Objective To observe the clinical effect of different surgical methods in the treatment of mediastinal tumors.Methods A total of 74 cases of August 2011 -2015 years 7 months in our hospital admissions of patients with mediastinal tumor were divided into observation group (minimally invasive medi-astinal surgery)and control group (conventional thoracotomy),37 cases,compared to two groups of clini-cal curative effect.Results The total efficiency of treatment in the observation group was 89.19%,signifi-cantly higher than that of the control group and observation group complications rate is relatively lower,sig-nificant differences (χ2 =5.33,6.79,P <0.05);observation group the operative time,amount of bleeding and hospitalization time were (15.69 ±3.21)min,(3.541 ±56.29)ml,(597 ±3.11)d were significantly lower than control group,the difference between two groups was significant (t =12.54,11.49,13.54,P<0.05).Conclusions Phase,compared with the traditional surgical treatment for open and minimally in-vasive surgery can achieve a better therapeutic effect,reduce a patient's risk of complications,alleviate the injury of surgery.For patients with postoperative rehabilitation has a positive meaning.

Objective To explore the feasibility of the small figure-L unilateral transternal incision for the treatment of anterior mediastinal tumor.Methods Twenty patients with anterior mediastinal tumor were enrolled in the study.Under general anesthenai,after a 6 to 10cm middle skin incision was made,a unilateral figure-L partial sternotomy on the side occupied by the tumor was made in the second or third intercostals space,taking into account the tumor size and location.Tumors were resected with excellent exposure.Results All tumors were completely resected during the operation.In 7 cases,tumors encroached on the adjacent lung tissue,and lung tissue was partially resected.In 5 cases,tumors invaded the pericardium,and the pericardium was partially removed.Mean operating time was 110 minutes(85～130 minutes).The mean time of hospital stay was 7days after the operation,and there was no complication.All but one patients were alive with a mean follow-up period of 18 months(6～27 months).Conclusions The figure-L unilateral sternotomy is considered as an effective and useful minimally invisive approach for anterior mediastinal tumors.

Liver is one of the most commonly metastases in patients with colorectal cancer.Curative hepatic resection is the first choice of liver metastasis of colorectal cancer,which can improve the survival rate ranging from 30％ to 40％ in 5-year.In this article,we will review the operation indication,mode and advance on the current treatment strategies of colorectal liver metastases,and discuss the decision-making process,emphasize a surgery - centered multidisciplinary treatment for the treatment of hepatic metastases from colorectal cancer,to improve the survival rate.

Objective To investigate the expression of CCL20 and CCR6 in the patients with gastric cancer and To examine the relationship between chemokine expression and the occurrence and development of Gastric Cancer. Methods Real-time PCR , flow cytometry and ELISA are used to measure the gene transcription and protein expression levels of chemokine CCL20 and CCR6 in the serum of 50 patients with Gastric Cancer and 30 normal controls. Results The gene expression levels CCL20 and CCR6 in Gastric Cancer group are significantly higher than that in healthy controls. The level protein of CCL20 and CCR6 in peripheral blood of patients with gastric cancer are significantly higher than that in healthy peep le[ (45.4 ±10.9) pg/mL vs (18.6±4.7) pg/mL; (7.11 ±1.03%) vs (1.83±0.43%), P＜0.01. respectively],and the increase significantlyassociated with the clinical stage of Gastric Cancer. Conclusions The method for detecting the expression of CCL20 and CCR6 in patient with Gastric Cancer has been successfully established, and their expression levels were found to be correlated with the occurrence and development of Gastric Cancer. Thus, CCL20 and CCR6 may be involved in the regulatory mechanisms associated with the development of Gastric Cancer, and may be valuable in its diagnosis and prevention.

Objective To express the major allergen of Blattella germanica (Bla g 2) in Pichia pastoris and obtain the soluble protein. Methods The known Bla g 2 gene was used to design the primers which had the restriction enzyme sites. PCR method was applied to obtain the Bla g 2 gene. The gene fragment was then cut and ligated with the Pichia expression vector pGAPZaA, resulting in a recombinant plasmid pGAPZaA-Bla g 2. The linearized pGAPZaA-Bla g 2 was transformed into Pichia pastoris GS115 through electroporation, then screened to positive transformants, and the protein was expressed in YPD medium. Purification of the recombinant protein was achieved by metal (Ni2+) chelating affinity chromatography and Western-blotting assay indicated its IgE binding capacity. Results With the expressed reeombinanl protein, SDS-PAGE showed the presence of the product in the supernatant of the culture with Mr 45 000. After 3 days culture, the recombinant protein occupied 50% of the total proteins in the supernatant. The recombinant protein was purified and Western-blot demonstrated an adequate IgE binding capacity of the product. Conclusion A recombinant protein of Bla g 2 has been obtained, which is soluble in the supernatant and therefore can avoid a process of denaturalization and renaturation of the recombinant.

Objective To identify and purify the allergens of Tyrophagus putrescentiae. Methods Tyrophagus putrescentiae extract was analyzed by SDS-PAGE and Western blotting, and was partially purified by DE52 anion-exchange chromatography and HiLoad 16, 60 Superdex 200 prep grade Size-exclusion chromatography. Results 23 bands were found after SDS-PAGE with comparative molecular weight (Mr) of 177 000, 118 000, 107 000, 70 000, 67 000, 60 000, 52 000, 45 000, 41 000, 40 000, 38 000, 37 000, 35 000, 27 000, 23 000, 22 000, 18 000, 17 000, 16 000, 15 000, 14 000, 13 00 and 12 000. Five allergens were detected by Western blotting with Mr 128 000, 67 000-70 000, 36 000-37 000, 18 000 and 16 000, respectively. The positive reaction rate of 3 allergens, with Mr 128 000, 67 000-70 000 and 36 000-37 000, were 100%, while that of other 2 allergens with Mr 18 000 and 16 000 was 77.8% and 44.4% respectively。The allergen with Mr 18 000 was purified by anion-exchange chromatography and Size-exclusion chromatography. Conclusion Four major allergens and one minor allergen from Tyrophagus putrescentiae have been identified.

The rising ofmetabonomics after genomics and proteomics offers chances for the modernization of TCM.Metabonomics has much in common with TCM in the cognition of human body. Appropriate application of the methodology of metabonomics in TCM, such as TCM differential diagnosis and guidance of clinical treatment, would speed up the integration of TCM and modem life science and technology. Meanwhile the research of COPD in TCM will come into a new stage through the use of metabonomics. This article overviewed the current situation of Chinese medicine using metabolomics technology to raise its theory, science and diagnostic level, and the study of pulmonary-qi deficiency syndrome of COPD with metabonomics.

Objective To analyze and compare the clinical features of community-acquired pneumonia caused by Legionella in elderly (age≥60 years) and younger patients. Methods The epidemiological, clinical, laboratory data and the outcomes of 80 cases with community-acquired Legionella pneumonia (CALP) from January 2001 to October 2009 were studied retrospectively, and the differences between elderly and younger group were compared using univariate and multivariate analysis. Results (1) Underlying diseases, such as cerebrovascular diseases, chronic obstructive pulmonary diseases, diabetes mellitus and immunosuppressive therapy were significantly more frequent in elderly group than in younger group (all P＜0. 05). (2) No significant differences were observed between the two groups in legionella serotype. (3) Malaise, hyponatremia and hypophosphatemia were all more frequent in elderly group than in younger group (x2=5. 300, 5. 520, 4. 470; P=0. 021,0. 019, 0. 034, respectively). And elderly versus younger group had higher creatinine levels [(108.55±56.57) μmmol/L vs. (75.42±17.62) μmmol/L, t= -3. 062, P=0. 002], lower PaO2/FiO2 (＜300) (57.7% vs. 29.2%, x2=4. 120, P=0.042), less leucocyte counts [(8.34±3.65)×109/Lvs. (10.63±5.02)×109/L, t=-2.287, P=0.022]. (4) Elderly patients more likely complicated with congestive heart failure (P=0.037) and their length of staying in hospital was also longer (Z=-2.194, P=0.028). No significant differences were observed between the two groups in mortality, intensive care unit admission, and the need for corticosteroids or mechanical ventilation.Conclusions Elderly patients with CALP have a higher frequency of underlying comorbidities and more organs involvement than younger patients, although greater severity of illness at onset and outcome are not significantly different between the two groups.

Objective To observe the synergetic action of Zhenqi Fuzheng granule in prevention and treatment of critically ill patients with severe infection. Methods A retrospective study was conducted. 154 cases with critical illness were enrolled in the First People's Hospital of Baiyin in Gansu Province from January 2009 to December 2013. The control group consisted of 76 cases and only basic treatments were given;in the treatment group, there were 78 cases,besides the basic treatments,they also taken nasal feeding of Zhenqi Fuzheng granule 5 g twice a day,7 days constituting for 1 therapeutic course,a total of 1-3 courses. The incidences of pulmonary infection, urinary tract infection,deep venous catheter-related infections,rate of using antibiotics,fatality rate,infection relapse rate,disease course,pathogen flora distribution were observed in the two groups. Results Compared with the control group,the rates of lung infection,urethral infection,deep vein catheter-related infection,the rate of using antibiotics, fatality rate,infection relapse rate,the discovery rates of drug resistant Acinetobacter baumannii,Pseudomonas aeruginosa,Stenotrophomonas maltophilia,Staphylococcus aureus,and Blastomyces albicans were obviously reduced in treatment group〔lung infection:15.38%(12 cases)vs. 47.37%(36 cases),urethral infection:7.69%(6 cases) vs. 23.68%(18 cases),deep vein catheter infection:5.13%(4 cases)vs. 18.42%(14 cases),antibacterial drug using rate:48.72%(38 cases)vs. 77.63%(59 cases),fatality rate:10.26%(8 cases)vs. 18.42%(14 cases),infection relapse rate:28.21%(22 cases)vs. 48.68%(37 cases),the discovery rate of Acinetobacter baumannii:3.85%(3 cases) vs. 11.84%(9 cases), of Pseudomonas aeruginosa:2.56%(2 cases) vs. 9.21%(7 cases), of Stenotrophomonas maltophilia:5.13%(4 cases)vs. 13.16%(10 cases),of Staphylococcus aureus:5.13%(4 cases) vs. 6.58%(5 cases),of Blastomyces albicans:6.41%(5 cases)vs. 10.52%(8 cases),all P<0.05〕;the therapeutic course was obviously shortened(day:5.79±1.89 vs. 13.65±2.73,P<0.05). Conclusion In critically ill patients with severe infection,treatment of Zhenqi Fuzheng granule can reduce the incidences of severe lung infection, urinary tract infection,deep venous catheter-related infection,the 5-year relapse rate,fatality rate,and shorten the therapeutic course,lower the usage of antibiotics and detection rate of drug-resistant bacteria,therefore,clinically it is effective in such patients.

Objective To determine epidemiology and risk factors for nosocomial infections in severe patients.Methods The study included 434 patients (7394 patient-days)during a 2-year period (2010-2011).The incidence rate of infection,pathogenic bacteria,correlation factor of infected were analyzed.Results A total of 225 infections were identified in 113 patients(26.0％).The incidence and infection rates were 56.8 in 1000-patient days and 51.8％,respectively.The infections were pneumonia (40.9％),bloodstream (30.2％),urinary tract (23.6％) and surgical site infections (5.3％).Pseudomonas aeruginosa (22.6％),methicillin-resistant Staphylococcus aureus (22.2％) and Acinetobacter spp.(11.9％) were frequently isolated micro-organisms.Median length of stay with nosocomial infection and without were 13 days (Interquartile range,IQR,20) and 2 days (IQR,2),respectively (P ＜ 0.01).In logistic regression analysis,mechanical ventilation[odds ratio(OR):16.35 ;95％ confidence interval(CI):8.26 ～32.34;P ＜0.01),coma(OR:15.04;95％ CI:3.41 ～66.33;P ＜0.01),trauma(OR:10.27 ;95％ CI:2.34～45.01 ;P ＜0.01),nasogastric tube(OR:2.94 ;95％ CI:1.47 ～ 5.90; P ＜ 0.01),tracheotomy (OR:5.77 ;95％ CI:1.10 ～30.20;P ＜0.05) and APACHE Ⅱ scores 10 ～ 19(OR:10.80;95％ CI:1.10 ～ 106.01 ;P ＜0.05) were found to be significant risk faetors for nosocomial infection.Rate of nosocomial infection increased with the number of risk factors(P ＜0.01).Mortality rates were higher in infected patients than in non-infected patients(60.9 vs 22.1％ ;P ＜0.01).Conclusion These data suggest that,in addition to underlying clinical conditions,some invasive procedures can be independent risk factors for nosocomial infection in ICU.