Background and objective With further understanding and research into non-small cell lung cancer with tumours ≤2 cm in maximum diameter,segmental lung resection is able to achieve the same long-term prognosis as lobec-tomy.However,there are few studies on the prognostic effect of wedge resection on small volume invasive lung adenocarci-noma with an invasion depth of 0.5 to 1.0 cm.Therefore,this study focuses on the clinical efficacy and prognosis of wedge re-section in patients with small-volume invasive lung adenocarcinoma.Methods A retrospective analysis of the medical records of 208 patients who underwent surgery in the Department of Thoracic Surgery of the Affiliated Provincial Hospital of Anhui Medical University from February 2016 to December 2017 was made,and the postoperative pathological results confirmed small volume invasive lung adenocarcinoma.According to their surgical methods,they were divided into lobectomy group(n=115),segmentectomy group(n=48)and wedge resection group(n=45).Kaplan-Meier survival curve estimation and Cox proportional risk regression model were used to explore the influence of different surgical methods on the prognosis of patients with small volume invasive lung adenocarcinoma.Results The wedge resection group had better perioperative outcomes compared with the segmentectomy group and lobectomy group,with statistically significant differences in intraoperative bleed-ing(P=0.036),postoperative drainage(P＜0.001),operative time(P=0.018),postoperative time with tubes(P=0.001),and postoperative complication rate(P=0.006).There were no significant differences when comparing the three groups in terms of survival rate(lobectomy group vs segmentectomy group,P=0.303;lobectomy group vs wedge resection group,P=0.742;and segmentectomy group vs wedge resection group,P=0.278)and recurrence-free survival rate(lobectomy group vs segmentec-tomy group,P=0.495;lobectomy group vs wedge resection group,P=0.362;segmentectomy group vs wedge resection group,P=0.775).Univariate and multivariate survival analyses showed that consolidation tumor ratio(CTR)was the prognostic factor of overall survival and revurrence-free survival for patients with small-volume invasive lung adenocarcinoma(P＜0.05).Conclusion Wedge resection in patients with small volume invasive lung adenocarcinoma can achieve long-term outcomes similar to segmentectomy and lobectomy.When the CTR≤0.5,wedge resection is preferred in such patients.

Objective To evaluate the effect of doxepin on the expression of p38 mitogen-activated protein kinase (p38 MAPK) in the spinal cord of rats with neuropathic pain (NP).Methods Sixty clean-grade male Wistar rats in which intrathecal catheters were successfully implanted,weighing 200-250 g,were divided into 3 groups (n =20 each) by a random number table method:sham operation group (S group),NP group and doxepin group (D group).NP was induced by chronic constriction injury (CCI) to sciatic nerve.Doxepin 20 mmol/L (10 μl) was intrathecally injected at 3,7,14 and 21 days after CCI (T1-4) in group D.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before CCI (T0) and at T1-4.The rats were sacrificed after measurement of pain threshold at T4,and L4-6 segments of the spinal cord were removed for determination of the expression of p38MAPK protein by Western blot.Results Compared with S group,MWT was significantly decreased and TWL was shortened at T2-4,and the expression of p38MAPK protein was up-regulated in NP and D groups (P＜0.05).Compared with NP group,MWT was significantly increased and TWL was prolonged at T2-4,and the expression of p38MAPK protein was down-regulated in D group (P＜0.05).Conclusion The mechanism by which doxepin mitigates NP is related to down-regulating p38MAPK expression in the spinal cord of rats.

Objective To explore the effects of information-motivation-behavioral (IMB) skills model based WeChat education on the treatment compliance, the self-efficacy and the quality of life of diabetic nephropathy patients.Methods A total of 92 patients with diabetic nephropathy treated in Danyang People's Hospital from January 2015 to June 2016 were selected as the research object by convenient sampling method and randomly divided into observation group and control group according to the random number table, with 46 cases in each. The control group received conventional WeChat health education, and the observation group implemented WeChat health education based on IMB model. The treatment compliance, the self-efficacy and the quality of life were compared between the two groups 6 months after the nursing intervention. Results There was no statistically significant difference between the two groups of all dimensions and the total scores of treatment compliance before intervention (P>0.05). All the dimensions of treatment compliance of the observation group were higher than those of the control group after intervention, and the differences were statistically significant (t=3.365, 3.258, 3.989, 2.655, 3.513, 4.674, 3.747, 4.187,3.578;P<0.01). The change degree of the 10 dimensions of self-efficacy and total scores were all greater than those of control group, the differences were statistically significant (t=4.854, 5.632, 4.854, 4.241,3.896, 3.785, 3.789, 3.325, 3.314, 3.817,4.123;P<0.01). The improvement of all the dimensions of patients' life quality and its total score were all higher than the control group after intervention, with significant statistical difference (t=5.965, 4.763, 4.746, 4.547, 3.869;P<0.01).Conclusions Application of IMB model based WeChat health education on diabetic nephropathy patients can significantly improve the patient's treatment compliance, self-efficacy and quality of life.

Objective To explore a new method for lacrimal passage irrigation after laser dacryocystoplasty surgery. Method One-hundred patients (104 eyes), which underwent laser dacryocystoplasty surgery combined with lacrimal drainage tube indwelling, were divided into two groups. In Group A (50 patients, 52 eyes), lacrimal passage irrigation was performed by traditional No.5 needle. While in Group B (50 patients, 52 eyes), it was done by No.7 blunt round needle designed by the researchers. Lacrimal passage irrigation was performed three times, each at the 3rd day, 1 week and 1 month after surgery. The silicone tube was removed 3 months after surgery and the treatment was evaluated. Results The total effective rate was 64% (32/50) in Group A and 92%(46/50) in Group B. The difference was statistically significant (χ2=18.537, P < 0.01). Conclusions The No.7 blunt round needle showed better effect when used for lacrimal passage irrigation after laser dacryocystoplasty surgery. It could improve the efficiency of lacrimal passage irrigation, thus decreasing irrigation times and reducing psychological pressure for the patients, which is worthy of clinical application.

Objective To investigate the association between atrial fibrillation (AF) and epicardial adipose tissue (EAT) by echocardiography.Methods One hundred and thirty-eight patients of AF in First Affiliated Hospital of Chinese People's Liberation Army General Hospital from March 2014 to June 2016 were divided into two groups,including paroxysmal AF group with 87 casesand persistent AF group with 51 cases,and 112 cases of sinus rhythm were chosen as control group.Epicardial adipose tissue was measured using echocardiography in all patients,and the conventional parameters were recorded.One-way analysis of variance was used to compare the thickness of EAT in patients with paroxysmal AF group,persistent AF group and sinus rhythm group,and LSD-t test was used in further comparison between two groups.Multivariable logistic regression analysis was used to analyze the risk factors of AF.The receiver-operating characteristic (ROC) cure of EAT and left atrium diameter (LAD) were drawn to predict the incidence of AF.The correlation between EAT thickness and LAD was analyzed by Pearson correlation analysis.Results The thickness of EAT in patients with persistent AF,paroxysmal AF and sinus rhythm group were (4.75± 1.83),(4.32 ± 1.76) and (1.38 ± 0.68) mm,respectively.Epicardial adipose tissue was significantly larger in paroxysmal AF and persistent AF patients compared with that of sinus rhythm group,and the differences were statistically significant (t=-9.541,11.439,both P ＜ 0.01).Logistic regression analysis indicated that EAT thickness and LAD were independent risk factors of atrial fibrillation (odds ratio:3.17,95％ confidence interval:1.31-7.68,P ＜ 0.01;odds ratio:2.65,95％ confidence interval 1.69-4.15,P ＜ 0.05).The area under the curve (AUC) of EAT and LAD to predict presence of AF were 0.784 and 0.865,and the best threshold value were 4.45 mm and 40.00 mm,respectively.Pearson correlation analysis showed that the EAT thickness and LAD had significantly positive correlation (r=0.512,P ＜ 0.01).Conclusions The increase of EAT thickness is significantly correlated with the incidence of AF and is independent to traditional risk factors.Therefore,the increase of EAT thickness has certain clinical value to predict AF.

Objective To compare the ultra-microscopic changes of periodontal Ruffini's corpuscle induced by different patterns of tooth movement,and investigate the influence of different changes of the periodontal mechanical environment on the periodontal mechanoreceptor.Methods Thirty-two eight-weeks-old SD rats were divided into control group(n=4),none-extraction group(n=12) and extraction group(n=12),and none-extraction group and extraction group were further divided into three subgroups,namely 3 day and 14 day and 28 day.For control group,no intervention was performed.For none-extraction group and extraction group,the following interventions were conducted.In none-extraction group,the maxillary left and mandibular right third molars were moved distally.In extraction group,the maxillary left third molar was moved distally,and the bilateral mandibular third molars were extracted.The ultra-structures of periodontal Ruffini's corpuscle in the periodontal ligament of the distal root of the bilateral maxillary third molars were observed under the transmission electron microscope.Results The ultra-structrural changes in the none-extraction group were mainly characterized by degeneration or abnormal distribution of mitochondria in the axon terminal,which were almost recovered at 28 d.In the extraction group,the changes were mainly characterized by deficiency or abnormal elongation of the Schwann sheath and were not recovered at 28 d.Conclusions The ultra-structures of periodontal Ruffini's corpuscle might be influenced by tooth movement and occlusal changes,and the mechanorecepting function of it might be affected by changes of the periodontal mechanical environment.

Objective To compare the transplant-related toxicity and the efficacy of busulfan/fludarabine (Bu/Flu) and busulfan/cyclophosphamide (Bu/Cy) as conditioning regimen in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute myeloid leukemia(AML) in the first complete remission (CR1).Methods Totally 32 AML-CR1 patients underwent allo-HSCT were divided into Bu/Cy (Bu 3.2 mg· kg-1 · d-1,7-4 days before transplantation; Cy 60 mg · kg-1 · d-1,3-2 days before transplantation) and Bu/Flu (Bu 3.2 mg · kg-1 · d-1,5-2 days before transplantation; Flu 30 mg · m-2·d-1,6-2 days before transplantation) groups.The regimen-related toxicity (RRT),incidence and severity of graft-versus-host disease (GVHD),3-year cumulative relapse rate,non-relapse mortality (NRM),3-year event-free survival (EFS) rate and overall survival (OS) rate were compared between the two groups.Results The median follow-up duration was 617.5 (6-1261) days.All patients achieved successful engraftment on 30 day after transplantation.There were no significant differences in the median time to neutrophil engraftment (P =0.121) and platelet engraftment (P =0.171) between the two groups.The median duration of neutrophil count under 0.1 × 109/L and platelet count under 20 × 109/L in the Bu/Cy group were significantly longer than those in the Bu/Flu group (P =0.000 and P =0.047).The incidence of grades Ⅱ-Ⅳ RRT were 68.8％ and 25.0％ (P =0.032) in the Bu/Cy and the Bu/Flu groups,respectively.There were no significant differences in the incidence of acute GVHD (P =0.149),chronic GVHD (P =0.149),incidence of NRM (P =0.333),3-year cumulative relapse rates (P =0.834),3-year EFS rate (P =0.362) and OS rate (P =0.111) between the two groups.Conclusion Compared with Bu/Cy,Bu/Flu is a myeloablative condition regimen with milder bone marrow suppression and lower RRT incidence rate in allogeneic HSCT for AML-CR1 patients without compromising the efficacy.

ObjectiveTo investigate the therapeutic effects of the conditioning regimen with or without total body irradiation on allogeneic hematopoietic stem cell transplantation in acute leukemia.Methods We retrospectively evaluated clinical outcomes in 287 allo-HSCT recipients with acute leukemia (ALL- 105,AML-129,and AUL-53) who received myeloablative conditioning regimen with or without total body irradiation from January 2002 to August 2011.Two hundred and six patients obtained complete remission (CR) and 81 non-remission (NR) before transplantation.One hundred and ninety-nine patients received conditioning with total body irradiation (TBI+ Cy group,9 Gy given over 2 days),and 88 patients received busulfan (BuCy group,3.2 mg·kg-1 ·d-1 ),both followed by cyclophosphamide.ResultsThere were no statistically significant differences in hematopoietic reconstitution,regimen-related toxicity (RRT),graft-versus-host disease (GVHD) and relapse between two groups.For patients with AML and AUL,there was no significant difference in the 5-year survival between the two regimens (P＞ 0.05),while for ALL-CR patients,the TBI + Cy regimen had a higher over survival rate (52.0％ vs.31.3％,LogRank=4.249,P＜0.05) and DFS (50.4％ vs.27.8％,LogRank =4.445,P＜0.05) than BuCy.In TBI + Cy group and BuCy group,the proportion of CD19+ B cells at the first month after HSCT was (4.04 ± 1.86)％ and (1.47 ±0.99) ％ (P＜0.05),that of NK cells at 12th month after HSCT was (23.38 ± 12.19) ％ and (13.11± 7.99) ％ (P＜0.05),and that of CD4+ CD45RO+ cells at 9th month after HSCT was (14.63 ±6.17)％ and (9.07 ± 3.12)％ (P＜0.01),respectively.ConclusionUsing TBI-containing regimen was more effective for treating ALL-CR patients than busulphan-containing regimen,but no difference was found for long-term outcomes in patients with AML and AUL between the two regimens.The 9 Gy TBI-based regimens may not affect recipients' thymic function,T-cells reconstitution and immune tolerance,coming out a non-increase of GVHD.

Since several dengue viruses (DENV) have been isolated in Fujian Province during the past decade, sequencing and evolution analyses of viral envelope genes are helpful in determining their possible transmission origins. In this study, viral RNA was extracted from 12 DENV strains from Fujian between 20042010. Viral envelope genes were amplified, cloned into TA vectors and sequenced, and the sequence data were subsequently analyzed by bioinformatics software. Full-length E genes of DENV-1 or DENV-2 of 1 485 bp, and DENV- 3 of 1 479 bp were obtained. It was indicated, from BLAST analysis and phylogenetic trees, that DENV strains in Fujian Province during 20042010 shared the highest similarity with Southeast Asian strains, suggesting that DENV circulating in Fujian Province between 20042010 were probably imported from Southeast Asia. Hence, extensive monitoring on passengers from this region at the entry-ports should be strengthened.

Objective To investigate and evaluate the clinical value of full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas.Methods Seventy-two patients,who underwent full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas,were selected from the Medical Center of Pituitary Adenomas of our hospital from January 2009 to March 2012.To retrospectively investigate pre- and post-operation symptoms,hormone levels,images information,operation information,complications,following-up information and so on.Results Among the 72 consecutive patients,there were 22 nonfunctioning adenomas,twenty-four prolactin secreting adenomas,seven somatotropin secreting adenomas,five adrenocorticotropic hormone secreting adenomas,one thyrotropin secreting adenomas,and 13 multi-secreting adenomas.The tumor removal was total in 56(77.8％),subtotal 13(18.0％),and partial 3(4.2％).Five cases had CSF leaks,and 6 diabetes insipidus.After 3-24 months of follow-up,the levels of increasing-hormone declined to normal levels in most patients.Conclusion Full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas is a kind of technique which is safe,minimally invasive,having less complications and fast recovery.However,it is necessary for surgeons to accept systematic and specialized training,and own advanced equipments.