas, the highest expression level of VEGF mRNA was observed at 8h and 16h after VIP treatment, which was significantly higher than that at 0h (P < 0.01). c-fos ASO significantly reversed VIP-induced upregulation of VEGF mRNA expression (P < 0.01)

CONCLUSIONSVIP can increase the expression and secretion of VEGF in lung cancer cells by activating the transcription factor c-fos, then promote the angiogenesis of lung cancer and thus play an important role in the pathogenesis of lung cancer.

BACKGROUND¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) is considered as one of the most valuable diagnostic methods of chest malignant tumors, except for pathological diagnosis. But in clinic, the cases whose diagnosis of ¹⁸F-FDG PET is different from pathological diagnosis are not rare. This study is to evaluate the initial value of ¹⁸F-FDG PET in the diagnosis and staging of the chest malignant tumors.

METHODSFifty-one cases of chest tumors in Xi'an who underwent ¹⁸F-FDG PET were collected. Additionally, pathologic diagnosis had also been experienced on the patients through operation, percutaneous puncture, bronchoscopy or film preparation of pleural fluid. By the comparison of ¹⁸F-FDG PET diagnosis and the pathologic diagnosis, accuracy, sensitivity, specificity, false positive rate, positive predictive and negative predictive of ¹⁸F-FDG PET were calculated.

RESULTSIn 51 patients, there were 34 patients whose ¹⁸F-FDG PET diagnoses were consistent with the pathological diagnoses, including 31 true positive, 3 true negative. Out of another 17 patients, 11 were false positive, including 2 sarcoidosis, 6 tuberculosis of the lung, 2 inflammatory pseudotumor of the lung and 1 pulmonary cryptococcosis, and 6 were false negative. The calculated values were 66.67% on the overall accuracy, 83.78% on sensitivity, 21.43% on specificity, 78.57% on false positive rate, 16.21% on false negative rate, 73.81% on positive predictive value and 33.33% on negative predictive value.

CONCLUSIONSCurrently, ¹⁸F-FDG PET is still one of the most advanced unwounded technologies for the chest malignant tumor diagnosis. However, this technology experiences difficulties in detection of some high metabolized benign disease, such as tuberculosis from malignant tumor. Hence, in order to take advantage of ¹⁸F-FDG PET technology and have more accurate diagnosis of chest tumors, both results from the ¹⁸F-FDG PET and the clinic actuality should be considered.