Objective To investigate the expression of Ptch-1 and Gli-1, hedgehog pathway-related genes in squamous cell carcinoma (SCC), and the effect of cyclopamine, a specific inhibitor of hedgehog signaling pathway, on the proliferation of a SCC cell line Tca. Methods Skin samples were resected from 42 patients with SCC and 10 normal human controls. Immunohistochemistry and in situ hybridization were employed to study the expression and distribution of Ptch-1 and Gli-1 in these specimens. Tca cells were incubated with cyclopamine (1, 2, 5, 10 μmol/mL) for 48 hours, or cyclopamine (5 μmol/mL) for 1-8 days. The same concentrations of lycopersicin served as the control treatment. Then, MTT assay was performed to detect the proliferation of Tca cells. A fraction of Tca cells were cultured in the presence of 5 μmol/mL cyclopamine for 72 hours followed by BrdU assay for the evaluation of cell growth and proliferation. Results A significant increment was shown in the expression of both Patch-1 and Gli-1 by immunohistochemistry (χ2= 5.656, 6.732, P<0.05, 0.01, respectively) and in situ hybridization (χ2=6.787, 9.600, respectively, both P<0.01) in SCC tissue compared with the control specimens. And both of them were predominantly distributed in the cytoplasm of SCC cells. As MTT assay revealed, cyclopamine notably inhibited the proliferation of Tea cells, and the effect increased with the concentration and action time of cyclopamine. Further more, the percentage of BrdU-positive cells was 26% in cyclopamine-treated Tca cells, significantly higher than that in the blank control cells (77%) and lycopersicin-treated cellls (72%). Conclusions Hedgehog signaling pathway is activated in the lesions of SCC, and inhibition of the pathway may facilitate the treatment of SCC.

Objective To discuss the value of video-assisted thoracoscopy plus minithoracotomy (VATM) in the management of thoracic diseases. Methods An 1.5 cm incision was made along the middle axillary line at the 7th costal interspace on the diseased side to introduce the thoracoscope. After the exploration of intrathoracic lesion, another incision 5~8 cm in length close to the lesion was made. The thoracic cavity was opened by way of the costal interspace. Surgical performance of exploration, dissection, hemostasis and suture was performed under thoracoscope and direct vision by using routine surgical instruments and thoracoscopic instruments. A total of 43 cases of VATM were carried out. Results The operation time was 40~150 min (mean, 67 min). The length of incision was 5~8 cm (mean, 6 cm). The chest drainage lasted 2~5 d. No postoperative complications occurred. The postoperative hospital stay was 5~8 d (mean, 6 d). Follow-up found no recurrence for 3~22 months in 18 cases of spontaneous pneumothorax and pleural effusion, and found no recurrence, distant metastasis or incision implantation for 5~20 months in 3 cases of lung cancer receiving either lobectomy or wedge resection. Simple biopsy of tumor was conducted in 6 cases of lung cancer, who obtained chemotherapy or gamma knife radiotherapy postoperatively and survived 5~21 months. Conclusions VATM is practical, minimally invasive and safe. By using routine surgical instruments it has an optimistic outlook.

Objective To compare the effects of different levels of controlled low central venous pressure (CVP) on blood loss in patients undergoing hepatic lobectomy. Methods One hundred ASAⅠ -Ⅱ patients, aged 28-78 yr, weighing 39-90 kg, undergoing elective hepatic lobectomy under general anesthesia, were randomly divided into S groups ( n = 20 each) with CVP controlled at 1, 2, 3, 4 and 5 mm Hg during the course of operationrespectively (groups CVP1-5 ) . Anesthesia was induced with midazolam, fentanyl, etomidate and vecuronium. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with iv infusion of propofol and remifentanil, inhalation of isoflurane and intermittent iv boluses of vecuronium. CVP was maintained at the predetermined levels by restricted infusion or by administration of diuretics or vasoactive agents and so on during operation. The blood loss before, during and after removal of the diseased liver parenchyma ( V1-3 ) was recorded.The liver parenchyma transection area ( TA) was determined and the blood loss per transaction area ( VTA ) was calculated. Fluid infusion and blood transfusion were recorded during the three time periods mentioned above. MAP and HR were recorded before operation, at 5 min after removal of the diseased liver parenchyma was started and at the end of operation. Results Compared with group CVP5, the MAP during removal of the diseased liver parenchyma in groups CVP1,2 , V2 and VTA in groups CVP1-3,and the percentage of patients who needed blood transfusion during operation and the amount of fluid infused before completion of removal of the diseased liver parenchyma in groups CVP1-4 were significantly decreased ( P ＜ 0.05) . Compared with group CVP4 , V2 , VTA and MAP during removal of the diseased liver parenchyma were significantly decreased in group CVP2 and the amount of fluid infused was significantly increased before removal of the diseased liver parenchyma was completed in group CVP,( P ＜ 0.05) .Conclusion When CVP is controlled at 3 mm Hg, the hemodynamics is stable and blood loss is less during hepatic lobectomy.

Objective To evaluate the clinical application value of multislice spiral CT (MSCT) in diagnosis andclinical treatment of the chronic suppurative otitis media(CSOM). Methods Multislice spiral CT with direct axial plane and saggitalmultiplanar reformation(MPR) were performed in 61 cases including 76 ears.The results from those images were comparedwith that of operations. Results The sagittal MPR images preferably could delineate the anatomical details of the temporal bone and theadjacent relationship,and could display the tympanicand mastoid segment of the facial nerve,sigmoid sinus plate and the glomusjugular better.On the sagittal MPR images,the disruption of the ossicular chain and bony erosion in the tympanic cavity and antrum weredisplayed in 38 ears.The destruction of the facial nerve canal was severe in the type of cholesteatoma compared with the type of granuloma of chronic suppurative otitis media.The congenital abnormities were showed in 8 ears of the sigmoid sinus plate and 2 ears of the glomus jugular.Conclusion CT sagittal MPR images are of significant clinical value in showing the degree and location of destruction of the canal of facial nerve , and the relation between around structures in chronic suppurative otitis media.

Objective To investigate the in vitro effects of KAAD-cyclopamine, a specific inhibitor of hedgehog signaling pathway, on the growth and apoptosis of human squamous cell carcinoma cell line A431. Methods A431 cells were cultured and treated with KAAD-cyclopamine(0.5, 1, 2, 5 μmol/L).Then, MTT assay was used to detect the proliferation of A431 cells, and light microscopy to observe cell morphology at different time points with a 24-hour interval. Flow cytometry was used to assess cell cycle,and annexin-V/propidium iodide double staining to evaluate the apoptosis in these cells after 48 hours of treatment with KAAD-cyclopamine. Results KAAD-cyclopamine of 0.5, 1, 2 and 5 μmol/L inhibited the proliferation of A431 cells by (7.0±2.3)%, (20.6±2.8)%, (48.3±3.4)% and (61.6±3.3)%, respectively (F = 49.92, P＜0.01 ). Furthermore, in the presence of KAAD-cyclopamine of 5 μmol/L, on day 1, 2, 3, 4,and 5 the proliferation of A431 cells was suppressed by (18.5±2.6)%, (56.1±3.7)%, (65.4±2.8)%,(71.2±1.9)% and (75.9±3.0)%, respectively, the difference was significant among these time points(F =16.32, P＜0.01 ). Statistical analysis showed that KAAD-cyclopamine downregulated the growth of A431 cells in a dose-and time-dependent manner (r = 0.91, 0.86, P＜0.01 and 0.05, respectively). Light microscopy revealed typical morphological changes of cell damage in A431 cells. KAAD-cyclopamine in creased the percentage of cells in G1 phase from (51.8±2.9)% to(76.2±1.8)% (F = 26.34, P＜0.01 ), the proportion of hypoploid cells from (1.7±0.3 )% to (8.7±0.2)% (F = 6.32, P＜0.05 ), which suggested that KAAD-cyclopamine could arrest A431 cells in G1 phase of the cell cycle. The apoptosis ratio in KAAD-cyclopamine-treated cells was significantly higher than that in the untreated control [ (46.2±2.8)% vs (18.5±3.1 )%, F = 32.01, P＜0.01 ]. Tomatidine treatment did not affect the proliferation or apoptosis of A431 cells (both P＞0.05).Conclusion KAAD-cyclopamine can markedly suppress the proliferation and induce apoptosis of A431 cells.

Objective To evaluate the prognostic values of leukocyte count,hemoglobin,biochemical parameters,erythrocyte sedimentation rate and immunoglobulin on mortality in patients aged 80 years and over.Methods Totally 342 patients(aged 85.6±4.0 years)were followed up for (82.0±36.9) months,and the cause and time of death were recorded.Results During the period of follow up,198 patients suffered from death.Compared with the survival group (132 cases),the death group had older age [ (86.5±4.4)years vs.(84.5±3.2)years,t=-4.86,P＜0.01 ],higher white blood cell [ (6.2± 1.7) ＞ 109/L vs.(5.5±1.3) × 109/L,t=-3.93,P＜0.01 ],lower hemoglobin [(134.4±14.4)g/L vs.(140.0± 12.6)g/L,t= 3.65,P＜0.01 ],slightly faster erythrocyte sedimentation rate [ 11 mm/h(15 mm/h) vs.9 mm/h (10 mm/h),U=- 3.31,P＜0.01 ],lower immunoglobulin M [ (0.9±0.5)mg/L vs.(1.1±0.8)mg/L,t =2.55,P＜0.05 ],slightly higher urea nitrogen [ (7.5±2.6) mmol/L vs.(6.8±1.6) mmol/L,t=2.81,P＜0.01]and creatinine [(113.0±32.5) μmol/L vs.(100.5±15.8) μmol/L,t=-4.65,P＜0.01 ].Cox multivariate analysis revealed that older age (RR=1.083,95％CI:1.040 1.127,P＜0.01),white blood cell count (RR=1.134,95％CI:1.021-1.260,P＜0.05),creatinine (RR=1.011,95％CI=1.0021.020,P＜0.05),hemoglobin(RR=0.835,95％CI:0.714-0.975,P＜0.05)andimmunoglobulin M(RR=0.710,95％CI:0.521-0.966,P＜0.03),aorticaneurysm(RR=2.144,95％CI:1.163-3.951,P ＜ 0.05 ) were the independent risk factors for death.Conclusions Aging,increased WBC count,decreased hemoglobin and immunoglobulin M,elevated creatinine and aortic aneurysm are the independent risk factors for death,which are powerful parameters for the prognostic evaluation in the elderly aged 80 years and over.

Objective To investigate the MSCT characteristics of peritoneal pseudomyxoma. Methods CT findings of peritoneal pseudomyxoma proved by surgery and pathology in 11 cases were retrospectively analyzed. Results On MSCT,the peritoneal pseud-omyxomas were irregular intraperitoneal cystic-solid masses, the CT attenuation was 18.5 ～ 27.6 HU, there were scallop-like, wavy and nodule-like indentations on the liver and/or spleen surface,large amount of mucinous ascites within abdominal, pelvic an-domentum cavity , thickening of peritoneum. On post-contrast administration , mild enhancement of peritoneum,cystic wall and omentum could be revealed. Conclusion MSCT examination has important value in diagnosis and differential diagnosis of peritoneal pseudomyxomas

Objective To retrospectively review the efficacy and side effects of intense pulsed light (IPL) and red light emitting diode (LED) in the treatment of steroid-dependent dermatitis.Methods Seventy patients with steroid-dependent dermatitis mainly manifesting as facial telangiectasis were treated with IPL for an average of 3.49 sessions with a 4-week interval.The energy density of IPL varied from 20 to 23 J/cm2,pulse width from 2.6 to 5.0 ms,and delay from 15 to 20 ms.Meantime,197 patients with steroid-dependent dermatitis,who mainly presented with facial skin sensitivity,were treated with red LED (633 ± 3 nm wave length) twice a week for an average of 4.23 sessions.The energy density of red LED was 128 J/cm2,and the irradiation lasted 20 minutes at each treatment.The efficacy and adverse reactions were assessed and recorded for each treatment.Results The total response rate was 88.57％ for IPL,and 83.76％ for red LED.There was a significant difference in the clinical efficacy between triple-pulse and double-pulse IPL (x2 =8.14,P ＜ 0.05).No severe adverse reaction was observed in any of the patients.Conclusion IPL and red LED are both effective in treating steroid-dependent dermatitis.

Objective To evaluate the efficiency and safety of hair removal with Lightsheer 800 nm diode laser. Methods Lightsheer, 800 nm diode laser, was used to remove hairs from different areas, including hairlines, lips, whiskers, armpit, chest, back, limbs and bikinis area, in 432 patients. Results At least twice treatments, the maximum 29 times, were needed to achieve satisfactory results. Total effective rate increased with the treatment times but depended on the different area:63.4 % of hairlines, 67.7 % of lips, 71.9 % of whiskers, 100 % of armpit, 100 % of chest, 100 %of back, 82.6 % of limbs and 100 % of bikinis area, respectively. The adverse effect was observed with temporal hypopigmentation in 4 patients and hyperpigmentation in 9 patients, without any scar formation. Conclusions Lightsheer 800 nm diode laser is a safe and efficient method of laser hair removal.

Objective To evaluate the effect of Rab23 on the proliferation of a squamous cell carcinoma cell line Sa3,and to investigate its mechanisms.Methods Cultured Sa3 cells were classified into four groups:normal control group transfected with green fluorescent protein (GFP),Rab23-overexpressing group transfected with a GFP-labelled Rab23-overexpressing plasmid,Rab23-silencing group transfected with a plasmid carrying a Rab23-targeting shRNA,empty vector group transfected with an empty vector.After additional culture for different durations,plate colony formation assay and flow cytometry were performed to evaluate the proliferative activity of Sa3 cells,and Western blot was conducted to detect the expression of Erl/phosphorylated-Erk in Sa3 cells.Statistical analysis was carried out by t test,one-way analysis of variance and Bonferroni's multiple comparison test.Results Stable Sa3 cell lines with overexpression or silencing of Rab23 were established by plasmid construction and lentivirus-mediated transfection.The plate colony formation assay showed that the colony formation rate was significantly lower in the Rab23-overexpressing group than in the normal control group (2.3％ ± 0.2％ vs.3.6％ ± 0.3％,P ＜ 0.05),but higher in the Rab23-silencing group than in the empty vector group (4.1％ ± 0.2％ vs.1.8％ ± 0.03％,P ＜ 0.01).Rab23 overexpression induced G1 phase arrest in Sa3 cells.The proliferation index was significantly decreased in the Rab23-overexpressing group compared with the normal control group (0.581 ± 0.035 vs.0.698 ± 0.018,P ＜ 0.05),but increased in the Rab23-silencing group compared with the empty vector group (0.567 ± 0.015 vs.0.444 ± 0.014,P ＜ 0.01).As Western blot showed,there were no significant changes in the expression of Erk in the Rab23-silencing or-overexpressing group compared with the normal control group,whereas the expression of p-Erk was attenuated in the Rab23-overexpressing group compared with the normal control group,but enhanced in the Rab23-silencing group compared with the empty vector group.Conclusions Rab23 could inhibit the proliferation of Sa3 cells,which may be associated with the Erk pathway.