Objective To identify clinical prognostic predicators and surgery indicator of stage IIIb-T_4 in patients with lung cancer patients whose tumor invaded heart, main vessel or carina. Methods From 1988 to 2000,151 patients with pathological stage IIIb-T_4 lung cancer who underwent resection by Shandong Provincial Hospital were analyzed as control samples, 112 patients with pathological stage IIIa-T_3N_1M_0 who underwent resection at the same time were also analyzed. Factors were estimated from the date of operation using the Kaplan-Meier and Log rank analysis. The Cox regression model evaluated the influence of factors on the survival. Results The median survival period were 26.1 months and the overall of 1-year, 3-year and 5-year survivals of the 151 patients were 73.5%, 33.1% and 16.6% respectively.The significant prognostic factors (P

Objective To evaluate the outcomes of transanal coloanal pull-through with resection of the internal anal sphincter in neonates and infants with Hirschsprung's disease.Methods Transanal coloanal pull-through with resection of the internal anal sphincter was performed on 101 neonates or infants with Hirschsprung's disease in our hospital.An incision slightly longer than one-half of the rectal circumference was made at the dentate line.Then,the muscular layer of the anterior rectal wall was dissected and separated upwards from the submucosal layer;meanwhile that of the posterior wall was also separated upwards along the rectal longitudinal muscles.After the muscular layer was separated to the level of the peritoneal reflection,a radial operation was performed by resecting the internal anal sphincter and muscle sheath of the posterior rectal wall.Results The operation was accomplished successfully in all the patients with less than 10 ml of intraoperative blood loss.The operation time ranged from 45 to 190 min(mean,90 min).No complications,including urine retention,incision infection,and anastomotic stenosis,occurred.Two patients(2/86,2.3%) developed enterocolitis after the operation.The incidence of fecal soiling was 27%(22/82) at 2 months after the operation,and then decreased to 4%(3/82) at 6 months.Anorectal manometry was performed on 78 patients at 1,2,3,and 6 months postoperatively.The results demonstrated that the anal resting pressure after the operation was significantly lower than that before the operation(P

OBJECTIVE:To provide reference for rational use of human serum albumin for surgical inpatients. METHODS:The utilization of human serum albumin for surgical inpatients in a hospital during Jan.-Mar. 2014 was analyzed and evaluated by UHC Guidelines for the Use of Album,Nonprotein Colloid,and Crystalloid Solutions(2010 edition)and European Immune Globu-lin and Albumin Use Recommendation. RESULTS:Among the 556 patients,totally 895 human serum albumin application were con-ducted,mainly involving development of gastrointestinal surgery(29.7%),hepatobiliary surgery(25.9%)and cardiothoracic sur-gery(13.1%). The main reasons were correcting hypoalbuminemia(62.9%),followed by albumin supplemented during major sur-gery(7.9%)and alleviating ascites in patients with cirrhosis(4.4%);only 95 applications(10.6%)were considered appropriate. The most prevalent inappropriate reason was for correcting hypoalbuminemia. CONCLUSIONS:Human serum albumin in the surgi-cal inpatients in the hospital shows a large amount,and low consistent rate between indications and guidelines. The rational stan-dardized utilization of human serum albumin should be strengthened.

Objective To observe the pathologic changes of ganglion cell and nerve plexus in internal anus sphincter of rats with congenital anorectal malformations (ARM).Methods Healthy and pregnant Wistar-Imammichi rats were induced to ARM by ethylene thiourea (ETU). There were 67 rats with ARM at all. The pelvis was continuously cut from the exactly midsagittal plane. The HE staining was performed, and the numbers of the ganglion cell and nerve plexus in the internal anus sphincter were observed under the microscope.Results The average numbers of the ganglion cell and nerve pluxes in the ARM embryos were (1.206±0.012) and (0.308±0.051). Those of the normal control embryos were (3.710±0.043) and (1.227±0.072) respectively. There was a significant difference between two groups ( P<0.05～0.01). While, those of the embryos without ARM which dealt with ETU were (3.012±0.032) and (1.187±0.004) respectively, didn't differ from the normal control embryos.Conclusion The decrease of the ganglion cell and the nerve plexus in internal anus sphincter is an important pathologic change of ARM.

OBJECTIVE:To systematically review the efficacy and safety of pirfenidone in the treatment of idiopathic pulmo-nary fibrosis (IPF),and provide evidence-based reference for clinical treatment. METHODS:Retrieved from Cochrane Library, PubMed,EMBase,CJFD,CBM,VIP Database and Wanfang Database,randomized controlled trials (RCT) about the efficacy and safety of pirfenidone (test group) versus placebo (control group) in the treatment of IPF were collected,and Meta-analysis was performed by using Rev Man 5.1.7 software after data extracting and quality evaluating by modified Jadad. RESULTS:Totally 4 RCTs were enrolled,involving 1 153 patients. Results of Meta-analysis showed the decrease value of lung capacity [WMD=0.39,95%CI(0.16,0.61), P<0.001] and decrease value of the percentage of forced vital capacity to expected value [RR=0.68, 95%CI(0.53,0.87),P=0.002] in test group were lower than control group,there was significant difference between 2 groups;there was no significant difference in the lowest oxygen saturation [WMD=0.53,95%CI(-0.78,1.84),P=0.43] between 2 groups,however,the results of subgroup analysis showed the remission degree of 1 200 mg/d PFD for the decrease of lowest oxy-gen saturation was superior to placebo group,there was significant difference between 2 groups [WMD=1.72,95%CI(1.33,2.10), P<0.001],but therewas no significant difference between the remission degree of 1800 mg/d and placebo;and there was no signifi-cant difference in the incidence of adverse reactions between 2 groups [RR=1.70,95%CI(0.46,6.31),P=0.43],but the incidence of photosensitivity veactions in test group was significantly higher than that of control group,there was significant difference [RR=9.35,95%CI(4.23,20.67),P<0.001]. CONCLUSIONS:The efficacy of pirfenidone in the treatment of IPF is good,but the inci-dence of photosensitivity reactions should be noticed.

Objective To compare the treatment effects between lymphatic chemotherapy and regional extended release chemotherapy (RERC) for rectal cancer lymph node metastasis. Methods The lymph nodes at or beside colon (first station), beside (second station) and at the root of mesentery blood vessel (third station) of the patients with rectal cancer in control group (20 cases), lymphatic chemotherapy group (20 cases) and RERC group (20 cases) were removed to compare proliferation index (PI), apoptotic index (AI) and AL/PI of cancer cells in the lymph nodes. Results The PI, AI, and AI/PI of cancer cells in correspondent lymph nodes were not statistically different between lymphatic chemotherapy group and the other 2 groups (F=4.973-7.394, 5.372-8.694, 4.527-5.436, P<0.05; t=3.128-7.688, 3.388-9.615, 6.518-13.180, P<0.05). The PI, AI, and AI/PI of cancer cells in the first and second station lymph nodes in RERC group were significantly different from those in control group (t=5.103, 4.927; 6.938, 6.450; 8.839, 9.021; P<0.05), and from those in the third station lymph nodes in RERC group (F=6.572, 8.964, 5.845, P<0.05; t=3.505, 3.353; 5.397, 4.701; 9.039, 8.629; P<0.05). Sorted by the treatment effects for cancer cells in lymph nodes, the first is each station of the lymphatic chemotherapy group, followed by the first and second station of the RERC group, and then the third station of the RERC group which was almost equal to any station of the control group. Conclusion Lymphatic chemotherapy is better than RERC in the treatment of rectal lymph node metastasis in the aspect of scale and degree.

ObjectiveTo investigate the experience of resection of superior sulcus tumors using the improved antero-cervical parastemal approach.MethodsThe clinical data of 3 patients with superior sulcus tumor from July 2005 to May 2010 were analyzed retrospectively.Three patients with superior sulcus tumor underwent en bloc resection using the improved antero-cervical parastemal approach.The 1st to 3rd rib were excised,1 case with 1/5 centrum vertebra excision,1 case with the 1st transverse process of thoracic vertebra excision,1 case with the 1 st and 2nd transverse process of thoracic vertebra excision,1 case with T1 nerve root and sellate ganglion excision.ResultsAll the patients recovered well after operation.There was no serious complication except for 1 case with secondary Horner syndrome.The mild paradoxicalbreathing was found in 3 cases postoperative dressing change,but they had no dyspnea and tolerance well.The paradoxical breathing was disappeared when the mediastinum was fixed after 14 d thoracic wall pressure dressing.The pathological diagnosis after operation:2 cases with squamous-celled carcinoma,1 case with adenosquamous carcinoma,there was no mediastinal lymph node metastasis,cutting edge was negative.Stage:2 cases with T3N0M0,1 case with T4N0M0.Three cases were treated with chemotherapy (NP plan) for 4 cycles after operation without radiotherapy.Three cases were followed up for 53,37, 13 months after operation,they were all survival without recurrence and good quality life.ConclusionsFor the treatment of especially anterior and middle seated superior sulcus tumors,improved antero-cervical parasternal approach provides a safe and effective exposure.The improved antero-cervical parasternal approach is worthy of promotion.

Objective To quantify sjTREC using a modified method in patients who underwent allogeneic hematopoietic stem transplantation (all-HSCT),and determine the level of thymic output function and analyse the influencing factors in post-allo-HSCT patients.Methods Real time quantitative PCR was used to detect sjTREC levels from the peripheral blood DNA of pre-transplantation,14 d,28 d,3 m,6 m,9 m,1 y,1.5 y,2 y,2.5 y,and above 2.5 y after HSCT,and analyse thymic output function and related factors after HSCT.sjTREC levels in 24 normal individuals were also determined to use as the normal range.Results The mean of Log (sjTREC copies/ml) in normal individuals was 3.74±0.26.Negative correlation existed between thte Log sjTREC and the age (r =-0.65,P ＜ 0.01).There was no clear association between the TREC and the gender.Log sjTREC in pre-transplantation patients was 3.09±0.52,and the levels of sjTREC in 14 d,28 d,6 m,1 y after HSCT were 1.18±0.22,2.16±0.31,1.31±0.2,1.83±0.31,respectively.There was no significant difference between normal individuals and patients 1.5 years after HSCT.The post-transplantation level of sjTREC was not related to the age,but was negatively correlated to the acute graft versus host disease (aGVHD) 1 year after HSCT.There was no difference between patients with or without aGVHD 1.5 years post-HSCT.Conclusion The modified method for detecting sjTREC is applicable to allo-HSCT.The recovery of thymic output function after allo-HSCT is slow,in which aGVHD may have a negative effect.

BACKGROUND:Surgical accuracy is a key to surgical success.The traditional positioning method mainly depends on surgeons' experience,which is too subjective to cause screw misplacement.Three-dimensional (3D) printing technology-assisted pedicle screw placement can make individualized surgical scheme,most importantly,it is accurate and simple showing promising application prospect.OBJECTIVE:To design an individualized pedicle guide plate with 3D printing and to simulate screw placement in vitro,and to explore its feasibility in vertebral pedicle screw placement.METHODS:Lumbar spine CT data of 11 patients with degenerative lumbar spine were selected from April 2016 to July 2016 at Hebei General Hospital,and 3D reconstruction of L1,L3 and L5 vertebrae of each case was performed.Pre-experiment was conducted based on one patient's lumbar CT data:according to the principle of screw placement,the screw position and orientation were designed to prepare the best pedicle guide plate model.Afterwards,the screw placement in vitro was simulated,and was then cut by chainsaw to verify the accuracy of screw placement.RESULTS AND CONCLUSION:(1) A total of 30 pedicle guide plates were used,and 60 screws were inserted in the patients,and the placement process was successful.The guide plates adhered well,none appeared with screw perforating the pedicle cortex,and the screw position was accurate and reliable.(2) There were no significant changes in the transverse section and sagtial section angles of the left and right pedicle screws before and after placement (P ＞ 0.05).(3) These results suggest that the 3D-printed individualized pedicle guide plate holds a good accuracy of placement,which can be applied in the vertebral pedicle screw placement,but further clinical trials are needed.

Objective To determine the best endoscopic treatment for acute obstructive suppurative cholangitis (AOSC).Methods Data of 93 patients who were diagnosed as having AOSC in endoscopic center in the last three years were retrospectively analyzed.All patients were divided into three groups according to the different treatment methods:ENBD group,ENBD+ERBD group and double ERBD group.Postoperative temperature,bilirubin levels and mortality were compared.Results For patients with high level obstruction,incidence of fever in ENBD+ERBD group and double ERBD group were significantly higher than that of ENBD group (1/18 VS 4/10,P ＜ 0.05;0 VS 4/10,P ＜ 0.05).There were no significant differences in incidence of fever(1/18 VS 0) or bilirubin level decrease (17/18 VS 14/15) between ENBD+ERBD group and double ERBD group.For high level obstruction,if the patient had biliary imaging with contrast medium during operation,they would have higher incidence of high fever[(4/10 VS 3.45％ (1/28)] and mortality(3/11 VS 0),lower declining rate of bilirubin level [10/14 VS 96.55％(28/29)] than those without.Conclusion Both left and right hepatic ducts drainage should be recommended for high level biliary obstruction.During the operation,contrast medium should be limited to minimum dose,and should be avoided in high level obstruction cases.Air biliary imaging could be used when necessary.