Objective To discuss the clinical efficacy of internal fixation assisted by thoracoscope in treatment of rib fractures.Methods The study enrolled 180 patients with rib fractures associated with thoracic deformity hospitalized from July 2010 to June 2013.Ninety out of the patients were operated on by thoracoscope-assisted internal fixation (operation group),and the remaining 90 fractures were treated non-operatively (non-operation group).Clinical markers recorded were duration of pain,time of ventilator use,hospital length of stay and complications.Patient mental health was measured with self esteem scale (SES).Patient mobility was evaluated at follow-up.Results Between operation and non-operation groups differences were observed in duration of pain [(3.1 ± 1.0)d vs (8.9 ± 1.2) d],time of ventilator use [(3.0 ± 1.0) d vs (4.8 ± 1.0) d] and hospital length of stay [(10.0 ± 1.1) d vs (15.8 ± 1.0) d] (P ＜ 0.01).SES in operation group was (28.3 ± 2.1) versus (24.4 ± 3.3) points in non-operation group (P ＜ 0.01).No major complications occurred in operation group,but there were 20 pleural effusion,15 severe thoracic collapse or deformity,14 lung infection,10 refractory chest pain and 2 upper limb dysfunction in non-operation group (P ＜0.01).Two patients presented mobility limitation in operation group,but 12 had evident loss of mobility in non-operation group (P ＜0.01).Conclusions Thoracoscope-assisted internal fixation is effective to accelerate the pace of recovery,relieve pains,reduce complications and thus can be a priority method for treatment of rib fractures.

Objective To explore the effect of Xinkang Tablets on myocardial apoptosis index,collagen volume fraction and sarcoplasmic reticulum Ca2+-ATPase activity of rats with adriamycin-induced heart failure.Methods The chronic heart failure (CHF) SD rat model was established by intraperitoneal injection of doxorubicin.After successful modeling,the rats with CHF were randomly divided into 5 groups,namely model group,western medicine group,and low-,middle-and high-dose of Chinese medicine groups,10 rats in each group.The rats in the above groups were given intragastric administration of distilled water,22.5 μg/kg of Digoxin mixed suspension,9,18,36 g/kg of XinkangTablets,respectively,in the volume of 10 mL/kg of distilled water dilution,once a day,for 5 continuous weeks.Another the same batch of 10 SD rats were randomly allocated to the sham operation group,and were treated with intragastric administration of the same volume of distilled water.And then the apoptotic rate of myocardial cells was measured by TUNEL method,the collagen volume fraction (CVF) was measured after Masson staining,and the sarcoplasmic reticulum Ca2+-ATPase activity was determined by inorganic phosphate assay.Results Compared with the sham operation group,the apoptotic rate of myocardial cells and CVF in the model group were increased(P ＜ 0.01),indicating that the myocardial remodeling occurred in rats with CHF.Compared with the model Group,the apoptotic rate of western medicine group and three Chinese medicine groups was significantly decreased(P ＜ 0.01),suggesting that Digoxin and Xinkang Tablets can relieve apoptosis to certain extent.The CVF in Digoxin group and middle-and high-dose of Chinese medicine groups were lower than those in the model Group (P＜ 0.05 or P＜ 0.01),indicating that Digoxin and Xinkang Tablets can delay the myocardial fibrosis.Last but not least,the SERCA2a activities in the middle-and high-dose of Chinese medicine groups were higher than those in the model group (P ＜ 0.05 or P ＜ 0.01),suggesting that Xinkang Tablets may relieve myocardial remodeling and improve cardiac function through the regulation of SERCA2a activity.Conclusion Xinkang Tablets decrease the apoptotic rate and myocardial cell volume fraction probably through the regulation of SERCA2a activity,which may play a role in counteracting apoptosis and myocardial fibrosis,and ultimately delay the remodeling of the myocardium.

Objective To evaluate the effect of remifentanil on Toll-like receptor 2 (TLR2) mRNA expression during renal ischemia-reperfusion (Ⅰ/R) in rats.Methods Fifty-four male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 3 groups (n=18 each) using a random number table:sham operation group (group S),Ⅰ/R group and remifentanil group (group R).Renal Ⅰ/R injury was produced by clamping the bilateral renal arteries for 45 min followed by reperfusion in Ⅰ/R and R groups.Bilateral renal arteries were only exposed but not clamped in group S.Remifentanil 1.0 μg · kg-1 · min-1 was infused via the tail vein starting from 15 min before ischemia until 30 min of reperfusion in group R,while the equal volume of normal saline was given instead in S and Ⅰ/R groups.The animals were sacrificed at 15 min before ischemia and 6 and 24 h of reperfusion,and the renal specimens were obtained for examination of the pathological changes (with light microscope) and for determination of the contents of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) (by ELISA) and expression of TLR2 mRNA (by RT-PCR) and cell apoptosis (by double staining and flow eytometry).The apoptotic rate was calculated.Results Compared with group S,TLR2 mRNA expression was significantly up-regulated,and the contents of TNF-α and IL-6 and apoptotic rate were increased at 6 and 24 h of reperfusion in Ⅰ/R and R groups.Compared with group Ⅰ/R,TLR2 mRNA expression was significantly down-regulated,and the contents of TNF-α and IL-6 and apoptotic rate were decreased at 6 and 24 h of reperfusion in group R.The pathological changes were significantly attenuated in group R as compared with group Ⅰ/R.Conclusion The mechanism by which remifentanil reduces renal Ⅰ/R injury is related to down-regulation of TLR2 expression and decrease in TLR2 activity and inhibition of inflammatory responses in renal tissues and cell apoptosis in rats.

Objective To investigate the effect of remifentanil on protein kinase C (PKC) activity during renal ischemia-reperfusion (I/R) in rats.Methods Seventy-five male Sprague-Dawley rats,weighing 250-300 g,were randomly divided into 5 groups (n=15 each) using a random number table:sham operation group (group S),I/R group,remifentanil group (group R),naloxone group (group N),and naloxone + remifentanil group (group NR).Renal ischemia was induced by clamping the bilateral renal arteries for 45 min using an atraumatic clamp followed by reperfusion.In R and NR groups,remifentanil 1.0 μg · kg-1 · min-1was infused via the caudal vein starting from 15 min before ischemia until 30 min of reperfusion.In N and NR groups,naloxone 0.3 mg/kg was injected via the caudal vein at 20 min before ischemia and 35 min of ischemia,respectively.The rats were sacrificed at 24 h of reperfusion and the kidneys were removed for determination of the ultrastructure of the renal tubular epithelial cells (using transmission electron microscope),activity of PKC in renal tissues (by ELISA),and expression of the PKC in renal tissues (by immuno-histochemistry).Results Compared with group S,the activity of PKC in renal tissues was significantly increased in the other four groups,and the expression of the PKC in renal tissues was up-regulated in group R.Compared with group I/R,the activity of PKC in renal tissues was significantlyincreased,the expression of PKC in renal tissues was up-regulated,and the pathological changes were attenuated in group R.Compared with group R,the activity of PKC in renal tissues was significantly decreased,the expression of PKC in renal tissues was down-regulated,and the pathological changes were aggravated in N and NR groups.Conclusion The mechanism by which remifentanil attenuates renal I/R injury may be related to up-regulation of PKC expression and increase in PKC activity through activating opioid receptors in rats.

Objective To assess the clinical value of 18F-FDG PET/CT for the prediction of postoperative recurrence and metastasis in patients with NSCLC.Methods Eighty-five patients (64 males,21 females; average age:58.0 years) with NSCLC were enrolled.All patients underwent 18 F-FDG PET/CT within one week before surgical operation and 3 months after the operation.The diagnosis of recurrent cancer and metastasis was confirmed by pathologic findings,other imaging modalities and clinical follow-up.The diagnostic efficacy of PET/CT was calculated and the predictors for postoperative recurrence and metastasis were analyzed.x2 test and two-sample t test were used for statistical analysis.Results Among 85 patients,43 had recurrence and metastasis post operation.The postoperative recurrence and metastasis were detected by 18F-FDG PET/CT in 9.3％(4/43) within 6 months,30.2％(13/43) within 1 year,76.7％(33/43) within 2 years and 97.7％(42/43) after 2 years.The sensitivity,specificity,accuracy of 18F-FDG PET/CT for the detection of recurrent tumor and metastasis were 97.7％ (42/43),95.2％ (40/42),96.5％ (82/85) respectively.The preoperative cancer staging,size and SUVmax of primary tumor were significant factors for the prediction of postoperative tumor recurrence and metastasis within 2 years (x2 =12.360,t=3.281 and 2.465,all P＜0.05),but not gender,age or pathological findings (x2 =0.639,0.012 and 3.800,all P＞0.05).Conclusions 18F-FDG PET/CT has an important role for the detection of postoperative recurrence and metastasis in patients with NSCLC.Preoperative cancer staging,size and SUVmax of the primary tumor might be the predictive factors for postoperative tumor recurrence and metastasis within 2 years.

Objective To discuss the major complications of urologic laparoscopic surgery.Methods From January 2004 to May 2012,2 250 urologic laparoscopic surgical procedures were performed in our institute,including radical nephrectomies (690 cases),partial nephrectomies (285 cases),simple nephrectomies (126 cases),nephrouretectomies (270 cases),renal cyst operations (281 cases),adrenalectomies (310 cases),pyeloplasties (93 cases),ureterolithotomies (48 cases),radical prostatectomies (43 cases),radical cystectomies (49 cases),donor nephrectomies (50 cases) and retroperitoneal lymph node dissection (5 cases).Medical records of each procedure were retrospectively evaluated.Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications,respectively.Major complications were defined as Satava grade Ⅱ or higher,and Clavien grade Ⅲ or higher.Results Among the 2 250 laparoscopic procedures,53 major complications occurred,resulting in a major complication rate of 2.36％.Major intraoperative and postoperative complication rates were 1.16％ (26 cases) and 1.20％ (27 cases),respectively.Vascular injuries were the most common intraoperative complications (58％) while the proportion of visceral injury was the second as 42％.The most common postoperative complication was bleeding (19 cases).Among them,3 cases died of multiple organ failure after second operations.Other major postoperative complications included wound infection (2 cases),urine leakage (1 case),adrenal crisis (1 case),ileus (2 cases) and incisional hernia (Ⅰ case) and 1 death caused by pulmonary embolism.Conclusion Major complications,including death,may occur at any stages during the urologic laparoscopic surgery.

Objective To observe the members' dynamic change of renin-angiotensin system (RAS) and angiotensin converting enzyme 2(ACE2)-Ang(1-7)-Mas axis during the continuous venovenous hemodiafiltration (CVVHDF) treating the dogs with multiple organ dysfunction syndrome (MODS),and to investigate the efficacy mechanism on cardiac function.Methods Dogs were subjected to hemorrhagic shock plus resuscitation and endotoxemia to establish MODS model,then they were randomly divided into 2 groups:CVVHDF group (n=8) and MODS group (n=6).After endotoxin injection completion,the CVVHDF group received CVVHDF for 12 h,MODS group didn't.Radioimmunoassay,euzymelinked mmunosorbent assay (ELISA) were used to detect the content of renin,Ang Ⅰ,Ang Ⅱ,Ang (1-7).Real-time PCR was used to detect the expression of renin mRNA and ACE2 mRNA.Western blotting was used to detect the protein content of renin,Ang Ⅱ,ACE2 and Ang (1-7).Results (1) Organ function:Compared with the MODS group,the vital signs,heart,lung and renal function were significantly ameliorated in the CVVHDF group,the difference had statistical significance (P＜ 0.05).(2) RAS changes:To detect index from the level of organs,genetic and molecular in arterial tissue,the results displayed that the content of renin,Ang Ⅰ,Ang Ⅱ,the expression of renin mRNA,the protein content of renin,Ang Ⅱ in CVVHDF group were lower than that in MODS group,the difference had statistical significance (P ＜ 0.01).(3)ACE2-Ang(1-7)-Mas axis's changes:Using the same methods above to detect corresponding indicators,the results displayed that the content of ACE2,Ang(1-7),the expression of ACE2 mRNA and the protein content of ACE2,Ang(1-7) in CVVHDF group were significantly improved than that in MODS group,the difference had statistical significance (P ＜ 0.01).Conclusions In the process of CVVHDF treating MODS,the ACE2 -Ang(1-7)-Mas axis plays the role which antagonizes the RAS system,and to protect the cardiac function.This research may be important for MODS' clinical rescue.

Objective To observe the safety and effectiveness of inductive chemotheray with lobaplatin plus 5-Fu (LF regimen) and concurrent chemoradiotherapy with lobaplatin for local-regionally advanced nasopharyngeal carcinoma (NPC) patients,and investigate the appropriate lobaplatin dose for the concurrent chemoradiotherapy.Methods Newly diagnosed local-regionally advanced NPC patients signed informed consent.The inductive chemotherapy was lobaplatin 30 mg/m2 + 5-Fu 4 g/m2 civ 120 h for 2 cycles every 21 days,then concurrent lobaplatin chemoradiotherapy was conducted.The initial lobaplatin dose for concurrent chemoradiotherapy was 50 mg/m2 with at least 3 cases in every dose level.If 2 of 3 patients presented dose-limiting toxicity (DLT),5 mg/m2 dose decreased for the next level until maximal tolerant dose (MTD) reached.The tumor response was evaluated after inductive chemotherapy,at the end of the chemoradiotherapy,3 months after chemoradiotherapy and 6 months after chemoradiotherapy.Results From Dec 2011 to Apr 2012,11 patients were enrolled in this study.After 2 courses of inductive chemoradiotherapy,CR,PR and SD were observed in 1,8 and 2 patients,respectively.At the end of the chemoradiotherapy and 3 months after chemoradiotherapy,CR and PR were observed in 10 and 1 patients,respectively.Six months after the chemoradiotherapy,all patients were CR.For the patients(3 in each arm) received 50 mg/m2 or 45 mg/m2 lobapaltin concurrent chemoradiotherapy,2 patients in each arm presented DLT.For the 5 patients received 40 mg/m2 lobapaltin concurrent chemoradiotherapy,no patients presented DLT.40 mg/m2 was suggested as the MTD.Inhibition of platelet was the major DLT.Conclusion Inductive chemotherapy with LF regimen and concurrent chemoradiotherapy with lobaplatin is safe and effective for local-regionally advanced NPC patients and the MTD of lobaplatin for the concurrent chemoradiotherapy is 40 mg/m2.Further clinical trial with large sample is expected.

OBJECTIVETo investigate the capability of semi-quantitative and quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict the response to concurrent chemoradiotherapy( CCRT) in patients with non-small cell lung cancer (NSCLC).

METHODSA total of 24 patients with stage III or IIIB NSCLC, who underwent 3.0T DCE-MRI before CCRT, were enrolled in this study. Semi-quantitative and quantitative parameters were calculated by Funtool and Omnikinetics software. The relationship between these obtained parameters and tumor response was evaluated by Spearmen' s correlation analysis. The patients were classified into two groups according to the tumor regression rate after treatment, as response group (group A) and non-response group ( group B). Mann-Whitney U test was used to compare the parameters of responders and non-responders. The value of the parameters on predicting response was calculated by receiver operating characteristic curve (ROC).

RESULTSThe tumor regression rate after treatment was negatively correlated with time to peak (TTP) and the extravascular-extracellular volume fraction (Ve), and was positively correlated with signal enhancement ratio (SERmax) and volume transfer constant (Ktrans) (P < 0.05 for all). Statistical significant differences were found between group A and group B both in semi-quantitative and quantitative parameters (P < 0.05). Group A had a lower TTP value [(34.66 ± 16.37) s vs. (44.09 ± 17.41) s] and Ve value [(0.19 ± 0.03) vs. (0.25 ± 0.05)] than group B, whereas group A had a higher SERmax [(166.50 ± 44.95)% vs. (113.57 ± 46.62)%] and Ktrans [(0.41 ± 0.17) min(-1) vs. (0.28 ± 0.12) min(-1)] than group B (P < 0.05 for all). The ROC analysis indicated that when setting the threshold of Ve on ≤ 0.21 for predicting response, the specificity, sensitivity and accuracy were 85.7%, 80.0% and 83.3%, respectively, with an area under curve of 0.875 (P < 0.001).

CONCLUSIONSBoth the semi-quantitative and quantitative DCE-MRI parameters are helpful for predicting the response after CCRT of NSCLC. Quantitative parameters seem to be more meaningful than semi-quantitative parameters.

Carcinoma, Non-Small-Cell Lung ; pathology ; therapy ; Chemoradiotherapy ; methods ; Contrast Media ; Humans ; Lung Neoplasms ; pathology ; therapy ; Magnetic Resonance Imaging ; methods ; ROC Curve ; Remission Induction ; Sensitivity and Specificity ; Time Factors

Objective To investigate the utility of virtual endoscopy ultrasound Fly-Thru in the diagnosis of obstructive bile duct diseases.Methods One-hundred patients with obstructed bile duct diseases underwent Fly-Thru examination.All Fly-Thru images were reviewed by two radiologists with different experience.The capabilities of Fly-Thru for bile duct obstructive degree evaluation and distinguishing malignant lesion from benign one were assessed respectively.Results The accuracy and sensitivity of Fly-Thru image in obstruction degree evaluation were 70.59％ and 89.2％ (95％CI 74.6％-96.9％).The diagnosis accuracy of 2DUS for lesion characteristics increased from 80％ to 84％,accompany with Fly-Thru images,especially for lesions in common bile duct from 77.2％ to 86.0％ (x2 =14.399,P =0.001).Conclusions The virtual endoscopy ultrasound Fly-Thru is only partly capable to display the obstructed degree of some bile ducts,but it can improve the diagnostic accuracy of common bile duct diseases.