Objective:To analyze the association of type 2 diabetes mellitus(DM) with the clinical and coronary angiographic features of coronary heart disease(CHD) in patients aged over 70 years old.Methods: A total of 310 elderly patients with coronary angiograph-confirmed coronary diseases,who were treated in Changhai Hospital during Apr.2006 to Jul.2008,were retrospectively analyzed.The patients were further divided into 2 subgroups according to the presence of DM: DM-CHD group(n=155) and non-DM-CHD group(n=155).The age,gender,blood pressure,blood lipid,ejection fraction(EF),the angiographic outcomes,etc.were analyzed and compared between the two groups.Results: The incidence of hypertension was significantly higher in the DM-CHD group than in the non-DM-CHD group(P

Objective To analyse the frequeney and pattern of lymph node metastasis in bilateral papillary thyroid microcarcinoma (PTMC), and establish the optimal surgical strategy for patients. Methods From March 2006 to August 2008, 58 bilateral PTMC patients received surgical treatment and the tumour characteristics, the frequency and pattern of lymph node metastasis and surgical management of these patients were retrospectively analysed. Results Forty-four patients received total thyroideetomy and 14 patients received near-totsl thyroideetomy, 47 patients received central compartment (level VI ) dissection and cervical level Ⅱ,Ⅲ, IV node exploration by internal jugular vein exposure,10 patients received level Ⅵdissection and unilateral cervical dissection and 1 patient received bilateral cervical dissection. The mean tumor diameter was (6.28 + 2.23) mm and 26 patients (44.8%) had node involvement, 88.5%(23/26) pa-tients had only level Ⅵ node involvement. Only 1 patient had node involvement in the jugular chain without level Ⅵ node involvement, 2 patients with level Ⅵ node involvement were associated with another cervical compartment nodes involvement. Conclusions Bilateral PTMC has high incidence of lymph node metasta-sis. The cervical level Ⅵ is the most common site of node involvement for bilateral PTMC and the surgical strategy for bilateral PTMC should include the cervical level Ⅵ dissection routinely.

Objective To investigate the feasibility of injection of sodium hyaluronate gel to upper lacrimal puncta in locating the nasal broken end of inferior canalicular laceration.Methods Together 52 patients(52 eyes) with inferior canalicular laceration who collected from March 2013 to March 2016 in the Third Affiliated Hospital of Nanchang University underwent canaliculax laceration anastomosis combined with silicone tube.Injection of sodium hyaluronate gel to the upper lacrimal puncta was introduced in group A (n =32/32 eyes) for locating the nasal broken end of lower canaliculax laceration,while microscope for searching the nasal broken end served as group B (n =20/20 eyes).In both groups,the silicone tubes were implanted in the lacrimal passage for more than 3 months after locating the broken end successfully.All patients were followed up from 6 months to 12 months,with mean follow-up of (8.2 ± 1.6) months,and then clinical data of the distance of lower canalicular laceration between lacrimal canal,time consuming for locating the nasal broken end,effective rate and postoperative comphcations were compared between two groups.Results The procedures in all patients were successfully.In group A,23 patients were cured and 5 improved,but the operation was failed in 4 patients,of which 3 patients occurred upper or lower lacrimal punctas teax;while in group B,13 patients were cured and 4 improved,but the operation was failed in 3 patients,of which 2 patients occurred upper or lower lacrimal punctas tear.There was no significant difference in the the distance of between lower canalicular laceration and lacrimal canal in group A [6.5-8.3 (7.3 ± 0.6) mm] and group B [6.6-8.2 (7.2 ± 0.5) mm] (P =0.40).The time consuming for locating the nasal broken end in group A [1.5-5.5 (3.3 ± 1.3) min] was shorter than that in group B [5.0-26.0 (17.0 ± 6.0) min],with significant difference (P ＜ 0.001).Conclusion It is an easy and accurate method of injection of sodium hyaluronate gel to upper lacrimal puncta for locating the nasal broken end of lower canalicular laceration with less time.

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on elderly patients with postoperative recovery quality.Methods Selected 60 cases of abdominal rectal cancer resection for elderly patients,which were ASA I or II,were randomly divided into two groups by a random number table method, while each groupincluded 30 cases:the control group( group N) and the dexmedetomidine group( group D) .Before the induction of anesthesia,group D vein was injected with micro pump ( more than 10 min) of dexmedetomidine 1μg/kg ( which was formulated with physiological saline as 4μg/mL) ,and then was given to maintain the dexmedetomidine 0.5μg/h and N group was injected with micro pump of the same volume of normal saline.The two groups of anesthesia were same,by which the static inhalation of composite general anesthesia.Observation were recorded before induction of anesthesia(T0),given dexmedetomidine(TI),after intubation 1 min(T1),5 min(T2),drawing tube immediately (T3),extubation after 5min(T4),30min(T5)the time of HR,BP,SpO2,BIS;propofol and remifentanil dosage,opera-tive time,operation time,a nesthesia time,recovery time,drawing tube time,extubation after Ramsay Sedation score, pain score,patient satisfaction and adverse reactions were recorded.Results In T3 period,the changes of HR (82 ± 14)times/min,SBP (130 ±8)mmHg,DBP (85 ±13)mmHg in group N were more obvious than (70 ±12)timse/min, SBP (121 ±7)mmHg,DBP (79 ±9)mmHg in group D,the difference between the two groups had statistical signifi-cance(t=6.28,4.63,2.08,all P<0.05).In T5 period,the levels of blood glucose (5.3 ±1.1)mmol/L and cortisol (402 ±78) nmol/L and ( 0.260 ±0.044 ) ng/L in group D were significantly lower than ( 5.9 ±1.2 ) mmol/L, (550 ±92)nmol/L,IL-6 (0.300 ±0.066)ng/L in group N(t=2.02,6.72,2.76,all P<0.05).However,the composite of dexmedetomidine group D patients with respiratory recovery time(7.5 ±2.3)min,calling the eyes open time(7.8 ±2.5) min,pull out the time of endotracheal tube (14.2 ±3.3) min compared with groups N of patients with respiratory recovery time (7.8 ±2.5)min,calling the eyes (14.8 ±3.2)min,pull out the time of endotracheal tube (13.9 ±3.1)min,showed no statistical significance (t=0.88,0.44,0.36,all P>0.05).In group N,postoper-ative restlessness in 8 cases,nausea and vomiting in 10 cases,chills in 9 cases,which were significantly higher than 2 cases,2 cases,2 cases in group D(χ2 =4.32,6.67,5.45,all P<0.05).At the same time,the satisfaction score of patient in group D (3.0 ±0.3)point,which was significant higher than (2.7 ±0.5)points in group N (t=1.88,P<0.05).Conclusion Dexmedetomidine detomidine composite sevoflurane anesthesia can improve the postoperative re-covery quality of elderly patients with rectal cancer radical surgery.

Objective To investigate the angiographic manifestation of the proper esophageal artery (PEA),the hish risk factom for the presence of the anomalous PEA in hemoptysis and to evaluate the safety of transcatheter aaefial embolization(TAE) of the PEA using gelatin sponge(GS).Methods Selective esophageal arteriography WSS performed in forty-three patients with hemoptysis,including 15 cases of pulmonary tuberculosis,18 cases of bmnchiectasis,7 cases of posttuberculous bronchiectasis and three cases of lung cancer. One case experienced failure of bronchial arterial embolization. The angiographic manifestation of the PEAs Was studied.The complications of the procedure and clinical results were observed in the patients who underwent TAE using GS.Results Thirty-nine PEAs were catheterized selectively in 37 patients(86.0%).Eighteen anomalous PEAs(46.2%)were catheterized selectively in 17 patients (45.9%).The anomalous PEAs showed tortuosity,dilatation,hyperplasia,shunting with pulmonary artery and anastomosis with the bronchial artery.All lesions involved basal segment of inferior pulmonary lobar. Bronchiectasis Was the most frequent disease for PEA abnormality. No complications occurred and satisfactory curative effect Was achieved with TAE of the anomalous PEAs.Conclusions It is necessary to perform selective proper esophageal arteriography when the lesion involves basal segment of inferior pulmonary lobar in hemoptysis.Supplemental TAE of the anomalous PEA using GS is safe and valuable in the management of hemoptysis.

Objective To investigate whether macrophage-activating lipopeptide-2 ( MALP-2) in-duces the expression of heme oxygenase-1 ( HO-1 ) in THP-1 cells and its possible mechanism .Methods Human monocyte cells THP-1 were cultured in vitro and then were incubated with various concentrations (0, 0.01, 0.1, 1.0 or 5.0 ng/ml) of MALP-2 for 16 h, or were stimulated by 5.0 ng/ml MALP-2 for different length of time (0 h, 4 h, 8 h, 12 h, 16 h or 24 h).The expression of HO-1 at mRNA and protein levels were detected by real-time PCR analysis and Western blot assay .The enzyme activity of HO-1 was detected by colorimetric analysis.THP-1 cells were pre-incubated with 30 μmol/L of SB203580, PD98059 and SP600125 for 30 min and then were cultured with 5.0 ng/ml MALP-2 for 16 h to investigate the role of mito-gen-activated protein kinases (MAPKs) signaling pathway in HO-1 production.After incubating THP-1 cells with 5.0 ng/ml MALP-2 for different periods of time, NF-E2-related factor 2 (Nrf2) protein was detected by Western blot assay to study the effects of Nrf2 pathway on MALP-2-induced HO-1 expression.Nrf2 and HO-1 proteins were measured by Western blot assay after transfecting THP-1 cells (1×106/well) with Nrf2 siRNA at a final concentration of 100 nmol/L.Results MALP-2 enhanced the expression of HO-1 at mRNA and protein levels as well as the enzyme activity of HO-1 in THP-1 cells in a concentration-dependent manner.The expression of HO-1 protein induced by MALP-2 was significantly inhibited by 30 μmol/L MAPKs specific inhibitors ( SB203580 , PD98059 and SP600125 ) .MALP-2 induced Nrf2 translocation at a concentration of 5.0 ng/ml.The expression of Nrf2 and HO-1 proteins were significantly decreased in Nrf 2 siRNA-transfected THP-1 cells.Conclusion MAPKs and Nrf2 signaling pathways were involved in the MALP-2 induced HO-1 expression .

Objective:To observe the molecular mechanism involved in expression of hemeoxygenase -1 (HO-1) induced by a macrophage-activating lipopeptide-2 (MALP-2).Methods:THP-1 cells were cultured in vitro and stimulated by MALP-2 for 12 h, expression of HO-1 was detected by Western blot .TLR2 and TLR6 neutralizing antibodies incubation , dominant negative plasmids transfection were used to assess the functional of TLR 2,6 in mediating HO-1 expression.Phosphorylation of c-Src and Akt were detec-ted by Western blot, and c-Src siRNA and PI3K inhibitor LY294002 were used to investigate the role of c-Src and PI3K in HO-1 ex-pression.Results:MALP-2 induced c-Src phosphorylation , and TLR2 and TLR6 neutralizing antibodies , or their dominant negatively plasmids could abrogate this effect .In addition, siRNA of c-Src could decrease the phosphorylation level of Akt , and the PI3K inhibi-tor could inhibit HO-1 expression.Conclusion: MALP-2 can induce THP-1 cells expression of HO-1 through TLR2,6/c-Src/PI3K pathways .

Objective To explore the diagnostic value of multi-slice spiral CT with big field of view,thin slice thickness,and postprocessing in endobronchial tuberculosis Methods Ninety-eight clinically diagnosed and tuberculosis bacillus positive patients were included The multi-slice spiral CT was performed using 3 mm thickness scan,MiIP,CVR,and CTVE management The CT diagnosis was made by the single-blind method and was compared with fiberoptic bronchoscope and pathology Results Main CT features were as follows: obstruction of bronchia in 13 cases (9 6%),uniform stricture of bronchia in 27 cases (19 8%),and non-uniform stricture of bronchia in 96 cases (70 6%) The lesions located in the main bronchia in 31 (22 8%),pulmonary lobar bronchia in 81 (59 6%),and pulmonary segmental bronchia in 24 (17 7%),respectively Multiple lesions were found in 56 cases (51 7%) The sensitivity,specificity,and accuracy of multi-slice spiral CT in the diagnosis of endobronchial tuberculosis were 89 8%,63 2%,and 84 6%,respectively Conclusion The exertion of multiple functions of multi-slice spiral CT can increase the diagnostic level for endobrochial tuberculosis,and spiral CT is a good supplementary to fiberoptic bronchoscope

Objective To investigate the incidence and relation to primary diseases of the nonbronchial systemic arteries (NBSA) supply to the pulmonary lesions, and to evaluate the clinical value of transcatheter arterial embolization (TAE) of the responsible NBSA for hemoptysis. Methods The aortography and subclavian artery angiography were performed in 139 patients with hemoptysis, including pulmonary tuberculosis in 66 cases (2 cases with post-thoracoplasty, 1 case with post-lobectomy, and 1 case with ventricular septal defect), bronchiectnsis in 41 ( 1 ease with post-lobectomy and 1 case with post- ligation of patent ductus arteriosus), bronchiogenic carcinoma in 15, unknown hemoptysis in 7, silicosis in 3, broncholithiasis in 3, bronchial cysts in 1, empyema in 1, postoperative lung cancer in 1, and chronic pulmonary embolism in 1, respectively. TAE was performed in patients with the discoverable responsible NBSA. The frequency, distribution and relation to primary diseases of the responsible NBSA were evaluated and the clinical results and complications were observed. Follow-up time ranged from 6 months to 5 years. Results Seventy-three patients (52. 5% ) had nonbronchial systemic contributions, including 5 cases of post-thoracotomy with pulmonary lesions, 1 case complicating with ventricular septal defect, 1 ease with post-ligation of patent ductus arterinsns, and 1 case of chronic pulmonary embolism. The total number of NBSA were 181 including posterior intercostal arteries (n = 88), internal thoracic arteries (n = 27 ), inferior phrenic arteries ( n = 21 ), proper esophageal arteries ( n = 20 ), lateral thoracic arteries ( n = 9 ), subscapular arteries ( n = 7 ), eostocervical trunks ( n = 5 ) and thyrocervical trunks ( n = 4 ) . Main responsible NBSA were posterior intercostal arteries (n = 75 ) and branches of subclavian and axillary artery (n =44) in patients with pulmonary tuberculosis, and proper esophageal arteries (n = 16 ) and inferior phrenic arteries (n = 17 ) in bronchiectasis. The clinical result was satisfactory and the bleeding ceased immediately in 69 eases including 19 cases of failed or repeated bronchial artery embolization (the arteries had been obstructive) and 4 cases of the normal bronchial arteries. No severe complications occurred except ipsilateral cerebellar infarction after subclavian artery angiography in 1 case and respiratory failure after internal thoracic artery embolization in another case. Sixty patients were followed up for more than 6 months. The result demonstrated episodic bloody sputum in 16 patients, re-bleeding in 11 and non-bleeding in another after TAE. Eight patients had non-bleeding and 2 patients had episodic bloody sputum who were re- bleeding and underwent repeated TAE. Conclusions The stimulation of adjacent lesions and the cardiovascular diseases with weakened or defected pulmonary perfusion can lead to the responsible NBSA supply to the lung in hemoptysis. During TAE for hemoptysis, the integrity angiograpby and TAE can improve the curative effect.

BACKGROUNDTo explore the possibility of the staging of pulmonary angiography with multi slice spiral CT (MSCT) and to evaluate its value in making surgical plan for patients with lung cancer.

METHODSMSCT with two-segment injection and three-protocol scan was performed in 73 patients with central type lung cancer. According to the site and degree, the involvement of pulmonary artery was divided into three grades and blindly compared with the surgery and pathology.

RESULTSMSCT in 68 cases (93.15%, 68/73) was successfully performed. The involvement of central pulmonary artery was grade I in 4 cases (5.88%, 4/68), grade II in 9 (13.23%, 9/68), and grade III in 55 (80.88%, 55/68). All patients with grade I underwent lobectomy. There was remarkable difference of lobectomy ratio between grade II and III (Chi-square=64.03, P < 0.005) and also between IIIa and IIIb (Chi-square=68.69, P < 0.005). All patients with grade IIIc were ruled out from surgery.

CONCLUSIONSThe staging of pulmonary angiography by MSCT is useful to demonstrate the site and degree of involvement of central pulmonary artery and provides more precise evidence of images for making surgical plan.