Objective To study the clinical efficacy of axillary incision and thoracoscopic surgery for spontaneous pneumothorax.Methods 106 cases of spontaneous pneumothorax in our hospital were given axillary incision surgery(axillary incision group) and thoracoscopic surgery(thoracoscopy group).The intraoperative blood loss,operative time,chest tube drainage time,postoperative hospital stay and surgery costs were compared between the two groups,and the occurrence of complications were observed.Results The armpit small incision group,intraoperative blood loss was (44.5 ± 5.2) ml,the thoracoscopic amount of blood loss was (38.3 ± 6.5) ml (t =6.378,P ＜ 0.01) ;armpit operation time of the small incision group was (68.0 ± 5.3) min,thoracoscopic operative time was (60.8 ±6.0)min; armpit chest tube drainage time of small incision group was (2.8 ± 0.8)d,thoracoscopic group of chest tube drainage time was (2.0 ± 0.5) d; axillary small incision group,length of stay was (4.8 ± 0.7) d,the thoracoscopic group hospitalization time was (4.0 ± 0.6) d,(t =3.552,4.215,3.076,all P ＜ 0.05) ; axillary incision surgery costs was (1 550 ± 348) Yuan,the thoracoscopic group cost of surgery was (4 290 ± 573) Yuan (t =-24.823,P ＜ 0.05).Two groups of patients with no surgical complications,chest X-ray review of lung reexpansion good thoracoscopic group one cases of recurrence of pneumothorax,axillary incision group without recurrence (P ＞ 0.05).Conclusion Axillary small incision and thoracoscopic surgery for spontaneous pneumothorax have the similar efficacy,thoracoscopic surgery is less trauma,faster recovery,shorter hospital stay,but the high cost of surgery,if patients physical condition is acceptable,which can be used axillary incision surgery.

Objective:To transfect genes using ultrasound targeted microbubble destruction (UTMD) techniques and observe the effects of RNA interference on cervical cancer (HeLa) cell line in silencing survivin gene and inducing apoptosis. Methods: Recombinant expression plasmid of short hairpin RNA (shRNA) targeting survivin gene was constructed. It was co-treated with microbubbles and transfected to cultured HeLa cells followed by exposure to ultrasound (P+UTMD group). Moreover, blank control group (C), plasmid group (P), ultrasound exposure group (US), plasmid and ultrasound exposure group (P+US), plasmid+ Lipofectamine group (P+L) were used as controls, respectively. Transfection efficacy was evaluated by observing the red fluorescence in the cells by fluorescent microscopy and flow cytometry(FCM). Ultrasound intensity and exposure time were optimized. Cell apoptosis was investigated using flow cytometry analysis, Hoechst staining, and DNA ladder method. Expression of survivin mRNA was assessed by RT-PCR. Results: Restrictive enzyme digestion and sequencing analysis verified that the recombinant plasmid was successfully constructed. UTMD significantly increased gene transfection efficacy in cultured HeLa cells (P<0.01). Gene transfer was the most prominent at ultrasound intensity of 1.0 W/cm2 and exposure time of 3 min (P<0.01). RT-PCR showed that the expression of survivin mRNA in P+UTMD group was inhibited by (83.33±2.73)%. The differences were significant compared with any other groups (P<0.01). FCM analysis showed that the apoptosis ratio in P+UTMD group was significantly increased as compared with other groups (P<0.01). Hoechst staining and DNA ladder showed that apparent apoptosis and DNA ladder were detected only in P+UTMD and P+L groups. Conclusions:UTMD effectively enhances the transfection efficacy of expression plasmid. It is a novel and effective non-viral gene transfer system and has promising foreground. UTMD mediates RNA interference silenced survivin gene and induces significant cell apoptosis, which provides a new method for tumor research and gene therapy.

Objective To investigate temperature changes in prefrontal cortex and hippocampus of heroin addicts with magnetic resonance spectroscopy (MRS).Methods 18 heroin addicts in the withdrawal state and 18 healthy volunteers (control group) were performed with MRS scan.First, resting-state MRS scan was performed on all subjects, and then did MRS scan again under visual stimulation while subjects were asked to carefully watch the heroin-related cue images.Measurements of NAA of the identified regions (the prefrontal cortex, bilateral hippocampus) were obtained from all subjects.Brain temperatures were calculated by the modified brain temperature-chemical shift equation.Results In resting state, the temperature of prefrontal cortex in heroin addicts group was higher than the control group, the difference was statistically significant (P<0.05),and the brain temperature was positively correlated with total dose of heroin (P<0.05).The prefrontal cortex/hippocampus temperature of heroin addicts group did not showed statistical significance between resting state and visual stimulation state (P>0.05).Conclusion MRS can be used to measure brain temperature noninvasively.Temperature change of brain may be helpful for exploring the mechanism of drug addiction and craving.

Objective To evaluate the effectiveness and predictive value of high-resolution manometry(HRM) for POEM in treating achalasia. Methods A total of 84 achalasia patients categorized into subtypes by HRM, who also underwent POEM, were enrolled in our study. Eckardt score, Barium esophagogram and HRM were performed before, 6 months and 1 year after POEM. Results POEM was successfully performed in all 84 patients. No perforation occurred in any patient. The Eckardt scores and esophageal diameter after POEM significantly reduced compared with those before(P<0. 05). The 4s-IRP decreased from 33. 4±9. 0 mmHg (1 mmHg =0. 133 kPa) to 14. 6±3. 8 mmHg six months after POEM (P<0. 05) and to 16. 4±3. 9 mmHg one year after POEM (VS preoperate, P<0. 05). The LESP before treatment was 41. 8±15. 4 mmHg, decreasing to 18. 4±7. 1 mmHg six months after POEM (P<0. 05) and 20. 7±7. 6 mmHg one year after POEM (VS preoperate, P <0. 05) . When categorizing patients into 3 subtypes by HRM, 4s-IRP of type II showed the most dramatic decrease six months after POEM(62. 8%), followed by typeⅠ(53. 5%), while type III had the least decrease(41. 8%). The mean decreasing rate of LESP in type III was 42. 3% six months after POEM, followed by typeⅠ(55. 3%) , while type II showed the highest rate(57. 8%). Conclusion POEM is a safe treatment for achalasia and has significant short-term efficacy with Type II responding best to POEM. HRM plays a vital role in typing AC and predicting the effectiveness of POEM and can be useful in selecting an appropriate treatment.

Objective To explore the lesion types of renal branches and evaluate the clinical results of endovascular treatment for renal artery branch lesions associated with fibromuscular dysplasia (FMD).Methods Eight cases with renal artery branch lesions due to FMD from June 2014 to December 2015 in Department of Vascular and Endovascnlar Surgery,Henan Provincial People's Hospital were retrospectively reviewed.The computed tomography angiography was routinely performed to ascertain the property of renal artery lesion,and digital-subtraction angiography was further performed to confirm FMD diagnosis and analyze lesion characteristics.The renal artery branch lesion types,blood pressure (BP),renin activity,glomerular filtration rate (GFR) and restenosis after operation were observed,and the outcomes were recorded.Results In 8 patients,6 patients were found with the second grade renal branch lesions and 2 patients were found with tertiary branch lesions,involving 2 and more branch arteries for 4 cases and 1 branch for 4 cases.Five cases with branch-type cystic dilatation or aneurysms with coexisting stenosis including 1 case with dissecting aneurysm and renal local infarction,and 1 case with aneurysm located in the bifurcations of branches,and 3 cases with only branch stenosis were found.The angiography showed the small branch lesions of renal artery indicating FMD-mediated focal (5 cases) and multiple stenosis (3 cases).The branch stenosis was not operated in 1 case with dissecting aneurysm and renal local infarction,as BP could be controlled by antihypertensive treatment.Other 7 cases underwent endovascular angioplasties and the technical successful rate was 100％ without complications.After 1 week of operation,BP was improved,renal function remained normal,plasma renin activity was reduced and GFR was recovered for all patients.During the follow-up period (3 to 12 months),BP improvement was observed in 3 cases,and cure were found in 4 cases,and patient's GFR and plasma renin activity were improved in all patients.There were 2 cases with re-intervention during the follow-up period due to restenosis,and the involved branches were unobstructed without obvious stenosis after 1-year follow-up.Conclusions FMD can affect the renal branch artery with different lesions types and endovascular treatment is the first choice for the renal branch lesion of FMD.

Objective To evaluate clinical outcome and complications of mesh-augmented vaginal reconstructive surgery in treatment of pelvic organ prolapse. Methods From Feb 2007 to Jan 2009, meshaugmented vaginal reconstructive surgery were performed on 66 women with pelvic organ prolapse stage Ⅲ-Ⅳ. Pre and postoperative symptoms, pelvic organ prolapse quantitation (POP-Q) stage and pelvic floor distress inventory-short form 20 (PFDI-20) measurements were studied to assess anatomic and quality-of-life outcome. Operative complications were also analyzed. Results Totally 65 patients underwent successful surgeries. The rate of follow-up was 97% (63/65) with a median follow-up of 17. 2 months. Subjective cure rate and objective cure rate were both 97% (61/63) at 6 and 12 months after surgeries, 51 women completed PFDI-20 measurements and scores were 102 ± 50 before surgery, 16 ± 21 at 6 months and 15 ± 20 at 12 months. It reached statistical difference when scores were compared before and after surgeries ( P ＜0. 05). Among 66 patients, 2 patients underwent organ injuries, 2 had recurrent prolapse, 4 had meshrelated complications and 1 had severe de novo stress urinary incontinence. Six patients underwent second surgery. Conclusions Mesh-augmented vaginal reconstructive surgery in treatment of pelvic organ prolapsed brought satisfied clinical outcome. The incidence of mesh-related complications was low and secondary operative interventions were effective.

Objective To evaluate the diagnostic and therapeutic value and safety of transcatheter arterial angiography and embolization in patients with endoscopic refractory gastrointestinal bleeding.Methods Thirty-one cases of endoscopic refractory gastrointestinal bleeding were performed DSA and treated with transcatheter arterial angiography and embolization.The safty and efficacy was evaluated.Results Angiographic positive rate of bleeding was 80.65％ (25/31);28 cases was treated with embolization.The success rate of first embolization was 75.00％ (21/28),and the total success rate was 82.14 ％ (23/28) by the second embolization.Seven patients received surgical resection after interventional therapy,including 2 cases of jejunal stromal tumors and 5 cases of gastric malignant tumors.Four cases of gastric cancer patients underwent rebleeding within 30 days after interventional therapy,of which 2 died of heart or lung function failure due to basic diseases.Except for 1 patient of anastomotic bleeding after gastrointestinal anastomosis occurred anastomotic fistula after embolization,who recovery with the support treatment,no other cases occurred serious gastrointestinal ischemic necrosis.Conclusion Interventional diagnosis and treatment for gastrointestinal bleeding hemostasis is effective and safety,and also can achieve good results especially for malignant gastric tumor hemorrhage,which can be used for endoscopic refractory gastrointestinal bleeding patients.

Flexible matching has recently been proposed as a method of improving interactions efficiency. In this study, the concept of flexible matching has been introduced, and the applicability of this strategy has also been described based on the power calculation of interaction between HER-2 polymorphism and smoking with breast cancer. A large-sample approximation method is used to estimate the power and efficiency of gene-environment interactions. In the basic scenario, power of interaction between HER-2 polymorphism and smoking of unmatched case-control study appears to be 30% while in the frequency matching case-control study it is 56%. However, when increasing the smoking prevalence in controls, greater power can be obtained (power=74%). Conclusions: Flexible matching strategies can increase the power and efficiency of case-control studies to detect and estimate the gene-environment interactions when compared with traditional frequency matching and it is especially useful under those scenarios when low environmental exposure of population, adverse gene-environment interactions or less paired controls are seen. Optimal matching design should be made available by weighing the benefits and loss due to flexible matching.

BACKGROUND:Inhibiting the apoptosis of intervertebral disc cel s can postpone the degenerative process of intervertebral disc. Survivin has a strong function of regulating cel proliferation and anti-apoptosis.
OBJECTIVE:To construct and identify the lentiviral vector encoding survivin gene of human.
METHODS:The survivin gene of human (BIRC5) was synthesized through the gene synthesis technology, amplified by PCR and analyzed by electrophoresis. The target gene was cloned into lentiviral expression plasmid to obtain the recombinant lentiviral vector Lenti-BIRC5. After transformation into competent E. coli cel s, the candidate clones were identified by PCR firstly. The positive clones were identified by gene sequencing. The lentivirus plasmid containing target gene was transfected into 293T cel s, and the expression of recombinant lentiviral vector Flag-Survivin fusion protein was detected through western blot analysis.
RESULTS AND CONCLUSION:The PCR results of electrophoresis and DNA sequencing showed that lentiviral vector containing human survivin gene was constructed successful y. Western blot analysis results showed that the target gene was transfected successful y and over-expressed in cultured cel s. The lentiviral expression vector of human survivin gene Lenti-BIRC5 was constructed successful y, which lays a foundation for the study addressing the anti-apoptotic effects of survivin on human nucleus pulposus cel s.

Objective To explore the interleukin (IL)-6,IL-10 and T cell subsets levels in bronchoalveolar lavage fluid(BALF) of children with refractory mycoplasma pneumonia.Methods A total of 53 children with refractory mycoplasma pneumonia were selected as the observation group,30 children with bronchial foreign body in our hospital were chosen as controls during the same period.ABC-double antibody sandwich ELISA method was used to detect IL-6,IL-10 levels and the CD3 +,CD4 + and CD8 + T levels were measured by means of flow cytometry in BALF.Results The IL-6 and IL-10 levels in BALF of children in the observation group were (63.25 ± 18.61) ng/ml,(31.83 ± 8.33) ng/ml respectively,and they were significantly higher than those of the controls[(30.51 ± 1.34) ng/ml,(11.01 ± 2.91) ng/ml] (P ＜ 0.05,respectively).The percentage of CD3 +,CD4 +,CD8 + T cells and the ratio of CD4 +/CD8 + T cells in BALF of the observation group were (48.47 ± 2.88)％,(21.16 ± 6.29)％,(23.04 ± 4.63)％,0.94 ± 0.33,respectively,and they were significantly lower than those of the controls [(64.24 ± 3.06) ％,(34.34 ± 7.59) ％,(26.71 ±5.29)％,1.56-±0.67] (P＜0.05,respectively).Conclusion The IL-6,IL-10 levels in BALF of children with refractory mycoplasma pneumonia significantly increased,suggesting that cell-mediated immunity play an important role in the pathogenesis of refractory mycoplasma pneumonia.