Objective To investigate the clinical effect of protective technique for intercostal nerve in the application of esophageal cancer surgery.Methods Seventy cases of esophageal and cardia cancer patients with thoracic operation were randomly divided into observation group and control group,and each group was 35 cases.Patients in the observation group were treated with improved protective technique of intercostal nerve during operation,and patients in the control group using the traditional methods of operation for treatment.All patients were treated with intramuscular injection of morphine analgesia drugs after operation.Results The pain score of every time point analgesia patients in the observation group (VAS score) was significant difference from that in the control group (t =3.041,2.854,1.827,2.156,1.965,2.706,P＜ 0.05).The incidence of adverse reactions of analgesia,the incidence of painless patients of postoperative 30 d and 60 d,morphine dosage,chest tube indwelling time and the average hospitalization time in observation group were 0,42.86％,68.57％,(10.6±5.2) mg (4.0±1.6) d,(17.6±4.5) d,and the control group were 17.14％,20.0％,34.29％,(22.8±7.6) mg,(4.8±1.8) d,(20.4±5.8) d (x2=4.56,4.24,8.24,t=7.838,1.965,2.257,P＜0.05).Conclusion The improvement protective technique for intercostal nerve in esophageal cancer surgery,not only can reduce thoracotomy acute postoperative pain,but also reduce the happening of the CPP.Meanwhile,the analgesic effect is good.It is proved with a simple operation,less adverse reaction,conducive to disease recovery after esophageal cancer surgery,indicating that it has clinical popularization value.

Background and purpose:It was reported that nuclear factor of activated T cells (NFAT) is closely related with carcinomas. Esophageal squamous cell carcinoma (ESCC) is one of the most common carcinomas in China. The present study investigated the expression and clinical significance of NFAT isoforms in ESCC. Methods:The expression of NFAT isoforms and the differences in different pathological levels of ESCC were detected in 104 specimens of human ESCC tissues and normal esophageal tissues by immunohistochemistry. Results:This study found that the positive rates of NFAT1 (53.8%), NFAT2 (10.6%), NFAT3 (26.9%), NFAT4 (45.2%) expression were significantly higher in tumor tissues than in adjacent normal esophageal tissues (P<0.001), respectively. The positive rate of NFAT1 expression was significant-ly higher in drinkers (62.3%) than nondrinkers (37.1%, P=0.01), and also higher in patients with lymph node metastasis (68.4% vs 5.5%, P=0.002) and with late stage (58.7% vs 36.2%, P=0.02). Multivariate analysis showed that NFAT1 expression was correlated with lymph node metastasis. The positive rate of NFAT3 was significantly higher in patients with lymph node metastasis (39.4%) than in those without lymph node metastasis (19.7%, P=0.03). Conclusion:These results suggest that the overexpression of NFAT1 and NFAT3 is associated with lymph node metastasis in ESCC.

Objective To observe the anti-atherosclerosis effects of Guizhi Fuling Capsule. Methods 50 healthy SD male rats were randomly divided into 2 groups: normal group (n=12) and AS model group(n=38). The model of experimental AS rats was established by feeding high cholesterol diet and intraperitoneal injecting VitD3. The normal control group was fed by ordinary diet. AS model group was further divided into 3 groups randomly: AS group(n=12), control group (n= 12), and therapy group(n= 12). The therapy group was given Guizhi Fuling Capsule by intragastric administration.The control group was given simvastatin and captopril by intragastric administration. 0.9% NaCl was given to the AS group instead of Guizhi Fuling Capsule. The rats were killed at the 16th weekend, and their aorta arch and breast aorta were observed.Blood fat and serum levels of Endothelin-1 (ET-1), Nitric oxide (NO), high-sensitivity C-reactive protein (hs-CRP) were detected respectively. Immunohistochemistry technology was used for observing the expression of intercellular adhesion molecule- 1 (ICAM- 1 ) in breast aorta. Results The values of ET- 1, NO, hs-CRP and the amount of ICAM- 1 were (142.61 ±25.67)ng/ml, (66.05 ± 8.63) μmol/L, (2.86±0.40)mg/L, (0.29±0.05) in the normal group; (182.38±22.96)ng/ml, (28.70±4.49)μmol/L, (5.60±0.49)mg/L, (0.58±0.06)in the AS group; (154.37±21.11)ng/ml, (45.88±11.36)μmol/L, (3.66±0.34)mg/L, (0.37±0.04)in the control group and (152.13±23.23)ng/ml, (57.67±8.96)μmol/L, (3.70±0.40)mg/L, (0.36±0.04) in the therapy group respectively. The levels of ET-1, NO, hs-CRP and the amount of ICAM-1 have significant difference between the AS group and the normal group(P=2.47E-4, 6.02E-19, 1.11E-12, 2.51E-18). There was also significant difference between the control group and the AS group(P=0.005, 1.59E-14, 1.87E-5, 3.87E-14). The level of NO in the therapy group was higher than that in the control group (P=0.002). The levels of ET-1, hs-CRP and the amount of ICAM-1 did not have significant difference between the therapy group and the control group(P=0.81, 0.81, 0.48) Conclusion Guizhi Fuling Capsule has effects of Anti-atherosclerosis on rats with AS.

Objective To assess roles of vascular endothelial growth factor(VEGF)and plateletderived growth factor(PDGF)in the mechanisms of lymphangiogenesis in epithelial ovarian carcinoma.Methods (1)Expression of Proxl,a newly described lymphatic endothelial cell nucleus marker,VEGF-A,VEGF-C,VEGF-D and PDGF-A,PDGF-B,PDGF-C,PDGF-D were detected bv RT-PCR in SKOV3 cell line and in 90 ovarian tissue samples,included 15 benigh tumors 10 borderline tumors, 45 malignant tumors and 20 normal ovarian samples.(2)Expression levels of Proxl,VEGF-A,-C,-D and PDGF-A,-B,-C,-D were detected in 90 ovarian tissue sample mentioned above by real-time quantitative PCR(RTQPCR).Resuls (1)Proxl was expressed in ovarian samples mentioned above,while not detected in SKOV3 cell. VEGF-A,-C,-D and PDGF-A,-B,-C,-D were found in SKOV3 cell and various ovarian tissues.(2)Expression levels of Proxl(2.2±1.3,P＜0.01),VEGF-A(3.5±1.5,P＜0.01),VEGF-C(19±14.P＜0.01),VEGF-D(3.0±1.8,P＜0.01)and PDGF-A(3.3±3.3,P＜0.05),PDGF-C(6.9±4.6,P＜0.01)in malignant group were found to be significantly higher than those in borderline group and benign group.(3)The expression levels of Proxl,VEGF-A and PDGF-A were significantly greater in samples from the patients with lymph node metastasis(Proxl:3.0±1.4,VEGF-A:4.1± 1.7,PDGF-A:4.9±4.1),peritoneum metastasis(Proxl:2.8±0.9,VEGF-A:4.0±1. 8,PDGF-A:4.5±4.0)and in stage Ⅲ-Ⅳ(Proxl:2.6±1.3,VEGF-A:4.0±1.4,PDGF-A:4.1±3.7)than those without lymph node metastasis,without peritoneum metastasis and in stage Ⅰ-Ⅱ.There was a significant increased in the degree of VEGF-C and VEGF-D expression in positive lymph node metastasis group(VEGF-C:24±13,VEGF-D:3.9±2.0)compared with negative group(P＜0.05).(4)There were significant positive correlations between the expression levels of Proxl and VEGF-D(r=0.62,P＜0.01),PDGF-C(r=0.91,P＜0.01)or PDGF-D(r=0.61.P＜0.01).Conclusions VEGF-A,VEGF-C and PDGF-A may promote lymphatic metastasis in epithelial ovarian carcinoma though else mechanisms other than lymphangiogenesis.VEGF-D may facilitate lymphangiogenesis and lymph node metastasis in epithelial ovarian cancer.There is no significant correlation between the expression of PDGF-B and lymphangiogenesis and lymph node metastasis.PCGF-C and PDGF-D may motivate lymphangiogenesis,but could not participate in lymph node metastasis in ovarian carcinoma.

Objective To explore the relationship between the hepatic injury and the severity of the patients with non-gallstone severe acute pancreatitis,so as to provide some evidences in the treatment on the hepatic injury,to lower the systemic and local applications of SAP,as well as lower the morality of SAP.Methods Patients suffering from non-gallstone SAP were retrospectively analyzed.We statisticated the occurrence of multiple organ dysfunction syndrome.We adopted the occurrence of MODS of the patients as the indicatrix of prognosis and analyzed the results.Univariate analysis and multivariate logistic regression analysis were used to analyze the ralationship between the markers of heapatic injury and the prognosis of the patients suffered of non-gallstone SAP.Results The univariate logistic regression analysis of the relationship between hepatic dysfunction and the occur of MODS of non-gallstone SAP shows that there were correlation between the occur of MODS and AST,ALT,ALB,respectively.The multivariate logistic regression analysis shows that there were correlation between the occur of MODS and AST,ALT,ALB,respectively.Conclusion The study showed that the heighten of the serum consentration of AST,ALT,TB and the degrade of the serum consentration of Alb were the independent influencing factors of patients with non-gallstone SAP,respectively,and suggested the unfavourable prognosis of the patients.

The purpose of this study is to investigate the basic situation of self-regulated learning among clinical medical undergraduates in the stage of professional courses and construct a structural model suitable for them to carry out self-regulated learning . Zimmerman's self-regulated learning concept framework was determined as the theoretical basis of this study. A questionnaire survey was performed to identify five main dimensions affecting self-regulated learning including expression of learning intention, self-efficacy, adjustment of learning behavior, management of curriculum strategies, and adaption of learning environment, and then, Amos 24.0 software was used to construct the structural model and draw the conclusion that self-regulated learning in this group centers on the regulation of learning behavior, with learning intention and self-efficacy as sub-centers.

BACKGROUNDWith the improvement of the surgical and anesthetic techniques, there are increasing numbers of elderly surgical patients with lung cancer. The purpose of this study is to examine the prognostic factors of surgical resection in patients more than 70 years of age.

METHODSData were retrospectively analyzed from 192 patients aged ≥70 years who underwent lung cancer surgery. Of these patients, 48.4% were in stage I, 20.8% in stage II, 19.3% in stage III, and 2.1% in stage IV. Patient demographics were the following: 79.2% male and 20.8% female; 21.9% ≥75 years older; and 11.5% had significant co-morbidities. Tumor characteristics: squamous cell carcinoma 49.0%, adenocarcinoma 35.9%, adenosquamous carcinoma 8.3%, small cell lung cancer 4.7%, others 2.1%.

OPERATIONSexploration 2.1%, wedge resection 8.3%, lobectomy 72.4%, more than lobectomy 12.5%, pneumonectomy 4.7%. Of these operations, 91.1% were radical surgery. The significance of prognostic factors was assessed by univariate and multivariate COX regression analyses.

RESULTSThe total 5-year survival rate was 33.5% in this series. Age, sex, symptom and co-morbidity had no impact on survival. Multivariable COX analysis demonstrated that incomplete resection (P=0.003), advanced surgical-pathological stage (P < 0.001) and other type of the tumor (P=0.016) were significant, independent, unfavorable prognostic determinants in patients.

CONCLUSIONSThoracic surgery is a safe and feasible approach in elderly patients with lung cancer. Every effort should be made to detect early stage patients who might benefit from surgical treatment. Lobectomy is still the ideal surgical option for elderly patients who are able to tolerate the procedure. More limited lung surgery may be an adequate alternative in patients with associated co-morbidities.