Objective To explore the clinical feasibility and safety of early intervention for severe stenosis of non-infarct related artery(non-IRA)in patients with acute ST-segment elevation myocardial infarction(STEMI) and multi-vessel disease(MVD)after successful primary percutaneous coronary intervention(PCI)for infarct-asso-ciated artery(IRA). Methods From May 1st,2011 to December 30th,2016,165 patients with STEMI and MVD were enrolled in our study. After the completion of primary PCI in IRA ,75 patients still in the hospital agreed to undergo a second staged PCI in severe stenosis of non-infarct arteries. We analyzed the in-hospital adverse events ,the length of hospital stay and clinical outcomes during the follow-up in the study population. Results There was no significant difference in the incidence of adverse events between the two groups during hos-pitalization. However,compared to patients treated with the IRA-only PCI,those treated with early intervention for severe stenosis of non-IRA was associated with greater benefits for clinical outcomes(including rehospitalization for heart failure,rehospitalization for ACS,recurrent angina pectoris,necessity for reintervention)during the follow-up except for the all-cause mortality. Conclusion Early intervention for severe stenosis of non-IRA is a feasible and safe procedure in patients with acute STEMI and MVD after successful primary PCI.

Objective To explore the application value of single-port inflatable mediastinoscopy combined with laparoscopy in the radical resection of esophageal cancer.Methods The retrospective descriptive study was conducted.The clinicopathological data of 27 patients who underwent single-port inflatable mediastinoscopic and laparoscopic radical resection of esophageal cancer in the General Hospital of Ningxia Medical University between September 2016 and April 2018 were collected.The surgical operators were divided into neck operation group and abdomen operation group.A "Y" tube was used to inflate the abdomen and mediastinum simultaneously with CO2,and the gas pressure was 12-16 mmHg (1 mmHg =0.133 kPa).Bilateral exchange free and join forces with the esophagus and xiphoid process operating small incision,the severed esophagus cardia;residual stomach was made into a 3-5 cm tubular stomach and was sutured at the top point;at the same time,esophagus was brought up from the neck,with a pouch suture between upper esophageal and stapling head;the tubular stomach through mediastinum-esophagus bed was pulled to the left neck and then gastroesophageal anastomosis manually or instrument was performed.Observation indicators:(1) surgical and postoperative recovery;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to May 2018.The measurement data with normal distribution were represented as x-±s.The measurement data with skewed distribution were described as M (range).Results (1) Surgical and postoperative recovery:all the 27 patients underwent successful single-port inflatable mediastinoscopic and laparoscopic radical resection of esophageal cancer,with complete tumor resection and without conversion to open surgery.There was no arrhythmia or myocardial ischemia through intraoperative electrocardiography.Among 27 patients,5 had intraoperative rupture of the pleura and 3 stopped intermittently inflation with CO2 due to obvious hemodynamic changes.The operation time and volume of intraoperative blood loss were (121±21)minutes and (100± 30)mL.Twenty-seven patients had no thoracic incision,obviously decreased postoperative pain and out-of-bed activity at day 1 postoperatively.The volume of postoperative mediastinal drainage was (40± 10)mL.The mediastinal drainage-tube was removed at 1 week after regular food intake.Of 27 patients,5 with pleural effusion were cured by puncture drainage;2 were complicated with anastomotic leakage,1 of them with a small amount of subcutaneous gas under neck incision at 12 days postoperatively was cured spontaneously through oral food intake,without special treatment,and the other had a small amount of subcutaneous gas under neck incision after solid food intake at 1 month postoperatively and then was cured after 1-week fluid food intake;1 with anastomotic stenosis was improved after dilation treatment.The squamous cell carcinoma was confirmed by postoperative pathological examination,without cancer cell infiltration in the upper and lower margins.The numbers of mediastinal lymph node dissected,abdominal lymph nodes dissected and positive lymph node,postoperative pathological staging and duration of hospital stay were respectively 9.5±2.2,8.2±2.5,1 (range,0-12),T1-3N0-1M0 and 13 days (range,11-21 days).(2) Follow-up and survival situations:27 patients were followed up for 1-20 months,with a median time of 10 months.During the follow-up,there was no recurrence or metastasis and death.Conclusion The single-port inflatable mediastinoscopy combined with laparoscopy in the radical resection of esophageal cancer is safe and effective,and it is especially suitable for patients with partial respiratory failure and closed thoracic cavity.

Objective To explore a desirable therapeutic regimen,which is effective,reasonable and practicable for locally advanced nasopharyngeal cancer (LA-NPC) patients in the era of IMRT,with a potential of translating into survival improvement of these patients.Methods Patients presented with stage Ⅲ-Ⅳ B,WHO type Ⅱ or Ⅲ NPC were randomly assigned to receive concurrent chemoradiotherapy (CCRT group) (45 cases) or induction chemotherapy plus radiotherapy alone (IC + RT group) (43 cases),with random number table.IMRT and rapid arc planning were generated in the same treatment planning system for all patients.These two arms received docetaxel plus cisplatin for first cycle of chemotherapy,and cisplatin only for the second cycle.Results Forty-five patients received CCRT and 43 received IC + RT.All the patients completed two cycles chemotherapy.Compared to the CCRT group,the incidence rate of grade 2-4 leukopenia was lower in IC + RT group[67.4 ％ (29/43) vs.86.7 ％ (39/45),x2 =4.628,P =0.031],while the incidence rate of dermatitis,mucositis,neutropenia and fungal infection of oral cavity had no significant differences (all P ＞ 0.05).The tumor response rate (95.3 ％ vs.100.0 ％,P =0.236),2-year overall survival rate (95.5 ％ vs.94.2 ％,P =0.627),2-year progression free survival rate (94.6 ％ vs.88.6 ％,P =0.303),2-year local recurrent free survival rate (97.3 ％ vs.95.5 ％,P =0.951),2-year regional recurrent free survival rate (94.7 ％ vs.96.2 ％,P =0.949),and 2-years distant metastasis free survival rate (93.7 ％ vs.91.5 ％,P =0.454) of the two groups were similar while comparing CCRT to IC + RT group.Conclusion Combined IMRT with TP/DDP regimen,the efficacy of IC + RT is similar to CCRT for LA-NPC.The IC + RT group has less severe leukopenia than CCRT group,which is worth further study.

OBJECTIVETo investigate the effect of poly-ADP-ribosylation in hexavalent chromium Cr(VI) induced cell damage.

METHODSThe study object, poly (ADP-ribose) glycohydrolase (PARG) deficient human bronchial epithelial cells (16HBE cells), was constructed previously by our research group. Normal 16HBE cells and PARG-deficient cells were treated with different doses of Cr (VI) for 24 h to compare the differences to Cr (VI) toxicity, meanwhile set up the solvent control group. On this basis, 5.0 µmol/L of Cr (VI) was selected as the exposure dose, after the exposure treatment, total proteins of both cells were extracted for two dimension fluorescence difference gel electrophoresis (2D-DIGE) separation, statistically significant differential protein spots were screened and identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS/MS), and further validated by Western blot.

RESULTSAfter Cr (VI) treatment, the survival rate of PARG-deficient cells was higher than normal 16HBE cells. When the doses reached up to 5.0 µmol/L, the survival rate of 16HBE cells and PARG-deficient cells were respectively (59.67 ± 6.43)% and (82.00 ± 6.25)%, the difference between which was significant (t = -4.32, P < 0.05). 18 protein spots were selected and successfully identified after 2D-DIGE comparison of differential proteins between normal 16HBE cells and PARG-deficient cells before and after exposure. The function of those proteins was involved in the maintenance of cell shape, energy metabolism, DNA damage repair and regulation of gene expression. The differential expression of cofilin-1 was successfully validated by Western blot. The expression level of cofilin-1 in the 16HBE cells increased after Cr (VI) exposure with the relative expression quantity of 1.41 ± 0.04 in treated group and 1.00 ± 0.01 in control group, the difference of which was statistically significant (t = -18.00, P < 0.05), while the expression level in PARG-deficient cells had no statistically significant difference (t = -8.61, P > 0.05).

CONCLUSIONMost of the identified differential proteins are closely related to tumorigenesis, suggesting that poly-ADP-ribosylation reaction may resist the cytotoxicity of Cr(VI) by inhibiting Cr (VI) induced tumorigenesis, which provides important reference data to clarify the mechanisms of poly-ADP-ribosylation in Cr (VI) induced cell damage.

Bronchi ; Cell Transformation, Neoplastic ; genetics ; Chromium ; Cofilin 1 ; DNA Repair ; Epithelial Cells ; Glycoside Hydrolases ; deficiency ; physiology ; Humans ; Tandem Mass Spectrometry

OBJECTIVETo reveal the role of poly-ADP-ribosylation and DNA methylation in carcinogenic process induced induced by Cr (VI), and to discuss the relations between them.

METHODSThe pre-established Poly (ADP-ribose) glycohydrolase (PARG) deficient cells and 16HBE cells were treated with different concentrations of Cr (VI), and the changes of total genomic DNA methylation level in different groups were detected by methylation immunofluorescent detection, as well as the changes of the activity of methyltransferases. Moreover, RT-PCR and western blotting method were applied to analyze the changes of expression of DNMT1, DNMT3a, DNMT3b and MBD2, upon the protein level.

RESULTSAfter treated by Cr(VI) for 24 h, the healthy 16HBE cells showed a significant lower level of genomic DNA methylation; however, there was no significant changes (P > 0.05) found in PARG deficient cells by immunofluorescence assay. When the dose of Cr (VI) reached 5.0 µmol/L, the activity of methyltransferases in 16HBE cells and PARG deficient cells (49.33 ± 2.65, 80.05 ± 2.05) decreased by 20% and 50% comparing with contrast group (99.27 ± 1.10, 99.30 ± 0.60) . After treated by Cr (VI) for 24 h, the expression of mRNA and protein level among DNMT1, DNMT3a, DNMT3b and MBD2 decreased significantly in healthy 16HBE cells; and the expression of DNMT1 and DNMT3a decreased in PARG deficiency cells. The relevant expression levels of mRNA of DNMT1 were separately (0.99 ± 0.09), (0.79 ± 0.10), (0.59 ± 0.13) and (0.39 ± 0.02) (F = 247.17, P < 0.01), the expression levels of protein were separately (1.00 ± 0.03), (0.69 ± 0.15), (0.65 ± 0.10) and (0.55 ± 0.13) (F = 214.12, P < 0.01), the expression levels of DNMT3a mRNA were separately (1.00 ± 0.04) , (0.93 ± 0.11) , (0.79 ± 0.07) , (0.59 ± 0.05) (F = 498.16, P < 0.01) , and the expression levels of protein were separately (1.00 ± 0.14) , (0.97 ± 0.11) , (0.79 ± 0.17) , (0.57 ± 0.15) (F = 390.11, P < 0.01) when the dose of Cr (VI) at 0, 0.3, 1.2 and 5.0 µmol/L. However, there were no significant changes of expression found in DNMT3b and MBD2.

CONCLUSIONPoly-ADP-ribosylation could regulate the activity of DNMT3b and MBD2, protect cells against the DNA methylation alteration induced by Cr(VI) and maintain the global genomic DNA methylation level.

Cell Line ; Chromium ; toxicity ; DNA (Cytosine-5-)-Methyltransferase 1 ; DNA (Cytosine-5-)-Methyltransferases ; metabolism ; DNA Methylation ; drug effects ; DNA-Binding Proteins ; metabolism ; Epithelial Cells ; metabolism ; Genome ; Humans ; Poly Adenosine Diphosphate Ribose ; metabolism ; RNA, Messenger ; genetics

With the advantages of displaying visceral organs intuitively,showing the operative procedure vividly,making and spreading videos conveniently in clinical teaching,electrobronchoscopy image system was adopted in clinical teaching of respiratory medicine to assist the traditional teaching method,to make up for the deficiencies of tradition method and to improve the learning effectiveness of respiratory medicine for medical students at internship.

Objective To investigate the chemical constituents of Citrus medica var. sareodactylis from Sichuan province, and to provide evidence for the development and utilization and quality evaluation of the medicinal material.Methods Various chromatographic techniques were used to purify the components of this herb. Compounds were identi-fied by their physical characteristics and spectral feature. Results Seven compounds were isolated from Citrus medica var. sarcodactylis, and they were identified as sibiricol (Ⅵ), 7-methylesculetin (Ⅶ), bergapten (Ⅷ), sigmasteryl acetate(Ⅸ), 5-methoxyfurfural(Ⅹ), limonin(Ⅺ), daucosterol (Ⅻ). Conclusion Compound Ⅵ, Ⅶ and Ⅸ are isolated from plants of Rutaceae for the first time.

Objective To evaluate the left ventricle geometry shape and left heart regional function in mitral insufficiency (MI) by quantitative tissue velocity imaging (QTVI) and the left ventricle systolic and diastolic geometry spbericity index. Methods Thirty normal subjects and 62 MI patients underwent QTVI and color Doppler imaging (CDFI) were enrolled in this study in order to measure the left ven-tricular geometry shape and left ventrieular regional function along LV apical long-axis view. Off-line LV regional velocity images along LV apical long-axis view were synchronously obtained. Peak tissue velocities of LV regional muscular tissue during systole(Vs),systolic acceler-ation(a), early diastole(Ve), LA contraction(Va)were synchronously measured as the index of left ventricular regional systolic and dias-tolic function. The left ventricle geometry shape index were reflected from the systolic and diastolic geometry sphericity index (SIs and Sid) and the left ventrieular ejection fraction (LVEF) and the peak D and peak a (PVd/PVa) of pulmonary veins flowing spectrum reflected the global left ventricular function index. The Vs, Ve, Va, a, PVd/PVd ratio, LVEF, SIs, SId were recorded and their correlation between normal subjects and patients with MI were compared. Result Vs, Ve,Va,a,PVd/ PVa ratio,SIs,SId in patients with MI were significantly re-duced. There was positive relation between Sis and a(r=0.602)and Ve/Va and SId(r=0.635). Conclusion There was negative rela-tion between regional cardiac function and LV spberieity, the higher cardiac function was accompanied with the lower SI.

OBJECTIVE To explore how to realize the superior effect of Hospital Information System(HIS) in management of Nosocomial Infection(NI).METHODS Based on the platform of HIS,the prospective investigation,prevalence surveying,targeted surveillance and usage of antibiotics were performed.Drug-resistance was also monitored in real time.RESULTS Applying the HIS,infection control personnel could perform the overall surveillance on patients′ nosocomial infections.The hospital infection control process was optimized and time was saved for all medical personnel.CONCLUSIONS The application of the HIS enhances the hospital infection management level and decreases the incidence rate of NI,which may deserve to be generalized.

Objective To approach the correlation of the left ventricular function in elderly patients with acute myocardial infarction (AMI) at low-risk factor. Methods Forty-five elderly patients hospitalized for AMI were registered, including 20 patients who were underwent emergency percutaneous coronary intervention (PCI) after the onset of AMI and 25 patients who received conservative non-invasive therapies. These 45 cases all received echocardiography(ECHO) examination in the 4th and 24th week after acute myocardial infarction. Results In the PCI group, end-diastolic volume index (EDVI) and end-systolic volume index (ESVI) had significant difference (P0.05) after therapy; WMSI was higher than PCI group (P