Evidence-based medicine was applied in the clinic teaching and ward inspection of superficial bladder cancer as far as no consensus was reached on its treatment.Some preferred to total cystectomy while others favored transurethral resection of bladder tumor and bladder instillation.In order to solve this problem,evidence-based medicine was applied in our clinic teaching procedure.Students were asked to read relative papers and draw the final conclusions with evidence-based medicine.Clinical guidance was provided for the students to promote clinical application.

Objective To analyze the prognosis of advanced esophageal carcinoma treated with paclitaxel and different platinum?based chemotherapy regimens plus intensity?modulated radiotherapy ( IMRT) , and to explore an optimal chemotherapy regimen. Methods A total of 242 patients with advanced esophageal carcinoma who were admitted to our hospital and treated with paclitaxel and cisplatin ( 68 patients), nedaplatin (85 patients), lobaplatin (58 patients), or oxaliplatin (31 patients) plus IMRT from 2008 to 2014 were enrolled as subjects. The prognosis of the four groups was analyzed after 2, 3, and ≥4 cycles of chemotherapy. The survival rates were calculated by the Kaplan?Meier method and analyzed by the log?rank test. The Cox model was used for the multivariate prognostic analysis. Results The sample number of 3 years was 168 cases. In all the 242 patients, the medium survival time was 31. 1 months and the 3?year overall survival ( OS) rate was 47. 4%. There was no significant difference in the 3?year OS rate between the cispaltin, nedaplatin, lobaplatin, and oxaliplatin groups ( 46. 2% vs. 56. 4% vs. 45. 7% vs. 29. 0%, P=0. 090) . The stratified analysis showed that the cisplatin, nedaplatin, and lobaplatin groups had a significantly higher OS rate than the oxaliplatin group ( 50. 1% vs. 29. 0%, P=0. 021 ) . There was no significant difference in the 3?year OS rate between patients receiving 2, 3, and≥4 cycles of chemotherapy ( 40. 1% vs. 49. 5% vs. 50. 8%, P=0. 264) . The multivariate analysis showed that esophageal tumor volume and the maximal size of metastatic lymph node were independent prognostic factors. Conclusions Combined with IMRT, paclitaxel plus cisplatin, nedaplatin, or lobaplatin?based chemotherapy achieves improved survival rates than paclitaxel plus oxaliplatin?based chemotherapy. Esophageal tumor volume and the maximal size of metastatic lymph node are independent prognostic factors.

Objective To investigate the expression and significance of TGF‐β receptor Ⅰ /TGF‐β receptor Ⅱ (TGF‐β Ⅰ /TGF‐β Ⅱ) in human skin malignant melanoma A375 cell line .Methods The reverse transcription‐real time polymerase chain reac‐tion (RT‐PCR) and Western blot were utilized to assess the expressions of TGF‐βR Ⅰ /TGF‐‐βR Ⅱ in A375 cell line and human normal melanocytes .Results The expressions of TGF‐βR Ⅰ /TGF‐‐βR Ⅱ mRNA and protein of A375 cells line were significantly lower than those of human normal melanocytes .Conclusion The down‐regulated expression of TGF‐βR in the TGF‐β/Smad signal pathway of human skin malignant melanoma may be one of the pathogenesis of skin malignant melanoma .

ObjectiveTo study the effect of heat stress on the cytoskeleton and cell cycle of human umbilical vein endothelial cell (HUVEC) in vitro.Methods HUVEC was cultured in vitro in 5%CO2 medium at 37℃ (control group) or 43℃ (heat stress group) for 1 hour. Coomassie brilliant blue R-250 staining was used to determine the effect of heat stress on the cytoskeleton. The cells in heat stress group were subsequently cultured at 37℃in 5%CO2 medium after heat stress for 1 hour, and cell cycle of HUVEC was determined at 0, 6, 12, 18 and 24 hours with flow cytometry.Results Under light microscopy normal cytoskeleton was observed in control group, but thicker and shorter cytoskeleton was found after a rise of temperature, and stress fibers were found in heat stress group. The DNA content of HUVEC at all time points in G0/G1 stage was 38.07%-55.19% after heat stress. The DNA content in control group was 48.57%, and it was 54.06%, 55.19%, 48.23%, 38.07%, and 41.03% at 0, 6, 12, 18, 24 hours in G0/G1 stage in heat stress group. DNA content in S phase was 35.33%-48.18%. The DNA content in control group was 44.62%, and it was 35.33%, 39.50%, 42.50%, 48.18%, and 47.99% at 0, 6, 12, 18, 24 hours in S stage in heat stress group. DNA content in G2/M phase was 5.31%-13.75%. The DNA content in control group was 6.81, and it was 10.61%, 5.31%, 9.27%,13.75%, and 10.98% at 0, 6, 12, 18, 24 hours in G2/M stage in heat stress group. It was demonstrated that compared with control group, the DNA content in G0/G1 stage was significantly increased when the HUVEC were separated from heat stress within 6 hours, and it recovered at a similar level as control group at 12 hours.Conclusion Heat stress can change the cytoskeleton of HUVEC, and cause stagnation at G0/G1 stage in cell cycle.

Objective To evaluate left ventricular systolic synchrony in patients with Ⅲ grade atrio-ventricular block(Ⅲ grade AVB) after pacemaker implantation by real-time three-dimensional echocardiography. Methods Methods Twelve patients with Ⅲ grade AVB implanted by VVI pacemaker, seven patients with Ⅲ grade AVB implanted by DDD pacemaker, twenty subjects with normal LV function were examined by Philips iE33 with a X3-1 probe. Results The minimal excursion in patients with Ⅲ grade AVB implanted by VVI pacemaker and DDD pacemaker was less than that in subjects with normal LV function (P <0.05) ,and two "bull eyes" displayed that some regional systolic timing delayed or ahead, but also some regional systolic excursion hypokinesis or dykinesis. Parameter index [including Tmsv 16-SD, Tmsv 12-SD, Tmsv 6-SD, Tmsv 16-Dif, Tmsv 12-Dif, Tmsv 6-Dif, Tmsv 16-SD (%), Tmsv 12-SD (%), Tmsv 6-SD (%), Tmsv 16-Dif (%), Tmsv 12-Dif (%), Tmsv 6-Dif(%)] of 17 segment time to minimal systolic volume in patients with Ⅲ grade AVB implanted by VVI pacemaker and DDD pacemaker was more than that in subjects with normal LV function (all P < 0.05). Conclusions Real-time three-dimensional echocardiography can rapidly evaluate left ventricular systolic synchrony in patients with Ⅲ grade AVB implanted by DDD pacemaker and VVI pacemaker.

Objective To investigate the clinical significance of compensatory angiogenesis and the angiosome-based revascularization strategy for endovascular procedures in treating infrapopliteal critical limb ischemia in elderly diabetic patients.Methods A retrospective study of 194 patients with diabetic feet (Fontaine Ⅳ) who had undergone endovascular procedures at our hospital from January 2005 to December 2014 was performed.Based on the angiosome concept,all subjects were classified into the direct revascularization group (DR group),the indirect revascularization through collaterals group (IR-tc group) and the indirect revascularization without collaterals group (IR-wc group).After one-year follow-up,the therapeutic effects were analyzed and compared between the three groups.Results During the one-year follow-up,the rate of unhealed ulcers,the re-intervention rate and the rate of major adverse limb events (MALE) were higher in the IR-wc group than in the DR and IR-tc groups (P=0.000 and 0.000,P=0.025 and 0.013,P=0.014 and 0.023,respectively).The IR-wc group presented a lower limb salvage rate as compared with those in the DR and IR-tc groups (P=0.011 and 0.027).Patients with a single recanalized branch had a higher rate of unhealed ulcers than those with multiple recanalized branches in the IR-wc group (93.9％ vs.71.0％,P=0.015).Conclusions The angiosome-based revascularization strategy has shown important value in guiding endovascular procedures for patients with diabetic foot disease and,in particular,the compensatory angiogenesis approach appears to be critical in generating favorable short-term clinical outcomes in the treatment of diabetic foot disease.

Objective To investigate the usefulness of HC visual laryngoscope designed for unskilled junior emergency resident doctors in respect of increasing the efficiency and success rate of emergency tracheal intubation.Methods A total of 80 patients needed the emergency tracheal intubation were at first divided into two groups randomly (random number).Patients in group A were operated by junior emergency resident doctors and patients in group B were operated by well experienced attending doctors.Then,the two groups of patients above were divided into two groups randomly (random number).Patients in group N were operated with conventional laryngoscope and patients in group HC were managed with HC visual laryngoscope.Then comparisons of the success rate of glottis exposure,the one-time success rate of tracheal intubation,the success rate of tracheal intubation,the complications,the number of attempt in successful intubation cases and the operative time consumed for successful intubation cases among the groups were done.Results (1)The success rate of glottis exposure,the one-time success rate and the success rate of tracheal intubation in group A-HC were 90%,70% and 90%,respectively which were significantly higher than those (50%,20% and 45%)in group A-N (P <0.05).The rate of complication,the number of attempt and operative time consumed for intubation cases in group A-HC were respectively 15%,(1.28 ± 0.43)and (31.44 ±5.06 ) s,which were significantly less than those [45%,(1.89 ±0.79 )and (45.89 ±4.99) s in group A-N (P <0.05 ).(2)The success rate of glottis exposure,the one-time success rate and the success rate of tracheal intubation in group B-N were 80%,65% and 80%, respectively which were significantly higher than those (50%,20% and 45%)in group A-N (P <0.05). The rate of complication,the number of attempt and operative time consumed for successful intubation cases in group B-N were 15%,(1.25 ±0.41)and (39.31 ±4.23)s,respectively which were significantly less than those [45%,(1.89 ±0.79)and (45.89 ±4.99)s]in group A-N (P <0.05).(3)There were no significant statistical differences in above results between group A-HC and group B-HC (P >0.05 ). Conclusions HC visual laryngoscope used by unskilled junior emergency resident doctors for emergency tracheal intubation,could increase success rate of glottis exposure,decrease the number of attempt of intubation,decrease rate of complication,shorten operative time required for intubation thus improving efficiency and success rate of emergency tracheal intubation,and maybe narrow the skill gap between unskilled junior resident doctors and well experienced attending doctors in respect of emergency tracheal intubation.

Objective To study the effect of heat stress on the permeability,cytoskeleton and cell cycle of human skeletal muscle cell (HSKMC).Methods The HSKMC membrane permeability was detected by calcium ion inflow with flow cytometer,the cytoskeleton was stained by CBB 250,and the cell cycle was determined by flow cytometer.Results After 1 h of heat stress on human HSKMC cells under different temperature gradient,the median level of calcium ion was 91.63 in 43 ℃ heat stress group compared with 22.98 in 37 ℃ control group.As temperature increased,thicker and shorter cytoskeleton and stress fiber were shown under the high power lens of microscope.The DNA expression of skeleton cells at G0/G1 stage was 44.13-62.98 in groups under heat stress.Compared with normal control group,DNA expression was much higher in heat stress group,when HSKMC was cultured under 37 ℃ temperature for another 18 h,it kept decreasing DNA expression to a similar level as control group.Conclusions Heat stress can cause calcium iron inflow resulting in intracellular calcium overload,and affect the cytoskeleton leading to loss of normal web ordered arrangement and increased gap in HSKMC cells,which give rise to blocking cell cycle into G0/G1 stage.

Objective To analyze the regions of abdominal lymph node metastasis in recurrent thoracic esophageal squamous cell carcinoma ( TE-SCC) after radical surgery, and to guide the design of target volume in postoperative adjuvant radiotherapy. Methods Patients with TE-SCC who were admitted to our hospital from February 2005 to April 2013 were enrolled as subjects. All patients were diagnosed with abdominal lymph node metastasis by imaging after R0 radical surgery. The exact regions of abdominal lymph node metastasis were classified according to the 7th edition of American Joint Committee on Cancer ( AJCC) TNM staging system for gastric cancer, and then retrospectively analyzed. The difference of two group was analyzed by χ2 test. Results Among the 1593 eligible patients, 148( 9. 3%) were diagnosed with abdominal lymph node metastasis after surgery. In the 148 patients, the abdominal lymph node metastasis rates in the upper, middle, and lower thoracic esophagus were 2. 3%, 7. 8%, and 26. 6%, respectively ( P=0. 000);the incidence rates of pathological stages T1/2 and T3/4 were 8. 7% and 9. 5%, respectively ( P=0. 601);the incidence rates of 0-2 and ≥3 metastatic lymph nodes in postoperative pathological examination were 4. 8%and 20. 1%, respectively (P=0. 000). The abdominal lymph node metastasis rate was the highest in the para-aortic lymph node ( 16a2) , followed by para-aortic lymph node ( 16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery ( 64. 9%, 41. 2%, 37. 8%, 32. 4%, and 20. 9%) , yielding an overall metastasis rate of 91. 9%. Conclusions The major regions of abdominal lymph node metastasis in esophageal carcinoma after radical surgery include para-aortic lymph nodes ( 16a2 and 16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery. These regions are the abdominal target volumes of postoperative adjuvant radiotherapy.

Sarcopenia is common in chronic heart failure. The pathogenesis of chronic heart failure-related sarcopenia is complex and diverse. Resistance training, as the main intervention for chronic heart failure-related sarcopenia, is widely applicated as effective and safe therapy.