Objective To investigate the risk fairs and significance of late recurrence in non-small cell lung cancer (NSCLC)patients who had undergone complete resection and remained recurrence-free for5 years.Methods 496 individuals diagnosed and surgically treated for Stage Ⅰ and Ⅱ A NSCLC were included.We examined patients at 3-month intervals for the first 2 years after surgery and typically at 6-month intervals thereafter on an outpatient basis.The follow-up evaluation included physical examination,inaging examination and tumor narkers.Pathological examination had also been performed when needed.Of these,336 patients remained recurrence-free for 5 years were followed up continuously for 3 years.Clinicopathologic factors were collected including age,sex,smoking history,preoperative serum carcinoembryonic antigen (CEA) level,surgical apprach,maximum tumor dimension on resected specimen,histologic type,histologic differentiation,intratumoral lymphatic permeation,intratumoral vascular invasion,pleural invasion and pathologic stage.The primary end event was lung cancer recurrence.The data collection ended in January 2011.Kaplan-Meier method was used for survival rate.Survival difference wasevaluated bylog-rank test.Multivariate Cox regression was used to test the relationship of recurrence-free probability to various clinicopathologic factors.Results At 5 years after resection,109 patients had died of disease and 33 had died of other causes.18 patients were alive with disease.The remaining 3 - 36 patients were alive and recurrence-free for the first 5 years.The median follow-up period of these 5-year recurrence free survivors was 27 months (range,3-36 months).34 (10.1％)patients developed a late recurrence at 3 years among the 336 patients.Recurrence was locoregional in 13 (38.2％)patients:6 patients in mediastinal lymph nodes,3 patients in ipsilateral lung,2 patients with pleural dissemination and 2 patients in other locations.Recurrence was distant in 21 (61.8％) patients:8 patients with multiple-organ metastases,13 patients with single-organ metastasis,and the latter consisted of 5 patients in contralateral lung,3 patients in liver,2 patients in central nervous system and 3 patients in other locations.Smoking history,preoperative serum CEA level,histologic differentiation,intratumoral lymphatic invasion,intratumoral vascular invasion,pleural invasion and pathologic stage were risk factors for late recurrence in univariate analysis.Multivariate Cox analysis demonstrated that intratumoral vascular invasion and intratumoral lymphatic invasion were independent risk factors for late recurrence.Conclusion NSCLC patients have a significant risk of late recurrence after complete resection 5 years,especially for the patients with intratumoral vascular invasion and intralumoral lymphatic invasion.It is needed and significant for the patients to follow up continuously after 5 years of complete resection.

Objective To analyze and discuss the effect of heat preservation on the recovery time of BIS and the concentration of propofol in the recovery period of the elderly patients with general anesthesia in order to provide guidance for clinical treatment.Methods 78 elderly patients with general anesthesia were selected as the subjects, and the patients were divided into the control group and the study group with 39 cases in each group.The patients were divided into the control group and the study group.Control group, only to be liquid input and covered by drapes, research group take liquid input and peritoneal flushing fluid heating and heating blanket coverage of insulation measures, were recorded and compared between the two groups from anesthesia began to operation to complete the different time points of esophageal temperature and MAP, and to observe the recovery time of patients and effect compartment concentration differences.Results Two groups at T0, T1 esophageal temperature no significant difference, study group T2-T6 esophageal temperatures were significantly higher than those of the control group (P<0.05), maps of the other two groups at different time points had no significant difference;when two groups of patients with propofol withdrawal BIS values had no significant difference, and in the time of discontinuation BIS is more than or equal to 80 recovery time and effect compartment concentration have significant difference (P<0.05).Conclusion The surgical treatment of elderly patients with general anesthesia can help maintain the body temperature, shorten the recovery time of BIS and reduce the concentration of propofol in the recovery period.

To explore the efficacy of managing benign prostatic hyperplasia (BPH) by family doctor system service in a local community.Among 132 BPH patients recruited from January 2012 to December 2013,74 of them received family doctor system service while the remainder medications only.After 6 months,international prostate symptom score (10.3 ± 5.6) and quality-of-life (2.98 ± 0.95) significantly improved in management group versus control group.And there were significant statistical differences (P ＜ 0.05).The intervention management of family doctor system service is effective for improving the symptoms and quality-of-life of BPH patients.

Objective To investigate the short-term clinical outcomes and perinatal risk factors in very low birth weight infants (VLBWI) with delayed enteral feeding (DEF).Methods Three hundred and fifty-five cases of VLBWI admitted to neonatal intensive care unit from Jan 2007 to Oct 2011 served as study objects,and the clinical data of which were analysed retrospectively.According to days to initiate enteral feeding after birth,355 VLBWI were divided into two groups:DEF group (initiate enteral feeds ≥5 days,n =55)and early feeding group (initiate enteral feeds ≤4 days,n =298).The short-term clinical outcomes were compared in 299 cases,including DEF group 44 cases and early feeding group 255 cases,in which cure or improvement were achieved and hospital stay ＞ 14 d.The perinatal risk factors were subjected to univariate and multivariate logistic regression analysis.Results The incidence of DEF was 16.05％ (57/355) in VLBWI.The time to regain birth weight in DEF group was significantly longer than early feeding group [(11.86 ± 3.86) d vs (9.76 ± 3.83) d,P ＜ 0.01],and the incidences of parenteral nutrition associated cholestasis [27.27％ (12/44)] and extrauterine growth retardation at discharge [79.55 ％ (35/44)] in DEF group were also significantly higher than early feeding group respectively [11.76％ (30/255) and 61.57％ (157/255),P ＜ 0.05].Multivariable logistic regression analysis showed that infants born to mother with placental abruption had higher risk of exposure for DEF than those without placental abruption (OR =2.74,95％ CI 1.06 ～7.05,P ＜ 0.05).Similarly,infants with mechanical ventilation had also higher odds of DEF than those with-out mechanical ventilation (OR =3.51,95 ％ CI 1.92 ～ 6.42,P ＜ 0.01).Conclusion Placental abruption and mechanical ventilation are independent risk factors for DEF in VLBWI.Improving neonatal outcome through enhancing obstetric quality and strengthening cooperation between obstetric and neonatology department is still the key to reduce DEF in VLBWI.

Objective:To study the mathematical relation between the measurements of root canal curvature obtained by Schneider's method(?_S) and Weine's method(?_W).Methods:The axis of a curved root canal was simplified by an arc (whose radius was r and central angle ?) and 2 tangent line segments (whose lengths were l_1 and l_2),the relation of ?_S and ?_W was studied with the help of mathematical analysis according to the different ways of determining the measured angles on the simplified axis.The graphs of the function were analysed.Results:The following formulas were proved:(1)tan?_S=(1-cos?_W+ ksin?_W)/(sin?_W+kcos?_W),k=l_2/r;(2)?_W/2≦?_S≦?_W.If ?_W was in the interval [0,?],a proximate linear correlation existed between ?_S and ?_W.Conclusion:There is a complex function between the 2 angles(?_S and ?_W) measured by Schneider's method and Weine's method,the ratio of the length of the apical straight part to the radius of the canal curvature is an important factor determining the different values of ?_S and ?_W.

Objective: To study the nursing of patients with morbid obesity treated with laparoscopic vertical banded gastroplasty (LVBG). Methods: Before operation, obese degree, obesity-related conditions and mental states were examined routinely. Monitoring of respiratory tract, observing operative complications and instructing of diets were done after operation. Results: Among 6 patients, 5 were at the third degree of obese, one was at second. In obesity-related conditions, 4 patients had hypertension and acantha derma, 1 had arthritis, and all had respiratory sleeping syndrome. The operations were all successful. The food amount food and body weight both decreased significantly 1 month after operation. The common operative complications were mild bleeding (1 case), shoulder-back pain (1 case), nausea and vomiting (5 cases). Diet principle was high protein, low energy, liquid food was the first choice. Conclusion: Observing and preventing respiratory sleeping syndrome are the main points of postoperative cares. Instructing patients to establish correct diet habit is the key to reach the best efficacy of LVBG.

Objective To study the microanatomy of the area in which the facial nerve being easy to damage in mastoid surgery, in order to provide microanatomical datas for the clinical works. Methods In 20 adult wet skull specimens (40 temporal bones), the segments of facial nerve and their adjacent structures in the area in which the facial nerve being easy to damage were observed according to operation of mastoid surgery. Results The length of the horizontal segment was (8.85 ± 1.01) mm (7.10-11.25 nun), the diameter was (1.88 ± 0.65) mm (1.55-1.90 mm); The angle opening towards anterior direction between horizontal segment and vertical segment was (115.50 ± 6.89°) (109.5°-128.6°); The vertical distance from the cochlearform process to this segment was (1.89 ± 0.58) mm (0.90-3.05 mm); The vertical distance from the midpoint of the base of stapes to this segment was (1.92 ± 0.52) mm (1.44-2.56 mm); The vertical distance from the head of the stapes to this segment was (2.30 ± 0.85) mm (1.97-3.11 mm); The angle towards posterior direction between horizontal segment of facial nerve and tympanic tegmen was (28.5°± 3.66°) (25.8°-31.5°); The diameter of the pyramidal segment of facial nerve was (1.89 ± 0.65) mm (1.56-1.88 mm); The distance between the su mmit of pyramidal segment of facial nerve and the apex of shor limb of incus was (2.55 ± 0.21) mm (2.10-2.90 mm); The distance from the su mmit to the eminence of the lateral semicircular canal was (2.86 ± 0.31) mm (2.23-3.56 mm); The diameter of the proximal part of vertical segment of facial nerve was (2.13 ± 0.13) mm (1.90-2.40 mm); The angle towards superior direction between verical segment of facial nerve and chorda tympani nerve was (38.60 ± 1.99°) (28.5°-52.5°); The vertical distance from the top of the pyramidal eminence to the vertical segment of the facial nerve was (2.05 ± 0.65) mm (1.85-2.36 mm). Conclusions The eminence of the lateral semicircular canal, short limb of incus, cochlearform process, tympanic tegmen, stapes, pyramidal eminence, chorda tympani nerve in the area are important landmarks to be located in mastoid surgery. The anatomic relations in this area are complicated and compact. Anatomical knowledge is very important to the surgery of this area.

Objective:To analyze the wall thickness of C-shaped canals in permanent mandibular second molars.Methods:40 ex-tracted permanent mandibular second molars with C-shaped root were collected from native Chinese and were scanned by micro-CT scan-ner.The specimens were reconstructed three-dimensionally by software Mimics 10.01.The roots were sliced from cemento-enamel junc-tion (CEJ)to apex with 1 mm intervals.The cross-sectional root canal configurations were classified into 5 types according to the Fan's Classification.The minimum buccal wall thickness (MBWT),minimum lingual wall thickness(MLWT)and their locations,as well as the wall thickness at the mesial and distal reference sites were detected.Two-way ANOVA and post hoc LSD-t tests were used to com-pare the mean thickness at 4 sides.Results:Among 370 cross-sections of 40 C-shaped roots,C1,C2 and C3 canals were observed on 126(34.1%),46 (12.4%)and 160 (43.2%)sections respectively.Except at the 10 mm level,the mean MLWT was always lower than MBWT;and the MLWT and MBWT were always lower than the wall thickness at the mesial and distal reference sites.The differ-ence was statistically significant (P <0.05)along the root length above the 12 mm level.The MBWT of the C2 and C3 canals was more likely located at the mesial region,and the MBWT of the C1 and the MLWT of C1,C2 and C3 was more frequently located at the center region.Conclusion:The lingual wall of C-shaped canal in mandibualr second molars was the thinnest zone among four sides,and care should be taken during root canal instrumentation and post space preparation to avoid perforation.

Objective To introduce the clinical types of perforator branches of anterosuperior malleolus flap and explore its application.Methods Anterosuperior malleolus flap coupling with dorsal pedal flap was used for repairing the soft tissue defect of hands in 18 patients,in which anterosuperior malleolus flap-dorsal pedal single flap in 12 cases,anterosuperior malleolus flap-dorsal pedal bilobate flap in 4 cases,anterosuperior malleolus flap-dorsal pedal trilobate flap in 2 cases;Anterosuperior malleolus retrograde island (bone) flap was used in recovering pedal soft tissue in 22 patients,the flap pedicled from stem of anterior tibial artery in 16 cases,dorsal pedal flap-anterosuperior malleolus flap in 2 cases,the flap from perforate vessels without injuring the anterior main tibial artery in 2 cases,the bone flap combined with the distal of tibia in 2 cases.Results In the 18 cases of hands,17 cases survived,and 1 case of flap mild necrosis at the distal site took a second-phase skin-grafting to repair.Twenty cases of anterosuperior malleolus retrograde island (bone) flap survived,and the other 2 cases needed secondary skin-grafting to repair the necrosis edge of flaps because of venous limited.After a follow-up from 3 to 6 months,30 cases showed the satisfied postoperative outlook,with the good healing of the donor sites.Typing the 40 cases according to the location of perforator branches of the anterosuperior malleolus flap,20 cases locate in the medial of anterior tibial muscle,16 cases locate between the anterior tibial muscle and extensor hallucis longus,4 cases locate between extensor hallucis longus and extensor digitorum longus.Conclusion Knowing the clinical types of the perforator branches of anterosuperior malleolus flap is not only helpful for the accurate processes of operations、preventing cutaneous branches,but also improving the success rate of surgery.

BACKGROUND: Previous research has investigated the effect of nano-zirconium dioxide-toughened hydroxyapatite (nano-ZrO2-HA) on the proliferation and differentiation of rabbit bone marrow stromal cells.OBJECTIVE: To evaluate the biocompatibility of nano-ZrO_2-HA compound.METHODS: The experiments of acute toxicity,subacute toxicity,pyrogen,hemolysis,and intramuscular implantation were performed on New Zealand rabbits,healthy adult Kunming mice,and adult rats according to "Technical Evaluation Standards of Biomedical Materials and Medical Instruments",promulgated by Chinese Board of Health.RESULTS AND CONCLUSION: Acute toxicity: All experimental animals survived.There was no significant difference in body mass before and after testing (P> 0.05).Pyrogen: Heating reaction was not tested.Hemolysis: Generally speaking,hemolytic crisis was not observed after 1 hour,and hemolytic rate was less than 5%.Intramuscular implantation: Infection did not occur in any animals,and materials were not discharged at all.Four weeks later,muscles were closely integrated with materials.A certain quantity of tissue grew into material pore,and peripheral muscle still had normal morphology and structure.Subacute toxicity:There was no significant difference in body mass and blood routine before and 2 weeks after testing.HE staining demonstrated that necrotic focus and other lesion were not observed in heart,liver,and kidney tissues under optic microscope.The results suggested that nano-ZrO_2-HA was non-toxicity,and it had no pyrogen and hemolysis effect,as well as it did not stimulate to the muscle of rabbit.Inflammatory rejection did not happen to the animal.The nano-ZrO_2-HA was closely integrated with the muscle,characterizing by great biocompatibility.Therefore,it can be used as substitution materials in clinical experiment.But it still needs to be evaluated completely.