Objective To evaluate the relationship between the CT features and pathology of peripheral adenocarcinoma.Methods Eighty patients with peripheral pulmonary adenocarcinoma (including 44 well-differentiated,23 moderate and 13 poorly one)confirmed by pathology were collected in this series.The comparative study on CT finding and pathologic data was done.Results Air bronchograms were seen in 35 cases (79.6%)in high differential adenocarcinoma and were seen in 7 cases(30.4%) in moderate differential adenocinoma but not seen in low differential ones.The emergeua rate of lobular sign,burr sign,sign of hollowed and sign of blood vessel bundle was high in low differentiated adenocarcinoma.Lymphnode metastases and distant matestasis in moderate-low differentiated adenocarcinoma were much more than that of high differentiated ones. Conclusion The air bronchogram in nodule on CT image is important in evaluating diagnosis and progrosis of peripheral adenocarcinoma.

Objective To compare the effects of general anesthesia versus combined epidural?general anesthesia on postoperative complications in the patients undergoing thoracic surgery. Methods Two hundred twenty?one patients of both sexes, aged 18-80 yr, weighing 36-100 kg, of American Society of Anesthesiologists physical status Ⅰ?Ⅲ, scheduled for elective thoracic surgery, were randomly divided into either combined epidural?general anesthesia group ( group GE, n=112) or general anesthesia group ( group GA, n=109) . The patients were further allocated to high?risk population and low?risk population. Anesthesia was induced with target?controlled infusion of remifentanil and iv injection of propofol, sufentanil and rocuronium. A double?lumen endotracheal tube was placed, and the patients were mechanically ventilated. Partial pressure of end?tidal CO2 was maintained at 30-40 mmHg. Anesthesia was maintained with inhalation of 1% sevoflurane, target?controlled infusion of remifentanil, iv infusion of propofol, and intermittent iv boluses of sufentanil. 2% lidocaine 4 ml∕h was infused epidurally in group GE, and normal saline 4 ml∕h was given in group GA. Bispectral index value was maintained at 40-60 during surgery. Patient?controlled epidural analgesia ( PCEA ) was performed after surgery. PCEA solution contained
0.125% ropivacaine and sufentanil 0.5μg∕ml ( in 250 ml of normal saline) . The PCEA pump was set up to deliver a 2 ml bolus dose with a 20?min lockout interval and background infusion at 4 ml∕h, and visual analogue scale ( VAS) score was maintained less than 4. When VAS score ≥ 5, sufentanil 5 μg was injected intravenously as the rescue analgesic. The requirement for rescue analgesics after surgery, length of hospital stay after surgery, complications during postsurgical hospital stay ( cardiovascular events, cardiac insufficiency, acute coronary syndrome, pulmonary infection, stroke, transient cerebral ischemic attack) , and death within 30 days after surgery were recorded. Results Compared with group GE, the incidence of postsurgical cardiovascular events and atrial fibrillation was significantly decreased in group GA ( P<0.05) . In the high?risk population, compared with group GE, the length of hospital stay after surgery was significantly shortened, and the incidence of postsurgical atrial fibrillation was decreased in group GA ( P<0.05) . In the low?risk population, compared with group GE, the length of hospital stay after surgery was significantly shortened (P<0.05), and no significant change was found in the incidence of postsurgical complications, requirement for rescue analgesics after surgery, and fatality rate in group GA (P>0.05). Conclusion Compared with combined epidural?general anesthesia, general anesthesia alone provides lower occurrence of postsurgical complications for the patients undergoing thoracic surgery, and offers advantage for the high?risk patients having underlying diseases before surgery.

Objective To explore clinical effect and life quality study of Shenyi capsule combined with docetaxel and cisplatin in treatment of advanced breast cancer.Methods 135 cases of advanced breast cancer of Huangshi Central Hospital were collected and diagnosed from July 2013 to December 2014 in accordance with the random number table,were divided into treatment group(n=69) and control group(n=66).Both groups were given regular basis treatment, control group was treated by docetaxel(75 mg/m2,twice a day)and cisplatin(25 mg/m2,once a day), and treatment group combined with Shenyi capsule(20 mg,twice a day)on the basis of control group treatment.4 weeks were 1 course, and all the cases were taken 12 weeks of continuous treatment.Observed and compared the clinical efficiency and life quality of two groups.Results The remission rate of 63.77% in treatment group was higher than control group of 40.91%, difference was statistically significant(χ2 =7.070,P=0.008).After treatment, the SF-36 scale in treatment group significantly increased from ( 54.69 ±8.78 ) to ( 63.87 ±12.08 ) , and higher than that of control group ( 57.95 ±11.95 ) , differences were statistically significant(P<0.05).The adverse reactions in treatment group was lower than control group, difference was statistically significant(Z=2.858,P =0.000).Conclusion The clinical effect in treatment of advanced breast canceris obvious by Shenyi capsule combined docetaxel and cisplatin.It can significantly improve clinical effect and life quality.

SUN Shu-chun,the chief researcher,is one of the famous expert of osteo-traumatology of TCM.He makes systematic sort and study on chirismus on basis of succeeding experience predecessors and his own years of clinic experience.He is good at treating cervical syndrome with TCM chirismus,especially combine it with drugs.In osteo-traumatology academic circles,he is called "the best doctor at home".Professor SUN advocates that the rule of applying various therapies according to different conditions,combination of rigid-flexible,light,skill,gentle,harmony should be obey when we use chirismus.His diagnostic and therapeutic methods and thoughts are original and ingenious.In this article,the author analyzes the academic experience of tendon trauma of professor SUN.

Vascular cognitive impairment (VCI) is a large class of syndromes caused by cerebrovascular risk factors, clinical or asymptomatic cerebrovascular disease from mild cognitive impairment to dementia. Its incidence is increasing, however, its pathogenesis remains uncertain, and the effective therapeutic means are lacking, Therefore, all aspects of research are increasingly receiving attention. This article mainly reviews the advances in research on vascular cognitive impairment from the concept, typing, diagnosis, prevention and treatment.

Objective To investigate the effect of ulinastatin on acute lung injury in rats with severe heatstroke.Methods Fourty-eight rats were randomly (random number) assigned into control group (HS group,n =12),low dose Ulinastatin group (LUTI group,n =12),high dose Ulinastatin group (HUTI group,n =12) and non-thermal group (Sham group,n =12).Rats were prepared with pre-warm chamber to initiate heatstroke.The change of rectum temperature (Tc),heat-rate (HR) and mean arterial pressure (MAP) under heat-stress were recorded.The time-point of heatstroke onset and Tc ＞42 ℃ was observed.Arterial blood samples were draw at 0 min,20 min,40 min and 60 min for testing partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2).Bronchoalveolar lavage fluid (BALF) were collected at 60 min,and the concentrations of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-l β) and interleukin-6 (IL-6) in BALF were measured with enzyme linked immunosorbent assay kit.Lung tissues were harvested for observing pathological change and measuring the expression of iNOS with Western blot test.Results Compared with HS group,the time-point of Tc ＞ 42℃ (P =0.00),severe heat-stroke (P =0.00) and the median of survival time (P =0.00) in LUTI and HUTI groups were significantly increased.At 60min after heat-stress,the level of PaO2 in HS group was much lower than those in other groups (P =0.00).But there were no differences between LUTI and HUTI groups (P =0.91).The value of PaCO2 in HS group was much higher than those in other groups (P =0.00).And the differences between LUTI and HUTI groups were no significant (P =0.79).The concentrations of TNF-α,IL-1β and IL-6 in HS group was the highest in four groups (P =0.00,P =0.04 and P =0.04),followed by LUTI,HUTI and Sham group.The concentrations of proinflammatory cytokine in LUTI were higher than those in HUTI group (P =0.02,P =0.00,P =0.00).Compared with HS group,the pathological injuries were alleviated in LUTI and HUTI group (P =0.00).The expression of iNOS in lung tissue of HS group was strengthened than LUTI and HUTI group (P =0.00),and there was a significant difference between LUTI and HUTI group (P =0.03).Conclusion Ulinastatin improves respiratory dysfunction and the prognosis of severe heatstroke rats through reducing the inflammatory and oxidative injury in lung tissue.

Objective To explore the clinical significance and the dynamic changes of serum anti-inflam-mation factor interleukin-10(IL-10)and inflammatory factor interleukin-8(IL-8)in cerebral infarction.Methods The serum levels of IL-10 and IL-8 in 30 patients were measured by double-antibody sandwich enzyme-linked inunu-nosorbent assay(ELISA)on days 1.3,7 and 14 respectively after infarction.Results The serum levels of IL-10 and IL-8 were higher in patients than those in control group on days 1,3 and 7(P<0.05).Conclusion IL-10 and IL-8 are involved in the pathophysiology of acute cerebral infarction.

Objective To evaluate the relationship between single nucleotide polymorphism(SNP) of candidate genes and radiation-induced esophagitis (RIE) in patients with lung cancer. Methods Between Jan. 2004 and Aug. 2006,170 patients with pathologically diagnosed lung cancer were enrolled in this study. The total target dose was 45-70 Gy( median 60 Gy). One hundred and thirty-two patients were treated with three-dimensional conformal radiotherapy(3DCRT) and 38 with two-dimensional radiotherapy(2DRT).Forty-one patients received radiotherapy alone, 78 received sequential chemoradiotherapy and 51 received concurrent chemoradiotherapy. Thirty-seven SNPs in 20 DNA repair genes were analyzed by using PCR-based restrieted fragment length polymorphism(RFLP). These genes were apoptosis and inflammatory cytoking genes including ATM, ERCC1, XRCC3, XRCC1, XPD, XPC, XPG, NBS1, STK15, ZNF350, ADPRT,TP53, FAS, FASL, CYP2D6 * 4, CASPASE8, COX2,TGF-β, CD14 and ACE. The endpoint was grade ≥2 R I E. Results Forty of the 170 patients developed grade ≥2 R I E, including 36 in grade 2 and 4 in grade 3. Univariate analysis revealed that radiation technique and concurrent chemoradiotherapy were statistically significant relatives to the incidence of R I E (P = 0. 032,0.049) , and both of them had the trend associating with the esophagitis( P = 0.072,0. 094 ). An increased incidence of esophagitis was observed associating with the TGF-β1-509T and XPD 751 Lys/Lys genotypes ( χ2 = 5.65, P = 0.017 ;χ2 = 3.84, P = 0. 048 )in multivariate analysis. Conclusions Genetic polymorphisms in TGF-β1 gene and XPD gene have a significant association with radiation-induced esophagitis.

Objective:To evaluate the relationship between the development of postoperative delirium and sleep quality in elderly patients undergoing non-cardiac surgery.Methods:The medical records of elderly patients who underwent elective non-cardiac surgery from May 2011 to November 2013, aged ≥ 65 yr, with American Society of Anesthesiologists physical status Ⅱ or Ⅲ, were collected. The patient′s age, gender, body mass index, years of education, preoperative comorbidities, and results of the last preoperative laboratory examination; sedatives given at the night before surgery, anesthesia methods, intraoperative medication, anesthesia time, surgical time, surgical type, whether it was a malignant tumor, and intraoperative intake and output; postoperative analgesia methods, subjective sleep quality scores and postoperative delirium were collected.The patients were divided into delirium group and non-delirium group according to whether delirium occurred on the morning of 1st postoperative day and later. Multivariable logistic regression analysis was used to determine the risk factors for postoperative delirium and evaluate the relationship between postoperative delirium and sleep quality.Results:A total of 700 patients were ultimately enrolled, and 111 patients developed delirium, with an incidence of 15.9%.The results of multivariable logistic regression analysis showed that poor sleep quality on the night of surgery, advanced age, previous stroke history and postoperative intensive care unit admission of patients with catheters were risk factors for postoperative delirium ( P<0.05). Conclusions:Poor sleep quality on the night of surgery, advanced age, previous stroke history and postoperative intensive care unit admission of patients with catheters are the risk factors for postoperative delirium.

OBJECTIVETo investigate the relationship between p53 codon 72 polymorphism and susceptibility to esophageal squamous cell carcinoma in China.

METHODSThe p53 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism among 204 healthy controls and 91 patients with esophageal squamous cell carcinoma (ESCC).

RESULTSThere was no significant difference between patients and controls with respect to allele frequency for the p53 Pro allele (0.480 versus 0.588, P=0.11); however, the Pro/Pro genotype of p53 among cases (39.6%) was significantly (P<0.05) more frequent than that among controls (21.1%). Subjects homozygous for the p53 Pro allele had a more than 2-fold increased risk of developing ESCC (OR=2.18; 95%CI=1.10-4.35, adjusted for age, sex, and smoking), whereas the Arg/Pro genotype was not associated with elevated risk of the cancer (adjusted OR=0.84; 95%CI=0.42-1.68). No interaction between smoking and Pro/Pro genotype was observed for risk of ESCC.

CONCLUSIONThe p53 codon 72 polymorphism may play a role in susceptibility to esophageal carcinogenesis.

Alleles ; Arginine ; genetics ; Asian Continental Ancestry Group ; genetics ; Carcinoma, Squamous Cell ; ethnology ; genetics ; Codon ; genetics ; Confidence Intervals ; Esophageal Neoplasms ; ethnology ; genetics ; Genetic Predisposition to Disease ; Genotype ; Humans ; Odds Ratio ; Polymorphism, Genetic ; Proline ; genetics ; Tumor Suppressor Protein p53 ; genetics