Objective To explore the feasibility of the small figure-L unilateral transternal incision for the treatment of anterior mediastinal tumor.Methods Twenty patients with anterior mediastinal tumor were enrolled in the study.Under general anesthenai,after a 6 to 10cm middle skin incision was made,a unilateral figure-L partial sternotomy on the side occupied by the tumor was made in the second or third intercostals space,taking into account the tumor size and location.Tumors were resected with excellent exposure.Results All tumors were completely resected during the operation.In 7 cases,tumors encroached on the adjacent lung tissue,and lung tissue was partially resected.In 5 cases,tumors invaded the pericardium,and the pericardium was partially removed.Mean operating time was 110 minutes(85～130 minutes).The mean time of hospital stay was 7days after the operation,and there was no complication.All but one patients were alive with a mean follow-up period of 18 months(6～27 months).Conclusions The figure-L unilateral sternotomy is considered as an effective and useful minimally invisive approach for anterior mediastinal tumors.

Objective To observe the clinical effect of different surgical methods in the treatment of mediastinal tumors.Methods A total of 74 cases of August 2011 -2015 years 7 months in our hospital admissions of patients with mediastinal tumor were divided into observation group (minimally invasive medi-astinal surgery)and control group (conventional thoracotomy),37 cases,compared to two groups of clini-cal curative effect.Results The total efficiency of treatment in the observation group was 89.19%,signifi-cantly higher than that of the control group and observation group complications rate is relatively lower,sig-nificant differences (χ2 =5.33,6.79,P <0.05);observation group the operative time,amount of bleeding and hospitalization time were (15.69 ±3.21)min,(3.541 ±56.29)ml,(597 ±3.11)d were significantly lower than control group,the difference between two groups was significant (t =12.54,11.49,13.54,P<0.05).Conclusions Phase,compared with the traditional surgical treatment for open and minimally in-vasive surgery can achieve a better therapeutic effect,reduce a patient's risk of complications,alleviate the injury of surgery.For patients with postoperative rehabilitation has a positive meaning.

Objective To investigate the expression of CCL20 and CCR6 in the patients with gastric cancer and To examine the relationship between chemokine expression and the occurrence and development of Gastric Cancer. Methods Real-time PCR , flow cytometry and ELISA are used to measure the gene transcription and protein expression levels of chemokine CCL20 and CCR6 in the serum of 50 patients with Gastric Cancer and 30 normal controls. Results The gene expression levels CCL20 and CCR6 in Gastric Cancer group are significantly higher than that in healthy controls. The level protein of CCL20 and CCR6 in peripheral blood of patients with gastric cancer are significantly higher than that in healthy peep le[ (45.4 ±10.9) pg/mL vs (18.6±4.7) pg/mL; (7.11 ±1.03%) vs (1.83±0.43%), P＜0.01. respectively],and the increase significantlyassociated with the clinical stage of Gastric Cancer. Conclusions The method for detecting the expression of CCL20 and CCR6 in patient with Gastric Cancer has been successfully established, and their expression levels were found to be correlated with the occurrence and development of Gastric Cancer. Thus, CCL20 and CCR6 may be involved in the regulatory mechanisms associated with the development of Gastric Cancer, and may be valuable in its diagnosis and prevention.

Liver is one of the most commonly metastases in patients with colorectal cancer.Curative hepatic resection is the first choice of liver metastasis of colorectal cancer,which can improve the survival rate ranging from 30％ to 40％ in 5-year.In this article,we will review the operation indication,mode and advance on the current treatment strategies of colorectal liver metastases,and discuss the decision-making process,emphasize a surgery - centered multidisciplinary treatment for the treatment of hepatic metastases from colorectal cancer,to improve the survival rate.

Objective To evaluate clinical utility of contrast-enhanced ultrasonography (CEUS) in percutaneous liver biopsy of liver occupying lesions.Methods According to intralesional microperfusion situation observed with CEUS,31 of 32 patients with liver occupying lesions underwent liver biopsy under the guidance of conventional ultrasound.Acquirement of adequate quantity of specimen for pathological examination was successfully achieved.Results Of 32 patients with liver occupying lesions,conventional ultrasound indicated intralesional necrosis and liquefaction in 3 patients,while CEUS indicated necrosis and liquefaction in 10 and multiple occupying lesions in 4 patients,of which 1 of the 2 lesions of 1 patient showed a rapid wash-in and washout of a focal contrast agent,the other lesion of the same patient showed synchronized enhancement with liver in all the three phases,and the remaining 3 patients showed rapid wash-in and washout.Of 6 patients conventional ultrasound indicated no blood flow,CEUS showed varying enhancement in 5 patients and no enhancement during all the three phases in 1 patient considered as focal nodular necrosis and did not undergo biopsy.All the 31 patients with liver occupying lesions underwent biopsy in the enhanced area in the arterial phase of CEUS.On the average,each patient was punctured for 2.13 times (66/31) .The successful rate of biopsy was 100% (31/31) .The confirmation rate was 96.80% (30/31) .Conclusion reflecting the situation of microperfusion sensitively,distinguishing necrosis and liquefaction accurately,determining benign or malignant initially and guiding to puncture accurately,CEUS is of grest clinical importance in biopsy of liver occupying lesions.

Objective To determine epidemiology and risk factors for nosocomial infections in severe patients.Methods The study included 434 patients (7394 patient-days)during a 2-year period (2010-2011).The incidence rate of infection,pathogenic bacteria,correlation factor of infected were analyzed.Results A total of 225 infections were identified in 113 patients(26.0％).The incidence and infection rates were 56.8 in 1000-patient days and 51.8％,respectively.The infections were pneumonia (40.9％),bloodstream (30.2％),urinary tract (23.6％) and surgical site infections (5.3％).Pseudomonas aeruginosa (22.6％),methicillin-resistant Staphylococcus aureus (22.2％) and Acinetobacter spp.(11.9％) were frequently isolated micro-organisms.Median length of stay with nosocomial infection and without were 13 days (Interquartile range,IQR,20) and 2 days (IQR,2),respectively (P ＜ 0.01).In logistic regression analysis,mechanical ventilation[odds ratio(OR):16.35 ;95％ confidence interval(CI):8.26 ～32.34;P ＜0.01),coma(OR:15.04;95％ CI:3.41 ～66.33;P ＜0.01),trauma(OR:10.27 ;95％ CI:2.34～45.01 ;P ＜0.01),nasogastric tube(OR:2.94 ;95％ CI:1.47 ～ 5.90; P ＜ 0.01),tracheotomy (OR:5.77 ;95％ CI:1.10 ～30.20;P ＜0.05) and APACHE Ⅱ scores 10 ～ 19(OR:10.80;95％ CI:1.10 ～ 106.01 ;P ＜0.05) were found to be significant risk faetors for nosocomial infection.Rate of nosocomial infection increased with the number of risk factors(P ＜0.01).Mortality rates were higher in infected patients than in non-infected patients(60.9 vs 22.1％ ;P ＜0.01).Conclusion These data suggest that,in addition to underlying clinical conditions,some invasive procedures can be independent risk factors for nosocomial infection in ICU.

Objective To observe the synergetic action of Zhenqi Fuzheng granule in prevention and treatment of critically ill patients with severe infection. Methods A retrospective study was conducted. 154 cases with critical illness were enrolled in the First People's Hospital of Baiyin in Gansu Province from January 2009 to December 2013. The control group consisted of 76 cases and only basic treatments were given;in the treatment group, there were 78 cases,besides the basic treatments,they also taken nasal feeding of Zhenqi Fuzheng granule 5 g twice a day,7 days constituting for 1 therapeutic course,a total of 1-3 courses. The incidences of pulmonary infection, urinary tract infection,deep venous catheter-related infections,rate of using antibiotics,fatality rate,infection relapse rate,disease course,pathogen flora distribution were observed in the two groups. Results Compared with the control group,the rates of lung infection,urethral infection,deep vein catheter-related infection,the rate of using antibiotics, fatality rate,infection relapse rate,the discovery rates of drug resistant Acinetobacter baumannii,Pseudomonas aeruginosa,Stenotrophomonas maltophilia,Staphylococcus aureus,and Blastomyces albicans were obviously reduced in treatment group〔lung infection:15.38%(12 cases)vs. 47.37%(36 cases),urethral infection:7.69%(6 cases) vs. 23.68%(18 cases),deep vein catheter infection:5.13%(4 cases)vs. 18.42%(14 cases),antibacterial drug using rate:48.72%(38 cases)vs. 77.63%(59 cases),fatality rate:10.26%(8 cases)vs. 18.42%(14 cases),infection relapse rate:28.21%(22 cases)vs. 48.68%(37 cases),the discovery rate of Acinetobacter baumannii:3.85%(3 cases) vs. 11.84%(9 cases), of Pseudomonas aeruginosa:2.56%(2 cases) vs. 9.21%(7 cases), of Stenotrophomonas maltophilia:5.13%(4 cases)vs. 13.16%(10 cases),of Staphylococcus aureus:5.13%(4 cases) vs. 6.58%(5 cases),of Blastomyces albicans:6.41%(5 cases)vs. 10.52%(8 cases),all P<0.05〕;the therapeutic course was obviously shortened(day:5.79±1.89 vs. 13.65±2.73,P<0.05). Conclusion In critically ill patients with severe infection,treatment of Zhenqi Fuzheng granule can reduce the incidences of severe lung infection, urinary tract infection,deep venous catheter-related infection,the 5-year relapse rate,fatality rate,and shorten the therapeutic course,lower the usage of antibiotics and detection rate of drug-resistant bacteria,therefore,clinically it is effective in such patients.

The rising ofmetabonomics after genomics and proteomics offers chances for the modernization of TCM.Metabonomics has much in common with TCM in the cognition of human body. Appropriate application of the methodology of metabonomics in TCM, such as TCM differential diagnosis and guidance of clinical treatment, would speed up the integration of TCM and modem life science and technology. Meanwhile the research of COPD in TCM will come into a new stage through the use of metabonomics. This article overviewed the current situation of Chinese medicine using metabolomics technology to raise its theory, science and diagnostic level, and the study of pulmonary-qi deficiency syndrome of COPD with metabonomics.

Objective To analyze the clinical,radiologic and pathological features of endobronchial metastasis from prostate cancer, and its diagnosis and treatment. Methods Ten cases of endobronchial metastasis from prostate cancer with pathological evidence in our hospital were retrospectively analyzed.The clinical, radiologie andpathological features and the diagnostic procedures and treatment of the cases were reported and analyzed while combined with literature. ResultsAn average age at diagnosis of advanced prostate cancer was 65.5 years. Emoptysis(5/10), cough (4/10), dyspnea (4/10) and weight loss (5/10) were the common symptoms.Chest X-ray disclosed hilar and mediastinal lymphadenopathy (4/10), hilar mass (3/10) or atelectasis (2/10) . Bronchoscopic examination revealed that most of lesion located in single lobar or segmental bronchus (6/10). Bilateral upper lobe were most susceptibly involved(7/10). Polypoid lesions or mass in lumen of bronchi(8/10)were more frequent than infiltrative lesion(2/10), which could obstruct the orifice of the bronchi in different extent. Immunohistochemical staining for prostate specific antigen or prostatic acid phosphatase was positive, and most patients responded well to endocrine therapy. Conclusions Clin.ical and radiologic features of endobronchial metastasis from prostate cancer are similar to those of primary bronchogenic carcinoma. Immunohistoehemical study is helpful for differential diagnosis and the short-term efficacy of endocrine therapy is significant.

Objective To analyze and compare the clinical features of community-acquired pneumonia caused by Legionella in elderly (age≥60 years) and younger patients. Methods The epidemiological, clinical, laboratory data and the outcomes of 80 cases with community-acquired Legionella pneumonia (CALP) from January 2001 to October 2009 were studied retrospectively, and the differences between elderly and younger group were compared using univariate and multivariate analysis. Results (1) Underlying diseases, such as cerebrovascular diseases, chronic obstructive pulmonary diseases, diabetes mellitus and immunosuppressive therapy were significantly more frequent in elderly group than in younger group (all P＜0. 05). (2) No significant differences were observed between the two groups in legionella serotype. (3) Malaise, hyponatremia and hypophosphatemia were all more frequent in elderly group than in younger group (x2=5. 300, 5. 520, 4. 470; P=0. 021,0. 019, 0. 034, respectively). And elderly versus younger group had higher creatinine levels [(108.55±56.57) μmmol/L vs. (75.42±17.62) μmmol/L, t= -3. 062, P=0. 002], lower PaO2/FiO2 (＜300) (57.7% vs. 29.2%, x2=4. 120, P=0.042), less leucocyte counts [(8.34±3.65)×109/Lvs. (10.63±5.02)×109/L, t=-2.287, P=0.022]. (4) Elderly patients more likely complicated with congestive heart failure (P=0.037) and their length of staying in hospital was also longer (Z=-2.194, P=0.028). No significant differences were observed between the two groups in mortality, intensive care unit admission, and the need for corticosteroids or mechanical ventilation.Conclusions Elderly patients with CALP have a higher frequency of underlying comorbidities and more organs involvement than younger patients, although greater severity of illness at onset and outcome are not significantly different between the two groups.