Objective To investigate the diagnostic value and safety of medical thoracoscopy in unexplained exudative pleural effusion.Methods A retrospective analysis was conducted using the clinical data of 70 routine medical thoracoscopy examinations of unexplained exudative pleural effusion in patients.The lesions were examined pathologically under direct vision.Results White military nodules were observed under endoscopy,with multiple pro-truding nodules,focal irregular thickening of the pleura,pleural congestion,edema and adhesion.The diagnostic accu-racy of thoracoscopy was 95.7%.Among the diagnosed cases,there were 35 cases of tuberculous pleurisy,20 cases of malignant pleural effusion,8 cases of parapneumonic effusion,4 cases of pleural effusion from congestive heart failure and 3 cases of idiopathic pleural effusion,with no serious complications.Conclusion Medical thoracoscopy is a safe and accurate method in the diagnosis of unexplained exudative pleural effusion.Medical thoracoscopy is beneficial in the establishment of treatment method quickly and allows observation of the pleural lesions in pleural effusion patients using the naked eye.

Objective:To investigate the correlation between the expression of Golgi phosphoprotein 3 (GOLPH3) and the occurrence of apoptosis in colorectal cancer cells (CRC). Methods:Immunohistochemical assays of GOLPH3 and caspase-3 were performed on the paraffin-embedded sections of 62 CRC samples using the standard streptavidin-peroxidase technique. The apoptotic index of the CRCs was examined using the in situ terminal deoxynucleotidyl transferase nick-end labeling technique. The relationship of the GOLPH3 expression, the cell apoptosis, and the clinicopathologic parameters was analyzed. Results:The positive rates of GOLPH3 expression were significantly higher in the CRC tissues (53.2%) than in the normal colorectal mucosa (37.2%;P<0.05). Likewise, GOLPH3 expression was significantly higher in poorly differentiated cancer tissue, tissue outside the serous membrane, metastatic lymph node tissue, and the stage III CRCs, as compared with those of the moderately to well differentiated tissue, tissue inside the serous membrane, lymph node tissue without metastasis, and the stage I to II CRCs (P<0.05). However, GOLPH3 expression was not significantly correlated with the other clinicopathologic pa-rameters, namely, the age and sex of the patients as well as the site, depth, and length of the invasive tumor (P>0.05). The caspase-3 expression and apoptotic index were significantly lower in the GOLPH3-positive CRC tissue than in the GOLPH3-negative tissue (P<0.05). GOLPH3 expression was negatively correlated with the apoptotic index of CRCs based on the Spearman correlation (r=-0.320, P<0.05). Conclusion:GOLPH3 overexpression in CRC tissue is negatively correlated with apoptotic index.

AIM: To probe into the development strategy, department construction and management methods of the pain department according to the current situation of pain treatment in China.METHODS: Based on on-spot investigation and individual correspondence,we made a comprehensive evaluation of the collected materials and testified them from the hospital departments involved. Under the current situation of pain treatment in China, namely, difficulty in forming a large scale and yielding social and economic results, relation between pain and rehabilitation therapy is discussed to explore the feasibility, advantages and disadvantages of combining the two.RESULTS: The construction of the pain department should make full use of the human, financial and equipment resources available in the rehalilitation department, merging the pain department with the rehabilitation department to set up the pain and rehabilitation center. It will give full play to the respective advantages and avoid the weaknesses and produce large-scale results. The ward layout should consist of pain, rehabilitation and physiotherapy wards, operation room and nurse station. Outpatient diagnosis and treatment and the economic effect should be improved. Treatment should be centered on micro-invasive operations with comprehensive treatment as supplement so as to form the specialty-based characteristic. The department should be managed as an enterprise.CONCLUSION: The pain department should be merged with the rehabilitation department to set up the pain and rehabilitation center to achieve collaborative development.

Objective We studied the clinical features and its significance of coal worker's pneumoconiosis combined with sleep apnea Methods In 40 patients with coal worker's pneumoconiosis combined with sleep apnea hospitalized from February 2006 to December 2009, polysomnography ( PSG) , blood routine, urine routine, blood pressure and biochemical indicators were measured and analyzed. Results Patients with coal worker' s pneumoconiosis combined with sleep apnea manifested mainly as duplicate hypoxemia and multi-organ dysfunction: high blood pressure, dysfunction of heart, lung and kidney, increase of serum glucose, blood lipids, blood uric acid and finally led a vicious cycle to aggravate the above mentioned damage. Conclusions In clinical, multiple-organ dysfunction resulted from severe hypoxemia and hypercapnia caused by coal worker's pneumoconiosis combined with sleep apnea, should be fully aware and give ational and effective treatment early to reverse or delay the further function damages of multiple organs, and therefore significantly improve the prognosis.

Objective To evaluate the effect of YunKe on bone metabolism of patients with rheumatoid arthritis (RA). Methods A total of 108 RA patients were divided into YunKe group (n = 72), non-YunKe group (n = 36), and 54 controls. The bone mineral densities (BMDs) of the wrists, hips and lumbar spines were measured by dual-energy X-ray absorptiometry. Moreover , the expression of cross-linked N-telopeptides of type I collagen (NTX) in the serum was detected for statistically analyzing the difference between YunKe group and non-YunKe group. Results In RA group, the BMDs of wrist, hip and lumbar spine declined compared with that of control group (P < 0.001, respectively). In YunKe group, the BMDs of wrist, hip and lumbar spine after 6 months all were improved with statistically significance (P < 0.01, respectively); The differences also were statistically significant when compared with those in non-YunKe group (P < 0.01, respectively). In YunKe group, NTX level in the serum declined after 3 months of the treatment. The difference was statistically significant when compared with that in non-YunKe group (P < 0.001), but the difference disappeared 6 months later. Conclusions The BMD of wrist joints is low and declines in RA patients significantly. The treatment withYunKe improves the BMDs of the wrist , hip and lumbar spine and decreases the serum NTX. This study proposed that YunKe could inhibit the chronic loss of bone mass induced by RA.

Objective:To study the association of RAC1 gene polymorphisms with protein expression levels of Rac1-GTP. Methods:A total of 182 healthy Hans population in Hubei were recruited. The 4 tag-SNPs in RAC1 gene were genotyped by Real time TaqMan-MGB genotyping assay. And the Rac1-GTP protein levels in plasma samples from all participants were determined by enzyme linked immunosorbent assays ( ELISA ) . The distribution characteristics of Rac1-GTP expression levels were also analyzed. Furthermore,the expression levels of Rac1-GTP were compared among different genotypes of the 4 tag-SNPs in RAC1 gene. Results:The distribution of Rac1-GTP expression levels was positive skewed in healthy Chinese Hans population. The expression levels were significantly higher in females than in males (P<0. 05),and appeared in decreased trend with age,but without significant differences (P>0. 05). Different expression levels of Rac1-GTP were observed in different genotypes for rs702482 and rs10951982 (P<0. 05). However,no significant difference was found for rs702483 and rs6954996 (P>0. 05). Conclusion:RAC1 genetic polymorphisms can potentially affect the expression levels of Rac1-GTP protein in healthy Chinese Hans population.

ObjectiveTo understand the difference in characteristics between juvenile dermatomyositis (JDM) and adult dermatomyositis (ADM).Methods Sixty-one cases of JDM were retrospectively analyzed and compared with 30 cases of ADM. Results The rashes were presented as the initial symptom in all expect one JDM patients. Gottron’s papules were presented in 90% JDM patients and 67% ADM patients. Calcium deposition was presented in 7% JDM patients and none of the ADM patients. The cardiovascular system was involved in 7 % JDM patients and 23% ADM patients. Cancer occurred in none of JDM patients and 13% ADM patients. In JDM and ADM patients, the ratio of elevated muscle enzymes from highest to lowest was LDH, hy-droxybutyric acid enzyme, CK-MB, AST, and CK. The positive ratio of magnetic resonance (MRI) all exceeded 80% in JDM and ADM groups. Two cases died in each group.Conclusions The clinical presentation of JDM is basically the same as that of ADM. The most common initial symptoms in JDM are skin rashes and Gottron's papules. Cardiovascular disease and cancer are less in JDM than in ADM. MRI is valuable in the diagnosis of DM.

Objective To analyze the mammographic findings of triple-negative breast cancer [TNBC,which is estrogen receptor (ER) negative,progesterone receptor (PR) negative,and human epidermal growth factor receptor 2 ( HER2 ) negative ] and triple-positive breast cancer ( TPBC,which is ER positive,PR positive,and HER2 positive ),and to evaluate the relationship of immunohistochemologic receptor status and mammographic findings.MethodsThe immunohistochemistry results of 631 cases with breast cancers were reviewed,including 117 cases of TNBC and 44 cases of TPBC.All of the patients took mammography at initial diagnosis.We retrospectively evaluated the visibility,morphology,distribution and size of the lesion (masses and calcifications) and breast density on mammography of TNBC,and compared them with those of TPBC.The age onset and tumor sizes of TNBC and TPBC were compared by using Chi-square test and t test.ResultsThe visibility rate of TNBC and TPBC on mammography were 88.0％(103/117) and 90.9％ (40/44),and the difference between them was insignificant ( x2 =0.055,P ＞0.05).TNBC was more frequently associated with merely a mass (56/103) than TPBC (12/40) (x2 =6.860,P＜0.01 ),and the mean diameter of the mass of TNBC [ ( 2.6 ± 1.4 ) cm ] was larger than that of TPBC [(2.0 ± 0.6) cm](t =2.087,P ＜ 0.05). TNBC were less frequently associated with microcalcifications (37/103) than TPBC ( 24/40 ) ( x2 =7.423,P ＜ 0.01 ).Mammographic density and lesion visibility were similar between the two different immunophenotypes of breast cancers.The mean age of TNBC (52±9) was more than that of TPBC (48 ±8) (t =2.759,P ＜0.01).Infiltrating ductal carcinoma was the main pathologic type of both groups.Basal-like breast cancer accounted for 49％ (57/117 ) of TNBC while none happened in TPBC.ConclusionsTNBC shows merely a mass with indistinct margins,lager size and is less associated with microcalcifications.These mammographic features might be useful in diagnosing triple negative breast cancer.

BACKGROUND:There was no effective method to thoroughly treat tibial bone defect and soft tissue defect. The application of Ilizarov technique solved shortening deformity, soft tissue injury and joint contracture to some degrees.
OBJECTIVE:To discuss the effects of Ilizarov external fixation on treatment of tibial bone defect and the parameter selection of Ilizarov steel ring.
METHODS:We retrospectively analyzed the clinical data of 67 patients with tibial bone defects, who were treated and fol owed up from March 2007 to January 2012. Al patients had fracture of tibia and received one-stage operation. After treatment, postoperative limb suffered from tibia osteomyelitis and soft tissue injury. Ilizarov external fixation was placed in the limb. The length of defected tibia and area of defected soft tissues were compared at 1, 3 and 6 months after external fixation and final fol ow-up. The ankle joint Kofoed score and knee joint ROM score were observed before and after external fixation. In final fol ow-up, functional recovery was evaluated in accordance with diagnosis and treatment criteria of Johner-Wruhs fracture of shaft of tibia.
RESULTS AND CONCLUSION:A total of 67 patients were fol owed up for 6 to 35 months. Bone defects in 67 cases were rebuilt and the fracture was healed, but five cases had poor healing. Among 44 cases of soft tissue injury, wound had healed in 40 cases, and wound had not healed in 4 cases. The length of tibia defect and the area of soft tissue defects were improved at 1, 3, and 6 months after the operation (P<0.05). After operation, the ankle joint Kofoed score and knee joint ROM were significantly better than those before operation (P<0.05). During final fol ow-up, the excellent and good rate of each therapeutic plan was 85%. For the tibial osteomyelitis bone defect with the merged skin defect, the trauma was smal using Ilizarov technique, which can avoid several complicated operations, shorten the time and reduce the expenses of treatment, but there were some weaknesses and limitations. The size and material of Ilizarov external fixation affect the efficiency of the fixation and postfixation adjustment.

Objective:To establish a method for the detection of 8 single nucleotide polymorphisms (SNPs) of RAC1 gene,and to analyze the genotypic and allelic distributions of the 8 SNPs in healthy Chinese Han population.Methods:The real-time fluorescence TaqMan-MGB probes allele classification technology was used for the determination of the 8 SNPs in 150 cases of healthy volunteers in Hubei China ,and the results were validated by direct gene sequencing.Results: The method established in this study can accurately screen the genotypes of the 8 SNPs of human RAC1 gene.Highly linkage disequilibriums were found between rs 10951982 and rs9374 , rs702482 and 836488 ,respectively.All the 8 sits were in accordance with Hardy-Weinberg equilibrium.Six Tag-SNPs were selected by Heploview software:rs10951982 ,rs6954996 ,rs6951997 ,r1s2977 ,rs702482 and rs702483.The MAFs of the 8 SNPs in our study were close to the MAFs in CHB and Asian in Hap Map database .Significant distribution differences were also observed in different races.Conclusion:No significant differences are observed in this study in healthy Chinese Han population.But differences are found when compared with the data of other races in Hap Map.