Objective To compare the changes of blood coagulation system and the clinical interventional effect of low molecular weight heparin (LMWH) in elderly patients who had received thoracic surgery. Methods Ninety-six thoracic surgery patients (age≥70 years) were divided into control group ( 54 cases ) and experimental group ( 42 cases ) ( postoperative 1-7 days, subcutaneous injection with LMWH ) from September 2007 to December 2009 by random digits table. Observed perioperative changes in prothrombin time (PT),activated partial thromboplastin time (APTT),platelet (Plt),D-dimer (D-D),fibrinogen (Fib), anti- X a activity, and clinical performances. Also observed the influence of diabetes mellitus of surgery coagulation function. Results The preoperative indexes of coagulation function were no significant (P ＞ 0.05 ). In control group PT prolonged, Fib and D-D increased, the differences between preoperative and postoperative each time were significant (P ＜ 0.05 ). Fib and D-D in control group increased than those in experimental group postoperative each time (P ＜ 0.05 ). In experimental group anti- X a activity increased postoperative each time (P ＜ 0.05 ),compared with control group was also significant (P ＜ 0.05 ). Diabetes mellitus had no significant influence on coagulation function. One patient appeared pulmonary thromboembolism in control group,and no one appeared venous thromboembelism and bleeding adverse reactions in experimental group. Conclusion Thoracic surgery in elderly patients have high blood coagulation state, prone to venous thromboembolism, LMWH given early postoperative prophylactic treatment is beneficial to improve the hypercoagulable state and have better security.

Objective To discuss the feasibility,safety,technical points and clinical effects of completely thoracoscopic resection of benign neurogenic tumors on apical chest.Methods From January 2004 to June 2009,11 patients underwent surgical resection of benign neurogenic tumours on apical chest.A complete thoracoscopy was used in 5 cases,and the remaining 6 cases received traditional open thoracotomy.By analysis on the clinical symptoms,tumor types,complications,operative time,blood loss and drainage time after operation,the advantages and disadvantages of complete thoracoscopy were compared to traditional open thoracotomy for resection of benign neurogenic tumors on apical chest.Results There was one patient in each group that suffered from light transient Horner's syndrome,who recovered spontaneously.The group of complete thoracoscopy was superior to the group of traditional open thoracotomy in operative time,blood loss during the operation,drainage time and postoperative hospital stay.Conclusion For benign neurogenic tumors on apical chest,a resection with complete thoracoscopy is as safe and effective as the traditional open thoracotomy,and the former is characterized by less operative trauma and quicker recovery.

Bronchoplasty was extended to the segmental level and the effect of the multi-segmental surgery for the central non-small lung cancer was observed. The involved lobular bronchi and part of main bronchi were resected and single-layer continuous suture with 5-0 Prolene was used for suturing of the carina of the reconstructed segmental bronchi to form lobular bronchi. Then, single-layer continuous suture with 4-0 Prolene was employed to anastomose the "lobular bronchi" with main bronchi. Our results showed that the 15 bronchoplasties were successfully performed. The tumors were completely removed and postoperatively, the pulmonary functions of the patients were substantially improved. No broncho-pleural fistula and stomal stenosis took place in all the cases. The quality of life of the patients were obviously improved. It is concluded that multisegmental bronchoplasty can completely remove the tumor of central non-small-cell lung cancer and conserve more non-involved lung. The procedure is especially suitable for those patients with severely impaired lung functions and it expands the indications of surgical resection of lung cancer.
Anastomosis, Surgical ; Bronchi/*surgery ; Carcinoma, Non-Small-Cell Lung/*surgery ; Lung Neoplasms/*surgery ; Pneumonectomy/*methods ; Pulmonary Surgical Procedures/*methods ; Recovery of Function ; Treatment Outcome

Objective To investigate the tellurite resistance level,the presence of tellurite resistance (ter) gene cluster and their relationships in non-O157 Shiga toxin-producing Escherichia coli(STEC) isolates.Methods Tellurite resistance level was evaluated by plate dilution method and the ter gene cluster was tested by PCR.Results Only 5 of 39 non-O157 STEC isolates tested in this study were identified to have ter gene cluster,which showed relatively high levels of tellurite resistance ranging from 128 μg/ml to 512 μg/ml.In contrast,the other 34 isolates without ter gene cluster were sensitive to potassium tellurite and showed very low levels of tellurite resistance,the minimal inhibitory concentration (MIC) was ＜1 μg/ml for 29 isolates,8 μg/ml for 2 isolates and 2 μg/ml for 3 isolates.Conclusion Most non-O157 STEC isolates were sensitive to potassium tellurite.It could be concluded that much attention should be paid when screening the non-O157 STEC isolates using the selective medium supplemented with potassium tellurite.

Objective To discuss the technical points and clinical effects of thoracic reconstruction after resection of the sternal tumnors with autogenous rib graft and pedicle oinental flap. Method A retrospective study was made on 12 patients,who underwent resection of sternal tumors and thoracic reconstruction with autogenous rib graft and pedicle omental flap between January 2004 and March 2010. The tumor involved the manubrium in 4 patients and the sternal body in 8 patients. Results All operations of 12 patients were succeed with no perioperative mortality or severe complications. Incisions healed by primary intention healing,and no paradoxical breathing was found. The postoperative period was uneventful.Conclusion It's an effective way to treat sternal tumors by the resection and thoracic reconstruction with autogenous rib graft and pedicle omental flap.

Objective The difficulty of full thoracoscopic Ivor-Lewis is the lack of a safe and low cost anastomosis.By improving the surgical process,to explore the application of circular stapler in the intrathoracic esophagogastric anastomosis.The thoracoscopic operation mode of esophageal cancer changes from simply following the McKoewn procedure to Ivor-Lewis and McKoewn procedure.Methods Retrospective analysis 123 cases of implementation thoracoscopic esophageal cancer from July 2009 to February 2013,which including the cases of intrathoracic anastomosis and cervical anastomosis.Divided it into two groups:intrathoracic anastomosis groups,which including thoracoscopic esophagectomy resection,gastroesophageal anastomosis and anastomotic pedicled omentum embedding,the cervical anastomosis groups,which including thoracoscopic esophageal free and gastroesophageal neck anastomosis.To comparing the incidence of ARDS,postoperative hoarseness,anastomotic complications (Anastomotic leakage and anastomotic strictures within two months after surgery),guardianship time of ICU and postoperative hospital stay between the two groups.Results All the patients were no deaths.The cervical anastomosis group operative time was significantly lower than the intrathoracic anastomosis group.The incidence of anastomotic fistula and anastomotic stricture of intrathoracic anastomosis group was significantly lower than that of the cervical anastomosis group,total hospitalization time of the intrathoracic anastomosis group were significantly lower than that of the cervical anastomosis group,there is no significant differences in postoperative hoarseness and ARDS incidence between the two groups.Conclusion For the lower esophageal carcinoma,it is technically mature and safe to apply the circular stapler for Ivor-Lewis surgery and sleeve omentumembedding anastomotic technique in full thoracoscopic,and the technology should be widely applied; for the upper esophagealcarcinoma,McKoewn procedure should be applied.

Objective To analyze the subtypes of eae genes in various non-O157 Shiga toxin-pro-ducing Escherichia coli ( STEC) strains isolated in China.Methods The complete nucleotide sequences of 10 eae genes were amplified by PCR and sequenced.The BLASTn software was used to analyze the se-quences for eae gene subtyping.A phylogenetic tree was constructed based on the10 ea e gene sequences to-gether with the gene sequences of 30 different subtypes in GenBank and those of STEC strains of 7 prevalent serotypes (O157 ∶H7, O26 ∶H11, O103 ∶H2, O111 ∶H8, O145 ∶H28, O45 ∶H2 and O121 ∶H19) using MEGA 5.0.Multilocus sequence typing (MLST) was performed on the 10 STEC strains with reference to the Escherichia coli ( E.coli) MLST website ( http://mlst.warwick.ac.uk/mlst/dbs/Ecoli) for the typing of multiple loci.A minimum spanning tree ( MST) was constructed using the BioNumerics software to inves-tigate the phylogenetic relationships between the 10 eae gene-positive STEC strains in this study and hemolyt-ic uremic syndrome-associated enterohemorrhagic E.coli ( HUSEC) strains as well as all human STEC strains of O157, O26, O45, O103, O111, O121 and O145 serotypes submitted to the E.coli MLST website data-base.Results The complete nucleotide sequences of eae genes in 10 non-O157 STEC strains were 2.8 kb in length and belonged to 3 known subtypes.The predominant subtype wasβ1, accounting for 60%of the 10 STEC strains (6/10), followed byθandγ1 subtypes with two strains in each type.The eae gene sequences in certain strains were identical to those of the prevalent serotypes.Seven sequence types ( STs) were identi-fied from the 10 STEC strains carrying eae gene.Conclusion The eae genes harbored by the non-O157 STEC strains isolated from different specimens in China were diverse and had close phylogenetic relationships with the highly pathogenic and prevalent STEC strains.This study implied that the STEC strains harboring eae gene had high pathogenic potential.

Objective To understand the molecular characteristics of human-derived non-O157 Shiga toxin-producing Escherichia coil (STEC) strains circulating in five regions of China.Methods Twenty-seven non-O157 STEC strains isolated in five geographic regions were investigated by serotyping, stx1/stx2 subtyping and PCR screening for adhesion and other virulence genes.A multilocus sequence typing (MLST) scheme provided by E.coil MLST database were performed to amplify and sequence seven housekeeping genes (adk, icd, fumC, rgyrB, purA, mdh and recA) in those strains.Results Twenty-seven non-O157 STEC strains were typed into 16 O∶H serotypes.Among those strains, 11 harbored stx1a, 12 harbored stx1c, two harbored stx2e and the other three strains respectively harbored stx1a+stx2b, stx2d and stx2g.Positive rates of eae, efa1, saa, paa, toxB, astA and ehxA genes were 18.5%, 18.5%, 29.6%, 22.2%, 11.1%, 11.1% and 25.9%, respectively.The 27 strains were typed into 16 different sequence types (STs) based upon MLST.Conclusion Human-derived non-O157 STEC strains circulating in five regions of China are heterogeneous in their serotypes, stx1/stx2 subtypes and virulence gene profiles.

Objective Identify novel protein kinase Cε(nPKCε)-interacted proteins in the cortex of hypoxic preconditioned mice.Methods Immunoprecipitation (IP) and two-dimensional electrophoresis (2-DE) combining with ImageMaster 2D Platinum software were applied to analyze the differential expressions of nPKCe-interacted proteins;the target protein spots were identified by matrix-associated laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) and Western blot.Results Compared with control group,there were 34 upregulated protein spots and 20 downregulated protein spots in cytosolic fraction,while 27 upregulated prtein spots and 28 downregulated protein spots were determined in particulate fraction of cerebral cortex of HPC mice.The levels of nPKCε-interacted HSP 70 and 14-3-3γ/protein expressions increased significantly in both cytosolic and particulate fractions;but the protein level of nPKCε-interacted HSP60 increased only in particulate fraction of cerebral cortex of HPC mice.Conclusion nPKCε might be involved in the development of cerebral HPC via the regulation of its interacted proteins such as HSP60,HSP70 and 14-3-3γ.

Objective In order to improve the diagnosis accuracy , 18F-FDG PET/CT results of 169 cases of lung lesions were analyzed. Methods The data of 169 pathological diagnosed patients were collected. SPSS 18.0 was used for the data analysis. Results In 169 cases, 122 cases were proved malignant by patholog-ical diagnosis, in which 110 cases were correctly diagnosed by PET/CT. 47 cases were proved benign by patho-logical diagnosis, in which 15 cases were correctly diagnosed by PET/CT. The sensitivity was 90.2%, specificity was 31.9%, and the accuracy was 74.0%. Conclusion In order to improve the accuracy rate of PET/CT exam-ination and reduce the existence of false positive cases and false positive cases , we should estimate SUV (max) objectively and diagnose according to the size of the lesion , clinical history and laboratory results.