Objective To evaluate the risk factors of myasthenic crisis after thymectomy for myasthenia gravis.Methods Meta-analysis was performed to screen risk factors of myasthenic crisis after thymectomy for myasthenia gravis based on 21 associated articles published and carried out using Stata12.0.Results Twenty one studies were identified, including 3 092 patients and 698 patients developed myasthenic crisis after thymectomy.Complicated with thymoma(OR =3.93, 95％ CI 2.37-6.50, P =0.000), Ossermen classification (OR =0.12, 95 ％ CI 0.09-0.17 , P =0.000) , history of preoperative myasthenic crisis (OR =5.36, 95 ％ CI 3.82-7.51, P =0.000) , use steroid hormonea (OR =1.75,95 ％ CI 1.26-2.43, P =0.001) , postopertive lung infection(OR =4.27,95％ CI 1.63-11.18, P =0.003) , operation methods(OR =0.34,95％ CI 0.21-0.56, P =0.000) , the dose of preoperative anticholinesterase drags (OR =0.35, 95 ％ CI 0.18-0.66, P =0.000) ,pulmonary function(OR =0.18, 95％ CI 0.06-0.57, P =0.004), preoperative serum level of anti-acetylcholine receptor antibody(OR =0.06, 95％ CI0.03-0.13, P =0.000)were associated with myasthenic crisis after thymectomy.Gender, course of disease were not associated with myasthenic crisis after thymectomy.Conclusion With thymoma, Ossermen classification, history of preoperative myasthenic crisis, use steroid hormonea, operation methods, the high dose of preoperative anticholinesterase drugs, poor pulmonary function, postopertive lung infection, high preoperative serum level of anti-acetylcholine receptor antibody are risk factors affecting myasthenic crisis after thymectomy.

Objective To summarize the experience in the diagnosis and surgical treatment of pulmonary sequestration. Method The clinical data from 15 patients with pulmonary sequestration underwent surgical operation from July 2000 to January 2009 were reviewed and analyzed retrospectively. Results Pulmonary sequestration was diagnosed in 14 patients before the operation with the diagnosis rate of 93.33% (14 /15).Preoperation plane and contrast chest CT scan were performed in all cases,and 9 patients performed angiography reconstruction. Twelve patients with intralobar sequestration underwent lobectomy and 3 patients with extralobular sequestration underwent local lesion resection. Abnormal supply arteries were intraoperatively found in 14 patients originating from the thoracic main artery, 1 patient from the eeliac artery. Smooth recovery was achieved in all patients. No perioperarive death occurred. Conclusions Pulmonary sequestration is a rare disease with high misdiagnosis rate in some patients. Contrast enhanced CT scan and angiography may improve the diagnosis of pulmonary sequestration. Operation is a safe and effective method for the treatment of pulmonary sequestration.

Objective To explore the correlation between caring behavior and critical thinking of nursing students in clinical practice. Methods Totally 203 nursing students in clinical practice were investigated with Critical Thinking Disposition Inventory- Chinese Version (CTDI- CV) and Caring Behavior Scale (CBS). Results The structural model obtained a good fit. Critical thinking and caring behavior were positively correlated with each other(β=0.46,P<0.01). Conclusions Nursing students′caring behavior could improve their critical thinking. With the cultivation of critical thinking of nursing students, nursing educators should pay attention to improving their caring behavior.

Objective To evaluate the application of preoperative CT-guided Hook-wire localization of pulmonary nodules in thoracoscopic lobectomy of lung.Method Twenty eight patients with 31 pulmonary nodules of ground-glass opacity (GGO) detected by CT scan were admitted in our hospital from December 2008 to December 2013,including 17 males and 11 females with an average age of 55.The lesions were located by CT-guided Hook-wire technique,and lobectomy plus lymphadenectomy or pulmonary wedge resection were performed according to the results of fast frozen pathology.The characteristics of pulmonary nodules and general condition of the patients were analyzed.Results Among 31 nodules,19 were malignant and 12 benign with an average size of (1.8 ± 0.6) cm and thickness of (1.2-± 0.4) cm.The vertical distance from pleural to nodules was (1.5 ± 0.7) cm and the insert depth of needle was (2.5 ± 0.9) cm.The time for CT-guided Hook-wire localization was (16.5 ± 5.2) min.The operation time for pulmonary wedge resection and pulmonary lobectomy was (18.5 ± 5.5) min and (54.7 ± 12.5) min,respectively.Intraoperative frozen section showed malignant tumors in 18 patients (19 GGO nodules),lobectomy plus lymphadenectomy were performed in 16 cases; 2 patients did not undergo pulmonary lobectomy because of poor physical condition or 2 GGO nodules in different lobes.There were no operation complications in this series.Postoperative pathologic findings of 31 nodules showed 9 cases of adenocarcinoma,10 bronchioloalveolar carcinoma,5 atypical adenomatous hyperplasia,2 epithelioid hemangioendothelioma,2 chronic inflammation,1 hamartoma,1 inflammatory pseudotumor and 1 sarcoidosis.The average postoperative hospital stay was (6.6 ± 1.9) days.Conclusions Endoscopic resection of pulmonary GGO nodules with CT-guided Hook-wire localization technique is feasible and safe,with less complications and less time consuming.

This study retrospectively analyzed 7 patients with severe pectus excavatum who underwent thoracoscope-assistant Nuss procedure from July 2006 to June 2008.All the participants were followed up for 1 to 24 months(mean,15.7 months).No intraoperative or postoperative complications were found in any of the patients.The operating time was 40 to 55 minutes.Mean hospital stay was 5 days (range,4 to 7days).Our experience with the minimally invasive repair of pectus excavatum might be encouraging.thoracoscope-assistant Nuss could effectively treat pectus excavatum in children,associated with minimal invasion,lower morbidity,less hospital stay,and considerable improvement in physiologic and psychological function.

Objective To evaluate the acute side effects and efficacy of three dimensional conformal radiotherapy(3DCRT)combined with chemotherapy(CT)for locally advance non-small cell lung cancer(NSCLC).Methods from May.2002 tO Dec 2004,36 patients with NSCLC were treated with three dimensional-conformal radiotherapy combined with chemotherapy navelbine+cisplafin(NP)Results The overall response rate(CR+PR)was 91.7% for the primary tumor,and 100%for metastases mediastinal lymph mode.The leucopenia mte was 94.4%(55.6%Grade 3.4)Acute radiation esophagitis occurred in 52.8%of patients(Grade 1.2)Acute radiation pneumonitis was observed in 11.1%of patients(Grade 1.2)Conclusion 3DCRT combined with CT is well tolerated in most patients with NSCLC.Its early responses are milder than the conventional radiotherapy combined with chemotherapy.Remote results awmt further follow-up

Objective The stentless full root aortic bioprosthesis has superior hemodynamics.Clinical data of Bio-Bentall procedure using stentless full root bioprosthesis of our center was retrospectively analyzed in this perspective for validation.Methods From November 2001 to March 2009,317 adult patients ( 196 male and 121 female) underwent modified Bio-Bentall procedure using the Medtronic Freestyle xenograft as a full root replacement.Two hundred and three patients received an isolated root replacement or a root and ascending aortic replacement (ARR).In 114 patients a variety of concomitant procedures including coronary artery bypass grafting ( n =32 ),mitral valve repair ( n =11 ) and aortic arch replacement ( n =36 ) were performed.(ARR + ).Results Mean patient age was (70.3 ± 10.2) years (range 17 -94 years),97 patients were 75 and older at time of procedure.Mean operative time for the ARR was ( 190 ± 57 ) min with a clamp time of 88 - 27 min.Mean operative time for ARR + group was (282 ±93) min with an average clamp time of (110 ±32) min.Overall operative mortality was 7.9％ (25/317),for ARR it was 5.4％ (11/203 ).Mean ICU stay was (4.9 ± 8.1 ) days,mean hospital stay being (9.8 ± 8.1 ) days.Necessity for bailout bypass surgery among patients with ARR was low at 1.5％ (3/203) comparable to stented xenograft implantations.Echocardiography demonstrated excellent clinical results with low transvalvular gradients especially when a single suture inflow anastomosis technique was used.Conclusion Full root stentless valve implantation preserving porcine root integrity is a valuable option in aortic valve/ascending aorta surgery.Though technically a more challenging operation,it does not lead to increased perioperative morbidity and mortality and can be beneficial mainly for elderly patients with small aortic roots with or without aortic root pathology.

A total of 850 patients undergoing the 3-field esophagectomy were retrospectively recruited and divided into tubular stomach reconstruction group (n =453) and whole stomach reconstruction group (n =397).They underwent esophagectomy through right thorax,left cervical part,abdominal triple incisions and esophageal reconstruction by hand-sewn two-layer anastomosis.In comparison with whole stomach,esophageal reconstruction with tubular stomach had a lower incidence of anastomotic leakage,less manifestation of intrathoracic syndrome and less occurrence of reflux esophagitis (P ＜ 0.05).However,the incidence of anastomotic stricture showed no significant difference between two groups (P ＞ 0.05).It suggests that,for esophageal cancer patients undergoing the 3-field esophagectomy,tubular stomach is better than whole stomach for esophageal reconstruction as reflected by reduced occurrences of postoperative anastomotic leakage,intrathoracic syndrome and reflux esophagitis.

Background and objective Fast track surgery (FTS) can accelerate rehabilitation and reduce postop-erative hospital stay. It has been effectively applied to several surgical diseases. However, the safety and effectiveness of FTS for patients with lung cancer in China is unclear. hTismeta-analysis aimed to evaluate the effect of FTS undergoing lung cancer surgery in China.Methods Using home and abroad databases to search all documents required. hTe deadline of retrieval was January 31, 2016. hTen the studies were screened according to the inclusion and exclusion criteria. Data were analyzed by RevMan 5.3 sotfware.Results 8 randomized controlled trials (RCTs) and 5 clinical controlled trials (CCTs) with 1,241 pa-tients were eligible for analysis. Compared with control group, FTS group can signiifcantly shorten postoperative hospital time (MD=-3.61, 95%CI: -5.05--2.16,P<0.000,01) and chest tube duration (MD=-2.62, 95%CI: -3.07-2.17,P<0.000,01), reduce incidence of postoperative complications (OR=0.30, 95%CI: 0.19-0.47,P<0.000,01) and hospitalization costs (MD=-0.92, 95%CI: -1.19--0.65,P<0.000,01).Conclusion FTS can safely and effectively accelerate the recovery of patients with lung can-cer in China, it exhibits important clinical values.

Non-coding RNAs can be constructed into a complex network of ceRNA by competitive combination of common microRNA recognition sequences(MREs). At present, abnormal expression of non-coding RNAs has been found in many human cancers, including lung cancer. More over, many kinds of ceRNA-microRNA-RNA have been found, which have been proved to be involved in the biological processes of lung cancer, such as occurrence, invasion, metastasis, drug resistance and prognosis. This review focuses on the differential expression of ceRNA network members in lung cancer cells and the effects of their specific changes on lung cancer.