Objective:This work presents the therapeutic advantage of induction therapy in patients withⅢA-N2 non-small cell lung cancer (ⅢA-N2 NSCLC). Methods:ⅢA-N2 NSCLC patients with ipsilateral mediastinal lymph node metastasis (>1 cm as shown by CT scan) who were admitted in our hospital between January 2008 and July 2013 were retrospectively analyzed. The response rates and survival outcomes of patients were presented and the prognostic factors were analyzed. Results:The 3-and 5-year overall survival (OS) rates were 57.7%and 34.2%, respectively, and the 3-and 5-year disease-free survival (DFS) rates were 37.9%and 30.5%, respec-tively. No significant differences in OS and DFS were observed between R0 and R1 resections (P=0.118; P=0.369), between groups who received neo-adjuvant chemo-radiotherapy and chemotherapy (P=0.771; P=0.953), between cases with and without clinical re-sponse (P=0.865;P=0.862), and among groups of different histological subtypes (P=0.685;P=0.208). However, patients with standard lobectomy or pathological nodal downstaging exhibited better OS (P=0.023 and P=0.024, respectively) and DFS (P=0.036 and P=0.025, respectively) than those who had extensive resections or persistent N2. Univariate analysis predicted better OS and DFS for both standard lobectomy and pathological nodal donwstaging. In addition, Cox multivariate analysis revealed that only pathological nodal downstaging could be considered as a favorable prognostic factor for DFS, while non-smoking and standard lobectomy are the corre-sponding variables for OS. Conclusion:Neo-adjuvant therapy with platinum-based doublet is feasible and useful in tumor and patho-logical nodal downstaging, which potentially improved resectability and survival rates in patients withⅢA-N2 NSCLC. Performing lo-bectomy or pathological nodal downstaging following induction therapy improved the patients' survival rate.

Objective To evaluate the synergy effect of Meropenem and Sulbactam combination against Meropenem-resistant and Meropenem-susceptible A.baumannii in vitro and optimize combination ratio of Meropenem and Sulbactam to achieve best synergy effect.Methods Evaluating the synergy effect of Meropenem and Sulbaetam combination through microdilution checkerboard method against Meropenemresistant and Meropenem-susceptible A.baumannii,isolated from inpatients of Chinese hospitals.Assessing the synergy effect of combination in different ratios of Meropenem to Sulbactam.Results The checkerboard method with the combination of Meropenem and Sulbactam demonstrated 25.0％ ( 10/40 ) synergism,67.5％ (28/40) partial synergism,7.5％ (3/40) additive,no indifference and antagonism in Meropenemsusceptible isolates,and 27.5％ (11/40) synergism,40.0％ (16/40) partial synergism,25.0％(10/40) additive,no indifference and antagonism in Meropenem-resistant isolates.Eleven Meropenemresistant isolates which showed synergism in synergy test were tested for MICs of combination of Meropenem and Sulbactam,using ratios of 4∶ 1,2∶ 1,1∶1 and 1∶2,and the MIC90 were 64∶ 16,64∶ 32,32∶32,32∶64 μg/ml,respectively.Conclusions Meropenem and Sulbactam combination show synergism or partial synergism against most A.baumannii isolates.The optimal ration of combination for clinical use may be 1∶ 1.

Objective:To investigate the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in adenosqua-mous carcinoma (ASC) of the lung after resection. Methods:Clinical data of patients suffering from ASC and receiving EGFR-TKI treat-ment at one institution between January 2006 and December 2014 were retrospectively reviewed. Results:A total of 27 EGFR muta-tion-positive patients with ASC subjected to EGFR-TKI therapy were enrolled in this study. EGFR mutations included deletion in exon 19 in 15 cases and point mutation at codon 858 in exon 21 in 12 cases. Of the 27 ASC patients who received EGFR-TKI treatment, 9 exhibit-ed a partial response and 11 manifested a stable disease, and these patients accounted for a disease control rate of 74.1%(20/27). The median overall survival (OS), median progression-free survival, and median relapse OS of the EGFR mutation-positive patients who underwent TKI therapy were 39 months [95%confidence interval (CI)=25.6-52.4], 15 months (95%CI=12.9-17.1), and 19 months (95%CI=0.9-37.1), respectively. The 3-and 5-year survival rates of these patients after operation were 51.9%and 15.3%, respectively. Con-clusion:The survival of EGFR mutation-positive ASC patients treated with EGFR-TKIs was satisfactory. EGFR testing was recommended for ASCs and EGFR-TKI treatment was suitable for ASCs with EGFR-sensitizing mutation.

Objective:To investigate the prognostic factors and survival of patients with combined small cell lung cancer (C-SCLC) after they underwent complete resection. Methods:The clinical records of C-SCLC patients who were subjected to complete resection and systematic nodal dissection in one institution between January 2010 and December 2014 were retrospectively reviewed. Results:Sev-enty-eight patients with histologically diagnosed C-SCLC were identified. The most common combined component was large cell neuro-endocrine carcinoma (LCNEC) (n=42), followed by squamous cell carcinoma (SCC) (n=18), adenocarcinoma (AC) (n=10), and adenosqua-mous carcinoma (ASC) (n=8). The overall survival (OS) rate of the entire cohort was 39.1%. Multivariate analyses using Cox's propor-tional hazard models revealed that size [<3 cm vs.>3 cm;hazard ratio (HR)=0.406;95%confidence interval (CI)=0.202-0.816;P=0.011], performance status (<2 vs.>2;HR=0.113;95%CI=0.202-0.631;P=0.013), combined non-small cell lung cancer (NSCLC) components (LCNEC vs. non-LCNEC, HR=3.00;95%CI=0.096-0.483;P<0.001), stage Ⅲ A vs.Ⅰ;HR=0.195, 95%CI:0.063-0.602;P=0.004) and adju-vant therapy (yes vs. no, HR=0.402;95%CI=0.195-0.831;P=0.014) were significant prognostic factors of OS. Conclusion:The mixed NSCLC components within C-SCLC significantly influence survival. Adjuvant therapy is beneficial for patients with complete resection of C-SCLC.

Objective To observe the effect of cognitive training combined with swallowing training real-time electrical stimulation on dysphagia and cognitive impairment after stroke. Methods 40 patients with dysphagia and cognitive impairment after stroke were randomly divided into observation group (n=20) and control group (n=20). The observation group accepted swallowing training (including routine vocal training and swallowing training real-time electrical stimulation) and cognitive training. The control group accepted routine vocal training and neuromuscular electrical stimulation. The cognitive function and swallowing function were accessed with Mini-Mental State Examination (MMSE) and Video Fluoroscopy Swallowing Study (VFSS) respectively before and 1 month after stroke. Results After treatment, the MMSE scores and the time for a bolus to pass the pharynx improved in both groups (P<0.05), and the observation group was superior to the control group (P<0.05). Conclusion Cognitive training combined with swallowing training real-time electrical stimulation can promote the recovery of swallowing function of patients with dysphagia and cognitive impairment after stroke.

Objective To evaluate the effect of ilaprazole enteric tablets on intragastric pH in duodenal ulcer patients. Methods A randomized, double blind, positive controlled clinical trial was carried out. A total of forty-two patients with duodenal ulcer were randomized into low dose ilaprazole group (5 mg/d), medium dose ilaprazole group (10 mg/d), high dose ilaprazole group(20 mg/d) and omeprazole group(20 mg/d). An ambulatory 24 hour intragastric pH study was performed at the fifth treatment day. Fraction time pH above 3, 4 or 5, median values of 24 hour diurnal pH and 12 hour nocturnal pH, the percentage of patients with total time pH above 3, 4 or 5 at least for 18 hours were evaluated. Results There were no significant differences of fraction time pH above 3 or 4, median values of 24 hour diurnal pH and 12 hour nocturnal pH and the percentage of patients with total time pH above 3, 4 or 5 at least for 18 hours among all the groups with different doses of ilaprazole and the omeprazole group. The fraction time pH above 5 in medium and high dose ilaprazole groups were (87.96 ± 12. 29)% and (89.86±15. 18)% respectively, which was higher than that in low dose ilaprazole group [(67. 17± 30. 16)%] and omeprazole group[(76. 14 ± 16. 75)%], P <0. 05. Conclusion Ilaprazole has a strong effect on intragastric acid control with a dose dependent trend.

OBJECTIVETo establish a peptide nucleic acid clamping PCR assay for detecting hepatitis B virus (HBV) drug resistance mutation.

METHODSRtM204I (ATT) mutant, rtM204V (GTG) mutant and rtM204 (ATG) wild-type plasmids mixed at different ratios were detected for mutations by PNA clamping PCR assay and direct sequencing, and the sensitivity and specificity of the two methods were compared. Serum samples from 85 patients with chronic HBV infection were detected for drug resistance using the two methods.

RESULTSThe sensitivity of PNA-PCR assay was 0.001% in a 10(5)-fold excess of wild-type HBV DNA with a detection limit of 10(1) copies. The sensitivity of direct sequencing was 10% with a detection limit of 10(4) copies. Mutants were detected in 73 of the 85 serum samples (85.9%), including YIDD in 40 samples, YVDD in 23 samples, and YIDD+YVDD in 10 samples. The agreement of PNA-PCR assay with direct sequencing was only 40% (34/85, YIDD in 21 samples, YVDD in 11 samples, and YIDD+YVDD in 2 samples). Neither of the two methods yielded positive results for the negative control samples, suggesting their good specificity.

CONCLUSIONPNA-PCR assay appears to be a more sensitive and rapid assay for detection of HBV genotypic resistance.

Antiviral Agents ; pharmacology ; DNA Primers ; DNA, Viral ; genetics ; Drug Resistance, Viral ; genetics ; Hepatitis B virus ; drug effects ; genetics ; Point Mutation ; Polymerase Chain Reaction ; methods

Objective:To investigate the correlation between levels of fibroblast growth factor-23 (FGF-23) and monocyte chemoattractant protein-1 (MCP-1) and glucocorticoids-induced osteoporosis (GIOP) in children.Methods:From May. 2018 to May. 2022, 80 children with glucocorticoid osteoporosis admitted to our hospital were selected as the study subjects, and the control group was 62 children who received glucocorticoid therapy but had normal bone mass. General data were collected and bone density and bone metabolism were measured, including type 1 collagen carboxy-terminal peptide (CTX-1), type 1 procollagen amino-terminal peptide (PINP), and osteocalcin (OC). The levels of MCP-1and FGF-23 in the serum of the two groups were detected, and univariate and multivariate analysis was performed using prism software to analyze the risk factors affecting GIOP.Results:There was no significant difference in general data between the two groups (both P>0.05). The levels of FGF-23 (264.81±24.61) and MCP-1 (194.16±15.76) in serum of GIOP children were significantly higher than those in the control group (207.97±9.91; 179.00±18.34) ( t=17.13, P < 0.001; t=5.29, P < 0.001) ; Compared with those of the control group (0.88±1.08; 23.98±2.45; 8.36±3.71; 4.56±2.21), bone mineral density (0.44±0.29), PINP (16.29±3.97) and OC (6.74±3.22) levels were decreased, and CTX-1 level was increased (6.62±1.11) ( t=3.58, P<0.05; t=13.40, P<0.05; t=2.78, P<0.05; t=7.25, P<0.05) of the study group. Multivariate Logistic regression model showed that FGF-23 ( OR=1.161, 95% CI: 1.080-1.341, P<0.05), MCP-1 ( OR=1.179, 95% CI: 1.044-1.448, P<0.05) and CTX-1 ( OR=3.018, 95% CI: 1.526-10.510, P<0.05) were independent clinical risk factors for GIOP in children (all P<0.05). PINP ( OR=0.453, 95% CI: 0.169-0.740, P<0.05) was a protective factor affecting GIOP in children. Conclusion:FGF-23 and MCP-1 were independent risk factors for GIOP in children.

Objective To evaluate the efficacy and safety of ilaprazole sodium for injection in the treatment of peptic ulcer bleeding.Methods It was designed as a multi-center,stratified randomized,double-blind,positive drug parallel controlled and non-inferiority study.From October 2014 to April 2015,at 40 hospitals,patients with peptic ulcer hemorrhage confirmed by gastroendoscopy were enrolled and divided into the ilaprazde sodium group (10 mg ilaprazole sodium for injection every 24 h,the first dose doubled) and the positive control group (40 mg of omeprazole sodium for injection every 12 h).The course of both treatment was 72 h.The hemostasis rate of overall group at 72 h,the clinical rebleeding rate at four to seven days,the blood transfusion rate,the incidence of switching to other treatments and the incidence of adverse reactions were compared between the two groups.A chi-square test or Fisher's exact probability method were performed for statistical analysis.Results A total of 533 patients with peptic ulcer bleeding were enrolled,355 patients in the ilaprazole sodium group and 178 patients in the positive control group.The hemostasis rates of ilaprazole sodium group and positive control group at 72 h were 97.69 ％ (339/347) and 97.14 ％ (170/175),respectively,and the difference was not statistically significant (P＞0.05).There were no rebleeding patients in both groups at four to seven days.The blood transfusion rates of ilaprazole sodium group and positive control group were 5.07 ％ (18/355) and 3.37 ％ (6/178).The incidence of switching to other treatments was 0.56％ (2/355) and 0.56％ (1/178),respectively,and the differences were not statistically significant (both P＞ 0.05).The incidence of adverse reactions in the ilaprazole sodium group was 3.94％ (14/355),which was lower than that of positive control group (8.43％,15/178).And the difference was statistically significant (Fisher's exact probability method,P=0.042).Conclusions The efficacy of ilaprazole sodium for injection in the treatment of peptic ulcer bleeding is similar to that of omeprazole sodium for injection.Moreover,the smaller the dose,the lower the frequency of administration and the better the safety.

Objective:To discuss the safety and feasibility for the use of 3D uniportal VATS sleeve resection.Methods:Totally 32 patients with central lung cancer received 3D uniportal VATS sleeve resection(group A) from June 2017 to May 2020 at Shanghai Chest Hospital. Meanwhile, 63 patients received conventional VATS sleeve resection(group B). The clinicopathological and perioperative outcome data were retrospectively collected and analyzed.Results:The baseline clinicopathological characteristics between these two groups were statistically similar. Compared with group B, the mean operative time[(174.19±73.69)min vs.(212.46±50.02)min, P=0.004] and blood loss[(73.13±42.70)ml vs.(130.48±133.72)ml, P=0.020] of group A were decreased, harvested lymph node stations was increased(7.63±1.59 vs. 6.76±1.70, P=0.018). Lymph nodes dissected showed no statistical difference(1.31±1.58 vs 1.21±1.96, P=0.803). There was no intraoperative death in both groups. Inspiringly, group A possessed lower rate of conversion to thoracotomy(0 vs. 36.5%, P=0.000), shorter chest drainage durations[(4.88±1.15)days vs.(6.81±3.8)days, P=0.007]. Although there were no deaths during hospitalization in both groups, the incidence of postoperative complications in group A was significantly lower than that in group B(25.0% vs. 47.6%, P=0.046). It also presented more complicated operations including pulmonary artery plasty(25.0% vs. 6.3%, P=0.024) and carina plasty(12.5% vs. 1.6%, P=0.005) against group B. Conclusion:3D uniportal VATS was a safe and feasible technique for the surgical treatment of central lung cancer when conducting a thoracoscopic sleeve resection.