Objective To study the level of serum vascular endothelial growth factor(sVEGF)in advanced non-small cell lung cancer(NSCLC) and its clinical significance.Methods Serum level of VEGF was detected by ELISA method in 96 patients with advanced NSCLC.sVEGF level was analyzed after giving 2-4 cycles of cisplatin-based chemotherapy.At the same time,serum level of VEGF in 50 healthy controls was detected.Results The level of sVEGF was significantly higher in patient with lung cancer than in control group (P＜0.01).No statistical significant defference was observed between sVEGF level of stage Ⅲ and Ⅳ NSCLC patients,the patients with squamocellular lung cancer and adenocarcinoma(P＞0.05);Descended sVEGF level was found in the patients with response to chemotherapy(P＜0.05).Conclusion sVEGF can be used to evaluate chemotherapy response and diagnoses in the patients with advanced NSCLC.

Major points: Zhongwan (CV 12), bilateral Zusanli (ST 36) and Neiguan (PC 6); for excessive cold-dampness, plus Pishu (BL 20) and Sanyinjiao (SP 6); for Liver-qi affecting stomach, plus Yinlingquan (SP 9) and Taichong (LR 3); for deficiency of both spleen and sto mach, plus Pishu (BL 20) and Weishu (BL 21). Forty-six cases of diabetic gastric disorder were treated with acupuncture and 30 cases got marked effect, 16 cases got effect and the total effective rate reached 100%.

Objective To investigate the effects of parecoxib pretreatment on the intrapulmonary shunt during one-lung ventilation in patients undergoing esophageal cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients of both sexes,aged 25-64 yr,weighing 45-70 kg,with body height 156-178 cm,undergoing elective esophageal surgery,were randomly divided into 2 groups (n =20 each):normal saline group (group NS) and parecoxib group (group P).Parecoxib 40 mg (in normal saline 10 ml) was injected intravenously 30 min before anesthesia in group P,while the equal volume of normal saline was given instead of parecoxib in group NS.Anesthesia was induced with iv injection of propofol,fentanyl and rocuronium.Bronchial blocker was inserted after tracheal intubation and the correct position was confirmed by bronchoscopy.Anesthesia was maintained with iv infusion of propofol and remifentanil and intermittent iv boluses of atracurium.HR,MAP,SpO2 and mean airway pressure (Pmean)were determined at 5 min of two-lung ventilation,at 40 min of one-lung ventilation,and at 30 min after re-expansion of the collapsed lung (T0-2).Blood samples were taken simultaneously from jugular vein and radial artery for blood gas analysis.Intrapulmonary shunt (Qs/Qt) was calculated.Results There were no significant differences in hemodynamic parameters and Pmean between the two groups (P ＞ 0.05).PaO2 was significantly lower,while Qs/Qt was significantly higher at T1,2 than at T0 in groups NS and P (P ＜ 0.05).PaO2 was significantly higher,while Qs/Qt was significantly lower at T2 than at T1 in groups NS and P (P ＜ 0.05).Qs/Qt was significantly lower at T1,2 and PaO2 was significantly higher at T2 in group P than in group NS (P ＜ 0.05).Conclusion Parecoxib 40 mg injected intravenously at 30 min before anesthesia can reduce the intrapulmonary shunt during one lung ventilation in patients undergoing esophageal cancer resection.

ObjectiveTo study the effects of intermittent subglottic secretion drainage(SSD)with an endotracheal tube on incidience of ventilator- associated pneumonia(VAP). MethodsWe searched computerized databases,including Cochrane library,Pubmed,EMbase,CBM,CNKI,Wanfang and some relevant databases from initializing to March 2012,extracting data about subglottic secretion drainage(SSD)with an endotracheal tube on incidence of VAP using RCT.The data had Meta- analysis by software RevMan5,and to those data which could not be conversed or merged,they underwent descriptive analysis. ResultsWeidentifled 5 randomized clinical trials that met the inclusion criteria with a total of 683 randomized patients.In Meta- analysis,the overall risk ratio for ventilator- associated pneumonia was decreased significantly by intermittent subglottic secretion drainage with an endotracheal tube.There was no significant difference on adverse events or on hospital or intensive care unit mortality.Databases,including ICU and hospital LOS,duration of endotracheal catheterization,bacteria concentration,which were difficult to be conversed and obtained full data,they underwent a descriptive research. ConclusionsCompared with the common endotracheal tubes,the use of endotracheal tubes with subglottic secretion drainage is effective for prevention of ventilatorassociated pneumonia.But it has no effect on adverse events or on hospital or intensive care unit mortality.So large sample RCTs with multiply- center should be carried out to assess the effect of the use of SSD.

B-Raf kinase (BRAF) gene is a driver mutation,and is an effective target in the treatment of non-small cell lung cancer (NSCLC).Studies have shown that BRAF inhibitors are effective for treatment of NSCLC with BRAF mutant.It is important to understand the clinicopathologic features and the research progress of BRAF inhibitors for the individual treatment of NSCLC.

Objective To study the diagnosis and treatment of testicular cancer in cryptorchids. Methods The data of 10 patients with cryptorchid tumor treated at our hospital between 1986 and 2003 were retrospectively analyzed.Their average age was 40 years (range,32~55 years).Of these patients,1 had the testis in the inguinal area;3,in the scrotum (with a history of inguinal cryptorchidism) and 6,in the abdomen.Cryptorchidism occurred on the left in 2 cases,on the right in 5 and bilaterally in 3.Three patients presented with stage Ⅰ A disease,5 with stage Ⅰ B,and 2 with stage Ⅱ D. Results All the 10 patients received surgical treatment including radical tumor resection,radical tumor resection with retroperitoneal lymph node dissection (RPLND),and palliative operation.Pathology showed that 9 cases had seminoma and 1 had seminoma accompanied by embryonic carcinoma.Radiotherapy was performed in 8 cases,and radiotherapy plus chemotherapy,in 2 (including 1 with embryonic carcinoma).Postoperatively,6 patients were followed up for 6 months to 14 years with a mean of 5.2 years;these patients showed no evidence of tumor recurrence and metastasis. Conclusions Cryptorchid testes have a greater risk of malignant change than do normally descended testes,and early intervention is advocated to prevent malignant canceration.Even treated with orchidopexy or orchiectomy,the patient should be followed up lifelong.Most of cryptorchid tumors are seminomas, and the ideal treatment strategies are tumor resection and radiotherapy.

Objective To investigate the value of magnetic resonance (MR) imaging for diagnosing typeⅠ congenital choledochocele and its complications. Methods The MR imaging data of 13 cases with proved typeⅠ congenital choledochocele associated with complications were retrospectively reviewed and compared with operative findings. MR imaging sequences included axial T2W and T1W plain scan, true-FISP coronal images, 2D-MRCP, and Gd-enhanced T1W images. Results All patients had cystic dilatation of the common bile ducts to various degrees. In 6 patients complicated with stone and infection, the bile duct showed uniform wall thickening with marked enhancement, and calculus were depicted within the duct lumen with dilatation of the proximal biliary duct. In 7 cases complicated with carcinoma of biliary duct, a polypoid soft tissue mass or nodule was seen inside the ductal lumen in 3 cases, or the duct wall was irregularly thickened in 4 patients. Six cases received curative operation, but one patient with extensive local infiltration, vascular encasement and lymphadenopathy had only palliative treatment. MR imaging observations were verified by surgery findings in all 13 patients. Conclusion MR imaging is very valuable not only in diagnosing typeⅠ congenital choledochocele, but also in revealing its complications.

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs)and anti-angio-genic drugs have individually demonstrated clinical benefit in the treatment of patients with advanced non-small cell lung cancer (NSCLC).Recent studies demonstrate that the combination of anti-EGFR and anti-angiogene-sis can more significantly enhance clinical benefit,and even can remit EGFR-TKIs resistance in the treatment of advanced NSCLC.According to the different kinds of anti-angiogenesis drugs,recent clinical studies mainly include the combination of anti-vascular endothelial growth factor monoclonal antibody bevacizumab plus EGFR-TKIs and multi-targeted receptor anti-angiogenic tyrosine kinase inhibitor plus EGFR-TKIs,and the for-mer results show a more significant improvement in terms of safety and efficacy in the treatment of advanced NSCLC.Therefore,the combination of bevacizumab plus EGFR-TKIs can be used as a new treatment standard in the treatment of some patients with NSCLC.

Objective To observe the clinical characteristics and surgical methods of strabismus following external approach for retinal detachment,and explore the common factors related to deviation angles of strabismus.Methods Twenty-five cases of secondary strabismus following external approach for retinal detachment underwent strabismus surgery were recruited,and the follow-up time was from 5 months to 41 months.Ophthalmic examinations were performed before operation.Clinical characteristics of these cases were observed by intraoperative exploration,including preoperative and postoperative eye position and ocular movement (at 1 week and further followup).The preoperative and postoperative deviation angles of strabismus were evaluated according to the times of retinal detachment operation,postoperative BCVA and the surgery procedure of hang-back recession.Results Before strabismus operation,all cases underwent abnormal eye-movements,8 cases suffered from diplopia,and scar adhesions were observed in all involved ocular muscles during operation.Seven cases underwent weakening procedure of extraocular muscle,18 cases underwent weakening procedure plus strengthening procedure.Ten cases underwent hang-back recession among them.At 1 week and the final follow-up,the eyeball in21 cases and 15 cases were in position,4 cases and 9 cases were in undercorrection,5 cases and 7 cases were in limitation,and 2 cases and 1 case were in diplopia.The more operations were performed in retinal detachment,the more scar adhesions were presented,and statistical significance existed with the mean deviation angles before and after operation(in a week) between cases that had one-time and over-one-time of retinal detachment surgery (P =0.01,0.00).No difference of mean deviation angles was found at one week after operation and at follow-ups between the cases with and without hang-back recession (P =0.26,0.63).Conclusion Abnormal eyemovements,diplopia and scar adhesion are the most common clinical characteristics of strabismus following retinal detachment surgery.Times of retinal detachment operation and postoperative BCVA can influence the deviation angles of strabismus,and hang-back recession seems the safe and effective method of strabismus surgery.

Objective To compare the effects of epidural administration of different combinations of lidocaine, corticosteroids (dexamethasone, prednisolone) and vitamins(B 1,B 6,B 12 ) on epidural space adhesion and nerve root inflammation in rabbits Methods Forty eight adult Japannese white rabbits of either sex weighing (2 38?0 31)kg were anesthetized with intramuscular ketamine 15 mg?kg -1 and midazolam 0 2 0 3 mg?kg -1 A catheter was inserted into epidural space at L 2 when the ligamentum flavum was exposed by surgery and advanced caudally for 2 3cm Correct placement of the catheter in epidural space was confirmed by injecting 0 5% lidocaine 0 2 ml through the cathter when the animal was awake 24h after epidural cathter placement 0 2ml?kg -1 of normal saline containing talcum power 1mg?ml -1 was injected into epidural space 3 days later the animal were randomly divided into 8 groups: group Ⅰ received no treatment, group Ⅱ epidural normal saline 0 2ml?kg -1 , group Ⅲ epidural 0 5% lidocaine 0 2ml?kg -1 , group Ⅳ epidural compound lidocaine solution 1 (lidocaine 100mg +dexamethasone 10 mg in 20 ml normal saline) 0 2ml?kg -1 , group V epidural compound lidocaine solution 2 (lidocaine 100mg+prednisolone 50 mg in 20 ml normal saline)0 2 ml?kg -1 , group Ⅳ epidural compound lidocaine solution 3 (lidocaine 100mg+dexamethasone 10 mg+vitamin B 1 200mg in 20 ml normal saline) 0 2 ml/kg, group Ⅵ epidural compound lidocaine solution 4 ( lidocaine 100mg+dexamethasone 10 mg+vitamin B 6 200mg in 20 ml normal saline) 0 2 ml/kg, and group Ⅷ epidural compound lidocaine solution 5 (lidocaine 100mg+dexamethasone 10 mg+vitamin B 12 200mg in 20 ml normal saline) 0 2 ml/kg One week later animals were killed by intravenous injection of air Spinal column below L 1 was removed Epidural space and nerve root adhesion was checked first with naked eye then examined under microscope Epidural space adhesion was divided into 4 grades according to Rydell Results 1 Macroscopic examination of epidural space for adhesion: there was no significant different between group Ⅰ and group Ⅱ,Ⅲ, also between group Ⅱ,Ⅲ and group Ⅳ,Ⅴ,Ⅵ,Ⅶ,Ⅷ; there was significant different between group Ⅰ and groupⅣ,Ⅴ,Ⅵ,Ⅵ,Ⅷ (P