Objective: Pemetrexed (PEM) is a multi-targeted chemotherapeutic agent for antifolate drugs. PEM has become the standard agent for the second-line treatment of advanced non-small cell lung cancer (NSCLC). This study aims to review and analyze the clinical efficacy and adverse reactions of PEM combined with carboplatin with respect to NSCLC treatment. Methods: A total of 40 patients suffering from NSCLC were selected and confirmed by pathology. On the first day of treatment, the conventional 500 mg/m2 dose of pemetrexed disodium was infused intravenously. On the second day, a combined therapy with carboplatin was conducted based on the conventional dose for a 21-day cycle with at least two cycles for each patient. The therapeutic efficacy and adverse reactions were evaluated and were compared with the proposed regimen of gemcitabine (GEM) combined with carboplatin. Results: After two cycles of the treatment, the curative effects of the PEM and GEM groups were 50% and 45%, respectively. The main adverse reactions are bone marrow suppression and gastrointestinal reactions. The incidence rates of bone marrow suppression, gastrointestinal reactions, amisulpride/AST, urea nitrogen, rash, and hair loss were obviously lower in the PEM group than in the GEM group. Statistically significant differences in adverse reaction were found between the two groups (P<0.05). Conclusion: The use of the combination regimen of PEM with carboplatin showed significantly more clinical effects and less adverse reactions for NSCLC treatment.

This article analyzes the medical ethical problems which are related to the education,research and therapy of mucosal disease.The author puts forward several countermeasures: ① increase the subsidize on the research of oral mucosal disease;②learn advanced technology to accelerate the developing of the treatment;③reform the education method,foster the collectivistic consciousness;④understand the patients' psychological characteristics,especially the cancerophobia;⑤comply with the principle of medical ethics-the right of patient come before everything else.

With the developments of endoscopic and interventional techniques, the role of surgical treatment in some diseases is gradually replaced by endoscopic or interventional treatment.The word surgery may not preserve only for surgeons, therefore it is redefined.According to different interventional pathways, digestive surgery can be divided into two categories, although both are with similar surgical essentials as resection and repair. Serosa surgery is traditional surgery,characterized for its pathway from skin to visceral serosa and cavity, either by open or laparoscopic platform. Mucosa surgery performs endoscopic operations from natural orifice then mucosa surface.The intercrossing or merging of different disciplines is an inevitable trend for modern medical science, traditional disciplines may be replaced by disease-centered medical model combined with multiple disciplines and techniques.Facing challenges, digestive surgeons should be confidential and inclusive;facing competitions, digestive surgeons should be brave enough for innovation and cooperation, and always regard patients' interest as his first priority.A universal norm for various disciplines should be set up on the practice of evidencebased medicine;surgeons in different specialties should learn from each other, and reinforcing comple-mentary advantages from each other;creating a novel disease-centered multidisciplinary heahhcare model on the basis of fusion of different disciplines is the development direction of digestive surgery.

Objective The aim of this study was to investigate the diagnostic value of the intravoxel incoherent motion (IVIM) for discriminating nonmetastatic from metastatic mediastinal lymph nodes in lung cancer.Methods IVIM was performed preoperatively on 66 patients with lung cancer during October 2015 to June 2016 in Capital Medical University Affiliated Beijing Chaoyang Hospital.Preoperative examination including the chest MRI scan,chest CT,head MRI,bone scan-ning and the cardiopulmonary function.None of the patients was undergone any kind of treatment about the cancer before the examinations,the neoadjuvant chemotherapy or radiation therapy,immunotherapy and gene targeted therapy were included.Measured the short axis diameter and the IVIM parameters of the mediastinal lymph nodes,apparent diffusion coefficient(ADC),diffusion coefficient(D),pseudo-diffusion coefficient(D *),and perfusion fraction(f).All the patients underwent the lobectomy or wedge resection and lymph node dissection or systematic sampling.By comparing the IVIM parameters of the nonmetastatic and metastatic mediastinal lymph nodes according to the pathological examination,draw the ROC curves to find the best cutoff value for diagnosis.And 42 cases were used to comparing the value of the MRI and CT in differential diagnosis.Results MRI measured 184 groups mediastinal lymph nodes,including 164 groups without metastasis,20 groups with metastasis.The ADC,D,D *,f values and short axis diameter of the nonmetastatic lymph nodes(n =164) were(2.880 ± 0.785) × 10-3 mm2/s,(0.670 ± 0.179) × 10-3 mm2/s,(0.383 ± 0.123) × 10-3 mm2/s,0.422 ± 0.119,(6.546 ± 1.932) mm,respectively,and (1.897 ±0.657) × 10-3 mm2/s,(0.472 ±0.210) × 10-3 mm2/s,(0.354 ±0.130) × 10-3 mm2/s,0.412 ±0.090,(7.510 ± 2.773) mm respectively for the metastatic lymph nodes (n =20).The ADC and D value of the nonmetastatic lymph nodes were significantly higher than the metastatic lymph nodes(P ＜0.01).While the other paraneters(D *,f,and short axis diameter) between the two groups did not show significantly different.Optimal cutoff values(area under the curve,sensitivity,and specificity) for distinguishing metastatic from nonmetastatic lymph nodes were as follows:ADC =1.890 × 10-3 mm2/s (0.871,92.7％,80.0％);and D =0.648 × 10-3mm2/s(0.740,70.0％,84.1％).Conclusion IVIM is useful to distinguish metastatic from nonmetastatic lymph nodes in lung cancer.The ADC and the D values are significant higher in metastatic lymph nodes,which more sensitive than the other parameters(D *,f,and short axis diameter).As a result,IVIM can be used in the N-stage diagnosis of lung cancer.

Objective:To evaluate the bond strength of root canal sealer AH Plus and GuttaFlow to root canal walls after final rinse with 4 different final irrigation regimens.Methods:60 teeth with single-canal were prepared chemomechanically using 5.25% sodi-um hypochlorite (NaOCl)as root canal irrigant.The teeth were then randomly distributed into 3 groups(n =20)according to the final irrigation protocol:1 7% EDTA followed by 2% chlorhexidine(CHX)(group 1 ),5.25% NaOCl followed by 1 7% EDTA(group 2), 0.9% normal saline(NS)(group 3).The root canals were then filled with sealers using a lentulo spiral and each group was distribu-ted into 2 subgroups according to the sealers(n =1 0):a.AH Plus;b.GuttaFlow.The roots were transversally sectioned to obtain 2mm thick dentinal slices.Then a push-out bond strength test was carried out and failure mode was observed by stereomicroscope. Results:The bond strength of AH Plus was significantly higher than that of GuttaFlow(P <0.05)regardless of the final irrigation reg-imens.When the root canals were filled with AH Plus,the push-out bond strength of group 1 (5.37 ±2.80)MPa was significantly lower than group 2(8.81 ±4.38)MPa and group 3(9.07 ±2.77)MPa(between group 1 and 2 or 3,P <0.05;between group 2 and 3,P >0.05).When the root canals were filled with GuttaFlow,the push-out strength of group 1 ,2 and 3 was (1 .40 ±0.59)MPa, (1 .26 ±0.62)MPa and (1 .05 ±0.27)MPa respectively(P >0.05).The failure modes of AH Plus and GuttaFlow were both mainly mixed,but the proportion of adhesive failure in the canals filled with GuttaFlow were obviously higher than AH Plus.Conclusion:The bond strength to root canal wall of GuttaFlow is significantly lower than that of AH Plus.1 7% EDTA followed by 2% CHX as fi-nal irrigant can reduce the bond strength of AH Plus but has no marked effect on GuttaFlow.

ObjectiveToexploretheeffectof ceremideonprocess of peritoneal mesothelial cells(PMCs) apoptosis induced by peritoneal dialysis solution(PDS).Methods PMCs were cultured with normal DMEM,1.5％ PDS and 4.25％ PDS.4.25％ mannitol was used as high osmotic pressure control.Ceremide were detected by LC-MS-MS.Flow cytometry was used in apoptosis analysis.Bax,p53 and bcl-2 protein expressions were detected by Western blotting.Results (1) PDS caused the increase of intracellular ceremide in PMCs,and normal and high osmotic pressure controls had no such effect.As the acidic sphigomyelinase inhibitor,desipramine significantly inhibited the production of ceramide induced by 4.25％ PDS [(56.08±12.24) μg/L vs (91.25:t:15.89) μg/L,P＜0.01]. (2) Compared with 1.5％ PDS,4.25％ PDS stimulated PMCs apoptosis (26.65％±6.21％ vs 4.04％±1.86％,P＜0.01),up-regulated bax and p53 proteins expression (P＜0.01),and down-regulated bcl-2 protein exprssion(P＜0.05).Desipramine obviously inhibited the apoptosis induced by 4.25％ PDS,decreased bax and p53 proteins expression,increased bcl-2 protein expression(P＜0.05).Exogenous C2-ceremide reversed the effect of desipramine(P＜0.05).Conclusion The increase of intracellular ceremide may play an important role in the PMCs apoptosis induced by high glucose PDS.

Objective Purpose This prospective randomized study was to explore the efficacy of different methods in preventing postoperative air leakage of video-assisted thoracoscopic (VATS) bullectomy for primary spontaneous pneumothorax.Methods The patients who underwent VATS bullectomy from January 2015 to March 2016 in Beijing Chao Yang Hospital were enrolled,and they were randomly assigned to experimental group and control group.The experimental group applied an absorbable polyglycolic acid(PGA) sleeve combining with an automatic stapler in the bullectomy.The control group resected the bullae using the automatic stapler alone.Covering the staple line with an absorbable polyglycolic acid sheet and pleural abrasion were performed in both groups.The baseline characteristics of the patients,postoperative air leakage,drainage tube removing time,postoperative hospital-stay,and postoperative complication were recorded.Results Finally,123 patients were enrolled in the study,the experimental group and control group were 58 and 65 cases,respectively.There was no operative mortality in either group.Compared with the control group,the postoperative air leakage (0.53 ± 0.99) days,chest tube drainage (2.98 ±1.03) days,postoperative hospital-stay (3.88-± 0.91) days in the experimental group were all significantly shorter.The rate of postoperative complications in the experimental group was(3.4％),of which one patient catched a pulmonary infection,the other one postoperative atelectasis.However,complications were developed in ten patients (15.4％) in the control group,which was significantly higher compared with the experimental group,including pulmonary infection five cases,postoperative atelectasis three cases,pleural effusion two cases.Conclusion The appliance of PGA sleeve in the operation for primary spontaneous pneumothorax could effectively prevent postoperative air leakage,as well as reduce the postoperative drainage tube removing time.Furthermore,the patient could recover more soon from the surgery,and have a shorter hospital-stay.

OBJECTIVE:To study the feasibility of purifying the effective blood-fat dropping parts from radix puerariae and fructus crataegi and to optimize the technical conditions and parameters.METHODS:Absorption capacities of four different macroporous resins on pueraria total isoflavones,crataegi total flavonoids and crataegi total triterpenic acid were compared.With adsorption quantity as index,optimization of the technics of purifying the effective blood-fat dropping parts from radix puerariae and fructus crataegi with macroporous resins were performed.RESULTS:AB-8resin showed a best adsorbability on the effective blood-fat dropping parts from radix puerariae and fructus crataegi,its optimum purification condition was the following,the concentration of the stock solution was0.13g crude drug/ml with a flow rate at0.5ml/min,and its pH value at about3.5(the same as the stock solution);80%ethanol solution was taken as the eluting solvent at an eluting flow rate of2ml/min.The purity coefficient of the purified effective portions was above85%.CONCLUSIONS:AB-8macroporous resin could be used for the purification of the effective blood-fat dropping parts from radix puerariae and fructus crataegi,the process is feasible and the reproduction of resin is easy.

Objective To investigate the galectin-3 (Gal-3) and osteopontin (OPN) expression in esophageal carcinoma and analyze its clinical significance.Methods Thirty-seven patients who suffered from esophageal carcinoma were selected from 2006 to 2008.There were 28 males and 9 females,aged from 41 to 82 vears old.The levels of Gal-3 mRNA and OPN mRNA in tissues were detected by Fluorescent PCR,and the levels of Gal-3 and OPN in blood plasma were measured by ELISA.Result The expression of Gal-3 mRNA and OPN mRNA were significantly different between the esophageal carcinoma,side of carcinoma and normal esophagus tissues (F=11.934,F=4.269,P<0.05);The expression of galectin-3 and osteopontin were correlated with pathological grading (F=3.216,P

Actins ; metabolism ; Adult ; Amyloidosis ; pathology ; Diagnosis, Differential ; Female ; Humans ; Intestinal Pseudo-Obstruction ; metabolism ; pathology ; Lupus Erythematosus, Systemic ; pathology ; Muscular Atrophy ; pathology ; Scleroderma, Systemic ; pathology ; Young Adult