Objective To observe the clinical effect of different surgical methods in the treatment of mediastinal tumors.Methods A total of 74 cases of August 2011 -2015 years 7 months in our hospital admissions of patients with mediastinal tumor were divided into observation group (minimally invasive medi-astinal surgery)and control group (conventional thoracotomy),37 cases,compared to two groups of clini-cal curative effect.Results The total efficiency of treatment in the observation group was 89.19%,signifi-cantly higher than that of the control group and observation group complications rate is relatively lower,sig-nificant differences (χ2 =5.33,6.79,P <0.05);observation group the operative time,amount of bleeding and hospitalization time were (15.69 ±3.21)min,(3.541 ±56.29)ml,(597 ±3.11)d were significantly lower than control group,the difference between two groups was significant (t =12.54,11.49,13.54,P<0.05).Conclusions Phase,compared with the traditional surgical treatment for open and minimally in-vasive surgery can achieve a better therapeutic effect,reduce a patient's risk of complications,alleviate the injury of surgery.For patients with postoperative rehabilitation has a positive meaning.

Objective To explore the feasibility of the small figure-L unilateral transternal incision for the treatment of anterior mediastinal tumor.Methods Twenty patients with anterior mediastinal tumor were enrolled in the study.Under general anesthenai,after a 6 to 10cm middle skin incision was made,a unilateral figure-L partial sternotomy on the side occupied by the tumor was made in the second or third intercostals space,taking into account the tumor size and location.Tumors were resected with excellent exposure.Results All tumors were completely resected during the operation.In 7 cases,tumors encroached on the adjacent lung tissue,and lung tissue was partially resected.In 5 cases,tumors invaded the pericardium,and the pericardium was partially removed.Mean operating time was 110 minutes(85～130 minutes).The mean time of hospital stay was 7days after the operation,and there was no complication.All but one patients were alive with a mean follow-up period of 18 months(6～27 months).Conclusions The figure-L unilateral sternotomy is considered as an effective and useful minimally invisive approach for anterior mediastinal tumors.

Liver is one of the most commonly metastases in patients with colorectal cancer.Curative hepatic resection is the first choice of liver metastasis of colorectal cancer,which can improve the survival rate ranging from 30％ to 40％ in 5-year.In this article,we will review the operation indication,mode and advance on the current treatment strategies of colorectal liver metastases,and discuss the decision-making process,emphasize a surgery - centered multidisciplinary treatment for the treatment of hepatic metastases from colorectal cancer,to improve the survival rate.

Objective To investigate the expression of CCL20 and CCR6 in the patients with gastric cancer and To examine the relationship between chemokine expression and the occurrence and development of Gastric Cancer. Methods Real-time PCR , flow cytometry and ELISA are used to measure the gene transcription and protein expression levels of chemokine CCL20 and CCR6 in the serum of 50 patients with Gastric Cancer and 30 normal controls. Results The gene expression levels CCL20 and CCR6 in Gastric Cancer group are significantly higher than that in healthy controls. The level protein of CCL20 and CCR6 in peripheral blood of patients with gastric cancer are significantly higher than that in healthy peep le[ (45.4 ±10.9) pg/mL vs (18.6±4.7) pg/mL; (7.11 ±1.03%) vs (1.83±0.43%), P＜0.01. respectively],and the increase significantlyassociated with the clinical stage of Gastric Cancer. Conclusions The method for detecting the expression of CCL20 and CCR6 in patient with Gastric Cancer has been successfully established, and their expression levels were found to be correlated with the occurrence and development of Gastric Cancer. Thus, CCL20 and CCR6 may be involved in the regulatory mechanisms associated with the development of Gastric Cancer, and may be valuable in its diagnosis and prevention.

The rising ofmetabonomics after genomics and proteomics offers chances for the modernization of TCM.Metabonomics has much in common with TCM in the cognition of human body. Appropriate application of the methodology of metabonomics in TCM, such as TCM differential diagnosis and guidance of clinical treatment, would speed up the integration of TCM and modem life science and technology. Meanwhile the research of COPD in TCM will come into a new stage through the use of metabonomics. This article overviewed the current situation of Chinese medicine using metabolomics technology to raise its theory, science and diagnostic level, and the study of pulmonary-qi deficiency syndrome of COPD with metabonomics.

Objective To analyze the clinical,radiologic and pathological features of endobronchial metastasis from prostate cancer, and its diagnosis and treatment. Methods Ten cases of endobronchial metastasis from prostate cancer with pathological evidence in our hospital were retrospectively analyzed.The clinical, radiologie andpathological features and the diagnostic procedures and treatment of the cases were reported and analyzed while combined with literature. ResultsAn average age at diagnosis of advanced prostate cancer was 65.5 years. Emoptysis(5/10), cough (4/10), dyspnea (4/10) and weight loss (5/10) were the common symptoms.Chest X-ray disclosed hilar and mediastinal lymphadenopathy (4/10), hilar mass (3/10) or atelectasis (2/10) . Bronchoscopic examination revealed that most of lesion located in single lobar or segmental bronchus (6/10). Bilateral upper lobe were most susceptibly involved(7/10). Polypoid lesions or mass in lumen of bronchi(8/10)were more frequent than infiltrative lesion(2/10), which could obstruct the orifice of the bronchi in different extent. Immunohistochemical staining for prostate specific antigen or prostatic acid phosphatase was positive, and most patients responded well to endocrine therapy. Conclusions Clin.ical and radiologic features of endobronchial metastasis from prostate cancer are similar to those of primary bronchogenic carcinoma. Immunohistoehemical study is helpful for differential diagnosis and the short-term efficacy of endocrine therapy is significant.

Objective To analyze and compare the clinical features of community-acquired pneumonia caused by Legionella in elderly (age≥60 years) and younger patients. Methods The epidemiological, clinical, laboratory data and the outcomes of 80 cases with community-acquired Legionella pneumonia (CALP) from January 2001 to October 2009 were studied retrospectively, and the differences between elderly and younger group were compared using univariate and multivariate analysis. Results (1) Underlying diseases, such as cerebrovascular diseases, chronic obstructive pulmonary diseases, diabetes mellitus and immunosuppressive therapy were significantly more frequent in elderly group than in younger group (all P＜0. 05). (2) No significant differences were observed between the two groups in legionella serotype. (3) Malaise, hyponatremia and hypophosphatemia were all more frequent in elderly group than in younger group (x2=5. 300, 5. 520, 4. 470; P=0. 021,0. 019, 0. 034, respectively). And elderly versus younger group had higher creatinine levels [(108.55±56.57) μmmol/L vs. (75.42±17.62) μmmol/L, t= -3. 062, P=0. 002], lower PaO2/FiO2 (＜300) (57.7% vs. 29.2%, x2=4. 120, P=0.042), less leucocyte counts [(8.34±3.65)×109/Lvs. (10.63±5.02)×109/L, t=-2.287, P=0.022]. (4) Elderly patients more likely complicated with congestive heart failure (P=0.037) and their length of staying in hospital was also longer (Z=-2.194, P=0.028). No significant differences were observed between the two groups in mortality, intensive care unit admission, and the need for corticosteroids or mechanical ventilation.Conclusions Elderly patients with CALP have a higher frequency of underlying comorbidities and more organs involvement than younger patients, although greater severity of illness at onset and outcome are not significantly different between the two groups.

Objective To describe the clinical and radiological characteristics, diagnosis, and treatment of bronchobiliary fistula (BBF). Methods From December 1975 to June 2007, 6 patients with BBF were successfully diagnosed and treated in this hospital. A retrospective analysis was performed and literatures on the disease were reviewed. Results All the cases were acquired BBF. The etiologies included liver abscess (3 cases), trauma (2 cases), and postoperative complication of hepatic carcinoma (1 case). The main symptoms the patients complained of were fever (6 cases), cough (6 cases), biliptysis (6 cases), dyspnea (4 cases), abdominal pain in right quadrant (4 cases) and pleuritic chest pain (2 cases). On physical examination, tenderness in the right upper quadrant (4 cases), dull percussion (3 cases), abnormal breath sounds (3 cases), percussion tenderness over hepatic region (2 cases) were main abnormalities. All the 6 patients underwent antibiotics treatment and percutaneous transhepatic biliary/abscess drainage. One of them underwent radiological coil embolization of the fistula. All the patients showed clinical improvement. Follow-up survey showed 1 case of cure, 1 case of long-term drainage until death of biliary tract bleeding one year later, and 4 cases of lost in follow-up. Conclusion Bronchobiliary fistula is characterized by biliptysis. Minimally invasive treatment should be the first therapeutic option.

OBJECTIVE:To observe the effects of Xingnaojing injection on the efficacy and safety of patients with acute cere-bral infarction merge blood stasis syndrome. METHODS:70 patients with acute cerebral infarction merge blood stasis syndrome were randomly divided into observation group(35 cases)and control group(35 cases). Control group received conventional treat-ment according to 2014 edition of Chinese guideline for diagnosis and management of acute ischemic stooke. Patients within throm-bolysis time window were given intravenaus infusion of rt-PA,and those out of thrombolysis time window orally received 0.3 g As-pirin tablet every evening,then 0.1 g after 1 week+40 mg Atorvastatin calcium tablet every evening,and if patients have arfficulty suallowing,gavage administiation was implemented. Observation group additionally received 30 ml Xingnaojing injection,adding in-to 250 ml 0.9% Sodium chloride injection,intravenous infusion,once a day. The treatment course for both groups was 14 d. Clini-cal efficacy,γ-interferon(IFN-γ),interleukin-13(IL-13),interleukin-4(IL-4),high-sensitivity C-reactive protein(hs-CRP)lev-els,the US National Institutes of Health Stroke Scale(NIHSS)rating,improved Barthel index(BI),infarction size before and af-ter treatment and the incidence of adverse reactions in 2 groups were observed. RESULTS:There was no significant difference in the total effective rate and incidence of adverse reactions in 2 groups(P>0.05). Before treatment,there were no significant differ-ences in IFN-γ,IL-13,IL-4,hs-CRP levels,the NIHSS rating,BI and infarction size in 2 groups(P>0.05). After treatment,the IFN-γ,hs-CRP levels,the NIHSS rating and infarction size in 2 groups were significantly lower than before,and observation group was lower than control group,IL-13,IL-4 and BI were significantly higher than before,and observation group was higher than control group,the differences were statistically significant (P<0.05 or P<0.01). CONCLUSIONS:Based on conventional treatment,Xingnaojing injection shows obvious efficacy the efficacy and safety of patients with acute cerebral infarction merge blood stasis syndrome,it can reduce the levels of inflammatory cytokines,improve neurological deficits,daily living skills and in-farct volume,with good safety.

Objective To investigate the influence of lumbar epidural anesthesia on cell apoptosis in rat kidneys with ischemia-reperfusion injury.Methods Thirty male Wistar rats were divided into three groups at random,including a sham-operated group,a model group,and an anesthesia group.Then the local norepinephrine,local angiotensin Ⅱ,plasma superoxide dismutase,plasma malondialdehyde and cell apoptosis index were observed at the 24 h after the reperfusion in rat kidneys of ischemia 60 min.Results Compared to the sham-operated group,ischemia-reperfusion of kidney caused a significant increase in contents of local norepinephrine,local angiotensin Ⅱ],and malondialdehyde in the model group and anesthesia group as well as increasing in the cell apoptosis index (P ＜ 0.05),and those parameters above were lower in the anesthesia group than those in the model group (P ＜0.05).Meanwhile,the activities of plasma superoxide were higher than those in model group (P ＜ 0.05).Conclusions The lumbar epidural anesthesia can reduce the excessive accumulation of neuroendocrine hormone in kidney,alleviate oxidative stress,which plays an important role in restraining the ischemia-reperfusion injury and cell apoptosis.