Objective To analyze the survival statistics and perioperative parameters of clinical stage Ⅰ non-small cell lung cancer patients who received systemic or selective mediastinal lymphadenectomy,and explore the value of selective mediastinal lymphadenectomy for clinical stage Ⅰ non-small cell lung cancer.Methods The clinical data of 984 patients with clinical stage Ⅰ non-small cell lung cancer who underwent lobectomy and systemic/selective lymph node dissection in Zhongshan Hospital from January 2005 to December 2010 were analyzed retrospectively.There were 581 males and 403 females with an average age of(59.6 ± 10.2) (24-84) years.786 patients received systemic mediastinal lymphadenectomy,and 198 patients received selective mediastinal lymphadenectomy.Results Average operation time of selective mediastinal lymphadenectomy group was(132.3 ±30.3) minutes,and that of systemic mediastinal lymphadenectomy group was(150.7 ±41.8) minutes with significant difference(P ＜ 0.01).Average amount of intraoperative bleeding of selective mediastinal lymphadenectomy group was (96.2 ± 53.5) ml,and that of systemic mediastinal lymphadenectomy group was (124.4 ± 65.4) ml with significant difference(P ＜0.01).There was no significant difference in overall survival rate between two groups(P =0.844).Recurrence rates were 25.3 ％ and 27.5 ％,respectively (P =0.533).Subgroup analysis showed no significant difference of 5-year survival rates between the two groups.Conclusion For patients with clinical stage Ⅰ non-small cell lung cancer,selective mediastinal lymphadenectomy can reduce operation time and amount of intraoperative bleeding.Survival of patients who received selective mediastinal lymphadenectomy was no worse than that of patients who received systemic mediastinal lymphadenectomy.

Objective To observe clinical results and indications of open reduction and internal fixation by bold canal titanium screws for treatment of radial head fractures. Methods From May 2003to February 2007,18 cases of radial head fractures were treated by open reduction and intemal fixation with bold canal titanium screws.There were 12 males and 6 females at age range of 15-53 years(mean 28.6 years).Of all,13 cases had Mason typeⅡ fractures,3 Mason typeⅣ and 2 Mason typeⅣ.Rehabilitation began as early as possible after operation if the internal fixation was secure;otherwise,rehabilitation began 2 weeks after operation.Postoperative plain radiography was made to observe fracture healing and complications. Results After operation,the rehabilitation was done at the first day in 15 cases and at 2 weeks in 3,with mean fracture healing time of 3 months.Function of elbows and rotation of forearnls were excellent except for 2 eases with Mason Ⅳ fractures.No deep branch of radial nerve injury occurred. Conclusion Open reduction and internal fixation with bold titanium canal screws can attain satisfactory clinical results in treatment of Mason type Ⅱ and Mason typeⅢradial head fractures.

Increasing the production and secretion of endogenous opioid peptide by immune cell can significantly induce myocardial protective effects against ischemia-reperfusion injury. Gene therapy is promising to increase endogenous enkephalin (ENK). However, classical viral and plasmid vectors for gene delivery are hampered by immunogenicity, gene recombination, oncogene activation, the production of antibacterial antibody and changes in physiological gene expression. Minimalistic immunologically defined gene expression (MIDGE) can overcome all the deficients of viral and plasmid vectors. The exon of rat's preproenkephalin (PPENK) gene was amplified by PCR and the fragments were cloned into pEGFP-N1 plasmids. The recombined plasmids were digested with enzymes to obtain a linear vector contained promoter, preproenkephalin gene, RNA stable sequences and oligodesoxy nucleotides (ODNs) added to both ends of the gene vector to protect gene vector from exonuclease degradation. A nuclear localization sequence (NLS) was attached to an ODN to ensure the effective transport to the nucleus and transgene expression. Flow cytometry, laser confocal microscopy and Western blotting demonstrated that PPENK-MIDGE-NLS can transfect leukocyte of rat in vivo, increase the expression of proenkephalin (PENK) in tissue, and the transfection efficiency depends on gene vector's dosage. These results indicate that PPENK-MIDGE-NLS could be an innovative method to protect and treatment of myocardial ischemia-reperfusion injury.
Animals ; Cloning, Molecular ; Enkephalins ; genetics ; Gene Expression ; Genetic Therapy ; Genetic Vectors ; Leukocytes ; Plasmids ; Promoter Regions, Genetic ; Protein Precursors ; genetics ; Rats ; Transfection ; Transgenes

Objective To analyze the safety, feasibility and operative technique details of non-grasping en bloc mediastinal lymph nodes dissection technique in uniportal video-assisted thoracic surgery(VATS) for lung cancer.Methods From April, 2014 to March, 2015,46 patients with lung cancer received non-grasping en bloc mediastinal lymph nodes dissection after uniportal VATS lobectomy.Clinical data of the cases were analyzed retrospectively.There were 19 males and 27 females.The age was(57.2 ± 9.0) (38-73) years.The first 6 cases were performed in the lateral decubitus position while the later 40 cases were all performed in the semiprone position.Results All cases accepted uniportal VATS non-grasping en bloc mediastinal lymph nodes dissection successfully.Arm fatigue of surgeon and assistant was obviously relieved when the patient was placed in the semiprone position.The thoracic drainage time was(3.2 ± 2.1) (1-12)days and the postoperative length of hospital-stay was(6.0 ± 4.5) (2-27) days.The number of dissected mediastinal lymph nodes stations was (4.3 ± 0.8) (3-6)and the number of dissected mediastinal lymph nodes was (11.8 ± 4.9) (4-30).There were 42 cases with stage No , lease wit stage N1, and 3 cases with stage N2 in pathological examination.Five patients developed minor postoperative complications.No perioperative death occurred.Conclusion Uniportal VATS non-grasping en bloc mediastinal lymph nodes dissection for lung cancer was safe and feasible, which could decrease the interference of the instruments and help to keep the surgical field clear.Non-grasping en bloc mediastinal lymph nodes dissection would be performed more smoothly in the semiprone position with less damage to lung and better ergonomics.

Objective To discuss causes and corresponding prevention for groin pain occurred early after total hip arthroplasty(THA).Methods A retrospective study was done on 189 cases(193 hips)treated with THA including unilateral procedures in 185 hips and bilateral procedures in eight hips to analyze common causes for early groin pain.Results Groin pain was found in 9.3% hips(18/ 193)during hospital stay,including 1.6%(3 cases)with deep infection,1.6%(3 cases)with incision infection,1%(2 cases)with posterior dislocation,4.1%(8 cases)with leg lengthening and 1%(2 cases)with hematoma.Conclusions Despite of the numerous diagnostic alternatives available to the orthopedic surgeon,detailed history,careful physical examination,necessary laboratory and imaging stud- ies can contribute to a correct determination of causes for groin pain.Meanwhile,appropriate indication, accurate preoperative radiographic measurement,intraoperative standardized surgical procedures and per- fect rehabilitation are necessary to avoid complications.

BACKGROUND:Stem celltherapy for renal ischemia-reperfusion injury has been the hot topics for many scholars. Its mechanism is very complex, which could not be explained by simple mechanism of stem cells differentiation. It is the result involving a variety of mechanisms. OBJECTIVE:To investigate the influence on immune cells during the bone marrow mesenchymal stem celltherapy for renal ischemia-reperfusion injury, then to preliminary summarize the immune regulation mechanism of bone marrow mesenchymal stem celltherapy for renal ischemia-reperfusion injury. METHODS:First, we established a model of renal ischemia-reperfusion injury in rats and, cultured and purified rat bone marrow mesenchymal stem cells in vitro. Then, the bone marrow mesenchymal stem cells were transplanted into the rat models. Using flow cytometry detection technology, we analyzed the proportion of CD4+CD25+regulatory T cells of rat spleen cells, discussed the effects on immune cells during the bone marrow mesenchymal stem celltherapy for renal ischemia-reperfusion injury, and then transferred the rat’s spleen cells to the nude mice which were subjected to renal renal ischemia-reperfusion injury. Renal function and renal histological changes of nude mice were assessed. RESULTS AND CONCLUSION:The bone marrow mesenchymal stem celltransplantation could significantly inhibit the decrease of CD4+CD25+regulatory T cellof spleen cells in rats with renal ischemia-reperfusion injury. The transplantation of spleen cells from the above-mentioned rats to nude mice could obviously protect nude mice from renal ischemia-reperfusion injury, characterized by lower serum creatinine, blood urea nitrogen and renal tubule pathologic damage score. Therefore, bone marrow mesenchymal stem cells have protective effects on renal ischemia-reperfusion injury by regulating the immune system.

OBJECTIVETo explore the relation of the anogenital distance (AGD) with cryptorchidism in male newborns.

METHODSThis study included 350 male infants delivered in two community hospitals between September 2013 and September 2014. Within 24 hours after birth, a pediatric surgeon measured the AGD of the neonates and determined whether they had cryptorchidism. According to the testicular position, we divided the undescended testes into three types: upper scrotal, inguinal, and non-palpable.

RESULTSTotally 39 cases of cryptorchidism were found in the 350 newborns. The AGD of the cryptorchidism infants was significantly shorter than that of the normal neonates ([2.01 ± 0.22] vs [2.35 ± 0.19] cm, P < 0.01), and statistically significant differences remained even when preterm and low birth-weight infants were excluded ([2.32 ± 0.14] vs [2.06 ± 0.19] cm; (2.37 ± 0.17) cm vs (2.12 ± 0.12) cm, all P < 0.01). The newborns with higher-position cryptorchidism had a shorter AGD, though with no significant difference (F = 0.434, P > 0.05). No significant differences were observed in the AGD between unilateral and bilateral cryptorchidism ([1.96 ± 0.13] vs [2.02 ± 0.17] cm, P > 0.05).

CONCLUSIONShorter AGD is associated with a higher incidence of cryptorchidism in male newborns. AGD could serve as a potential biomarker for disruption of androgen action during the male programming window period.

Androgens ; physiology ; Cryptorchidism ; diagnosis ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Male ; Perineum ; abnormalities

Objective To compare the effect of continuous femoral nerve block (CFNB) with patient controlled intravenous analgesia (PCIA) on pain relief,rehabilitation efficacy,satisfaction degree following total knee arthroplasty (TKA) in an attempt to find a safe and effective analgesia at the stage of rehabilitation.Methods The records of 116 patients undergone unilateral TKA for osteoarthritis or rheumatoid arthritis of the knee were evaluated.The patients with preoperative American Society of Anesthesiology (ASA) score of 1 to 3 were randomized into CFNB group (58 cases) and PCIA group (58 cases) according to the random number table.Both operations were performed under ultrasound guidance.Postoperative visual analogue score (VAS),knee function,incidence of adverse reaction,and satisfaction degree were compared between the two groups.Results Regardless of the score at postoperative 4 and 12 hours,VAS between CFNB and PCIA groups revealed significant differences at postoperative 24 [(3.2±1.1)pointsvs (4.1 ±1.5)points],48 [(3.4±1.2)pointsvs (4.1 ±1.0) points] and 72 hours [(3.3 ± 1.2) points vs (4.0 ± 1.1) points] (all P ＜ 0.05).Time to achieve knee rehabilitation training objectives like straight leg raise,walking with crutches,and passive bending to 90° were similar between the two groups.Both groups achieved comparable knee function status with respect to Hospital for Special Surgery (HSS) score,Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score,and maximal knee flexion angle at postoperative 3 months.Postoperative nausea and vomit were significantly more frequent in PCIA group (24％) than in CFNB group (14％) (all P ＜O.05),but patients in both groups were satisfactory.Conclusion Ultrasound guided CFNB is an effective analgesic method during the early stage of TKA,for it can control pain,accelerate rehabilitation training and function recovery,reduce adverse reaction as well as improve patients' satisfaction.

OBJECTIVETo explore effective approaches of treating elderly patients with distal tibiofibular fractures.

METHODSFrom August 2008 to October 2012,175 elderly patients with distal tibiofibular fractures were treated with locking compression plate (LCP) through anterior tibial. There were 112 males and 63 females with an average of 71.3 (ranged 60 to 83) years old. Of them,89 cases were treated by anterior tibial tension reduced incision with LCP,including 62 males and 27 females with a mean age of (71.8 +/- 6.4) years old. Eighty-six patients were treated by distal tibial incision with LCP,including 58 males and 28 females with a mean age of (70.3 +/- 6.7) years old. Swelling time, operation time, intraoperative blood loss, hospital stay, healing time, complications and AOFAS scores were compared between two groups after operation.

RESULTSSwelling time in anterior tension reduced incision with LCP and distal tibial incision with LCP was (5.6 +/- 1.3) and (9.7 +/- 2.1) days, healing time was (4.2 +/- 1.4) and (5.4 +/- 1.9) months,and complications were found 3 in tension reduced incision and 10 in distak tibial incision respectively;and all data shown statistically significant differences between two groups (P < 0.05). At 12 months after operation,AOFAS score was 89.0 +/- 9.7, 87.9 +/- 9.4; and there was no statistically significant difference between two groups (P > 0.05).

CONCLUSIONTension reduced incision through anterior tibial combined with locking compression plate fixation in treating elderly patients with distal tibiofibular fractures can provide good clinical effects with quick fracture healing and low complications.

Adult ; Aged ; Aged, 80 and over ; Bone Plates ; Female ; Fibula ; injuries ; surgery ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Tibia ; injuries ; surgery ; Tibial Fractures ; surgery ; Treatment Outcome

Objective To investigate the expression of tumor suppressor gene p16~(INK4A) in mouse endometrium during the estrus cycle and early pregnancy and its possible role in blastocyst implantation. Methods Reverse transcription polymerase chain reaction(RT-PCR) was used to detect the expression of p16~(INK4A) mRNA,immunohistochemistry and Western blotting were applied to detect p16~(INK4A) protein in mouse endometrium tissues during the estrus cycle and early pregnancy. Results The intensity of p16~(INK4A) mRNA expression in mouse early pregnancy was higher than that in the estrus cycle.Compared with the other 3 stages, the level of p16~(INK4A) mRNA expression at estrus was obviously higher. During the early pregnancy, the level of p16~(INK4A) mRNA expression increased steadily from day 2 to day 5,reaching the maximal level on day 5,then decreasing. Both immunohistochemical and Western blotting analysis showed the same results in expression patterns of p16~(INK4A) protein for mouse endometrium tissues as those results of RT-PCR.Conclusion p16~(INK4A) is involved in the embryos penetrating into the endometrial barrier.