Objective To study the short-term(≤1 year) effect of video-thoracoscope in the treatment of chronic obstructive pulmonary diseases (COPD) accompanied with pneumothorax.Methods 52 COPD cases with pneumothorax from June 2005 to June 2007 were divided into thoracoscope group(n=28) and open heart group(n=24).The patients were followed up at 1,6 and 12 month after surgery,for determination of BODE index,including body mass index,air block,difficulty in respiratory and motor ability.Results No operative death and servere complicatins occurred.Pneumothorax did not relapse.One month after surgery,air block was[(58.62±15.73)% vs (50.12±11.38)%],difficulty in respiratory was[(1.04±0.37)s vs( 1.72±0.45)s] and motor ability was [(387.32±52.07)m vs (318.35±61.52)m] in thoracoscope group and open heart group (P<0.05).At the six month after surgery,body mass index was[(27.19±2.18)kg/m2 vs (20.90±2.35)kg/m2] in thoracoscope group and open heart group(P<0.05);At the 12 month after operation,there was no significant difierence in BODE index between the two groups(P>0.05).Conclusions Video-thoracoscope in treating COPD with pneumothorax can remarkably improve the quality of life early after surgery.

Objective To explore the clinical characteristics of bronchial carcinoma in elder patients and determine the operative indication, surgical technique, and management in the perioperative period. Methods 16 patients with bronchial carcinoma aged 80 and over received major pulmonary resection through muscle sparing mini-thoracotomy. The operative procedures were lobectomy(8 cases), bilobectomy (3 cases), sleeve lobectomy (2 cases), pneumonectomy (1 case), and lobectomy plus wedge resection (2 cases). Clinical data were analyzed retrospectively. Results Of the 16 patients, 6 with stage Ⅰ disease, 3 with stage Ⅱ and 7 with stage Ⅲdisease. There were no perioperative death occurred. The most popular postoperative complications were cardiac arrhythmia, pulmonary infection and hypoxemia. Conclusion Major pulmonary resection is a rational choice for part of the octogenarian patients with lung cancer.

Objective To observe the long-term efficacy of human fibrin sealant (FS) in the treatment of proximal type Ⅰ endoleak after endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm (AAA).Methods The clinical data of 104 AAA patients with proximal type Ⅰ endoleak receiving EVAR + FS in Changhai Hospital from 2003 to 2012 was retrospectively analyzed,among those 77 cases were with less than 15 mm proximal neck,21 cases with greater than 60 degrees proximal neck angulation,37 cases with severe calcification or thrombosis in proximal neck.After failure of conventional endoleak therapy FS was injected through AAA catheter and long-term efficacy was evaluated by CTA during the follow-up.Results Intra-sac pressure decreased significantly after FS injection.Three patients (2.9％)died perioperatively.Postoperative 1'-,3' and 5 year survival rate was 91.8％,80.6％ and 60.2％respectively.Maximum diameter of AAA decreased from (58.78 ± 13.41) mm to (52.6-± 12.2) mm.There was no FS injection related complications.Conclusion Intra-sac injection of FS is an effective,economical and safe method for treating post-EVAR endoleak,especially for AAA with relatively short and twisted aneurysm neck.

OBJECTIVETo study the expression of peroxisome proliferators-activated receptor (PPAR) in human glioma tissue and its influence on tumor growth.

METHODSExpression of PPAR mRNA in glioma tissue was determined by real-time reverse transcription polymerase chain reaction (RT-PCR). Subsequently, MTT (3-(4, 5)-dimethylthiahiazo(-z-y1)-3, 5-di-phenytetrazoliumromide) assay, flow cytometry, reactive oxygen species assay kit and Western blotting were used to assay U87 cells with agonist activity of PPAR.

RESULTSThe data demonstrated that the expression of PPAR in glioma was low and negatively correlated with its pathological grade. Activation of PPAR suppresses tumor cell proliferation, delays the cell cycle at G1 phrase, and induces apoptosis and accumulation of reactive oxygen species (ROS) in U87 cells.

CONCLUSIONThe expression of PPAR mRNA in human glioma was low. PPAR protein plays a critical role in the progression of glioma via the PPAR signal pathway.

Apoptosis ; Cell Cycle Checkpoints ; Cell Line, Tumor ; Cell Proliferation ; Gene Expression ; Glioma ; genetics ; metabolism ; physiopathology ; Humans ; PPAR alpha ; genetics ; metabolism ; Signal Transduction

Objective To investigate the situation and the causes of neonatal death in Henan Province.Methods This study retrospectively analyzed the clinical data of 277 neonates who died at 18 hospitals in Henan Province in 2017.Distribution and causes of neonatal deaths,differences between perinatal conditions of premature and term/post-term infants,causes of early (＜ 7 d) and late (7-28 d) neonatal deaths and the differences in neonatal death cases between Maternal and Child Health Care Hospitals and General/Children's Hospitals were analyzed.We used t,rank-sum and Chi-square test (or corrected Chi-square test,or Fisher's exact test) for statistical analysis.Results (1) A total of 50 993 newboms were admitted to the 18 hospitals in 2017,297 of which died with a mortality of 5.82‰.After excluding 20 cases with uncertain birth or maternal pregnancy history or clinical data,277 cases with complete data were analyzed.Among them,168 (60.6％) were preterm neonates and 109 (39.4％) were term/post-term ones.Early and late neonatal deaths accounted for 74.0％ (205 cases) and 26.0％ (72 cases),respectively.(2) The top five causes of neonatal deaths were infection (78 cases,28.2％),asphyxia (54 cases,19.5％),neonatal respiratory distress syndrome (NRDS,33 cases,11.9％),severe congenital malformations (26 cases,9.4％) including cyanotic congenital heart diseases,digestive malformations,airway malformations and neural tube defects and pulmonary hemorrhage (23 cases,8.3％).Among them,the top three causes of early neonatal deaths were asphyxia (48 cases,23.4％),infection (43 cases,21.0％) and NRDS (33 cases,16.1％),while the main causes of late neonatal deaths were infection (35 cases,48.6％),major congenital malformations (9 cases,12.5％) and chromosome abnormities/inherited metabolic diseases (7 cases,9.7％).(3) Maternal complications during pregnancy accounted for 79.1％ (219 cases) and the predominant types were pregnancy-induced hypertension (43 cases,19.6％),followed by infection (36 cases,16.4％),placental-related conditions (32 cases,14.6％),gestational diabetes mellitus (23 cases,10.5％),hypothyroidism (20 cases,9.1％),fetal distress (18,8.2％),twin-twin transfusion syndrome (10 cases,4.6％) and cholestasis syndrome (9 cases,4.1％).(4) Compared with the term/post-term cases,the preterm cases had higher proportions of multiple births [27.4％ (46/168) vs 6.4％ (9/109),x2=14.016,P ＜ 0.05],assisted reproduction [7.1％ (12/168) vs 0.9％ (1/109),x2=4.421,P ＜ 0.05] and maternal hypertensive disorders of pregnancy [21.4％ (36/1 68) vs 6.4％ (7/109),x2=11.353,P ＜ 0.05],infection [16.7％ (28/168) vs 7.3％ (8/109),x2=4.295,P ＜ 0.05] and twin-to-twin transfusion syndrome [6.0％ (10/168) vs 0.0％ (0/109),x2=6.707,P ＜ 0.05].(5) Among all the early neonatal deaths,preterm cases had a higher incidence of NRDS than term/post-term neonates [20.3％ (27/133) vs 8.3％ (6/72),x2=1 1.937,P ＜ 0.05],but lower incidence of meconium aspiration syndrome (MAS),severe congenital malformations and chromosome abnormalities/inherited metabolic diseases [0.8％ (1/133) vs 5.6％ (4/72),x2=4.508;3.8％ (5/133) vs 16.7％ (12/72),x2=10.233;1.5％ (2/133) vs 6.9％ (5/72),~=4.172;all P ＜ 0.05].Among the late neonatal deaths,the incidence of severe intracranial hemorrhage in preterm infants was higher than that in term/post-term neonates [7.1％ (3/42) vs 0.0％ (0/30),x2=2.205,P ＜ 0.05].(6) Compared with the cases in General/Children's Hospitals,those in Maternal and Child Health Care Hospitals showed a higher proportion of preterm neonatal deaths [67.3％ (105/156) vs 52.1％ (63/121),x2=6.010,P ＜ 0.05],younger gestational age [(32.8±5.3) weeks vs (34.6±4.9) weeks,t=3.072,P ＜ 0.05],lower birth weight [(2 132.6± 1 014.5) g vs (2 409.4±987.3) g,t=-2.513,P ＜ 0.05],and higher average age of death [M(P25-P75),3 (1-8) d vs 2 (1-4) d,Z=3.710,P ＜ 0.05].Conclusions Neonatal death occurs mainly within one week after birth in those with maternal complications.Late preterm deaths and term/post-term cases account for nearly half of total neonatal deaths.The causes of death for preterm and term/post-term newborns vary with postnatal age.Infection,asphyxia and severe congenital malformations are important causes of neonatal deaths.

Objective To investigate the association between baseline IgM level and treatment response to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC). Methods A retrospective analysis was performed for the clinical data of 637 PBC patients who were diagnosed and treated with UDCA for the first time in The Fifth Medical Center of Chinese PLA General Hospital from January 2010 to January 2020. The PBC patients were divided into UDCA complete response group with 436 patients and UDCA poor response group with 201 patients, and baseline clinical data were compared between the two groups. According to the optimal cut-off value of IgM determined by the area under the ROC curve (AUC) of baseline indices in predicting the risk of poor treatment response, the patients were divided into IgM ≥1.5×ULN group and IgM < 1.5×ULN group, and baseline parameters, treatment response, and prognostic model score were compared between groups. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Cochran-Mantel-Haenszel test was used for subgroup analysis, and forest plots were plotted for related risk values. Results Compared with the UDCA complete response group, the UDCA poor response group had significantly higher proportion of patients with liver cirrhosis, levels of total bilirubin, aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bile acid, total cholesterol (TC), IgA, and IgM, and positive rate of anti-Gp210 antibody at baseline ( χ 2 =4.596, Z =-9.932, -8.931, -8.361, -7.836, -4.694, -3.242, and -2.115, χ 2 =15.931, all P < 0.05). The UDCA poor response group had significantly higher Mayo Risk Score, Globe score, and UK-PBC risk score than the UDCA complete response group ( t =4.092, Z =-10.910 and -11.646, all P < 0.001). Compared with the normal IgM group, the elevated IgM group had significantly higher levels of AST, ALP, TC, IgA, and IgG and a significantly higher positive rate of anti-Gp210 antibody ( Z =-3.774, -5.063, -4.344, -2.051, and -6.144, χ 2 =25.180, all P < 0.05). IgM had an AUC of 0.552 in predicting poor treatment response. Compared with the IgM < 1.5×ULN group, the IgM ≥1.5×ULN group had significantly higher levels of AST, ALP, TC, and IgG, a significantly higher positive rate of anti-Gp210 antibody, and a significantly higher poor UDCA response rate ( Z =-4.193, -5.044, -3.250, and -5.465, χ 2 =25.204 and 8.948, all P < 0.05). IgM ≥1.5×ULN had an odds ratio of 1.416 (95% confidence interval [ CI ]: 1.129-1.776, P =0.003) in predicting poor response. The subgroup analysis showed that for patients without liver cirrhosis, IgM ≥1.5×ULN had an odds ratio of 1.821 (95% CI : 1.224-2.711, P =0.003) in predicting poor response. Conclusion Baseline IgM level has an important value in predicting UDCA response. IgM level should be closely monitored during treatment in PBC patients with a high baseline IgM level, and second-line drugs should be given in time if the abnormality persists.