Objective:To explore the sex-based heterogeneity in demographic and pathological trends of lung cancer during the past 30 years.Methods:Patients with primary lung cancer who received surgical treatment in the Department of thoracic surgery, Shanghai Pulmonary Hospital Tongji University from 1989 to 2018 were retrospectively analyzed. The differences between male and female patients in age, smoking history, pathological stage and type were compared. Mann- Kendall trend test was performed for trend analysis. Results:A total of 58 433 patients were included in this study, encompassing 30 729(52.6%) men and 27 , 704(47.4%) women. Compared with male patients, female patients were younger(56.0 years old vs. 59.7 years old), and had a higher proportion of non-smokers(98.3% vs. 52.3%), stage Ⅰ lung cancers(60.6% vs. 49.3%), and adenocarcinoma(93.7% vs. 56.1%, all P-values <0.001). Trend analyses revealed that the proportion of female patients increased year by year, and surpassed males in 2015, with the current ratio of male to female being 1∶1.5. After 2013, the age of onset in females was getting younger, and the average age decreased from 58.7 years old to 54.7 years old( P=0.02). The decrease in the proportion of smoking patients was mainly reflected by male patients(from 68.5% to 31.1%, P<0.01). Stage Ⅰ lung cancers in male and females outnumbered advanced stage in 2012 and 2010, respectively, with a much higher proportion in female patients. Among male patients, adenocarcinoma has replaced squamous cell carcinoma as the most common pathological type since 2012, while in female patients adenocarcinoma remained the most common pathological type of lung cancer, and its proportion continued to increase reaching over 98%. Conclusion:A dramatic change in gender distribution was noticed during the past 30 years. Female patients became the primary population in surgically-treated lung cancers, with a trend of getting younger. The proportion of smokers and squamous cell carcinoma decreased significantly in male patients, and adenocarcinoma has become the most common pathological type of lung cancer. The proportion of stage Ⅰ lung cancers was on a dramatic rise, with the popularization of CT screening for lung cancer.

Objective: To explore the therapeutic effect of salvianolic acid B (Sal B) on rat abdominal island flap after ischemia-reperfusion injury, and to explore the related mechanisms. Methods: Fifty-four male Sprague-Dawley rats were randomly divided into 3 groups and rat lower abdomen island flap models were established: ①Sham-operated group (Sham group): non-blocking blood vessels, intraperitoneal injection of equal volume of saline as Sal B group; ②Model group: blocking blood vessels for 8 h, intraperitoneal injection of the same volume of saline as Sal B group; ③salvianolic acid B group (Sal B group): blocking blood vessels for 8 h, intraperitoneal injection of 40 mg/Kg of Sal B per day. Seven days after continuous drug administration, the survival rate of the flaps in each group was evaluated, and then the animals from each group were sacrificed for the specimens which were used for the following tests: HE staining was performed to evaluate the microvessel density (MVD), and immunohistochemistry was used to detect the level of vascular endothelial growth factor (VEGF) and superoxide dismutase 1 (SOD1). The contents of superoxide dismutase SOD and malondialdehyde (MDA) in flap tissue were tested using the corresponding kit. Results: Seven days after flap operation, the survival rate of Sal B group flap[(65.62±13.20)%] was significantly higher than that of the model group, while HE staining showed an increase in MVD in Sal B group [(28.27±3.19)/mm² and (15.79±6.12)/mm², respectively]. The differences were statistically significant (P<0.05) . Moreover, immunohistochemistry demonstrated that the expression of VEGF and SOD1 obviously increased in Sal B group, and the content of SOD increased significantly. In addition, the expression of MDA decreased after Sal B treatment. The differences were statistically significant (P<0.05) . Conclusion Sal B is able to increase the expression of VEGF and SOD in the rat abdominal island flaps after ischemia-reperfusion injury, to reduce the content of MDA, and then to promote survival rate of rat abdominal island flap.

Objective To explore the effect of posterolateral combined with posteromedial approach in patients with posterior Pilon fracture. Methods The clinical data of 16 posterior Pilon fracture patients who had underwent posterolateral combined with posteromedial approach treatment from June 2014 to December 2016 were retrospectively analyzed. Results The patients were followed up for 12 to 18 months (average 14 months). There were no complications of incision infection, skin necrosis and nerve damage. All the fractures were healed. The fracture healing time was 12 to 24 weeks (average 16 weeks), and no loosening or breakage of the implant was observed. Claw toes deformity occurred in 1 case 6 months after surgery, and the symptom improved after tendon lengthening surgery. According to American Orthopedic Foot and Ankle Society (AOFAS) scoring system, the results of ankle function were excellent in 8 cases, good in 5 cases, and fair in 3 cases. Conclusions The posterolateral combined with posteromedial approach for treatment of posterior Pilon fracture can achieve satisfactory clinic effects because it has many advantages such as good exposure, easy reduction and fixation, less invasion of soft tissue and so on.

Objective:To investigate the diagnostic value of MRI and CT for the liver space-occupying lesions.Methods:The clinical data of 70 cases of patients with liver space-occupying lesions in our hospital from June 2012 to May 2016 were divided into two groups and retrospectively analyzed.35 cases underwent contrast enhanced ct scans (CT group),and others underwent dynamic contrast-enhanced MR imaging(MRI group).The pathological diagnosis,number of lesions and lesions diameter were ompared between two groups.Results:No significant difference was found in the pathological diagnosis,number of lesions(71 vs 70) and lesions diameter(2.25 ± 2.01 cm vs 2.19± 1.98 cm) between two groups(P＞0.05).As the gold standard by pathological diagnosis results,correct diagnostic rate of MRIgroup were 85.71％,which was 77.14％ CT group and lower than that of the MRI group,but no significant difference was found between two groups (P＞0.05).The incidence of adverse reactions in CT group was significantly higher than that of the MRI group (P＞0.05).Conelusion:Both CT and MRI enhancement scanning have higher diagnostic value for the liver space-occupying lesions,but MRI enhancement scanning has higher safety and tolerability.

OBJECTIVETo analyze the clinical features and genetic cause for a family affected with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

METHODSClinical manifestations, neuroimaging, and genetic analysis were performed.

RESULTSThe main clinical features have included stroke, emotional disturbance and history of migraine without progressive memory impairment. A positive family history was confirmed. Cranial MRI has revealed multi-infarct lesions and white matter hyperintensity involving bilateral basal ganglia, subcortex and brain stem. All such features were in keeping with the diagnosis of CADASIL. A rare 2182C>T mutation in exon 14 of the NOTCH3 gene was identified in all available cases.

CONCLUSIONBoth clinical and molecular features suggested that the family has been affected with CADASIL.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Migraine Disorders ; genetics ; Receptor, Notch3 ; Receptors, Notch ; genetics

Objective To analysis the MRI features of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), to improve the understanding of MRI manifestations of this disease. Meth?ods The clinical manifestations, neuroimaging analysis and genetic analysis were performed in the CADASIL pedigree proband and his families. Results Five of six cases were confirmed with C2182T mutation on exon 14 of the NOTCH3, of which three cases were diagnosed by MRI. Brain MRI findings included bilateral symmetric distributed confluent lesions in the subcortical and periventricular white matter in the frontal lobe, hypointensity on T1WI and hyperintensity on both T2WI and T2 FLAIR imaging in four cases. The external capsule was involved in three cases, with hyperintensity on T2WI. Subcortical lacunar lesions (SLLs) were shown in three cases. Lacunar infarction in the basal ganglia and thalamus were presented in four cases. T2WI hyperintensity at the brain stem was found in two cases. Cerebral microbleeds were re?vealed in three cases. There was no O’Sullivan sign in all the six cases. Conclusions There is characteristic change of MRI in CADASIL patients, which may play a very important role in screening these cases.

Objective:To investigate the effect of up‐regulating miR‐519d on proliferation and apoptosis of laryngeal squamous cell carcinoma .Methods:The expression of signal transducer and activator of transcription 3 (STAT3) and miR‐519d in human laryngeal carcinoma epithelium cell line Hep‐2 and human bronchial epithelium cell (HBE ) were detected by real‐time fluorescent quantitative polymerase chain reaction (RT‐PCR) and Western blotting .After up‐regulating miR‐519d expression in Hep‐2 cell line by plasmid transfection technique ,the proliferation and apoptosis of transfected cells and control cells was detected by proliferation and apoptosis assays .Results:STAT3 mRNA expression in Hep‐2 cells was significantly higher than that in HBE cells (P<0 .05) .However ,miR‐519d expression in Hep‐2 cells was significantly lower than that in HBE cells (P<0 .05) .The STAT3 mRNA expression in the transfected Hep‐2 cells decreased significantly .During 0 and 7 day of post‐transfection culture ,proliferation rate of transfected Hep‐2 cells was significantly lower than that of untransfected cells (P<0 .05) .After 24 h culture ,the apoptosis rate of miR‐519d transfected cells was (2 .8 ± 0 .15)% ,while that of control cells was (0 .92 ± 0 .09)% (P=0 .000 4) .After 72 h culture ,the apoptosis rate of miR‐519d transfected cells was (23 .06 ± 3 .52)% , while that of control cells was (23 .26 ± 2 .56)% (P=0 .965 5) .Conclusions:STAT3 shows high expression in Hep‐2 cell , while the related miR‐519d shows low expression .By up‐regulating miR‐519d ,STAT3 expression could be suppressed ,so as to suppress the proliferation of tumor cells and promote the apoptosis of tumor cells .

Objective:To explore the clinical value of serum tumor markers ,which are carcino-embryonic antigen (CEA) ,car-bohydrate antigen 19-9 (CA19-9) ,carbohydrate antigen 72-4 (CA72-4) and cytokeratin 19 fragments (CYFRA21-1) ,in early diagnosis and treatment of laryngeal carcinoma .Methods :From January 2012 to June 2013 ,60 patients with laryngeal carcino-ma (case group) were selected ,and 60 corresponding participants in physical examination were also enrolled as healthy controls in this study .The serum contents of CEA ,CA19-9 ,CA72-4 and CYFRA21-1 were measured before and after operation in the two groups .The differences of sensitivity and specificity in detection of laryngeal carcinoma were compared between individual and combined detection of targeted indicators .Results:The serum levels of CEA ,CA19-9 ,CA72-4 and CYFRA21-1 were significantly higher in the study group than those in the control group (P<0 .01) .The serum levels of CEA ,CA19-9 ,CA72-4 and CYFRA21-1 of the study group were significantly higher in pre-operation than those in post-operation ,and the differ-ences were statistically significant (P<0 .01) ,among which CA19-9 showed the highest sensitivity (60 .00% ) ,while CA19-9 and CA72-4 showed the highest specificity (both were 100% ) .ROC curve analysis showed that the area under curve (AUC) of CA19-9 was 0 .987 ,which is significantly higher than those of CEA ,CA72-4 and CYFRA21-1 .The sensitivity of combined de-tection was significantly higher than individual test ,and the differences were statistically significant (P<0 .05) .Conclusions :Detection of serum CEA ,CA19-9 ,CA72-4 and CYFRA21-1 levels can be applied to early diagnosis of laryngeal carcinoma . Combined detection can significantly improve the sensitivity in diagnosis meanwhile maintain the superior specificity .

Objective To investigate the mechanism of protective effects of 17-β estradiol on the experimental model of spinal cord injury (SCI) rats.Methods First,the primary astrocytes were cultured and identified.When the third generation astrocytes were cultured,they were induced by H202 whose concentrations were established by the method of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT).The cells were randomly divided into five groups:control group; the group of treatment with 400 μmol/L H2O2 for 24 hours; the group of treatment with 20 nmol/L estrogen for 2 hours prior to exposure to 400 μmol/L H2O2 for 24 hours; the group of treatment with 20 nmol/L estrogen for 26 hours and the group of treatment with dimethyl sulfoxide for 26 hours.The proteins which were extracted from these cells after treatments with H2O2 for 24 hours were detected by Western blotting.Results The absorbances of the astrocytes of treatments with H2O2 were reduced( q' =-11.45,P =0.001 ).But exposure to estrogen prior to exposure to H2O2 provided partial restoration of the absorbances (q' =7.025,P =0.0025 ).The absorbances of the astrocytes among different groups showed significant differences( F =69.69,P =0.0025 ).The results suggested that estrogen might increase the cell viability in astrocytes.Compared with the group of treatment cells with H2O2,treatment cells with 17-β estradiol prior to H2O2 exposure down-regulated the expressions of both phosphatase and tensin homologue deleted on chromosome 10 ( PTEN ) ( F =290.003,P =0.001 ) and caspase-3 ( F =46.158,P =0.023 ).And,17-β estradiol treatment of cells increased the levels of p-Akt ( F =49.173,P =0.033 ) and Bcl-2 ( F =115.916,P =0.001 ) when compared with the group of treatment astrocytes with H2O2.Conclusion These findings suggest that the attenuation of PTEN expression mediated by estrogen is associated with an increase in phosphorylation/activation of the Akt and the Bel-2 expressions.These results suggest that the protective effects of 17-β estradiol on the experimental model of SCI rats may depend on the estrogen protection to the astrocytes which may be mediated by decreasing the PTEN expression.

Objective To investigate the relationship between tumor necrosis factor-α (TNF-α) in ischemic brain tissue and bran edema after cerebral ischemia-reperfusion in rats.Methods Eighty four male SD rats were randomly assigned to either a cerebral ischemia reperfusion group (n =44) or a sham-operation group (n =40). A model of middle cerebral artery occlusion for 120 minutes followed by reperfusion was induced in rats using the suture method. The infarct size was determined by 2, 3, 5-triphenyi terazoloride (TTC) staining at 6 h,24 h, 3 d, and 7 d respectively after the reperfusion. Dry-wet weight method was used to measure brain water content and evaluate the extent of brain edema. The enzyme-linked immunosorbent assay (ELISA) was used to detect the concentration of TNF-α in ischemic brain tissue. Results TNF-α level in ischemic brain tissue was increased at 6 h (445.8 ±91.7 pg/ml) after the reperfusion, and reached the peak at day 3 (715.5 ±121.3 pg/ml). There were significant differences compared to the sham-operation group and other time points (all P＜0.001). After that, it was decreased gradually, but it was still higher than that in the shamoperation group at day 7 (478.1 ± 145.5 pg/ml vs. 148.5 ± 101.7 pg/ml, P＜0.005). The initial change of the water content in brain tissue lagged behind the increased TNF-α. It did not increase significantly until 24 h after cerebral ischemia-reperfusion (P ＜0.001). It reached the peak at day 3 (P ＜0.001), and it was still higher than that in the control group at day 7 (P ＜0.05). The evolution of cerebral infarct volume was in accordance with the changes of TNF-α level. Conclusions TNF-α is associated with the changes of brain edema and infarct volume,and it is harmful to brain tissue.