Purpose:To evaluate the clinical effects and indications of surgical treatment of non small lung cancer invading the left atrium and great vessels and trachea carina. Methods:From August 1998 to Auguest 2003, we performed operations on patients with non-small lung cancer invading the left atrium in 3 cases, invading the descending aorta in 1 case, invading trachea carina in 3 cases; all the patients have been examined to exclude distant metastasis, including nuclear bone scan to exclude bone metastasis; there were 2 cases of left pneumonectomy and one of right pneumonectomy invading the left atrium, there were 3 cases of right sleeve pneumonectomy invading the trachea carina. For the cases invading the descending aorta, we performed the operation with atrium-aorta bypass, Pathology examination: all of the cases were squamous lung cancer, staging of T 4N 0M 0 for 6 cases,T 4N 2M o for 1 case. Results:No complication, follow up: 6 cases survived more than 1 year,1 case survived more than 9 months;4 cases were alive for more than 3 years, 1 case invading the atrium died in 30 months because of brain metastasis,1 case invading the carina died in 15 months because of pulmonary infection. Conclusions:For localized advanced non-small lung cancer invading the aorta and invading the carina and the atrium, if we selected the patient correctly and with a good surgical technique with complete radical resection of the tumor ,we can acquire good results.

Background and purpose:VATS lobectomy has gained popularity for lung cancer around the world.Complete anatomic resections and node dissections are routinely being performed at many centers under VATS,but some thoracic surgeons are concerned regarding the safety,benefit and radical resection of this operative method.Our study is to evaluate the reliability and feasibility of pulmonary resection by video-assisted mini-thoractomy(VAMT) for patients with lung cancer.Methods:72 patients with lung cancer received either lobectomy and systemic lymph node dissection by video-assisted mini-thoracotomy(VAMT group;n=32) or conventional thoracotomy(conventional group;n=40),lobectomy was performed by conventional or thoracoscopic instruments,specific lymph node clamps were applied for lymph node dissection.Results:VAMT was successfully performed without significant postoperative complication and blood transfusion.No significant differences were observed in the two groups with respect to the length of operation and the total groups of dissected lymph nodes.This study showed that VAMT is a minimally invasive surgery without impairing of the outcome and needed less operative blood loss and shorter postoperative hospitalization compared to conventional thoracotomy.Conclusions:Major pulmonary resection by video-assisted minithoractomy for patients with lung cancer is safe,reliable and less invasive,it is consistant with the surgical standard of lung cancer.Its long-term benefit needs to be clarified after further follow-up.

Purpose: To evaluate the causes and management of bronchial pleural fistula after pneumonectomy. Methods: Retrqspective analysis for Bronchus-pleural fistula( BPF) of 16 cases after pneumonectomy of 820 cases of lung cancer in our hospital. BPF occurred in right peumonectomy( 13/320) is more than in left pneumonectomy(3/500) . BPF occurred in the positive stump of bronchus ( 10/41) more than in negative stump of bronchus (6/779) ; BPF occurred in preoperative chemotherapy cases( 5/110) more than in non-preoperative chemotherapy cases( 11/710), No BPF occurred in the 70 cases in which the bronchial stump was covered by autogenous tissue. The management principle in early stage is thoracocentesis and wash with antibiotics; after identification of the infection in thoracic cavity or BPF, closed drainage for thorax was done. If the results of drainage are not very good, open drainage is necessary. Results: 2 cases were discharged with completely healing, (the cavity of 1 case was washed again and again with 5% NaHC03and urokinase , another case was operated again to cover the BPF using muscle flaps 3 days after the first operation), 8 cases were discharged with closed drainage, 4 cases were discharged with open drainage changing the wound covering every day, the BPF did not heal for a long time after open drainage in 1 case, 1 case died of function failure of body organs. Conclusions: BPF is related to management of the bronchial stump and radical resection for tumor, It is a useful method to cover the bronchial stump with autogenous tissues to decrease BPF's, especially for right pneumonectomy and preoperative chemotherapy or radiotherapy cases. The management principle of BPF is thoracocentesis for early cases, especially washing with antibiotics and 5% NaHC03and urokinase repeatedly, closed drainage when necessary is also a good method for curing empyema and BPF.

Objective To evaluate the reliability of video-assisted mini-thoracectomy(VAMT) for the diagnosis and treatment of patients with pulmonary peripheral nodules.Methods A total of 55 patients with pulmonary peripheral nodules(1 case of multiple nodules and 54 cases of solitary nodule) underwent VAMT.The surgery included wedge resection in 23 patients and lobectomy with lymph node dissection in 32 patients(The lobectomy was performed by using conventional combined with thoracoscopic instruments.A self-made lymph node clamp was applied for lymph node dissection).Results The operation was successfully accomplished under thoracoscopy in all the 55 patients.The operation time was 35~180 min(mean,109 min) and the intraoperative blood loss was 50~400 ml(mean,122 ml).No blood transfusion was required.Postoperative complications included air leakage in 1 patient(discharge on the 32 postoperative day) and delayed wound healing in 1 patient(discharge on the 19 postoperative day).The length of postoperative hospital stay of the other 53 patients was 4~11 days(mean,8.3 days).Final pathological diagnosis showed 15 cases of benign lesions,38 cases of primary lung carcinoma,1 case of atypical adenomatous hyperplasia,and 1 case of metastatic lung cancer.The benign lesions were cured by wedge resection.Anatomic lobectomy with lymph node dissection was performed in 32 patients with primary lung cancer.Of other 6 patients with terminal lung cancer,4 patients were conservatively treated because of an extensive dissemination and 2 patients received a palliative wedge resection because of poor pulmonary functions.Conclusions Video-assisted mini-thoracectomy is helpful for the diagnosis and treatment of pulmonary peripheral nodules.Its long-term effects for clinical early-stage lung cancer need further follow-up investigations.

Objective We aimed to compare the critical thinking ability between clinical nurses and college nursing students at different grades so as to provide scientific references for reform in nursing education and nursing practice. Methods A total of 287 clinical nurses and 656 nurses in grade one and grade three underwent the investigation by adopting Chinese version of critical thinking disposition inventory (CTDI-CV). Results The total scores of CTDI-CV of nursing students in grade one, nursing students in grade three and clinical nurses were (292.82±26.41), (284.71±26.20) and (290.58±24.87). Statistical difference existed between these groups. The scores of open-mindedness, inquisitiveness and maturity of judgement of nursing students in grade one and grade three were higher than that of the clinical nurses, while the scores of systematicity and self-confidence of critical thinking were less than that of the clinical nurses. Conclusions The current nursing education system needs further reform. At the same time we should also promote the transform of modern clinical nursing model.

As the human population ages and the life expectancy increases,tendon injuries will become more prevalent,especially among young individuals.Though the traditional operative therapy for tendon lesion can relieve the suffering of patients,the functional reconstruction is usually not optimistic.Tissue engineering is an advancing field,as the technology of construction in vitro and application in vivo matures,that can provide a more promising approach for tendon repair without tendon autograft.Challenges and future directions in the field of tendon tissue engineering focusing on four key parameters:seed cells,novel scaffolds,and mechanical stimulation.Recently,the discovery of TDSCs (tendon-derived stem cells) provides new ideas for the selection of seed cells and effect of mechanical stimulation on the tendon tissue engineering has become a hot spot.This article provides a review of recent progress in research about seed cells,scaffolds and mechanical stimulation for tendon engineering,and also speculates on the development in the future.

Objective To investigate the effect of breviscapine on lung injury in children undergoing open heart surgery with cardiopulmonary bypass(CPB).Methods Forty-five ASA Ⅱ or Ⅲ children aged 3-65 months weighing 5-21 kg undergoing open heart surgery with CPB were randomly assigned to 3 groups ( n =15 each):control group (group C),low dose breviscapine group (group B1 ) and high dose breviscapine group (group B2).Normal saline 15 ml(group C),breviscapine 0.5 mg/kg (group B1 )or 1.0 mg/kg(group B2 ) were injected iv over 30min after anesthesia induction.Blood samples were taken before operation ( T0 ),at 30 min and 1 h of aortic unclamping (T1,T2 ),at 3 h and 6 h after operation (T3,T4 ) for determination of plasma procalcitonin (PCT)and neutrophil elastase(NE) concentrations.PaO2 and PaCO2 were recorded at T0,T3,T4 for caculation of oxygenation index (OI) and alveolo-arterial oxygen partial pressure difference (PA-a O2 ).Results There were no significant differences in OI and PA-a O2 among the 3 groups( P ＞ 0.05).Plasma concentration of PCT was higher at T1～4in 3 groups,and plasma concentration of NE was higher at T1 in group C than that at T0 ( P ＜ 0.01 ).Plasma concentrations of PCT and NE were lower in groups B1 and B2 than in group C ( P ＜ 0.01).There were no significant differences in plasma concentrations of PCT and NE between groups B1 and B2 ( P ＞ 0.05).Conclusion Breviscapine(0.5,1 mg/kg) can inhibite systemic inflammatory response and attenuate lung injury in children undergoing open heart surgery with CPB.

Objective To evaluate the effects of lipoxin A4 (LXA4) administered at different time points on the expression of connexin43 (Cx43) during myocardial ischemia-reperfusion (I/R) in rats.Methods Seventytwo healthy male Sprague-Dawley rats,weighing 200-250 g,wcre equally and randomly divided into 6 groups:groups sham operation Ⅰ (group S1) and Ⅱ (group S2),groups myocardial I/R Ⅰ (group Ⅰ/R1) and Ⅱ (group I/R2),and groups LXA4 administered before chest opening (group LX1) and at 30 min of reperfusion (group LX2).Myocardial I/R was produced by 30 min occlusion of left anterior descending branch (LAD) of coronary artery followed by 120 min reperfusion.LXA4 100μg/kg was injected via femoral veins before chest opening and at 30 min of reperfusion in groups LX1 and group LX2,respectively.While normal saline 2 ml/kg was injected via the femoral vein at the corresponding time points in the other four groups.In groups S1 and S2,LAD was only threaded,but not ligated.Blood samples were taken from the femoral vein before chest opening and at 120 min of reperfusion for measurement of serum IL-8,TNF-α and cardiac troponin Ⅰ (cTnI) concentrations.The rats were then sacrificed after blood samples were taken at 120 min of reperfusion and hearts were removed for determination of Cx43 protein (by immunohistochemical SP method) and Cx43 mRNA expression (by real-time quantitative PCR),SOD activity and MDA content in myocardial tissues.The development of arrhythmia was observed from occlusion of LAD to 120 min of reperfusion.Duration of ventricular tachycardia (VTd) and ventricular fibrillation (VFd) was recorded.Scores of ventricular arrhythmias were calculated.Results The expression of Cx43 protein and mRNA was significantly down-regulated,and scores of ventricular arrhythmias,VTd,serum IL-8,TNF-α and cTnI concentrations,SOD activity and MDA content were increased in groups I/R1 and LX1 as compared with group S1,and in groups I/R2 and LX2 as compared with group S2 (P ＜ 0.05).The expression of Cx43 protein and mRNA was significantly up-regulated,SOD activity was increased,and scores of ventricular arrhythmias,VTd,VFd,serum IL-8,TNF-α and cTnI concentrations,and MDA content were decreased in group LX1 as compared with group I/R1,and in group LX2 as compared with group I/R2(P ＜ 0.05).The expression of Cx43 protein and mRNA was significantly lower,scores of ventricular arrhythmias,VTd and SOD activity were higher,and the serum IL-8,TNF-α and cTnI concentrations and MDA content were lower in group LX2 than in group LX1 (P ＜ 0.05).Conclusion LXA4 administered before myocardial ischemia and at 30 min of reperfusion can up-regulate the expression of Cx43 and reverse remodeling of Cx43,thus reducing myocardial I/R-induced arrhythmia in rats,and LXA4 administered before ischemia can provide better efficacy.

Objective To explore the appropriately operative chance , method, and perioperative management of coronary arterybypass grafting (CABG) in the patients with severe left main artery (LMA) stenosis with three-vessel-disease.Methods A total of296 patients with severe LMA stenosis with three-vessel-disease who underwent CABG surgery was analyzed retrospectively from 2003through 2013.Of them, 276 patients underwent conventional coronary artery bypass surgery on pump ( CCABG)and 20 patients underwentoff-pump CABG( OPCAB); 172 Patients was over 60 years old (58.1%)and 246 patients (83.10%) had concomitant diseasesincluding valve lesion, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect , stroke, renal failure,and cancer.Left internal mammary artery use was in 281 patients (95.1%); and 32 patients were implanted intra-aortic ballonpump(IABP) perioperatively.Results There were 7 cases(2.36 %) death of postoperative low cardiac output , ventricular fibrillation,cerebral infarction, renal failure, and multiple organ failure, respectively.Postoperative complications were low cardiac output ,respiratory failure , ventricular fibrillation, cereboembolism, cardiac tampomade, renal failure, stroke, and multiple organ failure.Afterfollow-up 2 to 84 months, there was 3 death in which 2 death of cardiac factors.Conclusions CCABG was a safe and effectivemethod in patients with severe LMA stenosis with severe three -vessel-disease.Preoperative insertion of IABP can certainly avoid the po -tential operative risk factor and significantly decrease the mortality and morbidity .

Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease.As a dengue non-endemic country,China has experienced several dengue outbreaks in recent years.However,dengue patients in China displayed distinct clinical characteristics compared to patients in endemic countries.To standardize the diagnosis and treatment of dengue fever,the experts of the Society of Infectious Diseases,Society of Tropical Medicine and Parasitology of Chinese Medical Association,and the Society of Emergency Medicine,China Association of Chinese Medicine have reached this guideline based on guidelines for diagnosis,treatment,prevention and control of dengue (World Health Organization,2009);guidelines for diagnosis and treatment of dengue (National Health and Family Planning Commission of the People's Republic of China,2014,Edition 2),health industry standard of the People's Republic of China "diagnosis for dengue fever (WS216-2018)" and systemic reports on dengue.The guideline includes 8 aspects:introduction,terminology,epidemiology and prevention,etiology and pathogenesis,clinical features,diagnosis,treatment and problems to be solved.