The postoperative recurrence rate of ⅢA-N2 non-small-cell lung cancer (NSCLC) is as high as 30 ％ to 60 ％, which will affect the survival period of patients.Postoperative radiotherapy to improve local control rate on prolonging survival is the research focus, but postoperative radiotherapy has been controversial.The reasons includes the old radiotherapy technology induces many side effects which reduce the survival benefit, and how to select patients with postoperative radiotherapy is very important to establish the position of postoperative radiotherapy.

Objective To construct a self-assessment system of patient safety by nurses.Methods Using self-designed questionnaires of self-assessment system of patient safety by nurses,29 nursing safety management experts were selected.Delphi method was adopted to carry out two rounds of interview.The self-assessment system of patient safety by nurses was built.The importance of the indicators went on weight analysis with specialist sorting.Results The system included 3 first-level indicators,9 secondlevel indicators,48 third-level indicators.The coefficient of variation of the indicators was ＜ 0.20,and the coordination coefficient was 0.25.Conclusions The initial construction of system of self-assessment patient safety by nurses has the advantages of focused expert advice,with scientific results,and is reliable.It can be used for nurses' self-assessment of the security situation in patients.

Objective To evaluate the effect of dexmedetomidine on the inflammatory responses in brain tissues in septic rats.Methods Seventy-two male Sprague-Dawley rats,aged 10 weeks,weighing 250-280 g,were randomly divided into 4 groups (n =18 each):control group (group C); sepsis group (group lipopolysaccharide (LPS)) ; distilled water group (group DW) and dexmedetomidine group (group D).Sepsis was induced by intraperitoneal injection of LPS 5 mg/kg (dissolved in normal saline 1 ml) in groups LPS,DW and DEX,while normal saline 1 ml was injected intraperitoneally in group C.Distilled water 20 μl was injected into the lateral cerebral ventricle in group DW,while dexmedetomidine 3 μg/kg (dissolved in distilled water 20μl) was injected into the lateral cerebral ventricle in group DEX.Six animals were sacrificed at 1,2 and 6 h after administration and hippocampi were removed for determination of TNF-α and IL-6 contents (by ELISA) and TLR4 mRNA expression in hippocampal tissues (by RT-PCR).Results Compared with group C,TNF-α and IL-6 contents in hippocampus tissues were significantly increased at each time point after administration in group LPS (P ＜ 0.05).Compared with group LPS,no significant change was found in TNF-α and IL-6 contents in hippocampal tissues (P ＞ 0.05),and TLR4 mRNA expression was significantly up-regulated at each time point after administration in group DW (P ＜ 0.05).Compared with group DW,TNF-α and IL-6 contents in hippocampal tissues were significantly decreased at each time point after administration,and TLR4 mRNA expression was significantly up-regulated at 2 and 6 h after administration in group DEX (P ＜ 0.05).Conclusion Dexmedetomidine can reduce inflammatory responses in brain tissues in septic rats via down-regulating TLR-4 mRNA expression.

OBJECTIVETo explore the protective mechanism of electroacupuncture (EA) at "Neiguan" (PC 6) on ischemic myocardial injury, and to explain the response patterns and characteristics of the specific effect of acupoints along meridians in sodium channel in the level of cardiac organ.

METHODSA total of 60 SPF male rats were randomly divided into a blank group, a model group, a non-acupoint group, a Neiguan group and a Lieque group, 12 cases in each one. Except the blank group, rats in the remaining group were treated with subcutaneous injection of isoprenaline to establish the model of myocardial ischemia. Rats in the Neiguan group, Lieque group and non- acupoint group were treated with EA, dilatational wave, with a frequency of 2 Hz/20 Hz. The intensity was 2-3 mA. The needles were retained for 20 min per time, once a day for consecutive 7 days. In the blank group and control group, the rats were grasped and fixed at the treating time each day. The western-blot method was used to test the expression of voltage-gated sodium channel alpha subunit (Nav 1.5), protein tyrosine kinase (PTKs) and protein tyrosine phosphatase (PTPs).

RESULTSThe expression of Nav 1.5 and PTKs in the model group was lower than that in the blank group (both P<0. 01); the expression in the Neiguan group and Lieque group was higher than that in the model group (all P < 0.01); the expression of Nav 1.5 and PTKs in the Neiguan group was higher than that in the Lieque group (both P < 0.01). The expression of PTPs in the model group and non-acupoint group was higher than that in the blank group (both P < 0.01); the expression of PTPs in the Neiguan group and Lieque group was significantly down-regulated, which was lower than the model group (both P < 0.01); the down-regulation in the Neiguan group was significantly different from that in the Lieque group (P < 0.05).

CONCLUSIONEA at "Neiguan" (PC 6), by down-regulating the expression of PTPs, up-regulating the expression of Nav 1.5 and PTKs, is likely to achieve the aim of regulation on sodium channel activity and calcium overload, further to improve myocardial ischemia, which provides experimental basis for the theory of the specific effect of acupoints along meridians.

Acupuncture Points ; Animals ; Disease Models, Animal ; Electroacupuncture ; Humans ; Male ; Myocardial Ischemia ; genetics ; metabolism ; therapy ; Myocardium ; metabolism ; Rats ; Rats, Sprague-Dawley ; Sodium Channels ; genetics ; metabolism

Objective To investigate the factors associated with postoperative metastasis, recurrence, and survival in patients with stage ⅢA ( N2 ) non?small cell lung cancer ( NSCLC ) , and to provide an objective basis for postoperative radiotherapy in patients. Methods Clinical data were collected from 199 patients who underwent complete resection and were diagnosed with stage ⅢA ( N2 ) NSCLC after surgery in our hospital from 2009 to 2013. The Cox regression model was used for the multivariate analyses of metastasis and recurrence. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. Results In the 199 patients, 173 had complete follow?up data. The 1?and 2?year metastasis, recurrence, and survival rates were 38?7%/52?6%, 27?8%/39?1%, and 92?5%/51?4%, respectively. The multivariate analysis showed that pathological type and two positive indices among preoperative CEA/CY211/SCC were two risk factors for metastasis ( P=0?013,0?014) . Positive lymph node number, metastatic lymph node number, lymph node metastasis rate, and two positive indices among preoperative CEA/CY211/SCC were risk factors for recurrence ( P=0?046,0?004,0?028,0?001) . All the above indices were risk factors for low survival rates ( P= 0?013 , 0?011 , 0?002,0?026 ) . Conclusions Patients with stage ⅢA ( N2 ) NSCLC who have positive lymph nodes, lymph node metastases, and two positive indices among preoperative CEA/CY211/SCC may benefit from postoperative radiotherapy.

Objective To investigate the microsurgical effect of spinal cord Intramedullary cavernous hemangioma.Methods The clinical data of 23 patients with spinal cord Intramedullary cavernous henangioma from January,2003 to March,2017 were analyzed retrospectively.McCormick clinical neurological function classification method and MRI examination were used to analyze the changes of neurological function and imaging changes beforeand-after operation.MRI and assess nerve function were reviewed 6-12 months after discharge.Results Twentytwo cases were totally resected,and subtotal excised in 1 case.The symptoms improved and even disappeared completely in 17 cases.There was no obvious improvement in 4 cases,2 cases were worse and no death cases.Twentyone cases were followed-up.The follow-up time was 3 months-9 years,and no tumor recurrence was found.Among the 14 cases of clinical neurological function Ⅰ-Ⅱ,10 cases recovered rapidly and most of the symptoms improved or even disappeared.Three cases had no obvious change.The other 1 case aggravated symptoms;Six cases of Ⅲ-Ⅳ patients in 7 cases of postoperative recovery,and 1 case of no change.According to preoperative neurological function grade Ⅰ-Ⅱ and Ⅲ-Ⅳ,the treatment effect of patients was compared,the difference was significant (x2=5.25,P＜0.05).Conclusion Microsurgical resection of spinal cord Intramedullary cavernous hemangioma is safe and effective.The preoperative nerve function,the relationship between the tumor and the spinal cord,and the surgical skill and the degree of resection are the important factors that affect the prognosis.

OBJECTIVETo study differential expression of microRNA (miRNA) in peripheral blood mononuclear cells (PBMNC) from patients with different types of aplastic anemia (AA) and explore the role of miRNA in the pathogenesis of AA.

METHODSmiRNA microarray were used to determine the differential expression profile of miRNA in PBMNC from patients with AA. Real-time quantitative polymerase china reaction (RQ-PCR) was used to verify the differential expression of miRNA. Candidate miRNA were analyzed with bioinformatics tools.

RESULTSCompared with the normal controls, 6 miRNAs were up-regulated and 10 were down-regulated in patients with severe aplastic anemia (SAA), while 24 miRNAs were up-regulated and 12 were down-regulated in patients with chronic non-severe aplastic anemia (CAA). Compared with CAA patients, 4 miRNAs were up-regulated and 11 were down-regulated in SAA patients. Compared with normal controls, 3 miRNAs were up-regulated and 4 were down-regulated in both SAA and CAA patients. As verified by RQ-PCR, expression of miR-155-5p and miR-1260b were increased in both CAA and SAA patients compared with the normal controls (P<0.01). The expression of miR-155-5p and miR-1260b of CAA patients were higher than that of SAA patients (P<0.01). Bioinformatics analysis showed that target genes of miR-155-5p and miR-1260b may be involved in regulation of cell metabolism, gene expression and transcription, TNF signaling pathway, B cell receptor signaling pathway, Fc gamma R-mediated phagocytosis and other signaling process.

CONCLUSIONThere are characteristic differential expression profiles of miRNA in PBMNC from CAA and SAA patients, in which miRNA-155-5p and miRNA-1260b are both up-regulated. The common target gene predicted for miRNA-155-5p and miRNA-1260b is ETS1. miRNA-155-5p and miRNA-1260b may act synergistically to inhibit the expression of ETS1 and promote differentiation of Th17, therefore play an important role in the pathogenesis of AA.

Objective To evaluate the role of multiple dorsal midline plication (MDMP) procedure in correction of Donnahoo type Ⅲ chordee in postpubertal patient.Methods From September 2010 to July 2013,33 postpubertal patients with Donnahoo type Ⅲ chordee (＞ 20°) were treated with MDMP procedure.The age ranged from 18 to 37 years with an average of 29 years.Primary surgery was indicated in 18 patients including type Ⅲ chordee in 11 and type Ⅲ/Ⅳ in 7,with associated hypospadias in 12.Redo surgery was warranted in 15 patients including type Ⅲ chordee in 13 and type Ⅲ/Ⅳ in 2,with associated urethral defects necessitating repair in 12.Intraoperative artificial erection was induced to confirm the degree and length of chordee.Longitudinal plication sutures,4 dots each,were applied close to the midline in a parallel fashion on each apex of curvature,to achieve satisfactory orthoplasty with 16-dot to 64-dot plication according to the chordee status,and the urethral repair indicated was achieved simultaneously.Results Satisfactory orthoplasty was achieved with 16-dot plication in 16 patients,24-dot in 10,32-dot in 6,and 64-dot in 1 patient whose penile curvature was severe and long.Followup was obtained from 35 to 69 months with an average of 46 months.Three patients lost of followup.Urethroplasty-related complications were noted in 5 patients including urethrocutaneous fistula in 2,urethral dehiscence in 1,urethral diverticulum in 1,and urethral stricture in 1.Mild cicatrical curvature (less than 15 degree) was noted in 2 patients.No postoperative priapism,erectile dysfunction,and paraesthesia was noted,nor chordee recurrence.Conclusions When applied appropriately,MDMP is an effective procedure in correction of Donnahoo type Ⅲ chordee in postpubertal patient with good and long-standing orthoplasty.

Transverse sinus is an important pathway of intracranial venous reflux,which is also crucial for maintaining cerebral circulation and stabilizing intracranial pressure.Transverse sinus stenosis(TSS)is the most common variation of transverse sinus,which might lead to changes in sinus hemodynamics and pressure and closely related to idiopathic intracranial hypertension,pulsatile tinnitus and chronic headache.The progresses in imaging researches of transverse sinus stenosis were reviewed in this article.

OBJECTIVE：To study the improvement eff ects and its mech anism of Guiyuan decoction formula granules （GDFG） on model mice with decreased ovarian reserve （DOR）. METHODS ：Totally 42 female ICR mice whith with normal estrous cycle were randomly divided into control group ，model group ，estradiol valerate group （positive control ，0.15 mg/kg）and GDFG low-dose，medium-dose and high-dose groups （0.75，1.49，2.98 g/kg），with 7 mice in each group. Except for control group ，other groups were given cisplatin （3 mg/kg）intraperitoneally to establish DOR model. After modeling ，administration groups were given relevant medicine intragastrically；model group and control group were given normal saline intragastrically ，once a day ，for consecutive 4 weeks. After last administration ，ELISA assay was used to measure the serum levels of anti-Müllerian hormone （AMH）and follicle-stimulating hormone （FSH）in mice. Histopathological morphology of ovarian was observed by HE staining. Protein distribution of AMH receptor Ⅱ（AMHRⅡ）and Smad 4 in ovarian tissue were observed by immunohistochemistry. Protein expression of AMHR Ⅱ and Smad 4 were detected by Western blot assay. RESULTS ：Compared with control group ，theserum level of AMH ，the expression of AMHR Ⅱ and Smad 4 protein in ovarian tissue in model group were significantly decreased （P＜0.01），while the FSH level in serum was significantly increased （P＜0.01）；follicles were crumpled and lost nucleus ，ovarian interstitial were fibrosis ，luteum were loose ； AMHRⅡ and Smad 4 protein in ovarian tissue were mainly distributed in the follicle membrane and ovarian interstitial. Compared with model group ，the serum level of AMH ，the expression of AMHR Ⅱ and Smad 4 protein in ovarian tissue was increased significantly in GDFG groups （P＜0.01），while the serum level of FSH was decreased significantly （P＜0.05 or P＜0.01）；in ovarian tissue ，follicles at all levels could be found and follicle morphology was improved ，and no obvious nuclear loss and cumulus formation were found ；AMHRⅡ and Smad 4 protein were mainly distributed in the follicular nucleus （except for GDFG high-dose group) and the granular cell membrane （mainly distributed in the sinus follicles of GDFG medium-dose group ）；they were slightly distributed around the mature follicular nucleus or in corpus luteum. CONCLUSIONS ：GDFG can improve ovarian function of DOR model mice. The mechanism may be related with promoting serum level of AMH ，protein expression of AMHR Ⅱ and Smad 4，improving the distribution of AMHR Ⅱ and Smad 4 protein in ovarian granulosa cell membrane and follicular nucleus ， reducing FSH levels.