Objective:To investigate the efficacy of postoperative chemotherapy in patients with early-stage pulmonary large cell neu-roendocrine carcinoma (LCNEC) after resection. Methods:A cohort of 50 patients who underwent resection and systematic nodal dissection for LCNEC between January 2008 and December 2014 in our institution was retrospectively reviewed. The patients were divided into adjuvant chemotherapy group (32 cases) and non-chemotherapy group (18 cases). Follow-up information was investigated. Results:The median survival and the 5-year survival rate were 48 months and 72.5%for the adjuvant chemotherapy group whereas 29 months and 35.6%for the non-adjuvant chemotherapy group, respectively. Univariate and multivariate analyses using Cox's proportional hazard models showed that postoperative chemotherapy was a signifi cant prognostic factor for OS (P=0.005;hazard ratio=0.281, P=0.008, respectively). Conclusion:Postoperative chemotherapy is beneficial to patients with early-stage pulmonary LCNEC after complete resection.

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 analyze the clinical pathological features of one patient with accessory breast cancer (ABC), and to explore the diagnosis, treatment, operation methods and prognosis of ABC patient. Methods: The patient received right axillary tumor resection, right axillary accessory breast resection and axillary lymph node dissection, didn't receive resection of breast in the affected side. According to the intraoperative frozen pathological diagnosis, the clinical diagnosis was ABC. After operation, the patient was treated with 8 cycles of AC-T regimen adjuvant chemotherapy (The first four cycles were given pirarubicin 60 mg · m-2, cyclophosphamide 600 mg · m-2 per cycle; the last four cycles were given docetaxel 100 mg · m-2 per cycle; every three weeks was a cycle of treatment), radiation therapy (The radiation dose was 50 Gy/25 f in the upper and lower part of the right collarbone and the tumor bed area, and after retract the tumor bed area was increased to 60 Gy) and endocrine therapy (Tamoxifen was administered at 20 mg per day). Results: The patient's breast color ultrasound and mammogram examination indicated that the right axillary mass of the patient was more likely to be malignant. The clinical diagnosis was right axillary ABC. According to the NCCN guide, the patient was treated with the standardized comprehensive treatment based on surgical treatment. 16 months after operation, the patient recovered well and had a normal life. There was no upper limb dysfunction and no lateral upper limb lymphedema, and there were no recurrence or metastasis Conclusion: ABC is extremely rarely seen in clinical practice. The clinical pathological features and treatment of ABC are similar to breast cancer. If there is no lesion in the mammary gland, it is not necessary to remove the mammary gland in the affected side.

Objective To develop a hepatic surgical planning software for hepatic operation on deciding the rational operational scheme, simulating procedures before the operation to accomplish the precise operation and decrease the operative risk. Methods The software was used in clinical practice to analyze the surgical anatomy of human liver, calculate the liver volume and vascular territory, disclose the hepatic structures and simulate the operation before operation. Results The surgical planning software is very convenient in analyzing the surgical anatomy of human liver, calculating the liver volume or vascular territory and simulating the operation before operation. Conclusion The developed surgical planning software is very helpful in clearly disclosing hepatic structures, rationally deciding operation scheme and virtually simulating the operation.

BACKGROUND:Currently, literatures about autologous vein transplantation are few, and the research on the effect of different parts of autologous vein transplantation are not found yet. OBJECTIVE:To summarize the experiences of establishing the fistula using autologous vein transplantation so as to investigate the method of improving the success rate of surgery. METHODS:We analyzed retrospectively the data of 40 cases of establishing the fistula using autologous vein transplantation, and then compared the successful rate of autologous vein transplantation fistula, blood flow and operating time, thereby analyzing the influence of diabetes melitus on the successful rate of autologous vein transplantation fistula. RESULTS AND CONCLUSION:The successful rates of autologous vein transplantation fistula at different parts ranging from high to low were as folows: the cephalic vein, great saphenous vein, basilic vein and smal saphenous vein. Blood flow of the upper limb for vein transplantation fistula was obviously higher than that of the lower limb (P < 0.05). The operating time of autologous vein transplantation fistula was longer in the upper limbs than in the lower limbs (P < 0.01). For patients with diabetes melitus, the successful rate of autologous vein transplantation was markedly lower than those with no diabetes melitus (P < 0.01). For the hemodialysis patients with poor upper limb superficial vein, autologous vein transplantation is a better way of establishing the vascular access. Vein transplantation of the upper limbs is better than that of the lower limbs in success rate and operating time. Autologous vein transplantation fistula is not suitable for the patients with diabetes melitus.

Objective To explore the potential role and function of miR-30 a in myocardial fibrosis after myocardi-al infarction( MI) .Methods We constructed the AAV plasmid vector which carried the miR-30 a gene of rat.The recombinant plasmid was detected by gene sequencing , enzyme digestion and PCR .Virus was packaged into HEK293 cells and virus titer was determined after extraction and purification by PCR .PBS fluid, rAAV9-miR-30 a-NC and rAAV9-miR-30 a were transmited to rat hearts from PBS group , miR-30 a-NC group and miR-30 a group respectively through transcoronary infusion before anterior descending coronary artery ligation .Sham group was set up at the same time.After 4 weeks, heart function was monitored by serial echocardiography , including fractional shortening ( FS) , and left ventricular ejection fraction ( LVEF) .Masson staining was used to calculate collagen volume fraction ( CVF) .The expression of collagen ⅠandⅢwere detected by immunohistochemistry . The mRNA level of miR-30a, TGF-β1 and CTGF were detected by real-time PCR.The protein level of TGF-β1 and CTGF were detected by western blot analysis .Results The cardiac function of miR-30 a group was improved significantly compared with PBS group and miR-30a-NC group (P<0.05).The levels of CVF,collagenⅠ,Ⅲexpression and Collagen Ⅰ/Ⅲ ratio in miR-30 a group was significantly lower than PBS group and miR-30 a-NC group ( P<0.01 ) .The mRNA and protein level of TGF-β1 and CTGF in miR-30 a group were reduced signifi-cantly than PBS group and miR-30 a-NC group ( P<0.001 ) .Conclusions The overexpression of miR-30 a after MI may reduce the mRNA and protein level of TGF-β1 and CTGF, so as to suppress myocardial fibrosis and im-prove cardiac function.

Objective: To evaluate the predicting value of the 2014 European Society of Cardiology (ESC) guidelines risk prediction model for sudden cardiac death (HCM Risk-SCD) in Chinese patients with hypertrophic cardiomyopathy (HCM), and to explore the predictors of adverse cardiovascular events in Chinese HCM patients. Methods: The study population consisted of a consecutive 207 HCM patients admitted in our center from October 2014 to October 2016. All patients were followed up to March 2017. The 5-year SCD probability of each patient was estimated using HCM Risk-SCD model based on electrocardiogram, echocardiography and cardiac magnetic resonance (CMR) examination results. The primary, second, and composite endpoints were recorded. The primary endpoint included SCD and appropriate ICD therapy, identical to the HCM Risk-SCD endpoint. The second endpoint included acute myocardial infarction, hospitalization for heart failure, thrombus embolism and end-stage HCM. The composite endpoint was either the primary or the second endpoint. Patients were divided into the 3 categories according to 5-year SCD probability assessed by HCM Risk-SCD model: low risk group<4%,intermediate risk group ≥4% to<6%, and high risk group≥6%. Results: (1) Prevalence of endpoints: All 207 HCM patients completed the follow-up (350 (230, 547) days). During follow-up, 8 (3.86%) patients reached the primary endpoints (3 cases of SCD, 3 cases of survival after defibrillation, and 2 cases of appropriate ICD discharge); 21 (10.14%) patients reached the second endpoints (1 case of acute myocardial infarction, 16 cases of heart failure hospitalization, 2 cases of thromboembolism, and 2 cases of end-stage HCM). (2) Predicting value of HCM Risk-SCD model: Patients with primary endpoints had higher prevalence of syncope and intermediate-high risk of 5-year SCD, as compared to those without primary endpoints (both P<0.05). (3) Predicting value of HCM Risk-SCD model: The low risk group included 122 patients (59%), the intermediate risk group 42 (20%), and the high risk group 43 (21%). There was a clear trend towards to higher heart rate, higher values of PTF_V1 and plane QRS-T angle, higher left ventricular mass index (LVMI), elevated maximal left ventricular outflow tract pressure gradient (LVOT-PGmax), enlarged left atrial dimension(LAD) and volume index (LAVI), reduced systolic mitral annular velocity (s'), and higher late gadolinium enhancement (LGE) volume and mass in patients with high risk of 5-year of SCD, as compared to those with low-intermediate risk (all P<0.05). Moreover, 5-year SCD probability was positively correlated with heart rate, plane QRS-T angle, LVMI, LAVI, LGE%, and negatively correlated with s'(r=0.161, P=0.019; r=0.669, P=0.001; r=0.206, P=0.004; r=0.284, P=0.000; r=0.351, P=0.000; r= -0.245, P=0.001; respectively). (4) LAD, LAVI, e' and s' were independent predictors for poor outcomes. HCM patients with LAD≥39 mm, LAVI≥49.6 ml/m², e'≤6.5 cm/s and s'≤6.6 cm/s were more likely to have adverse cardiovascular events (AUC 0.702, 95%CI 0.604-0.799, P=0.001; AUC 0.700, 95%CI 0.567-0.833, P=0.001; AUC 0.716, 95%CI 0.616-0.817, P=0.000; AUC 0.764, 95%CI 0.676-0.853, P=0.000,respectively). Conclusions The HCM Risk-SCD model is of value in predicting SCD for Chinese HCM patients. The plane QRS-T angle and LGE% are the best predictors of 5-year SCD risk in Chinese HCM patients. Moreover, conventional echocardiographic parameters, including LAD, LAVI, e' and s', are useful to predict adverse cardiovascular events among Chinese HCM patients.

Objective:To explore the effects of practice teaching based on Gagne's teaching theory combined with scene teaching method on core competency of nursing students in department of respiratory and critical care medicine.Methods:A total of 42 nursing students from the Respiratory and Critical Care Medicine Department of Beijing Jishuitan Hospital were enrolled and divided into observation group (21 cases) and control group (21 cases) using a random number table. Traditional teaching method was used in the control group, while Gagne's teaching theory combined with scene teaching method was used for teaching the observation group. After teaching, theoretical knowledge and actual operation ability of nursing students were assessed. The core competency of nursing students was evaluated by core competency assessment scale. The independent learning ability of nursing students was evaluated using an assessment tool. The self-evaluation of teaching effect in the two groups was compared. The t test or chi-square test was performed in SPSS 22.0. Results:The scores of theoretical knowledge and actual operation ability in the observation group were (88.10±7.52) and (90.81±4.88), respectively. These scores were significantly higher than those in the control group [(83.62±6.58) and (72.57±8.94), t=2.06, 8.21, P<0.05]. The scores of core competency and independent learning ability were significantly higher in the observation group than in the control group [(185.53±20.19) and (129.09±16.14) vs. (170.52±20.32) and (105.86±12.23), t=2.40, 5.10, P<0.05]. The score of self-evaluation on teaching effect was significantly higher in the observation group than in the control group [28 (25, 29) vs. 21 (20, 22), Z=5.39, P<0.05]. Conclusion:Gagne's teaching theory combined with scene teaching method in practice teaching of nursing students in the department of respiratory and critical care medicine should be promoted because this combined method improves the mastery of theoretical knowledge and actual operation skills, the independent learning ability and core competency of nursing students, and the effect of nursing teaching.

Objective To explore the predictive value of routine echocardiographic and electrocardiographic parameters in late gadolinium enhancement ( LGE ) in hypertrophic cardiomyopathy ( HCM ) . Methods The study population consisted of a consecutive series of 95 HCM patients .According to the presence of LGE on cardiac magnetic resonance (CMR) ,these patients were divided into two groups :HCM patients with LGE ( n = 71) and HCM patients without LGE ( n = 24) . The parameters of routine echocardiography and electrocardiography were compared between the two groups . ROC and Logistic analysis were made to find the predictors of LGE . Results ① As compared to those without LGE ,HCM patients with LGE had higher prevalence of chest pain ( P = 0 .027) ,β-blocker treatment ( P = 0 .024) , increased maximal left ventricular wall thickness ( MLVWT ) ( P < 0 .0001 ) ,non-sustained ventricular tachycardia ( P = 0 .034) ,prolonged the rate-corrected cardiac QT interval ( QTc) ( P = 0 .011) ,T-wave inversion ( TWI) ( P = 0 .009) ,but reduced early diastolic mitral annular velocity ( e′) ( P = 0 .001) . ②Univariate predictors of LGE on CMR were :increased MLVWT ,reduced e′ ,prolonged QTc and more TWI . Only MLVWT ( OR = 1 .23 ,95％ CI = 1 .05 - 1 .44 , P = 0 .013) and e′( OR = 1 .23 ,95％ CI = 0 .52 - 0 .96 , P =0 .028) remained independent after multivariable analysis . Furthermore ,the ROC analysis showed that these two parameters had discriminative ability to identify those with LGE . To be specific ,HCM patients with MLVWT ≥ 21 .5 mm or e′ ≤ 5 .55 cm /s were more likely to present with LGE . ③ The leads number of TWI was positively correlated with percentage of LGE in left ventricular mass ( LGE ％ ) ( r = 0 .220 , P =0 .044) ,but there was no correlation between location of TWI on ECG and territory of LGE on CMR . Conclusions In HCM patients ,MLVWT and e′ are independent predictors of LGE on CMR . Furthermore , although the leads number of TWI is correlated with LGE ％ ,no correlation has been found between location of TWI on ECG and territory of LGE on CMR .