Micrometastasis is small metastasis at the cellular and molecular level. Early detection of micrometasis through tumor markers can improve the accuracy of TNM staging, prognosis and subsequently treatment for lung cancer patients. Currently, a number of markers with good specificity and sensitivity have been found, including CK19 mRNA, Lunx mRNA, MUC1 mRNA and GPRP mRNA. These markers can be detected using methods such as RT-PCR, immunohistochemistry and western blot.

Since the theory of microcosmic syndrome differentiation was put forward in 1986, Chinese medicine academia has been unremittingly exploring this theory. Efforts were made to explain the syndrome in Chi-nese medicine with objective index of modern medicine, so that different syndromes of the same disease can be rec-ognized on the quantitative view and then apply syndrome differentiation with objective index. This paper compre-hensively analyzed and got the primary causes why microcosmic syndrome differentiation was difficult to apply. It in-cluded no-identical criterion, research design such as the choice of syndrome, reference syndrome, objective index and microcosmic level. Additionally, too many virtual syndromes resulting from applying syndrome differentiation on western medicine diseases existed widely. Consequently, it is extremely urgent that solve these problems and regulate the research thought.

Shu-Xue-Ning (SXN) injection was used as study subject in order to explore the feasibility of pharmacodynamics experiment of Phase 0 clinical trial in Chinese materia medica (CMM).This paper tried to establish key-technique standards which fit to the evaluation on CMM phase 0 (early) clinical evaluations.According to the established research methods,this research selected volunteers and assured low dose SXN injection inside their body.And then,serum before and after medication were collected for the HAEC in vitro experiment.Blood sample of the clinical dosage was used as control to verify the tendency consistency of pharmacodynamics in low dose and clinical dose.The results showed that in the H2O2 inducing HAEC damage experiment,low dose SXN injection can affect the cell proliferation,protect the shape of cells,reduce the release of ion owing to cell damages and influence the secretion in cells.Complete-sequence RNA gave differential multiterm expression before and after the low dose.It was concluded that compared with the clinical group,low dose medication had similar metabolic tendency.The pharmacodynamics experiment of phase 0 CMM clinical trial is feasible.

Objective To evaluate the feasibility, safety and clinical outcome of laparoscopic radical resection of rectal cancer in elderly patients with common chronic comorbidities. Methods The clinical data of 192 elderly patients with rectal cancer and common chronic comorbidities who were admitted to the Nanfang Hospital from January 2003 to December 2008 were retrospectively analyzed. All patients were divided into laparoscope group (n=91) and open group (n = 101). The operative procedures, clinicopathological data and outcomes of the two groups were collected and compared. All data were analyzed using the t test and chi-square test, and the survival of patients was analyzed using the life table and Kaplan-Meier curves. Results The sphincter preservation rate,operation time, postoperative length of hospital stay, morbidity rate were 85.7% (78/91), (194 ± 61) minutes,(14 ±8)days, 24.2% (22/91) in the laparoscope group, and they were 85.1% (86/101), (187 ±58) minutes,(14 ±8)days and 28.7% (29/101) in the open group, with no significant difference between the two groups (x2=0.012, t=0.874,-0.265, x2 =0. 505 , P ＞ 0. 05) . The intraoperative blood loss was (108 ±78)ml in the laparoscope group, which was significantly less than (270 ± 600) ml in the open group (t =-2. 650, P ＜0.05). The time to first flatus, time to liquid diet, time to out-of-bed activity were (3 ± 1) days, (4 ± 2) days and (3 ± 1)days, which were significantly shorter than (4 ± 1)days, (5 ± 2)days and (5 ± 1)days in the open group,respectively (t =-4. 545,-4. 587,-13. 310, P ＜ 0.05). The length of rectum resected and the number of lymph node dissected were (18 ± 5)cm and 9 ± 7 in the laparoscope group, and (18 ± 5)cm and 9 ± 8 in the open group, respectively, with no significant difference between the two groups (t = 1. 457, 0. 021, P ＞ 0.05), while the distance of distal resection margin to the tumors was (3.8 ± 1.5) cm, which was significantly longer than (3.1 ± 1.5) cm of the open group (t = 0. 283, P ＜ 0. 05). The 3-year cumulative survival rate, overall recurrence rate, local recurrence rate and distal metastasis rate in the laparoscope group were 76%, 12. 1% (11/91), 2.2% (2/91) and 9.9% (9/91), and they were 82%, 14.9% (15/101), 6.9% (7/101), 7.9% (8/101) in the open group, respectively, with no significant difference between the two groups (U=2. 600, x2 =0. 312, 2.400,0. 230, P ＞ 0.05). There were no significant difference in the cumulative survival rate between patients in TNM stage Ⅰ, Ⅱ and Ⅲ in the two groups (P ＞ 0.05). Conclusion Laparoscopic radical resection of rectal cancer is safe and feasible for elderly patients with common chronic comorbidities, and it has the advantages in quick recovery of patients after operaion.

Objective To evaluate the long-term safety and efficacy of domestic Firebird rapamycin-eluting stent in treatment of patients with coronary artery disease (CAD). Methods The 465 patients with CAD received percutaneous interventional therapy with domestic Firebird or imported Cypher rapamycin-eluting stent based on patients' will and they were followed up for more than 24 months. Results The 321 cases in Firebird group were followed up for (45.3 ±11.1)months, with 166 cases (51.7%) received reexamination by coronary angiography. The 144 patients in Cypher group were followed up for (46.1 ± 12. 1) months, with 82 patients (56.3%) received reexamination by coronary angiography. At the termination of follow-up, there were no significant differences in all-cause death (7.8% vs. 7.6 %, x2 = 1.32, P = 0. 250), cardiac death (5.9% vs.5.6%, x2 =0. 02, P=0. 877), acute myocardial infarction (2.8% vs. 3.4%, x2 =0. 15, P=0. 697),cardiovascular-cause rehospitalization (29.6% vs. 31.9 %, x2 =0.26, P=0. 610), acute and subacute thrombosis events (0.9% vs. 1.3%, x2 =0.19, P=0.661), late thrombotic events (1.2% vs.1.3%, x2 =0. 02, P=0. 900) and target lesion revascularization (3.4% vs. 4.2%, x2 =0. 15, P=0. 694) between two groups. Conclusions Domestic Firebird rapamycin-eluting stent has the same or similar long-term safety and efficacy with imported Cypher rapamycin-eluting stent.

Objective To assess value of serum level of ischemia modified albumin (IMA) in diagnosis for myocardial ischemia of coronary artery disease (CAD). Methods Seventy-two patients with clinically suspected myocardial ischemia of CAD admitted to The First People's Hospital of Hangzhou during November 2009 to May 2010 ready for undergoing coronary angiography, the gold standard for diagnosis of CAD, were randomly selected for the study. The patients were divided into CAD and non-CAD groups based on their coronary angiography. Serum level of IMA was determined with cobalt-albumin binding ( ACB) assay before coronary angiography, which served as diagnostic standard for CAD. Logistic regression analysis method was used to evaluate varied levels of IMA with area under the receiver operating characteristic curve (AUCROC) in diagnosis for myocardial ischemia of CAD. Results Mean level of IMA was (97 ±24) U/ml and (81 ±15) U/ml for CAD group (n =51) and non-CAD group (n =21), respectively. Sensitivity and specificity of a cut-off value of IMA 83.69 U/ml in diagnosis for myocardial ischemia of CAD was 80 percent and 57 percent, respectively, with a predictive value of a positive test 82 percent and that of a negative test 55 percent, respectively, from AUCROC. Logistic regression analysis demonstrated that both hypertension (P=0. 022, 6 = 1.421, OR=4. 141) and level of IMA (P=0.003, b= 1.780, OR=5.928) were independent predictors for CAD. Conclusions Sensitivity, specificity and predictive value of a positive test of the level of IMA are relatively high in diagnosis for myocardial ischemia of CAD, which is an independent predictor of it.

Objective Atherosclerosis is widely accepted as a chronic inflammatory disease. Serum biomarkers for vulnerable plaques not only serve as diagnostic tools for the identification of patients with acute coro-nary syndrome, but also assist the identification of high-risk patients. However, the existing data are limited and conflicting. In the present study, we determined whether the plasma levels of interleukin-1β (IL-1β) are correlated with adverse cardiac outcomes in patients with ST-evaluate acute myocardial infarction (STEAMI) undergoing pri-mary percutaneous coronary intervention (PCI). Effect of the plasma intedeukin-1β level on prognosis of patients with ST-segment elevation acute myocardial infarction. Method This prospective single-center study included 96 patients with SIEAMI with onset < 12 h who underwent primary PCI, 271 patients with stable angina pectoris (SAP) and 148 control subjects without coronary artery disease who were consecutively admitted to hospital be-tween Mar, 2006 and Mar, 2008. Plasma IL-1β levels were measured by enzyme-linked immunosorbent assay in all subjects. The patients with STEAMI were then followed prospectively for the occurrence of major adverse car-diac events (MACE) (including cardiovascular death, non-fatal myocardial infarction, heart failure, and cardio-genie shock) during hospitalization. We determined the association between IL-1β levels with the risk of MACE using multivariate logistic regression. Results Compared with the SAP patients and control subjects, patients with STEAMI had higher levels of IL-1β (P < 0.05). During hospitalization, 32 patients (33.3%) experienced MACE [23 males, 9 females; age: (75.44±13.45) years]. In the STEAMI patients, IL-1β was elevated in patients with MACE compared with patients without MACE (median [range]: 26.52 [12.010 to 155.244] pg/mL vs 2.157 [0.433 to 83.021] pg/mL; P < 0.01) by non-parameter analysis. Significant and positive correlations be-tween IL-1β and cardiac troponin-I (cTnI) (r = 0.353, P =0.004) were observed by Spearman's correlations analysis. Multivariate logistic regression analysis revealed that IL-1β levels ≥20 pg/mL were significantly and in-dependently associated with MACE during hospitalization (odds ratio: 32.05; 95% confidence interval: 4.28 to 240.151; P =0.001). Conclusions The present study revealed that patients with STEAMI had elevated IL-1β levels on admission. The plasma IL- 1β level is an independent inflammatory predictor for in-hospital MACE in pa-tients with STEAMI undergoing percutaneous coronary intervention.

Objective: To explore whether human adipose-derived stem cells (ADSCs) express PD-L1 and Gal-9 and its potential influence factors. Methods: ADSCs isolated from 28 healthy female donors who underwent liposuction of the abdomen or breast tissue were cultured and characterized. The expression of PD-L1 and Gal-9 were detected using flow cytometry. The impact of donor age, body mass index (BMI), donor site and interferon-γ (IFN-γ) on the expression of PD-L1 and Gal-9 was analyzed using multivariate linear regression analysis. Results: The cultured cells fulfilled the criteria for defining MSCs according to the international standards and expressed PD-L1 and Gal-9. Breast-derived ADSCs had higher expression levels of PD-L1 (37.24%±8.20%) and Gal-9 ( 4.41%±2.65%) than those in abdomen-derived ADSCs (28.80%±8.59% and 2.51%±1.39%, respectively) (P=0.018, P=0.039). Multivariate linear regression analysis showed that donor age and site were independent risk factors affecting PD-L1 expression (P=0.009, P=0.006). The expression of PD-L1 decreased by 0.385% for every one year of age increase, and it was 8.58% higher in the breast-derived ADSCs than in the abdomen-derived ADSCs. Donor site was an independent risk factor for Gal-9 expression (P=0.041). Gal-9 positive expression rate in the breast-derived ADSCs was 1.898% higher than that in the abdomen-derived ADSCs. BMI was not a risk factor affecting PD-L1 or Gal-9 expression on ADSCs. The expression of PD-L1 and Gal-9 on ADSCs were significantly upregulated after 48 hours stimulation with 20 ng/ml IFN-γ in vitro. Conclusions Human ADSCs expressed PD-L1 and Gal-9. Donor age, site and IFN-γ treatment were independent risk factors affecting the expression of PD-L1 and Gal-9 on ADSCs.

Objective:To investigate the application of case-based learning (CBL) combined with evidence-based learning (EBL) teaching in clinical teaching of oncology.Methods:Totally 57 resident doctors were divided into experimental group and control group. The experimental group received CBL and EBL teaching, and the control one received lecture-based learning (LBL) teaching. The teaching effect was evaluated by examination and questionnaire, and the data were analyzed by SPSS 20.0.Results:The examination scores of the experimental group and the control group were (85.393±7.213) and (81.276±8.035), and the ones of case analysis were (34.393±2.485) and (32.379±3.005) respectively. Meanwhile, questionnaire survey showed that the evaluations of experimental group were significantly better than those of the control one in promoting learning interest and initiative, retrieval ability, self-learning ability, clinical thinking and learning efficiency ( P<0.05). Conclusion:The teaching effect of integration of CBL and EBL is better than LBL.

Objective To evaluate the clinical efficacy and safety of short-term intensive statin therapy in patients with acute coronary syndrome ( ACS) .Methods A total of 218 ACS patients admitted in Hangzhou First People′s Hospital from March 2013 to July 2013 were enrolled into this study .The patients were randomly assigned to receive atorvastatin 80 mg/d during hospitalization , and 40 mg/night after discharge for one month ( intensive group , n=107 );or receive atorvastin 20 mg during hospitalization and 20 mg/night after discharge for one month ( control group, n =111 ).The biochemical indexes were measured on the admission and after one-month treatment.Results After one-month treatment, the total cholesterol, triglycerides and LDL cholesterol of intensive group were significantly lower , and the high density lipoprotein cholesterol was higher than baseline values ( 0.75 ±0.14 ) mmol/L vs.( 1.52 ±0.88 ) mmol/L, P<0.05;(2.21 ±0.78)mmol/L vs.(4.55 ±1.12)mmol/L, P<0.05;(1.76 ±0.31)mmol/L vs.(2.23 ±0.77) mmol/L, P<0.05; (1.15 ±0.34) vs.(1.52 ±0.41) mmol/L, P<0.05.The liver enzymes creatine kinase in intensive group was not significantly changed , but the creatinine levels decreased (82.53 ±23.85)μmol/L vs.(57.81 ±15.27) μmol/L, P<0.05, and the blood homocysteine and ultra-sensitivity C-reactive protein levels also decreased compared with the baseline ( 10.52 ±4.66 ) mmol/L vs.(30.70 ±18.82 ) mmol/L, P <0.05;( 8.06 ±2.68 ) mg/L vs.( 19.75 ±11.91 ) mg/L, P <0.05. Conclusions Short-term intensive statin therapy can effectively reduce blood lipid , cholesterol and homocysteine levels and raise HDL cholesterol levels; also with its anti-inflammatory and renal protective effect the therapy can provide more clinical benefit for patients with ACS .