Objective: To determine the efficacy of lobectomy and wedge resection in the management of early stage (T 1N 0M 0) non small cell lung cancer. Methods: We analyzed the results of 109 patients with pathologic stage (T 1N 0M 0) non small cell lung cancer who underwent open wedge resection (n=21), video assisted wedge resection (n=30), and lobectomy (n=58) to assess perioperative morbidity and mortality, recurrence rates, survival difference and late pulmonary function among the three groups. Results: There were no differences among the three groups in regard to histologic tumor type, perioperative morbidity and mortality, late pulmonary function. Analysis demonstrated the wedge resection groups to be significantly older and to have reduced pulmonary function despite a higher incidence of treatment for chronic obstructive pulmonary disease when compared with patients having lobectomy. Statistically, the mean hospital stay was significantly less and locoregional recurrences rate higher in the wedge resection groups. Kaplan Meier survival curves were nearly identical at 1 year (open wedge resection, 94%; video assisted wedge resection, 95%; lobectomy, 91%). 5 year survival was 58%, 65% and 70% respectively. Log rank testing demonstrated significant differences between the survival curves during the 5 year period of study (P=0.02). Conclusion: Wedge resection, done by thoracotomy or video assisted techniques, appears to be a viable surgical treatment of stageⅠ(T 1N 0M 0) non small cell lung cancer for patients with cardiopulmonary physiologic impairment. Because of the increased risk for local recurrence, anatomic lobectomy remains the surgical treatment of choice for patients with stage I non small cell lung cancer who have adequate physiologic reserve.

ObjectiveUnderstanding demand conditions for medical practice of the current medical schools nursing undergraduate and practical status of education,providing realistic and reliable basis for the reform of the nursing practice,and inquirying the practical measures of the teaching reform.MethodsAnalysing the 118 questionnaires issued by nursing students participated in medical practice and investigating the purpose of the nursing students wanting to achieve,the teaching form approved,the deficiencies proposed and overall satisfaction of teaching.ResultsThere is a considerable gap between nursing students' satisfaction,the strong demand,great interest of medical practice and current situation.ConclusionWe should concerne about the interns' strong demand for medical practice,pay attention to the teaching content,methods,objectives and organizational arrangements for many aspects of the construction and improvement.

Objective To assess the effect of a noninvasive equipment (the human biological stimulation feedback instrument) for the screening of metabolic syndrome (MS). Methods The samples were selected from the International Health Care Center of the Second Affiliated Hospital of Zhejiang University College of Medicine. From January to December 2012, according to the inclusion criteria, a total of 5674 consecutive participants (3 437 men, 2 237 women) without medical history of diabetes mellitus underwent general health screening in this hospital, which included questionnaire investigation, all MS components and the risk assessment of the human biological stimulation feedback instrument. MS was defined according to 2004 the Chinese Diabetes Society (CDS) criteria. Results The 5 674 subjects were divided into three groups in accordance with the human biological stimulation feedback instrument risk score: the normal group, metabolic abnormalities low risk group, metabolic abnormalities high risk group. The detection rate of MS corresponding to the three groups was 8.73% (251/2 876), 29.32% (612/2 087), 32.77% (233/711), respectively (trend χ2=372.14,P<0.001). With the increase of risk score, the detection rate of MS increased. A total of 1 096 (male 879, female 217) were diagnosed MS by CDS criteria. The area under the curve (AUC) of the test was 0.674 (95%CI 0.658-0.691, P<0.000 1)for predicting MS. The corresponding cutoff value was 25.00%, the sensitivity, specificity, positive predictive value and negative predictive value of diagnosis of MS was 77.80%, 56.00%, 30.20%and 91.30%, respectively;409 subjects who had no history of MS and diabetes mellitus follow up for two years, the AUC of the test was 0.719 (95%CI 0.644-0.794)for predicting MS. The corresponding cutoff value was 25.00%, too. And the sensitivity and specificity of diagnosis of MS was 78.00%and 59.80%, respectively. The detection rate of MS was positively correlated with the risk score. Conclusion We found that the human biological stimulation feedback instrument is a potential screening approach for early predicting MS in health checkup with simple and noninvasive procedure and high negative predictive value, although its diagnostic efficiency is not so good. And it might have a warning effect on the progress of MS.

BACKGROUND:Tumor necrosis factor-α-induced protein-8 like-2 (TIPE2), an anti-inflammatory protein, through the T cel receptor (TCR) and TOLL-like receptor signaling pathway, implements negative regulation of adaptive immunity and innate immunity, and thus effectively maintains the stable internal environment of the body.
OBJECTIVE:To construct a recombinant adenovirus that can overexpress rat TIPE2 gene.
METHODS:TIPE2 cDNA target gene was amplified from rat’s lymphocytes using RT-PCR, cloned into shuttle plasmid pShuttle-clontech, and then subcloned into artificial adenovirus vector AdC68. Hereafter, HEK 293 cel s were transfected to generate a recombinant adenovirus. HEK293A cel s were infected using this recombinant adenovirus, and then TIPE2 gene level was tested by western blot method.
RESULTS AND CONCLUSION:Based on results of PCR, digestion identification and sequencing, the obtained cDNA was the coding sequence region of TIPE2. Western blot findings showed that the recombinant adenovirus could overexpress TIPE2 gene. These findings indicate that the recombinant adenovirus is constructed successful y and can express TIPE2 gene stably.

Objective:To investigate the immune depression to donor-origin cells induced by the Mixed Chimera after sublethal whole body irradiation.Methods:Recipients in the experiment were Wistar and SD rat,and Wistar rats were selected as the donor.Donor and recipient rats were divided randomly into three groups.Recipient were conditioned with sublethal whole body irradiation (WBI).Group A was infused with bone marrow cells (BMC) of Wistar rats;group B infused with bone marrow mesenchymal stem cells (BM-MSCs)of Wistar rats;and group C with normal saline.Then they were administered cytoxan(CTX) by intraperitoneal injection.The mechanisms for immune depression were explored by performing mixed lymphocyte reaction (MLR).Results:The results showed that donor lymphoid chimeras could be found in the immune depression SD rats and chimerac cells in group A was more than in group B by FCM assay (P

Objective To compare the effects of rib internal fixation and thoracic external fixation in treatment of traumatic flail chest. Methods Eighty six cases of traumatic flail chest with multiple injuries,admitted to hospital from January 2006 to June 2009 ,were recruited into the study and divided into rib internal fixation and thoracic external fixation groups randomly. The clinical data were analyzed retrospectively. Rib internal fixations with Ti-Ni shape memory alloy embracing connector were performed in internal-fixation group(n = 45) and thoracic external fixations were performed in external-fixation group(n = 41). The outcomes were compared between the two groups. Results No patient in internal-fixation group developed chest wall deformity,while 19 patients in external-fixation group had chest wall deformity left. The mean times of hospital stay([ 15. 1 ± 1.8]d vs [22. 9 ±2. 8]d,t = - 15. 724,P ＜0. 01) ,ICU stay([5.7 ± 1.5]d vs [ 14. 4 ±2. 9]d,t =- 17.711, P ＜ 0. 01), and mechanical ventilation([ 3.9 ± 1.5 ] d vs [ 1 1.6 ± 2. 3 ] d, t = - 17. 256, P ＜ 0. 01),in internal-fixation group were significantly shorter than those in external-fixation group. The occurrence rate of respiratory complications (including pulmonary inflammation and (or) atelectasis and (or) respiratory failure)in internal-fixation group was significantly lower than those in external-fixation group(35.6% vs. 70. 7% ,x2 =10.641,P ＜ 0.01). Followed-up data of three months after discharge showed that the pulmonary function parameters, such as total lung capacity([ 89. 5 ± 3. 1 ] % vs. [ 79. 1 ± 5. 1 ] %, t = 11. 705, P ＜ 0. 01), forced vital capacity([ 80. 2 ± 2. 8 ] % vs. [ 69. 8 ± 3. 8 ] % ,t = 14. 241 ,P ＜0. 01) ,forced expiratory volume in the 1st second ([74.8 ±4.4]% vs. [71.9 ±3.6]% ,t =3.201,P ＜0.01),peak expiratory flow ([82.8 ±4.4]%vs. [79. 8 ±4. 9]% ,t =2. 885,P ＜0. 01) and forced expiratory flows at 75% of the vital capacity( [68.2 ±2. 2] % vs. [61.9 ± 2. 9 ]%, t = 11. 286; P ＜ 0. 01) were significantly higher in internal-fixation group than those in external-fixation group. Conclusion Rib internal fixation for traumatic flail chest can quickly correct chest wall deformity, stabilize thoracis and eliminate paradoxical chest wall movement. Patients accepted this treatment have a shorter therapy process during the intensive care unit and hospital stay, less pulmonary complications. They also show less long-term restrictive pulmonary functions impairment, when compared to the patients in the thoracic external fixation group. Rib internal fixation with Ti-Ni shape memory alloy embracing connector is a simple and effective therapy.

Objective To summarize the clinical experience of surgical treatment of malignant tra-cheal tumor.Methods Two hundred and fifty-eight medical charts about surgical treatment of malignant tracheal tumor between July 1980 and July 2007 were retrospectively reviewed.The main histological type were adenoid cystic carcinoma (104/258) and squamous cell carcinoma (93/258).Operative methods in-cluded circumferential resection end to end anastomosis of trachea (n=157),carinal resection and re-construetion (n=51),sleeve pneumonectomy(n=22),windowing removal(n=23),tracheal allotrans-plantation(n=2),circumferential reflection and anastomosis of trachea with assistance of extracorporeal cir-culation (n=3).Results No patient died from operation in the 258 cases,and the overall 5-and 10-year survival rates were 64.O%(165/258)and 58.1%(150/258),respectively.The morbidity rate was 5.4%(14/258).Conclusiom Surgical excision is the most effective treatment of malimmnt tracheal tumor.Tracheal resection and carinal reflection are the main operative methods in the treatment of malignant tracheal tumor.Decreasing operative complications is the key of successfully surgical treatment.

Objective To investigate the sleep features in the patients with irritable bowel syndrome (IBS) and compare the sleep quality between those IBS patients who were with and without anxiety and depression.Methods Pittsburgh sleep quality index questionnaire (PSQI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were measured in the 145 IBS patients and 59 regular physical examination volunteers.IBS patients were also divided into two subgroups-patients with or without anxiety and depression based on cutoff scores of SAS and SDS.Comparisons of sleep quality were made between subgroups, and between IBS patients and volunteer controls.Results Compared with the controls,the SAS raw score, SDS raw score and SAS positive incidence in IBS patients were shown statistically significant differences (P ＜ 0.05 ), while the SDS positive incidence had no statistically significant difference(P ＞ 0.05 ).PSQI total scores were significantly higher in the IBS patients without anxiety and depression (P ＜ 0.05), 3 domains (sleep quality, sleep disturbances and daytime function disorder) were also found statistically significant differences ( P ＜ 0.05 ), compared with the controls.The IBS patients with anxiety and depression were statistically significantly different from the controls ( P ＜ 0.05 ) in 6 domains (sleep quality, sleep latency, sleep efficiency, sleep disturbances, sleep time and daytime function disorder) and significantly higher PSQI total scores( P ＜ 0.05 ).Statistically significant differences (P ＜0.05) were also found in all 7 domains and with higher PSQI total scores in IBS patients with anxiety and depression, compared with IBS patients without anxiety and depression.Conclusions IBS patients were more likely to have sleep abnormality, mainly in sleep quality, sleep disturbances and daytime function disorder and PSQI total scores.The abnormalities of these factors were independent of emotional disorder.However, emotional disorder worsened the sleep disorder in IBS patients.

OBJECTIVE: To study the effect of transplanting autologous bone marrow mesenchymal stem cells (BMSCs) at different time point after myocardial infarction on cardiac function, and to approach its mechanism. METHODS: Thirty healthy Taihu Meishan swine were prepared for myocardial infarction models, and divided into 6 experimental groups, with 5 animals in each group. BMSCs were transplanted into 3 groups through coronary artery at 3 hours, 2 weeks and 4 weeks after myocardial infarction, named G1, G2 and G4, respectively. Meantime, DMEM culture medium was injected in the control group at correspond periods. Each swine was examined by MRI and Doppler before infarction, before transplantation, and at 8 weeks after infarction, respectively, to observe the change of cardiac function. The VEGF values of blood serum in different periods after transplantation were detected. All swine hearts were harvested after 8 weeks (the experimental terminus), and the planting and differentiation of transplanted cells in cardiac muscle were detected by the method of immunity histochemistry. The density of blood vessels in cardiac muscle was acquired simultaneously. RESULTS: There was no statistic difference of cardiac function between G1 and its control groups. The groups of G2 and G4 could improve cardiac function compared to the control groups, and G4 was superior to G2 (P < 0.05). There was no statistics difference of the decreased absolute value of myocardial infarcted area between G1 and the control groups. The myocardial infarcted area of G4 was greater than G2 (P < 0.05). The value of blood serum VEGF rose obviously in the G2 and G4, while G1 and all control groups did not present any marked changes, the rising amplitude of G4 was larger than G2 (P < 0.05). There were not any planting and differentiation of transplanted stem cells in G1 and all control groups at 8 weeks after infarction, but G2 and G4 could display, especially in G4 group (P < 0.05). There was no statistic difference of the density of blood vessels in cardiac muscle between G1 and all control groups at 8 weeks after infarction, but the differences were significant in all experimental groups, which was superior in G4 group to G1 and G2 groups (P < 0.05).CONCLUSION: There is disparity of transplanting BMSCs at different time point after myocardial infarction on cardiac function. Transplantation in acute period of myocardial infarction has no significant effect, but transplantation in non-acute period can ameliorate cardiac function. The therapeutic effect of transplanted at 4 weeks is superior to other time point. The MRI can display the location and compass of infarct cardiac muscle, and reflect the variation of cardiac function.

Objective To investigate the efficiency of autologous transplantation of bone-marrow mononuclear cells for treatment of patients with diabetic lower limb ischemia. Methods Twenty patients of type 2 diabetes (22 legs) with diabetic lower limb ischemia were treated by autologous transplantation of bone-marrow mononuclear cells. Results All ischemic legs were preserved except three feet, which were amputated due to the previously existed foot gangrene in one and unsolved pain in two. The pain-alleviated rate was 85.0%. The amputation rate was 13.6%. The skin turned warm in all legs(100.0%). TcPO2 of the ischemic legs was elevated in 17 patients with 19 legs. Angiography showed a noticeable increase of visible collateral vessels in 7 patients with 8 limbs who had angiographic follow-up. Conclusion Autologous transplantation of bone-marrow mononuclear cells could be a simple, safe, and effective method to treat patients with diabetic lower limb ischemia.