Stage Ⅲ A non-small cell lung cancer (NSCLC) has high heterogeneity and there are some controversies over the treatment of this disease,especially for patients with stage ⅢA-N2 NSCLC.This article investigates whether preoperative or postoperative radiotherapy can improve the survival of patients with stage ⅢA-N2 NSCLC and evaluates the effect of surgical treatment.

Objective To study the critical thinking disposition status of senior vocational nursing students in Henan province. Methods CDTI-CV was used for investigation in 506 nursing students and the results underwent analysis. Results The total score of CDTI-CV was low among these nuring students,the score of desire for knowledge,self-confidence and analyzing ability was the lowest.The scofe of the rest 6 dimensions were lower than the other provinces except for the cognition degree.Conclusions we should aim at weak aspects to study critical thinking educational reform,especially construct accelerando clinical didactical model to promote the development of critical thinking ability of nursing students.

Objective To investigate the potential role of miR-34a on breast cancer recurrence and prognosis.Methods In this study,88 breast cancer patients underwent mastectomy with detailed clinical follow-up information.Extracting RNA from the formalin-fixed paraffin embedded samples,miR-34a levels were quantified by quantitative real-time polymerase chain reaction (qRT-PCR).miR-34a levels among clinico-pathological variables were accessed by Mann Whitney-U test.RFS and OS survival curves were derived from Kaplan-Meier estimates and the curves were compared by Log-rank tests.All statistical tests were two-sided.Results Significantly lower miR-34a level was found in tumor tissue compared to paired normal tissue (P =0.000).A potential relationship between miR-34a levels and existing clinico-pathological parameters of breast cancer,such as menstrual status,tumor size,nodal involvement,stage of disease,hormone receptor status,HER2 status,or tumor subtype was investigated.No statistically significant difference were identified for these features (P ＞ 0.05).miR-34a level was significant lower among G3 group than G1 + 2 group (P =0.024).Down-regulated miR-34a level was observed in breast cancer with later relapse compared to patients without relapse (P =0.008).When considering 2-△Ct =0.117 (median level)as cut-off value,patients with miR-34a up-regulation showed a positive association towards a longer survival,either RFS(P=0.026,Log-rank test) or OS(P =0.019,Log-rank test).Conclusions miR-34a,as a tumor suppressor,promotes differentiation and contributes to relapse when down-regulated.miR-34a has the potential as prognostic factor for breast cancer.

ObjectiveTo investigate the expression of miR-155 in whole blood of patients with breast cancer and explore the possibility of miR-155 in whole blood as a marker of beast cancer. Methods65 cases (breast cancer:47 cases, non-breast cancer:18 cases) in Thyroid and Breast Surgery Department of No.1 People's Hospital of Huai'an from Dec 2010 to Apr 2011 were enrolled according to the selected criteria.Two milliliters anticoagulant blood were sampled to isolate total RNA.The expression level of miR-155 in whole blood was measured by real-time quantitative polymerase chain reaction (real-time qPCR)analysis.The relationship between the expression level of miR-155 in whole blood and the clinical pathological fearutres was analyzed.ResultsThe expression level of miR-155 in breast cancer patients was up-regulated compared with that in non-breast cancer patients(P ＜ 0.05).The expression level of miR-155 in patients with positive lymph nodes was up-regulated compared with that in patients with negative lymph nodes( P ＜ 0.05).The expression level of miR-155 in stage Ⅲ breast cancer was up-regulated compared with that in stage Ⅰ & Ⅱ breast cancer( P ＜ 0.05 ).The expression level of miR-155 in patients with positive ER and PR was down-regulated compared with that in patients with negative ER and PR breast cancer.Conclusion The study demonstrates that the expression of miR-155 in whole blood is related to clinical pathological features of patients with breast cancer and can be used as a potential marker of breast cancer.

Objective To enhance the solubility and bioavailability of curcumin (CUR).Methods A novel curcumin nanoparticles were prepared.The CUR-PGD nanoparticles were prepared by the method of ultrasound precipitation combined with high-pressure homogenization using codendrimer PAMAM-co-0.25OEG (PGD) as stabilizer.The stability of CUR-PGD nanoparticles was measured in 0.9% sodium chloride solution,5% glucose, PBS and plasma.Results The drug loading capacity (DL%) of CUR-PGD nanoparticles was 41.2%, the solubility of CUR was increased to 1.5 mg·mL-1 (50 times of CUR bulk powder).The mean diameter of the nanoparticles was 438.0 nm with spherical morphology and the zeta potential was 41.4 mV.The nanoparticles was stable in 0.9% sodium chloride solution,5% glucose, PBS and plasma and there was no hemolytic phenomenon, which meant they were suitable for intravenous administration.The DSC and XRD spectra of CUR-PGD nanoparticles showed that the CUR was presented as crystal morphology in the nanoparticles.The CUR released from nanoparticles was detected in different releasing medium and presented obvious controlled release behavior.Conclusion PGD may be an effective stabilizer for the preparation of CUR-PGD nanoparticles and CUR-PGD nanoparticles are a promising drug delivery system for CUR application in clinic.

Objective To study the homology characteristics of clinicaly isolated and colonized linezolid(LZD)-resistant Enterococcus faecalis (E.faecalis) strains from a patient.Methods Ten E.faecalis strains (2 were isolated from urine specimens and 8 were from stool specimens) isolated from a patient with pulmonary infection were performed antimicrobial susceptibility testing, homology of E.faecalis was determined by pulsed-field gel electrophoresis (PFGE).Results Before and after patients received LZD therapy, 2 E.faecalis strains isolated form urine specimens were both resistant to LZD (MICs: 8 mg/mL, 16 mg/mL, respectively), among 8 strains from stool specimens (6 were isolated before therapy, and 2 were isolated after therapy), LZD susceptible, intermediate, and resistant strains were 4, 2, and 2 respectively(MICs: 0.25-12 mg/mL).10 strains of E.faecalis were homologous by PFGE typing.Conclusion In this case, the detection of E.faecalis from urinary tract and intestinal tract is homologous, which suggested that LZD-resistant Enterococcus may be colonized in vivo for a long time, and may be shift to cause bacterial infection.

Objective:To study the relationship between neutrophil to lymphocyte ratio (N/L) and traditional cardio‐vascular risk factors among community 35~64‐year‐old residents .Methods :A total of 1884 residents (548 males and 1336 females) from urban Shenyang city received baseline condition questionnaire on cardiovascular diseases and re‐lated diseases from Apr 2011 to Feb 2012. According to presence of cardiovascular risk factors or not ,subjects were divided into healthy control group (n=675) and risk factor group (n=1209);according to number of risk factors , risk factor group was further divided into one risk factor group (n=491) ,two risk factors group (n=263) and ≥3 risk factors group (n=455) .Morning blood sample and urine sample were retained to measure blood and urine rou‐tine ,blood glucose and blood lipid profile etc in all subjects .N/L was compared and analyzed among all groups .Re‐sults:Among patients with only one of following risk factors [hypertension ,diabetes mellitus (DM) ,dyslipidemia and obesity] ,N/L levels of patients with hypertension or DM were significantly higher than that of healthy control group [1.55(1.15 ,1.95) ,1.60(1.21 ,2.07) vs .1.45(1.09 ,1.91)] , P<0.05 both ,and there were no significant difference between any other one risk factor group and healthy control group , P>0.05 all .Among risk factor sub‐groups ,N/L level of ≥3 risk factors group was significantly higher than that of two risk factors group [1.57(1.16 , 2.04) vs .1.41(1.07 ,1.89) ,P<0.05] ,and there was no significant difference between any other two groups (P>0.05) .Conclusion:N/L significantly related to hypertension or DM ,and N/L level of ≥3 risk factors group was sig‐nificantly higher than that of two risk factors group ,N/L is helpful to assess risk of cardiovascular diseases .

Objective To compare the efficacy and safety of Iamivudine-interferon sequential therapy and lamivudine monotherapy in HBeAg-positive chronic hepatitis B (CHB) patients.MethodsA total of 172 patients with HBeAg-positive CHB were randomized to sequential group (n=83) or lamivudine group (n=89).Sequential group were administrated with lamivudine 100 mg/d and 5 million units interferon alpha 2b subcutaneous injection every other day for 24 weeks were added since week 25 of treatment.Lamivudine group were administrated with lamivudine 100 mg/d for 48 weeks.All subjects were followed up for 24 weeks after drug withdrawal.Measurement data with homogeneity of variance were analyzed by using t test and data with heterogeneity of variance were analyzed by using rank sum test.The comparison of rates was done by chi square test or Fisher exact test.ResultsThe baseline hepatitis B virus (HBV) DNA levels of patients in sequential group and lamivudine group were (7.8±1.0) and (7.9±1.1) lg copy/mL,respectively (P＞0.05),and the baseline alanine aminotransferase (ALT) levels were (210.5 ± 150.1 ) and (211.9 ± 160.9) U/L,respectively (P＞0.05).At the end of treatment,higher ALT levels [(78.4±146.1) vs (36.1±32.4) U/L,P＜0.05)] and HBV DNA levels [(4.5±1.5) vs (3.8±1.3) lg copy/mL,P＜0.05)] levels,lower response rates (65.8％ vs 83.5％,P＜0.05),and similar HBeAg loss rates (31.6％ vs 22.2％,P＞0.05) and HBeAg seroconversion rates (27.6％ vs 16.0％,P＞0.05) were found in sequential group compared with lamivudine group.At the end of follow-up,higher ALT levels [(126.0±143.1) vs (82.7±83.0) U/L,P＜0.05)],similar HBV DNA levels [(5.3±1.5) vs (5.0±1.5) lg copy/mL,P＞0.05)],similar HBeAg loss rates (25.0％ vs 32.3％,P＞0.05) and HBeAg seroconversion rates (25.0 ％ vs 26.2 ％,P＞0.05) were found in sequential group compared with lamivudine group.YMDD motif mutation rate in sequential group was lower than lamivudine group at week 48 of treatment (10.5％ vs 26.9％,P＜0.05).ConclusionsLamivudine-interferon sequential therapy and lamivudine monotherapy are both effective in HBeAg-positive CHB patients,while HBV mutations are reduced in patients with sequential therapy.

OBJECTIVETo explore the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with Surepath liquid-based cytology test for lung and mediastinal lymphadenopathy.

METHODSEighty EBUS-TBNA cases in West China Hospital of Sichuan University collected from December 2011 to June 2014 were retrospectively analyzed. The conventional smears and Surepath liquid based preparations were reviewed and compared with histological biopsy. Evaluated whether liquid based preparation could improve the satisfactory rate and diagnostic accuracy.

RESULTSThis study included 53 men and 27 women, the male to female ratio was 1.96:1.00; the age ranged from 17 to 79 (mean 54) years. One to four lymph node groups were aspirated in each patient, resulting in a total of 109 lymph node groups, including 57 paratracheal, 34 subcarinal, three tracheal bronchial, seven pulmonary and four hilar lymph node groups. The definite locations of four other mediastinal lymph node groups were not known. The overall satisfactory rate of conventional smears and liquid-based cytology test was 90.0% and 92.5%, respectively. By histology, there were 37 cases diagnosed as malignant tumors, nine as tuberculosis, two as sarcoidosis, 11 as unexplained granulomatous inflammation, and 27 as other benign lesions. The sensitivity, specificity and accuracy of conventional cytological smears for tumors were 86.5%, 97.7% and 92.5% respectively; the positive and negative predictive values were 97.0% and 89.4% respectively. The sensitivity, specificity and accuracy of the liquid-based preparation were 89.2%, 97.7% and 93.8% respectively; the positive and negative predictive values were 97.1% and 91.3% respectively. Combining the conventional cytological smears and liquid based preparation, the sensitivity, specificity and accuracy were 91.9%, 97.7% and 95.0% respectively; and the positive and negative predictive values were 97.1% and 93.3% respectively.

CONCLUSIONSEBUS-TBNA is a good method to diagnose lung and mediastinal lymphadenopathy. Surepath liquid based cytology test could improve the sample satisfactory rate, the diagnostic sensitivity and accuracy. If combined with immunocytochemistry it could be useful for further tumor typing. EBUS-TBNA combined with Surepath liquid based preparation is an effective complement for the histologic biopsy.

Adolescent ; Adult ; Aged ; Biopsy, Fine-Needle ; China ; Female ; Humans ; Immunohistochemistry ; Lung ; diagnostic imaging ; Lung Neoplasms ; diagnostic imaging ; Lymph Nodes ; diagnostic imaging ; Lymphatic Diseases ; diagnostic imaging ; Male ; Middle Aged ; Needles ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography ; Young Adult

Objective To investigate the value of strong ion gap (SIG),anion gap (AG),and the anionic gap corrected by albumin (ACAG) and lactate in evaluating the prognosis of severe pneumonia in children. Methods Pediatric patients with severe pneumonia hospitalized in the Affiliated Hospital of North Sichuan Medical College from June 2014 to June 2017 were selected as study subjects. A total of 20 death pa-tients (death group) and 59 survivors (survival group) were analyzed respectively according to their progno-sis. The data of Na + ,K + ,Cl - ,HCO -3 ,Mg2 + ,Ca2 + ,pH,PaCO2 ,P,albumin and lactate were obtained from blood gas analysis and blood biochemistry. Based on these data,ACAG was calculated by the Henderson-hasselbalach formula and SIG was calculated by the Stewart-Figge formula. Results There were significant differences in ACAG,SIG,and lactate levels between death group and survival group(P < 0. 05). The area under the ROC curve of ACAG was 0. 756,and the area under the ROC curve of SIG was 0. 936,which were larger than the area under the diagnostic reference line (P < 0. 05),the results were statistically significant. The sensitivity and specificity of ACAG was 79. 7％ and 70. 0％ respectively,and the cut off was 12. 7. The sensitivity and specificity of SIG was 81. 4％ and 95. 5％ respectively,and the cut off was 2. 7. Conclusion SIG,ACAG and lactate have the guiding value in assessing the prognosis of children with severe pneumonia. Meanwhile,SIG has a greater guiding significance for the assessment of the prognosis of children with severe pneumonia.