Objective:To explore the correlation between lymph node metastasis rate and prognosis in non-small cell lung cancer (NSCLC) patients with stage Ⅲ A/N 2. Methods:The clinical data of 350 NSCLC patients with stage Ⅲ A/N 2 receiving surgical treatment from January 2012 to June 2015 in Shanxi Provincial Cancer Hospital were retrospectively analyzed. The patients were divided into the high lymph node metastasis rate group and the low lymph node metastasis rate group according to the optimal cutoff value of lymph node metastasis rate determined by Cox hazard regression model. The relationship between clinicopathological features and lymph node metastasis rate was analyzed. Prognostic risk factors were analyzed by using Cox regression model, and overall survival (OS) and disease-free survival (DFS) of both groups were analyzed by using Kaplan-Meier method. Results:The optimal cutoff value of lymph node metastasis rate was 0.2. There were 180 cases with high lymph node metastasis rate (>0.2) and 170 cases with low lymph node metastasis rate (≤0.2). The proportion of the patients with adenocarcinoma and the highest lymph node metastasis in the high lymph node metastasis rate group was higher than that in the low lymph node metastasis rate group [72.2% (130/180) vs. 52.9% (90/170), 52.8% (95/180) vs. 29.4% (50/170), all P<0.05]. The proportion of patients with jumping N 2 lymph node metastasis, single station N 2 lymph node metastasis and single station N 2 lymph node metastasis in the highest group was lower than that in the low lymph node metastasis rate group [51.1% (92/180) vs. 71.8% (122/170), 25.0% (45/180) vs. 44.1% (75/170), 38.9% (70/180) vs. 75.3% (128/175), all P<0.05]. Cox multi-factor regression model analysis showed that adenocarcinoma, multiple stations N 2 lymph node metastasis, lymph node metastasis rate were independent risk factors of DFS for NSCLC patients with stage Ⅲ A/N 2 ( HR = 2.201, 95% CI 1.444-3.355; HR=2.971,95% CI 1.950-4.529; HR=3.543, 95% CI 1.874-6.699; all P<0.05). Lymph node metastasis rate was an independent risk factor of OS for NSCLC patients with stage Ⅲ A/N 2 ( HR = 3.669, 95% CI 1.941-6.938, P<0.05). The 5-year OS rate of the low lymph node metastasis rate group was higher than that of the high lymph node metastasis rate group (64.00% vs. 36.58%, χ2 = 11.422, P = 0.001). The 5-year DFS rate in the low lymph node metastasis rate group was higher than that in the high lymph node metastasis rate group (45.00% vs.18.32%, χ2 = 13.624, P<0.01). Conclusion:Lymph node metastasis rate is an independent influencing factor for the prognosis of NSCLC patients with Ⅲ A/N 2 stage, and it can effectively evaluate the prognosis.

AIM: To research the processed products of Rhizoma Atractylodis Macrocephalae at the level of sesquiterpene lactones from it. METHODS: Sesquiterpene lactones were separated by the silica gel column and layer preparation, and the active substances were determined by HPLC. RESULTS: Atractylone、atractylolide Ⅰ, atractylolide Ⅲ, and biepiasterolid were separated from Rhizoma Atractylodis Macrocephalae. Atractylone was (0.535 8)%, atractylolide Ⅰ was (0.044 0)% and actractylolide Ⅲ was (0.081 4)% in Atractylodis stir-fried with wheat bran determined by HPLC. CONCLUSION: The method has good accuracy and repeatability and it can be used for the quality control of Rhizoma Atractylodis Macrocephalae.

Objective To study the TCM syndrome distribution and the laws of blood pressure variability in patients with primary hypertension.Methods Totally 443 patients with primary hypertension were selected; four diagnostic data were collected to conduct syndrome differentiation (main syndrome was chosen for compound syndrome); 24 h ambulatory blood pressure was monitored and blood pressure variability of each syndrome was compared.Results Among 443 cases of patients, liver-kidney yin deficiency syndrome (157 cases) > qi yin deficiency syndrome (83 cases) > yang deficiency syndrome (76 cases) > phlegm dampness syndrome (65 cases) > liver yang hyperactivity syndrome (62 cases). There was statistical significance in ages of different syndromes, but there was no statistical significance in gender, family history and course of disease (P>0.05). Compared with liver-kidney yin deficiency syndrome, 24 h systolic blood pressure and 24 h mean blood pressure of phlegm dampness syndrome were significantly different (P<0.05); circadian rhythm abnormality rates of liver-kidney yin deficiency syndrome, liver yang hyperactivity syndrome, qi yin deficiency syndrome, phlegm dampness syndrome and yang deficiency syndrome were 80.85% (38/47), 66.67% (14/21) ,81.48% (22/27), 86.96% (20/23), and 78.79% (26/33), respectively, without statistical significance in different syndromes (χ2=3.031,P=0.553).Conclusion Among the 443 hypertensive patients, patients with liver-kidney yin deficiency syndrome were the most, and patients with liveryang hyperactivity syndrome were the least. Phlegm dampness syndrome has the highest blood pressure, while liveryang hyperactivity syndrome has the lowest blood pressure. Patients with liver-kidney yin deficiency syndrome are with the highest blood pressure variability, while patients with qi yin deficiency syndrome are with the lowest blood pressure variability.

BACKGROUND: Pathological changes of pulmonary emphysema are not reversible according to the existent pathogenesis of pulmonary emphysema. Research over many years report that injury of pulmonary blood capillary may take part in new pathogenesis of pulmonary emphysema based on lung volume reduction operation and bronchial lumen occlusion. Mesenchymal stem cells (MSCs) have multi-directional differentiation potencies, such as the differentiation into vascular endothelial cells. Therefore, MSCs may promote pulmonary vascularization and repair pulmonary tissue.OBJECTIVE: To observe the effect of MSCs transplantation on pathological changes of arterial blood gas and pulmonary tissue in model rats with pulmonary emphysema, and investigate the therapeutic effects on MSCs on pulmonary emphysema and the pathogenesis of pulmonary emphysema.DESIGN: Randomized controlled animal study.SETTING: The Second Hospital of Shanxi Medical University.MATERIALS: Thirty healthy Wistar rats, 6 weeks old, of either gender, weighing 180-200 g. They were provided by Physiological Experiment Animal Center, Shanxi Medical University. All rats were randomly divided into MSCs treatment group, model group and control group with 10 rats each.METHODS: The experiment was carried out in the Physiological Laboratory of Shanxi Medical University from April 2005 to April 2006. Rats in the MSCs treatment group and in the model group were anesthetized and intratracheally perfused with 250 U/kg Porcine pancreatic elastase (PPE) to establish pulmonary emphysema models; while, rats in the control group were perfused with saline. The models were successfully established 4 weeks later. All rats were anesthetized and then femur and tibia were obtained to separate and culture MSCs in vitro. Immunocytochemistry was used to detect the expression of CD71 in order to evaluate MSCs. Bromium azacytidine-labeled MSCs were inserted along caudal vein into rats in the MSCs treatment group; while, rats in the model group and control group were inserted with the same volume of PBS solution.MAIN OUTCOME MEASURES: ① Changes of arterial blood gas in the three groups; ② Pulmonary tissue was used for pathological sections in order to calculate mean alveolar number, mean alveolar area and mean linear intercept; ③Immunocytochemical staining was used to measure numbers of CD34+ cells so as to determine proliferation of alveolar blood capillary.RESULTS: Three rats in all died during the model establishment, while another 3 rats were supplied. Therefore, an overall number of 30 rats were involved in the final analysis. ① Culture and evaluation of MSCs: At 3 days after inoculation, MSCs were generally adherent to walls and fusiformly shaped. In the third generation, the expression of CD71 was observed on the surface of MSCs.② Comparisons of arterial blood gas in the three groups: There were no significant differences in pH value, PO2, PCO2 and SaO2 in the three groups (P ＞ 0.05). ③ Pathological changes of pulmonary tissue: Pathological changes in the MSCs treatment group were milder than those in the model group;meanwhile, mean alveolar number in the MSCs treatment group was more than that in the model group, and there was significant difference between them (F=80.201, P＜ 0.05). While mean alveolar area and mean linear intercept in the MSCs treatment group were smaller than those in the model group, and there were significant differences (F =26.755,26.875, P ＜ 0.05). ④ Comparisons of CD34+ expression in pulmonary tissue: Relative positive area of CD34+ in the MSCs treatment group and model group was smaller than that in the control group (F =20.411, P ＜ 0.05), but that in the MSCs treatment group was larger than that in the model group, and there was significant difference between them (F=20.411, P＜ 0.05).CONCLUSION: MSCs can reverse the pathological changes of pulmonary emphysema; on the other hand, the decrease of the number of pulmonary capillary maybe one of the important pathogeneses of pulmonary emphysema.

Objective To investigate the roles of mitochondrial DNA (mtDNA) in the respiratory function of cerebral mitochondria in rats exposed to acute hypoxia by observing the changes of mitochondrial respiratory function and cytochrome C oxidase (COX) activity. Methods The rat cerebral cortex mitochondria were isolated by centrifugation. Mitochondrial respiratory function and COX activity were measured by Clark oxygen electrode. Results ① Compared with the control group (C), hypoxia group (H) showed significantly elevated state 4 respiration (ST4), decreased state 3 respiration (ST3), and respiratory control rate (RCR). ② ST3 in group of treatment with chloramphenicol (CAP) plus hypoxia (MH) was significantly lower than that in Group C, while ST4 in Group MH was significantly lower than that in groups C and H. RCR in Group MH was lower than that in Group C, but higher than that in Group H. ③ COX activity in Group H was significantly lower than that in Group C. In Group MH, COX activity was higher than that in Group H, but was still lower than that in Group C. Conclusion The complete expression of mtDNA may play an important role in mitochondrial respiratory function. CAP treatment might be beneficial to the recovery of rat respiratory function.

Objective To investigate the effects of ghrelin on proliferation of vascular smooth muscle cells(VSMC)and the expression of mitochondrial fusion 2(Mfn-2)in cultured human aortic smooth muscle cells(HASMCs).Methods HASMCs were cultured in vitro,treated with different concentrations(10-9,10-8,10-7,10-6,10-5 mol/L)ghrelin or 10-6 mol/L ghrelin for different time(0,6,12,18,24 h).Subconfluent HASMCs at passage 4-6 were used in experiments.MTT essay was used to investigate the effect on proliferation of HASMCs.RT-PCR and Western blot were used to analyse the expression of Mfn-2.Results 10-7-10-5 mol/L ghrelin inhibited the proliferation of HASMCs,and the inhibitory effect of concentration of 10-6 mol/L was the most obvious(P<0.01).Ghrelin inhibited the proliferation of HASMCs in 6-24 h,and it reached the peak at 24 h(P<0.01).10-6 mol/L ghrelin significantly increased the expression of Mfn-2 mRNA and protein(P<0.01).The up-regulation of 10-6 mol/L ghrelin on Mfn-2 mRNA and protein expression reached the peak at 18 h(P<0.01).Conclusion Ghrelin might inhibit the proliferation of HASMC by up-regulating the expression of Mfn-2.

Objective To evaluate the feasibility of endooscopic minimally invasive McKeown esophagectomy in the treatment of esophageal carcinoma. Methods From June 2012 to August 2015, the data of 180 patients with esophageal carcinoma was retrospectively analyzed. The patients were divided into endoscopy McKeown esophagectomy group (EME group) and open McKeown esophagectomy group (OME group), each group had 90 patients. The clinical pathological data, perioperative data and postoperative complications between the two groups were analyzed. Results The operation time in EME group was longer than that in OME group [(289 ± 30) min vs. (252 ± 28) min, t= 8.063, P< 0.05]. The intraoperative blood loss and postoperative blood loss on the first day after operation in EME group were less than those in OME group [(178.94 ± 47.84) ml vs. (323.44 ± 59.51) ml, t=17.952, P<0.05; (220.93 ± 49.07) ml vs. (362.59 ± 68.37) ml, t= -15.968, P< 0.05]. There was no significant difference between the two groups in the number of lymph node dissection (t= -1.913), postoperative hospitalization days (χ2= 4.858) and postoperative complications (exact probability method) (all P> 0.05). Conclusions Endoscopic minimally invasive McKeown esophagectomy has the same effect as open surgery, and trauma is small. Therefore, for the patients who are suitable for the minimally invasive surgery, it can be preferred.

Objective To investigate the safety and therapeutic effect of intra-carotid infusion with cold sa line in rats with acute focal cerebral ischemia-reperfusion injury.Methods 60 rats were randomly divided into six groups:sham operated group,normal infusion group,stroke group,local hypothermic group,local normothermic group,and systemic infusion group.Brain infarct volume and cerebral water content were analyzed 48 h after ischemia.Neurological deficits were assessed using the mNSS 24 h and 48 h after infarction.Results In the local hypothermic group,brain temperature was reduced to 33 to 34 ℃ within 5 to 10 minutes,and this significantly low temperature maintained to nearly 60 minutes after infusion continued.Physiological variables were not significantly different among each time point (P ＞ 0.05).No significant morphological abnormality was found in brain sections stained with TTC and HE.Animals receiving local cold infusion significantly decreased infarct volume and brain water content compared to stroke group (P ＜ 0.05).Both 24 h and 48 h mNSS in local hypothermic group was significantly lower than those in other groups (P ＜ 0.05).Conclusions Intra-carotid infusion with cold saline can quickly and effectively reduce brain temperature and is a relatively safe cooling method.Local hypothermia significantly reduced brain infarct volume,decreased brain water content and improved neurological functional outcomes after brain ischemia.

Objective To analyze the incidence and possible etiological factors of hyponatremia after acute cervical spinal cord injury (CSCI),and evaluate the effect of severity of CSCI,age,sex and injured segment on hyponatremia.Methods From June 2005 to March 2011,a series of patients with CSCI caused by cervical vertebras trauma were treated in our department.Except patients combined with craniocerebral injury or chronic diseases,other patients were divided into three groups:complete CSCI group,incomplete CSCI group and no neurological disorder group.Concentration of natrium in blood in all patients was analyzed respectively.Results All 102 patients (83 males,19 females) were selected with an average of 45.6years old.There were 23 patients with complete CSCI,60 with incomplete CSCI and 19 with no neurological disorder.Hyponatremia was found in 15 patients in complete CSCI group,23 patients in incomplete CSCI group and 1 patient in no neurological disorder group.The incidence of hyponatremia was significantly different between three groups,among which the complete CSCI group had the highest incidence.Multiple linear regression analysis showed hyponatremia was obviously correlated with the injury degree of spinal cord,but not correlated with the age,sex and injury segment of the patients.Conclusion Hyponatremia is a common complication in patients suffered from CSCI.Although the balance of natrium in blood is very complicated and influenced by many factors,autonomic nerve system and neuroendocrine system dysfunction,and hemodynamic changes after CSCI may play a key role in happening of electrolytical abnormality.

Objective To investigate the toxic reaction,toxic organs or target tissues of protamine recombinant human insulin (Insulin NPH),and provide basis for clinical trials by single dose toxicity test in mice,repeated toxicity and immunogenicity of Beagle's dogs,and systemic active allergy in guinea pig.Methods ① Using maximum dose method,mice in single dose toxicity test were sc injected with normal saline (NS),vehicle,and Insulin NPH (2092-2488 IU/kg),the toxic reactions after injection were monitored.② In repeated toxicity study,Beagle's dogs were sc administrated with vehicle,the original (Humulin NPH,1.5 IU/kg)and different doses of Insulin NPH (0.5,1.0 and 1.5 IU/kg) for 30 d continuously,followed by a 14-d recovery.During the administration and recovery period,general observation,local irritation,body weight,anus temperature,blood glucose,and electrocardiogram (ECG) were checked,moreover,hematology,serum biochemistry and urine were detected.Also,organic weights and histopathological examination were conducted.Binding antibodies in dog serum were measured by indirect ELISA method in immunogenicity test.③ In systemic active allergy study,cavies were sc injected with low-and high-dose (4 and 12 IU/kg) Insulin NPH,normal saline and vehicle.Besides,ova as positive control was also included.After five times of sensitization test with above doses,the excitation reactions of iv injection with tripled sensitizing doses were observed.Results No obvious toxicity was observed in mice after injected with 165 times of usual clinical dose of Insulin NPH.Repeated toxicity study of Beagle's dogs revealed that 1.0 IU/kg was the no-toxic-effect dose (NOAEL) for Insulin NPH,which was equivalent to 2 times of clinical dose.No bindingantibodies were found in immunogenicity test.There was no obvious allergic symptom in the active systemic allergy study of guinea pig.Conclusion Under the experimental conditions,no serious toxicity of Insulin NPH is found.