Objective To analyze the influence of thoracoscopy combined with laparoscopy for radical operation of esophageal carcinoma and open ones on the perioperative effects and postoperative quality of life.Methods The data in 74 esophagus cancer patients in the thoracic surgery department of our hospital from October 2012 to June 2015 were collected and divided into the endo-scopic group and open group according to different operative ways.The perioperative effects and complications in the two operation ways were analyzed.The EORTC QLQ-C30 and QLQ-OES18 were used to conduct the questionnaire investigation and comparative analysis.Results The mean intraoperative blood loss,postoperative catheter drainage,hospitalization time,occurrence rates of post-operative complications such as pneumonia,hydrothorax and gastric emptying disorder in the endoscopic group were lower than those in the open group,while the operative time was longer than that in the open group,the differences were statistically significant (P <0.05).The total healthy status and function scores at postoperative 1,12 weeks in the two groups were decreased and symp-tom scores were increased,which at postoperative 24 weeks were back to close to preoperative level.The scores in the aspects of to-tal healthy status,physical functioning,role functioning,social functioning,fatigue,pain,dyspnea and difficultly coughing at postop-erative 1,12 weeks in the endoscopic group were superior to those in the open group,in which the scores of total healthy status, physical functioning and fatigue symptom at postoperative 24 week were still superior to those in the open group,the differences were statistically significant(P <0.05).Conclusion Thoracoscopy combined with laparoscopy for radical operation of esophageal carcinoma has the advantages in the aspects of intraoperative blood loss,catheter drainage,hospitalization time,some postoperative complications and QOL scores,but the operative time is longer.

Objective: The purpose of our experiment is to use new type esophageal prosthesis, which is pulmonary tissue with vascular pedicle, to repair the partial esophageal defect. Methods: Twelve adult mongrel dogs were used for the study. Middle lobar bronchus of right lung was ligated and incised, so the pulmonary tissue with vascular pedicle was made. A 4 cm long and 1/2～2/3 circled esophageal wall, and full-thickness defect was created. The defect was patched by pulmonary tissue with vascular pedicle. Results: Seven dogs were put to death at planned times after the reconstructive operation. One dog is still alive without any problems for more than 12 months. One dog survived 38 days and then died of chronic empyema. The other three dogs died of anastomotic leak at 5～7 days after operation. The living dogs could be fed orally at seventh day after operation. Epithelization was found in the luminal surface of the defect. Conclusion: It was feasible that the partial esophageal defect was replaced by pulmonary tissue with vascular pedicle.

The effects of ATP-sensitive mitochondrial K(+) channel (mitoK(ATP)) on mitochondrial membrane potential (Δψm), cell proliferation and protein kinase C alpha (PKCα) expression in airway smooth muscle cells (ASMCs) were investigated. Thirty-six Sprague-Dawley (SD) rats were immunized with saline (controls) or ovalbumin (OVA) with alum (asthma models). ASMCs were cultured from the lung of control and asthma rats. ASMCs were treated with diazoxide (the potent activator of mitoK(ATP)) or 5-hydroxydencanote (5-HD, the inhibitor of mitoK(ATP)). Rhodamine-123 (R-123) was used to detect Δψm. The expression of PKCα protein was examined by using Western blotting, while PKCα mRNA expression was detected by using real-time PCR. The proliferation of ASMCs was measured by MTT assay and cell cycle analysis. In diazoxide-treated normal ASMCs, the R-123 fluorescence intensity, protein and mRNA levels of PKCα, MTT A values and percentage of cells in S phase were markedly increased as compared with untreated controls. The ratio of G(0)/G(1) cells was decreased (P<0.05) in diazoxide-treated ASMCs from normal rats. However, there were no significant differences between the ASMCs from healthy rats treated with 5-HD and the normal control group. In untreated and diazoxide-treated ASMCs of asthmatic rats, the R-123 fluorescence intensity, protein and mRNA levels of PKCα, MTT A values and the percentage of cells in S phase were increased in comparison to the normal control group. Furthermore, in comparison to ASMCs from asthmatic rats, these values were considerably increased in asthmatic group treated with diazoxide (P<0.05). After exposure to 5-HD for 24 h, these values were decreased as compared with asthma control group (P<0.05). In ASMCs of asthma, the signal transduction pathway of PKCα may be involved in cell proliferation, which is induced by the opening of mitoK(ATP) and the depolarization of Δψm.

Objective To investigate the expression of RGC32 gene in pulmonary adenocarcinoma tissue and to explore the influence on proliferation and apoptosis of A549 cells.Methods Real-time PCR was applied to detect the expression of RGC32 gene in 36 cases of pulmonary adenocarcinoma and pericancerous tissues.RNA interference was used to inhibit the expression of RGC32 gene.After RNA interference,the expression of RGC32 gene was detected by real-time PCR,the apoptosis of the transfected cells was detected by flow cytometry and the inhibition ratio of cell proliferation was detected by methyl thiazolyl tetrazolium (MTT).Results The expression of RGC32 gene was upgraded in pulmonary adenocarcinomas tissues(1:2.2736,t=-29.185,P=0.01).After RNA interference,the expression of RGC32 gene transfected A549 cells was down-regulated significantly[(2.47±0.17)％ vs(4.65±0.26)％,t=-202.868,P=0.000].Comparing to the control cells,the apoptosis of experimental group cells increased significantly (2.9 ％ vs 45.4 ％,t=-37.915,P=0.01),and the inhibition ratio of cell proliferation increased significantly.Conclusion The expression of RGC32 gene shows an obvious upgraded in pulmonary adenocarcinoma.The low expression of RGC32 gene can induce apoptosis and inhibit proliferation of A549 cells.

Objective To evaluate the value of ghrelin on predicting prognosis in patients with chronic heart failure (CHF) after hospital discharge.Methods Totally 145 patients withCHF (age≥60 years,83 males and 62 females) were divided into 3 subgroups by New York Heart Association classification (NYHA):class Ⅱ (n=48),class Ⅲ(n=57) and class Ⅳ(n =40).According to the basic diseases,the CHF group was divided into five subgroups.All patients were followed up for about 2 years.The study included 55 healthy control subjects (30 males and 25 females).Results Plasma ghrelin level was lower in CHF cases (1.66±0.28) μg/L than in control subjects (2.27±0.26) μg/L (t 3.77,P＜0.01).The ghrelin level in NYHA Ⅱ(1.85±0.13) μg/L were higher than in NYHA Ⅲ (1.56±0.28) μg/L,the latter were higher than in NYHA Ⅳ (1.27±0.24) μg/L (P＜0.05).The plasma ghrelin level of patients after treatment (1.98±0.25) μg/L was increased compared with that of before treatment (1.66±0.28) μg/L (P＜0.05).No significant difference was found among the five basic disease groups (P＞0.05).During the follow up periods of (637±97)days,plasma ghrelin level was decreased in patients with cardiovascular event (1.26±0.38) μg/L than in patients without cardiovascular event (1.86±0.34) μg/L.The plasma ghrelin was negatively correlated with left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (P＜0.05).Conclusions The plasma ghrelin in elderly patients with CHF is decreased than in healthy adults,and its level is lower in patients with severe heart failure.The plasma ghrelin is a predictor of cardiovascular event and death in elderly patients with CHF.

The effects of cigarette smoke extract (CSE) on the expression of heat stress protein 70 (Hsp70) in human bronchi smooth muscle cells were investigated in vitro, and the changes in Hsp70 mRNA in the patients with chronic obstructive pulmonary disease and their significance were explored. Human bronchi smooth muscle cells were cultured with CSE at the different concentrations. The expression of Hsp70 mRNA and Hsp70 was detected by reverse translation-polymerase chain reaction (RT-PCR) and Western blotting respectively. Levels of Hsp70 mRNA and Hsp70 in lymphocytes from 20 patients with COPD and 20 healthy smoking control subjects were measured by RT-PCR and Western blotting. The results showed the expression of both Hsp70 mRNA and Hsp70 was decreased conformably in human bronchi smooth muscle cells treated with CSE at certain concentration in vitro. The A values of the Hsp70 mRNA expression were 0.24 +/- 0.11 and 0. 42 +/- 0.13 respectively in COPD patients and healthy smoking controls with the difference being significant (P < 0.01). There was also significant difference in the A values of the Hsp70 expression between COPD patients and healthy smoking controls (20.9 +/- 9.9 vs 44.8 +/- 15.3, P < 0.01). The levels of Hsp70 mRNA had strongly positive correlation with Hsp70 protein (r = 0.85, P < 0.01). It was suggested that the expression of Hsp70 mRNA was in concordance with the expression of Hsp70, which could provide a basis on the study of Hsp70 gene regulation and Hsp70 gene in the development of COPD.
Bronchi/metabolism ; Bronchi/pathology ; Cells, Cultured ; HSP70 Heat-Shock Proteins/*biosynthesis ; HSP70 Heat-Shock Proteins/genetics ; Muscle, Smooth/cytology ; Pulmonary Disease, Chronic Obstructive/*metabolism ; RNA, Messenger/biosynthesis ; RNA, Messenger/genetics ; Smoking

BACKGROUND: Esophageal replacement or reconstruction should be performed after esophageal resection. There are still no suitable substitutes for esophagus if the conventional esophageal substitutes cannot be used.OBJECTIVE : To investigate the feasibility of applying a pulmonary tissue with vascular pedicle to repair the intrathoracic esophageal defect.DESIGN: A prospective animal investigation.SETTING: Department of Thoracic Surgery, Second Hospital Affiliated to China Medical University.MATERIALS: This trial was carried out in the laboratory of Department of Thoracic Surgery, Second Hospital Affiliated to China Medical University during January 2003 to June 2004. Fourteen adult mongrel dogs of either gender, with body mass of 12 to 18 kg, were provided by Animal Room, Second Hospital Affiliated to China Medical University (License No.SYXK (Liao) 2003-0019).METHODS: Of 14 anesthetized dogs, the middle lobe of right lung was dissected and its right middle lobar bronchus was ligated without damaging pulmonary and bronchial vessels in order to make pulmonary flap. A part of full-layer intrathoracic esophageal wall was resected, which was 4 cm long and 1/2 to 2/3 circled esophageal wall. The defect was patched by pulmonary tissue with vascular pedicle which was inosculated with esophageal cross section. On the 3rd day after operation, intravenous transfusion was performed to maintain nutrition. Qn the 7th day after operation, the dogs were given oral liquid soft food gradually 2 weeks after the operation. The access to the food and the survival of dogs were observed. Every 2 dogs were sacrificed respectively at the 2nd, 4th, 6th, 8th and 10th postoperative weeks. To observe the healing of esophageal defect, light microscope, transmission electron microscope, esophagography and endoscope were used in this study.MArN OUTCOME MEASURES: ①Survival situation and access to food of dogs after operation. ② The healing of esophageal defect of dogs.RESULTS: Three of fourteen dogs died within one week after operation. Eleven dogs survived. ① The survival and access to food of experimental dogs after operation: One dog was alive without problems for more than 170 weeks. The living dogs could be fed orally on the 7th day after operation. ② The healing at esophageal defect of experimental dogs:At the 2nd week after operation, the esophageal defect was covered with collagen layer and inflammatory exudation. A little epithelization was observered at free edge of the anastomosis, which was 1 to 2 layers of stratified squamous epithelium cells. At the 4th to 6th weeks after operation, the internal surface of the defect was covered with 3 to 5 layers of stratified epithelium cells. At the 8th to 10th weeks after operation, the luminal surface of the defect was covered with 6 to 8 layers of stratified epithelium cells. The pathological changs of pulmonary flap mainly included pulmonary alveoli atelectasis and pulmonary fibrosis, and some inflammatory cells without infective focus were observed. In the transmission electron microscope examination, newborn stratified squamous epithelium cells were. found on the surface of pulmonary tissue flap at esophageal defect.CONCLUSION: It is feasible to repair the partial irregular intrathoracic esophageal defect with the autologous pulmonary flap in dogs.

AIM:To design a signal collecting system of urethral internal pressure based on embedded microprocessor(ARM).METHODS:Based on ARM,the signal collecting module of urethral internal pressure and signal amplifier circuit were designed with sensor technology.The A/D transition circuit was improved by signal feedback theory to increase measurement accuracy.The software of sensor temperature drift was rectified by second linear interpolation so to enhance the accuracy of data collection.RESULTS:In simulated static urethral internal pressure collection,the signals of urethral internal pressure that sensor collected were corresponded with the location completely and send them into RAM of ARM for following analysis.CONCLUSION:The ARM-based signal collecting system of urethral internal pressure has simple circuit,reliability,lower power consumption,high precision and strong spot data analysis.

Objective To investigate the effects of intestinal ischemia reperfusion (IIR) on the progression of inflammatory reaction in hemorrhagic necrosis pancreatitis (HNP).Methods Eighty rats were randomly divided into sham operation (SO) group,acute edematous pancreatitis (AEP) group,AEP + IIR group and HNP group according to the random number table.Erythrocyte velocity (EV),functional capillary density (FCD) and leukocyte adherence (LA) were observed at 0,1,2,3 and 6 hours after the models were completed.The serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected.All data were analyzed by using the analysis of variance or the t test.Results The level of EV in the AEP group significantly decreased at 1 hour,and got increased at 3 hours,while the level of EV in the AEP group was still significantly lower than that in the SO group ( t =9.60,P ＜ 0.05 ).The levels of EV in the AEP + IIR group and HNP group constantly decreased,and increased at 6 hours,but were continually lower than that in the AEP group ( t =6.03,6.12,P ＜0.05 ).The level of FCD in the AEP group was significantly lower than that in the SO group at 3 hours ( t =8.20,P＜0.05).The levels of FCD in the AEP + IIR group and HNP group were significantly lower than that in the AEP group at 3 hours (t =35.60,23.80,P ＜ 0.05 ).Compared with AEP group,the level of LA in the AEP group was significantly increased at 1 hour ( t =75.00,P ＜ 0.05 ) and reached peak at 3 hours.The levels of LA in the AEP + IIR group and HNP group were significantly higher than that in the AEP group at 1,2,3,6 hours (t =23.00,29.50,53.00,38.70,23.10,48.20,39.20,47.50,P＜0.05).Compared with SO group,the level of TNF-α in the AEP group significantly increased since l hour (t =77.00,P ＜ 0.05),and began to decrease at 3 hours; the levels of TNF-α in the AEP +IIR group and HNP group at 2 hours were significantly higher than that in the AEP group (t =23.50,18.10,P＜0.05).The levels of IL-6 in the AEP group at 1,2,3,6 hours were significantly higher than those in the SO group ( t =93.50,146.00,243.60,209.20,P ＜ 0.05 ).The levels of IL-6 in the AEP + IIR group and HNP group at 1 hour were not significantly different from that in the AEP group ( t =2.30,2.03,P ＞ 0.05),while the levels of IL-6 in the AEP + IIR group and HNP group at 2 hours were significantly higher than that in the AEP group (t =35.63,29.80,P ＜ 0.05 ).Conclusion IIR may enhance the inflammatory reaction of AEP and IIR might be one of the factors to exaggerate the inflammatory reaction of HNP.

Objective To explore the therapeutic effect of immune regulating nutrition on severe acute pancreatitis (SAP). Methods The clinical data of 80 patients with SAP who were admitted to the Union Hospital of Huazhong University of Science and Technology from February 2008 to October 2009 were prospectively analyzed. The 80 patients were equally divided into conventional nutrition (CN) group and immune regulating nutrition (IRN) group. Patients in the CN group received CN support, while patients in the IRN group were supplemented with ω-3 polyunsaturated fatty acid (ω-3 PUFA ) and glutamine at the basis of CN support.APACHE Ⅱ scores were evaluated at day 1, 4, 7, 10, 14 in the course of treatment. The differences in the incidence of pulmonary and abdominal infection, sepsis, and other clinical parameters including operation intervention, mortality, length of ICU and hospital stay between the two groups were compared. All data were analyzed using the t test and chi-square test. Results The APACHE Ⅱ scores of patients in the IRN group were 15.3 ± 1.8 and 9.0 ± 1.8 at day 4 and 7, which were significantly lower than 20.0 ± 2.7 and 13.3 ± 2.4 in the CN group, respectively (t = 3.3, 2. 8, P < 0.05). The APACHE Ⅱ scores of patients in the IRN group at day 10and 14 were also lower than those in the CN group, while there was no significant difference (t =0. 7, 0. 6, P>0.05). The incidences of pulmonary and abdominal infection and surgical intervention rate in the IRN group were 18% (7/40), 13% (5/40) and 5% (2/40), which were significantly lower than 38% (15/40), 33% (13/40)and 20% (8/40) in the CN group, respectively (χ2 =4.0, 4.6, 4.1, P<0.05). The incidence of sepsis in the IRN group was 5% (2/40), which was lower than 8% (3/40) of the CN group, while there was no significant difference between the two groups ( χ2 =0.0, P >0.05 ). The average lengths of ICU and hospital stay in the IRN group were (5.4 ± 1.6 ) days and ( 38.6 ± 9.3 ) days, which were significantly lower than ( 7.8 ± 2.8 ) days and (43.1 ± 1 1.6) days in the CN group, respectively ( t = 2. 7, 3. 7, P < 0.05 ). The morality was 5% (2/40) in the IRN group and 8% (3/40) in the CN group, with no significant difference between the two groups (χ2 =0.0,P >0.05). Conclusion CN support supplemented with ω-3 PUFA and glutamine can adjust the inflammation reaction of SAP and sustain the normal immune function, which is helpful in decreasing the incidence of severe infection.