Objective To investigate the efficacy of lateral lung volume reduction with small incision and ligation for the treatment of serious chronic obstructive pulmonary disease(COPD).Methods From April 1994 to May 2006,36 patients suffering from serious COPD complicated with severe emphysema underwent lateral lung volume reduction in our hospital.Small incision and ligation were used during the operation.Results After the surgery,6 patients developed pulmonary air-leak,and were cured after 180-minute to 5-day treatments(mean,1.6 days).No perioperative death in this series.One year after the operation,the patient had significantly higher FEV1 and PaO2,and lower TLC and RV than those determined preoperation [(839.9?76.0)ml vs(589.0 ?80.5)ml,t=18.451;(72?10)mm Hg vs(62?8)mm Hg,t=4.686;(5167.6?639.9)ml vs(6725.8?976.6)ml,t=8.116;(3062.4?722.0)ml vs(4329.6?669.9)ml,t=7.720;all P=0.000].In addition,they had significantly longer 6MWT than that before the operation [(306.0?24.8)m vs(223.8?36.7)m,t=11.135,P=0.000].Conclusion For the patients with COPD who had indications for lateral lung volume deduction,resection of emphysemic tissues by the procedure using small incision and ligation can improve their symptoms and physiological conditions.

Transforming growth factor-β is an important cytokine with various bioactivities, including embryonic development, wound healing, chemotaxis and cell cycle regulation. Epithelial-mesenchymal transition (EMT) is the main pathway of tumor cell to obtain the ability of invasion and metastasis. The TGF-β is the key factor known to induce EMT in cancer cells and plays an important role in the process. In recent years, some progress has been obtained. Some TGF-β inhibitors have approved in the market or in clinical trials. TGF-β inhibitors can play an important role on the treatment of tumors, glaucoma, liver and kidney fibrosis disease and scar repair. Novel TGF-β inhibitors reported in recent years were reviewed in this article.

Objective To evaluate the curative effects of intravenous methylprednisolone (IVMP) during the conservative management for patients with indirect optic nerve injury (ONI),and to analyze the benefits of visual evoked potential (VEP) monitoring in prognosis assessment.Methods Among the 253 patients with cranial-facial injury,108 sufferred from optic nerve injury including 89 cases without optic nerve decompression treatment.These 89 patients were randomly divided into:group A,in which patients were given methylprednisolone intravenously for 7 days; and group B,in which patients without methylprednisolone treatment.The extent of and time required for eyesight recovery were recorded.VEP measurement was carried out in all cases.Results No differences in gender,age and BMI (Body Mass Index,all P ＞ 0.05) were observed.The incidence of ONI was higher in patients with motorcycle accident than that in those with car accident (P ＜0.01).In the motorcycle accidents,casualties wearing a helmet had lower incidence of ONI (P ＜ 0.01).Patients treated with methylprednisolone had a shorter recovery time (P ＜ 0.01) from blindness,however there was no difference in long-term outcome between group A and B.In patients with visual improvement in the “ non-extinguished” group,the amplitude and latency of the P wave of VEP were markedly ameliorated after the treatments (P ＜ 0.01).Conclusions Most of the ONI casualties in our study were resulted from motorcycle accidents,and wearing a helmet is an effective protection measure.The intravenous methylprednisolone (IVMP) showed no effect on improving the prognosis in patients with conservative treatment.The IVMP shortened the recovery time at the expense of increase in risk of complications.VEP examination is beneficial in prognosis assessment for non-operative ONI patients.The improvement of the amplitude and latency of P wave has close correlations with patients'visual recovery.

Objective To investigate the potential and early effect of hypertonic saline resuscitation on Tlymphocyte subpopulations in patients with traumatically hemorrhagic shock.Method Eighty-two patients with acute traumatically hemorrhagic shock admitted from Department of Emergency，Beijing Tongren Hospital，from De cember 2006 to July 2008 were randomly divided into：hypotonic saline(HS)group(n=43)and Lactated Ringer's solution(LR)group(n=39).The criteria of eligible patients were systolic blood pressure＜90mm Hg at admission with definite evidence of blood loss.Patients with immune system diseases and those who died within 24 hours of admission were excluded.Patients in HS group received intravenous administration of 200 mL of 7.5% sodium chloride withhin 15～20 minutes，and LR group received routine therapy with Lactated Ringer's solution.Blood pressure and heart rate were recorded 10，20，and 60 minutes after the start of resuscitation and compared between two groups.Before and 24 hours after treatment，peripheral blood levels of T-lymphocyte subpopulations including CD3+，CD4+，and CD8+ were measured by using direct immunofluorescence test and compared between two groups.The inter-group comparison was carried out by using independent sample t-lest and intragroup comparison using paired t-test.The numabers of operation，complication cases and death cases were conducted by using X2 test.SPAS version 11.0 software was used for statistical analysis.Results The volume of solution infused in HS group was(3820±623)mL and in LR group was(5430±1254)mL(P＜0.05).At 10 and 20 minutes after the sdministration of solution.the mean blood pressures in HS group were both significantly higher than those in LR group(P＜0.01).The levels of CD3+and CD4+lymphocytes in peripheral blood in HS group 24 hours after treatment were sinificantly higher than those in LR group(P＜0.01).Totally，63(76.8%)patients were cured and 19(23.2%)patients died.ARDS occurred in 10 patients and MODS occurred in 14 patiellts.The mortality，and the rates of ARDS and MODS in HS group were sinificantly higher than those in LP group(P＜0.05).Conclusiom In patients with acute traumatically hemorrhagic shock.HS can increase the effective circulating vol. ume，ameliorate the perfusion of tissues and organs，improve the immune fuction of T-lymphocytes，decrease the rats of ABDS and MODS，mad decrease the morality.HS is more effective than routine solution used for resuscitation.

Objective To analyze clinical manifestation,diagnosis and treatment of 8 patients with gas gangrene in Wenchuan earthquake.Methods Eight patients with gas gangrene in Wenchuan earthquake were selected for analysis on their clinical manifestations.We finally diagnosed gas gangrene based on patients'clinical manifestation and the cultured ciostridium in the focus of infection.All the patients were treated with antibiotics,repeated surgical debridement,hyperbaric oxygen and nutritional support.Results Most patients had no erepitation of the extremities but found gas in interstice of tissues identified by X-ray,B-ultrasound and CT scanning.Film preparation of efflusion of all patients showed clostridium and bacterial culture manifested mainly perfringens.Most patients were demonstrated to be with polyinfection.In addition,all patients were characterized by pitchy necrotic tissues,effusion,systemic decrease of red blood cells,increase of white blood cells and platelet.No death or amputation occurred under active combined therapy.Conciusions Earthquake induces mainly open trauma often combined with mixed infection,when gas gangrene is one of main special infections.The predominant combined therapies include utility of antibiotics and thorough surgical debridement,while hyperbaric oxygen and nutritional support are important and effective adjunctive therapies.

ObjectiveToevaluatetheclinicalvalueoflaparoscopicrenalcystdecorticationandopencyst decortication surgery in the treatment of polycystic kidney disease.Methods Various clinical parameters were retro-spectively analyzed in 108 patients with polycystic kidney,include laparoscopic 60cases and open surgery 48cases.The observation indexes include operative time,operative bleeding,restoration time of bowel functions,postoperative drain-age volume,hospital time,postoperative complications,kidney function,blood pressure,and the clinical effects were estimated.Results In the laparoscopic group,the average operation time was (57.7 ±13.2) min,the average blood was (35.9 ±17.3)mL,the average time of exsufflation was (1.6 ±0.7)d,the average postoperative drainage volume was (23.2 ±4.3)mL,the average hospital time was (5.1 ±0.8)d.As compared with the open surgery group,the op-eration time,hospital stay,operative bleeding,postoperative drainage and hospital time of the laparoscopic group short-ened significantly(all P<0.05).The complication rate of the laparoscopic group and open surgery group were 5.0%and 16.7%separately.The complication incidence was significantly lower in the laparoscopic group than that in the open surgery group(P<0.05).At 3 months postoperative,the levels of serum creatinine(Cr),urea nitrogen(UN)and systolic blood pressure were obviously decreased compared with preoperative.There were no significant difference be-tween the two groups(P>0.05).The follow-up data showed that the cure rate and effective rate of the open surgery group were 81.2%and 18.8%,and the cure rate and effective rate of the laparoscopic group were 85.0% and15. 0%respectively.There were no significant difference of the clinical effects between the two groups (P >0.05). Conclusion The laparoscopic was superior to the open surgery in the operation time,hospital time,operative bleed-ing,postoperative drainage and hospital time.Laparoscopic renal cyst decortication in polycystic kidney is open surgery safer,little injury,quick recovery.Laparoscopic renal cyst decortication is safe and effective therapy,which can be used as primary surgical treatment for patients with polycystic kidney.

Leucine zipper tumor suppressor 2 (LZTS2) is a novel tumor suppressor gene that has been increasingly recognized in recent years. Currently, many studies illustrate that LZTS2 gene, the important candidate tumor suppressor gene, is already involved in the inhibition of tumorigenesis and aberrant proliferation of tumor cells, and other functions of tumor cells. Information from these stud-ies can contribute to the formulation of new strategies for the treatment of tumors.

OBJECTIVETo investigate whether telomerase activity, human telomerase RNA (HTR) and human telomerase reverse transcriptase (HTERT) expression were associated with tumor development in lung cancer and whether telomerase is regulated at gene level or transcriptional level.

METHODSExpression of HTR and HTERT was detected by reverse transcription-polymerase chain reaction (RT-PCR) in 68 human lung cancer and in 68 adjacent-neoplatic lung tissues. And telomerase activity was examined by a quantitative telomeric repeat amplification protocol (TRAP).

RESULTSIn 68 lung cancer tissues, telomerase activity, HTR and HTERT were expressed in 79%, 98.5% and 91.2% respectively, whereas all adjacent non-neoplastic lung tissues were telomerase negative. Most normal lung tissues expressed HTR (91.2%) and HTERT was detected in only 7 of 68 non-neoplastic tissues.

CONCLUSIONSThe relatively high frequency of telomerase activity in lung cancer whereas the detection of no telomerase activity in normal lung tissues suggested that telomerase may play an important role in tumorigenesis of lung cancer. Compared to HTR, HTERT expression was better associated with telomerase activity with a concordance of 88.9%. Telomerase activity may be regulated at transcription level or translation level.

DNA-Binding Proteins ; Gene Expression Regulation, Enzymologic ; Gene Expression Regulation, Neoplastic ; Humans ; Lung Neoplasms ; enzymology ; genetics ; RNA ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Telomerase ; genetics

Objective To analyze the reasons and outcomes of the unplanned re-operation in renal transplant recipients during perioperative period,and to summarize the corresponding strategies.Methods From January 2014 to September 2017,the clinical data of 20 cases of kidney transplantation which had a total of 22 unplanned re-operations were retrospectively analyzed.All patients were given quadruple immunosuppression with antibody induction and tacrolimus (TAC) and mycophenolate mofetil (MMF) plus prednisone (Pred).We analyzed the reasons,occurrence time,effect of re-operation and the renal function,as well as survival rate of all graft and recipient.The delayed graft function (DGF),acute rejection (AR) and incidence of pulmonary infection were monitored as well.Results Up to September 2017,during the follow-up of 1-36 months,the overall rate of unplanned re-operation was 4.6％,and 2 patients underwent 3 operations.For the reasons of re-operation,there were 18 cases of bleeding (13 cases of blood oozing from the wound surface,3 cases of renal parenchyma rupture because of rejection,and 2 cases of rupture of renal artery infection),2 cases of renal artery thrombosis and 2 cases of the repair of leakage of urine.Two operations were performed within 1 days for 9 cases,2-5 days for 5 cases,6-10 days for 3 cases,above 10 days for 45 cases.There was no deaths during the perioperative period.One patient died of rupture of exiliac aneurysm 3 months after the operation.One patient died of cerebral hemorrhage 6 months postoperation.The death censored graft survival rate was 72.2％ (13/18) and the incidence of DGF was 55 ％.Conclusion The major reason of unplanned re-operation for renal transplantation is associated with bleeding of various causes.And the incidence of DGF is high.If the secondary operation was performed with the correct decision,the kidney allograft recovers well.

Objective To summarzie the experiences of kidney transplantation from rhabdomyolysis.Methods The surgical procedures and treatment protocols of the kidney transplantation in 3 cases from DD donors who suffered from anuria due to rhabdomyolysis were retrospectively analyzed.Results Three recipients were donated by two donors.When the blood of kidneys is washed out,the color of the kidneys was brown,and when the kidneys restored the blood perfusion,the transplanted kidneys were dark brown.All of these 3 cases had delayed renal function,and 2 recipients who received the kidneys from the same donor secreted the urine 3 weeks after surgery.The creatinine gradually decreased,and they discharged when the renal function was normal.The urine volume in the another recipient was 3000 ml or more per day in the first two days,gradually decreased from the third day,until anuria.We conducted an exploration of the transplanted kidney due to the area of transplantation uplift.We found that the kidney was bright red during the operation,the hematoma was removed and hemostasis was done,the urine volume gradually increased from one week after surgery,and the creatinine levels gradually decreased.After two months the creatinine levels were 103μmol/L.Conclusion For the patients with rhabdomyolysis,their kidneys can be transplanted after active preservation,evaluation of the donor kidney function and blood flow,and the short-term outcome is satisfactory.