Abstract:Objective To study the species and distribution of rodents and blood-sucking insects in Xisha Islands of China, so as to provide evidence for prevention and control of infectious diseases in the area. Methods Using mouse cages and light trap, we collected rodents and blood-sucking insects (mosquito and midge) in Yongxing and Shi Islands (two islands of China's Xisha Islands) during November to December in 2013 and February to March in 2014. The specimens were identified by morphologic characters and molecular markers. Results A total of 160 rodent individuals, belonging to 3 species, were captured: Rattus norvegicus, Rattus tanezumi and Sorex sp, with Rattus norvegicu (61.25%) being the dominant species. The 315 collected mosquito samples belonged to 4 genera and 5 species, with the dominant species being Armigeres subalbatus (52.38%). The Anopheles mosquito was identified as Anopheles subpictus cytotype B by ITS2 sequence. The 121 collected midges belonged to 3 subfamilies, 4 genera and 8 species, with Culicoides peliliouensis (61.98%) being the dominant species. Conclusion The species numbers of rodents, mosquitoes, and midges in Yongxing and Shi Islands are 3, 5, and 8, respectively. This is the first record of Anopheles mosquitoes and midges in the area, and Forcipomyia (Lepidohelea) chrysolopha and Forcipomyia (Schizoforcipomyia) borbonicawere are firstly recorded in China.

Abstract:Objective: To investigate the effect of autologous angiogenin-overexpressing marrow stromal cells transplanted in a porcine model of chronic ischemia. Methods: Standard experimental pigs underwent placement of a left circumflex artery ameroid occluder and were randomized to treatment with marrow stromal cells transfected ex vivo by angiogenin gene (Group I, n=11), or with marrow stromal cells without any gene transfected (Group II, n=10), and an additional group of animals served as a control (Group III, n=10). Cells were cultured, ex vivo angiogenin gene transferred, labeled by CM-DiI and transplanted by directly operating epicardial injection . Rentrop score were evaluated by angiography analysis, and ejection factor by echocardiography after 4 weeks of the therapy. The percentage of infarct area, vessel density, angiogenin protein expression, CM-DiI labeled cells were also evaluated at the same time. Results: Group I revealed significantly greater improvement in the Rentrop score, ejection factor and showed the smaller infarction area and apparent more normal gross left ventricular geometry and wall thickness than the other groups. Di-I labeled cells were observed on fluorescence microscopy indicated the successful engraftment of marrow stromal cells in group I in contrast to the Group II, which showed only sporadic labeled cells. In Group I the protein expression of angiogenin by Western blot and vessel number were also significantly increased. Conclusion: Transplantation of autologous angiogenin-overexpressing marrow stromal cells increases the survival of implanted cells and improves the impair heart function.

Abstract:[Abstract] Objective To study the discharge change of CA1 place cell after hippocampal formation（HF）accepting the visual-vestibular-proprioceptive mismatch configuration as a match by learning, which could provide new scientific experimental data for revealing the fact that HF may encode any combination of sensory inputs. Methods The visual-vestibular-proprioceptive mismatch configuration was set up. According to theta rhythm recording and theta power calculation in rat hippocampal dentate gyrus, it was acquainted that the rat had been adaptive to the sensory conflict. The assembly discharge of CA1 area place cell was recorded in awake rat by using extracellular tungsten microelectrode record and stereotaxic techniques after the rat adapted to sensory mismatch. Results Out of 56 place cells, 14 showed consistent spatial firing in both the match and mismatch condition (both translocation-related experience-independent neurons). 33 showed different spatial firings across the sessions (both translocation-related experience-dependent neurons). The mean sizes of the place fields were larger in both translocation-related neurons than that of experience-dependent neurons. The firing rate distributions in the place fields were negatively skewed and asymmetric. Conclusion The HF encodes a naturally impossible new configuration of sensory inputs after adaptation, the HF is capable of updating it stored memory to accept a new configuration as a match. The HF may encode any combination of sensory inputs.

Abstract:Objective To establish a method using stirring ultrafiltration for isolating exosome from the culture supernatant of bone marrow mesenchymal stem cells(BMSCs). Methods The culture supernatant of BMSCs was collected and centrifuged at low speed to remove residual cells,and then the cell debris was removed by 0.22 μm filter. Then the clarified supernatant was purified by stirring ultrafiltration to obtain exosome. Transmission electron microscope was used to identify the morphology of exosome, Western blotting analysis was used to examine CD63, CD9 protein expression, and CCK-8 kit was employed to detect the effect of exosome on proliferation of human umbilical vein endothelial cells(HUVECs). Results Stirring ultrafiltration successfully isolated exosome from BMSCs culture supernatant; morphology of the isolated exosome was round or elliptic, with the diameter being about 100 nm. Results of Western blotting analysis showed positive expression of CD63, CD9 proteins. The exosome promoted proliferation of HUVECs in a dose-dependent manner. Conclusion Stirring ultrafiltration technique is a simple and efficient method for exosome isolation.

Abstract:Objective To study the relationship between α-fetoprotein (AFP) polymorphisms and peripheral AFP level in hepatocellular carcinoma (HCC) patients. Methods Using polymerase chain reaction-ligation detection reaction (PCR-LDR) technique, we determined the polymorphisms of AFP of 335 HCC patients; the serum levels of AFP were also determined. SPSS 13.0 software was used for statistical analysis. Results The GG genotype frequency of -205 C>G of AFP gene was significantly different between patients with AFP values ≥20 and <20 ng/mL (GG vs CC: χ²= 4.389, P=0.036). The frequency of G allele was also found significantly different between patients with AFP values ≥400 and <400 ng/mL (G vs C: χ²=4.410, P=0.036). No relationship was found between AFP expression and other polymorphisms, including intron1 A>T, intron7 A>G, 3'UTR A>G and intron2 A>G, in AFP gene. Conclusion In HCC patients among Chinese Han population, the C allele and CC genotype of -205 C>G polymorphism site in AFP gene is associated with higher AFP values.

Abstract:Objective To observe miRNA-140 expression in chondrocytes of patients with early osteoarthritis (OA)and the effect of transfecting double-stranded miR-140 (ds-miRNA-140) on chondrocyte function. Methods Normal and OA chondrocytes (4 weeks and 8 weeks) were collected from rabbit model of early OA (A, B and C group, respectively). Quantitative polymerase chain reaction was used to examine miRNA-140 expression and Western blotting analysis was used to examine Col2a1 and MMP-13 protein expression in each group. Col2a1 and MMP-13 protein expression was also observed in chondrocytes transfected with ds-miR-140. Results Compared with group A, miR-140 expressions in group B and C were reduced to 63% and 57%, respectively (P<0.01); the expression was not significantly different between the group B and C(P>0.05). Compared with group A, Col2a1 mRNA expressions in group B and C were reduced by 52% and 63%, respectively (P<0.01); while MMP-13 mRNA expressions were up-regulated by 3.01 and 4.15 folds, respectively (P<0.01). Transfection with ds-miR-140 increased Col2a1 mRNA by 60% and 127% in group B and C, respectively(P<0.01), and the expressions of MMP-13 mRNA in group B and C were reduced to 54.53% and 42.61%, respectively(P<0.01). The changes of Col2a1 and MMP-13 protein expression were the same as that of mPNA. Conclusion miR-140 expression is reduced in early OA cartilage, and transfection with ds-miR-140 may increase Col2a1 expression and reduce MMP-13 expression.

Abstract:Objective To investigate the regulatory effect of transforming growth factor-β (TGF-β) on miR-200b-200a-429 expression and the related mechanism. Methods RT-PCR was used to examine the expression of miR-200a, miR-200b and miR-429 in HK-2 cells treated with TGF-β. The miR-200b-200a-429 promoter was amplified by PCR and was cloned into pGL3 basic vector, which was then transfected into HK-2 cells and the luciferase activity of miR-200b-200a-429 gene promoter was detected by luminometer. Results Results of RT-PCR showed that TGF-β down-regulated miR-200a, miR-200b and miR-429 in HK-2 cells 24 h after TGF-β treatment. Vector of pGL3- miR-200b-200a-429-promoter was constructed successfully and was confirmed by sequencing. Dual-Luciferase reporter gene system was used to verify the promoter activity of the constructed reporter gene vector. TGF-β was found to significantly inhibit the activities of miR-200b-200a-429 promoter in HK-2 cells (P<0.05). Conclusion TGF-β may regulate the activity of miR-200b-200a-429 promoter.

Abstract:Objective To study the inhibitory effect of recombinant human endostatin injection-endostar against lymphatic metastasis of non-small cell lung cancer (NSCLC). Methods The mouse tumor model was established by subcutaneously injecting 0.2 mL A549 human lung cancer cell suspension (1×10⁷/mL) in the right armpit of nude mice. Fifty-six tumor-bearing nude mice were randomly divided into eight groups(n=7), including control group (physiological saline 0.2 mL,1/d), cisplatin group (cisplatin 20 μg, every other day), three endostar groups (endostar 2, 4, 6 mg/kg;1/d), and three endostar plus cisplatin groups (adding cisplatin 20 μg to three endostar groups, every other day). The drugs were injected via the tail vein for 14 d, and the animals were observed for 7 d following the last administration. Tumor diameters were recorded in each group and the changes of tumor size were observed. The tumor tissues and suspicious lymph nodes were subjected to H-E staining and immunohistochemical staining; the staining results were used to calculate the lymphatic metastasis rate, number of metastatic lymph nodes and micro-lymphatic vessel density (MLVD) of each group. Results The pre- and post-treatment differences of tumor diameters in all the experimental groups were significantly smaller than that in the control group, and those of the three endostar plus cisplatin groups were significantly smaller than those of the three endostar groups or cisplatin group (P<0.05). The lymphatic metastasis rate, number of metastatic lymph nodes and MLVD in three endostar groups and three endostar plus cisplatin groups were significantly less than that in control group and cisplatin group (P<0.05). Lymphatic metastasis positive rate, number of metastatic lymph nodes and MLVD in endostar plus cisplatin group were significantly lower or smaller than those in the control group and cisplatin group(P<0.05); for the three endostar groups and the three endostar plus cisplatin groups, the above three parameters in 6 mg/kg endostar group and 6 mg/kg endostar plus cisplatin group were significantly lower or smaller than those in 2 mg/kg and 4 mg/kg endostar groups or 2 mg/kg and 4 mg/kg endorstar plus cisplatin groups (P<0.05). Conclusion Both endostar and cisplatin can inhibit tumor growth, and combination of both has a stronger inhibition than they are used alone. Endostar can inhibit tumor lymphangiogenesis and lymphatic metastases in a concentration associated manner, which is not found for cisplatin.

Abstract:Objective To observe the sequential changes of collagen fibers in rats with diethylnitrosamine (DEN)-induced hepatocellular carcinoma (HCC), so as to provide a reference for pathogenesis research of HCC. Methods Fifty male Wistar rats, weighing 100-120 g, were randomly divided into normal group and HCC model group. The model group was intraperitoneally administered with 50 mg/kg DEN (0.1 mL), twice a week for 4 weeks, then once a week for another 10 weeks. The control group was given normal saline (0.1 mL) in the same manner. Finally the rats were sacrificed; the normal and diseased liver tissues were observed by H-E, Masson and argyrophilic fiber staining. The expression of collagen type Ⅰ and type Ⅲ mRNA was detected by fluorogenic quantitative PCR; the expression of matrix metalloproteinase (MMP) was examined by gelatinases spectrometry. Results Cirrhosis was found in rats 5 weeks after treatment with DEN and HCC was induced 14 weeks after DEN treatment; collagen deposition in liver tissues increased in a progressive manner, and the collagen contents in the HCC tissues was greatly less than that in the adjacent tissues, showing a decreasing trend. The contents of MMP-2 and MMP-9 in the HCC and adjacent tissues had opposite changes compared with collagen. Conclusion Collagen deposition in cirrhosis liver tissue is increased during the process of DEN-induced HCC, but it is decreased in HCC tissues in a progressive manner, which indicates that collagen might be degraded during the progression from cirrhosis to HCC.

Abstract:Objective To study the transmission of hepatitis B virus (HBV) from mother to child and the related influencing factors, so as to provide evidence for HBV control. Methods An epidemiological survey was conducted on 445 mother-infant pair participants with positive maternal HBsAg from 4 hospitals in Pudong New area of Shanghai. Peripheral blood samples of mothers and the umbilical cord blood samples of the infants were collected to detect the markers and DNA titer of HBV. HBsAg positive and HBV DNA positive in umbilical cord blood were defined as HBV positive in the infants. All the newborns received vaccination after birth according to the national regulation. Of the 445 participants, 104 newborns were followed for 7 months after birth, and the blood samples were collected and the markers and DNA titer of HBV were examined. HBsAg positive after 7 months was defined as immune failure. Results The positive rate of HBV in the newborns was 8.0% for mothers with positive HBsAg in our study. The HBV positive rate of newborns whose mothers were positive for both HBsAg and HBeAg was significantly higher than whose mothers were only HBsAg positive (26.7% vs 1.8%, P<0.05). The HBV positive rate was significantly higher in newborns whose mothers with HBV DNA >10⁶ copies/mL compared with those with HBV DNA <10⁶ copies/mL (23.6% vs 2.3%, P<0.05). The immune failure rate of hepatitis B vaccine was 3.8% 7 months after birth in our study, with all their mothers being positive for both HBsAg and HBeAg. Conclusion The maternal HBeAg positivity and the high concentration of HBV DNA are the main risk factors of neonatal infection, and they may lead to non-response to hepatitis B vaccine.

Abstract:Objective To develop a scoring system for differential diagnosis of benign and malignant pancreatic lesions and to evaluate its diagnostic efficiency. Methods We retrospectively analyzed the medical records of patients with pancreatic lesions (with pathologically confirmed diagnosis); the patients were treated in Changhai Hospital from November 2008 to May 2013. A differential diagnosis model was created using multiple logistic regression analysis. A scoring system for differential diagnosis of benign and malignant pancreatic lesions was established based on each regression coefficient, and then was externally validated. The differential diagnosis efficiency of the scoring system was assessed by its consistency, differential ability and accuracy. Results A total of 1 000 eligible participants were included in our research. The scoring system, which was scored from 0 to 14 points, comprised 4 variables: age, anorexia, diabetes history and serum CA19-9.The system had good consistency (P=0.13), a good differential ability (area under the receiver operating characteristic [ROC] curve=0.82,95% confidence interval [CI]: 0.79-0.86,P<0.001). When score 2 was used as the predictive cut-off value, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 81.46%, 66.88%, 77.86%, 88.26%, 54.12%, 2.46, and 0.28, respectively. The risk (88.26%) of malignant pancreatic lesions in patients with high-risk scores(>2) was significantly higher than that (45.88%) in patients with low-scores (≤2) (P<0.001). External validation results showed the scoring system had good differential ability (area under the ROC curve=0.81,95%CI: 0.76-0.86,P<0.001) and consistency (P=0.716). Conclusion The prediction model and its scoring system is of great value for risk stratification of benign and malignant pancreatic lesions, which may be serve as an initial evidence for differential diagnosis of pancreatic lesions.

Abstract:Objective To evaluate the values of CHADS2 score, CHA2DS2-VASc score, and self-modified CHA2DS2-VASc-LA2 score in predicting left atrial thrombus (LAT) in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 203 NVAF patients who underwent transesophageal echocardiography (TEE) examination and cardiac multislice CT scans before AF radiofrequency ablation in our department from June 2007 to June 2012 were included in this study. LAT was detected by TEE in 39 patients (thrombosis group) and not detected in 164 patients (control group). The patients' general condition, medical history, admission examination, CHADS2 score and CHA2DS2-VASc score were subjected to univariate analysis and multivariate logistic regression analysis. Then a new CHA2DS2-VASc-LA2 scoring system was formed by combining left atrial volume index (LAVI), recording LAVI ≥32 mL/m² as 2 points and CHA2DS2-VASc score, which was based on the results of logistic regression analysis. The receiver operating characteristic curve (ROC) was used to compare the values of CHADS2, CHA2DS2-VASc and CHA2DS2-VASc-LA2 scores for predicting LAT formation in NVAF patients. Results ROC curve analysis showed that CHADS2 score had a low predictive value (AUC [area under the curve]=0.661, P=0.002); CHA2DS2-VASc score (AUC=0.731, P<0.001) and CHA2DS2-VASc-LA2 score (AUC=0.771, P<0.001) had middle predictive values. The CHA2DS2-VASc-LA2 scores of the three patients with CHADS2 score being 0 in thrombosis group was increased, and there was no patient in the thrombosis group with CHA2DS2-VASc-LA2 score being 0. Conclusion Compared with CHADS2 and CHA2DS2-VASc systems, CHA2DS2-VASc-LA2 score has a better performance in predicting LAT in low-risk patients with NVAF. It is also suggested that pre-ablation TEE may be unnecessary if the CHA2DS2-VASc-LA2 score is 0.

Abstract:Objectives The aim of this study was to visualize and quantify the flow characteristics in both healthy and patients with Stanford B type aortic dissection. All deriving blood flow parameters from four-dimensional phase-contrast magnetic resonance imaging (4D PC-MRI) were post-processed by moving three dimensional 3D model methods. Methods Moving 3D model of a blood vessel were captured from 4D PC-MRI. Determining a reference vascular cross-sectional plane and capturing the displacement contours information at the same plane were all used to determine the plurality of target vascular cross-sectional planes at multiple times. The plurality parameters of target vascular cross-sectional planes were determined by temporal tracking. The differences of flow characteristics both healthy (n=19) and patients (n=8) with Stanford B type aortic dissection were analyzed by 4D PC-MRI. Variables are expressed as median and inter quartile range (IQR). Sample means were compared using Mann-Whitney U test. A value of P≤0.05 was considered significant for all statistical tests. Results All 4D PC-MRI data were effectively post-processed by the moving 3D model methods. Qualitative blood flow visualization in the aorta of healthy volunteers showed laminar, without turbulences or vortex formation. In the ascending aorta there was a slight helical flow pattern, while there were little changes of wall shear stress in the entire thoracic aorta. Aortic remodeling and false lumen thrombosis of type Stanford B thoracic aortic dissection were determined by 4D PC-MRI and confirmed by T1 3D MRI anatomy scan. Blood flow in the false lumen was multidirectional and complex, with a high proportion of reverse flow, against the predominant aortic flow direction or true lumen. The peak velocity of blood flow in false lumen typically arrived earlier, while not in normal condition. Helical flow was seen mainly near the entry tear of false lumen with higher possibility. The stroke volume was greater in the true (54.3 ml，IQR 43.2—64.8 ml) compared with the false lumen (31.6 ml，IQR 19.8—47.6 ml，Mann-Whitney P＜0.01). The majority of the flow in the true lumen was forward flow (91.4%，IQR 90.0%—94.2%), whereas the false lumen had a high proportion of backward flow (40.3%，IQR 23.2%—53.3%). Expansion rates were measured at the proximal and distal sites. The average velocity of blood flow in the false lumen (7.1 cm/s， IQR 4.9—9.8 cm/s) was less than the true lumen (18.0 cm/s，IQR 13.9—20.6 cm/s， Mann-Whitney P＜0.01). (4) Maximum velocity occurred earlier in the cardiac cycle (false lumen, 166.0 ms （IQR 132.8—210.0） vs true lumen, 215.0 ms （IQR 196.3—249.0 ms，Mann-Whitney P＜0.01). Helical flow was only seen in the false lumen and occurred in 8 of 10 patients,only seen in false lumen 6 of 8 patients. Helical flow typically developed in early-systole, at 158 ms (IQR 145—249 ms) after the R-wave, and lasted for 310 ms (IQR 217—537 ms). The maximum amount of rotation seen was 820° per cardiac cycle. Conclusion Moving 3D model methods were suited to visualize and quantify the flow characteristics and flow parameters from 4D PC-MRI. The changes of flow orientation, time to peak velocity, and helical flow are able to quantify the appearance and development of thoracic aortic dissection.

Abstract:The incidence of non-alcoholic fatty liver disease（NAFLD） is increasing nowadays. Until now there is still no effective treatment of NAFLD, and most researcheshave focused on molecular mechanisms of NAFLD andmetabolic disorders. This review discusses these new molecular mechanisms and their potential treatment of NAFLD, including PXR（pregnane X receptor），FOXO1(forkhead box protein O1)、FXR（farnesoid X receptor），PPARs（peroxisome proliferator-activated receptors），THR（thyroid hormone receptor），AMPK(AMP-activated protein kinase) ，p53,Nrf2(Nuclear erythroid 2-related factor 2)，mitochondria，cannabinoid receptors，and bile-acid receptor.

Abstract:The current studies have shown that plaque rupture of a vulnerable plaque is the main cause of Acute Coronary Syndrome (ACS). The important point is to find and treat a vulnerable plaque to prevent the acute event. Many imaging modalities have been introduced to identify thin-capped fibroatheroma (TFCA). But the morphology and the mechanism of rupture of vulnerable plaques are still the clinical problems. Intravascular Optical Coherent Tomography (IVOCT) is an examine method based on cardiac catheter. It uses near-infrared light, for up to 10 microns high-resolution images, thus to obtain images and tissue characterization on a microscopic scale. With the development of a new generation of Frequency-Domain OCT (FD-OCT), this technology has played a positive role in the study of TCFA. Our main objective is to review the studies of TCFA with OCT. Development of IVOCT might provide new insights into the diagnosis and treatment of coronary heart disease.

Abstract:Objective To construct recombinant adenovirus harboring snake venom cystatin (Ad/sv-cystatin) and to investigate its effect on invasion and metastasis (in vivo and in vitro) of human hepatocellular carcinoma (HCC) MHCC97H cells. Methods The recombinant Ad/sv-cystatin harboring sv-cystatin was constructed to infect MHCC97H cells. Then the growth of MHCC97H cells was assessed by CCK-8. Transwell matrigel assay was used to assess MHCC97H cell migration and invasiveness in vitro. Spontaneous lung metastasis assays were used to examine the effects of Ad/sv-cystatin on the invasion and metastasis of MHCC97H cells in vivo. Results Recombinant Ad/sv-cystatin harboring sv-cystatin gene could infect MHCC97H cells. Ad/sv-cystatin significantly inhibited the growth, migration and invasion of MHCC97H cells in vitro compared with control and Ad/null groups. Intra-tumoral injection of Ad/sv-cystatin significantly inhibited the lung metastasis of MHCC97H cells in nude mice compared with control and Ad/null-treated mice. Conclusion It is indicated that recombinant Ad/sv-cystatin can suppress MHCC97H cell growth, invasion and metastasis in vitro and in vivo, showing a potential for gene therapy of HCC.

Abstract:Objective To investigate the effect of high power microwave (HPM) radiation on morphology of liver cells and serum cytokines in rats. Methods Adult male Wistar rats were exposed to 100 mW/cm² intensity microwave radiation as experimental group, and rats without radiation were designed as normal controls. The blood samples were obtained from the hearts to determine the levels of aspartate transaminase (AST), alanine aminotransferase (ALT), interleukin (IL)-6,IL-10 and IL-18 on 1 d,7 d and 14 d after HPM radiation. Finally the rats were sacrificed and the right leaf tissues of liver were obtained immediately under ice bath, and the hepatic tissue changes were observed under routine light microscope. Results There were inflammatory cell infiltration, scattered, and patched cell degradation, and necrosis in rat hepatic lobule on 1 d and 7 d after HPM radiation; the situation was improved on 14 d after radiation, but there were still cell degradation and dotted necrosis. Serum levels of AST and ALT in the experimental group were significantly higher than those in the control group on 1 d and 7 d after HPM radiation (P<0.05,P<0.01),but not on 14 d after radiation (P>0.05). Serum levels of cytokines IL-6 and IL-18 in the experimental group were significantly higher than those in the control group on 1 d and 7 d after HPM radiation (P<0.01),and the changes recovered somewhat on 14 d after radiation. Level of IL-10 was decreased after radiation compared with the control group, with significant difference found on 1 d after radiation(P<0.05). Conclusion HPM radiation can cause damage to liver structure and function, which might be associated with the changes of serum IL-6,IL-10 and IL-18 levels.

Abstract:Objective To assess the safety and early oncologic results of minimally invasive esophagectomy (MIE) combined with super-extended two-field lymph node dissection for treating esophageal squamous cell carcinoma. Methods A total of 49 patients who underwent MIE through McKeown approach (right chest, left neck, and abdomen) between May 2012 and Dec. 2013 were enrolled in this study. Lymph node dissection fields included whole mediastinum, lower para-esophagus via thoracoscope route, and abdomen. Results The patients included 44 males and 5 females, with an age range of 45-78 years old and a median of 58 years old. Sixteen (32.7%) patients were at Stage Ⅰ. Forty-eight (98.0%) patients received complete resection, and 18 (36.7%) patients had post-operation complications, including 9(18.4%) with neck leakage and 7 (14.3%) with vocal cord paralysis. Post-operative early death occurred in one case. The mean number of removed lymph nodes was 18 and the lymph node metastasis rate was 42.9%(21/49); 28.6%(6/21)of the positive nodes were found in the upper mediastinum and lower para-esophagus areas. Seven of the 18 patients who were followed up had recurrence, with a recurrent rate of 38.9%. The 7 cases included 5 in the locoregional areas and 2 in distant organs. Conclusion MIE combined with super two-field dissection can achieve the lymphadenectomy effect recommended by National Comprehensive Cancer Network (NCCN), with satisfactory safety. Short-term follow-up indicates that the locoregional recurrence is more frequent than distant metastases, demanding more thorough mediastinal lymph node dissection.

Abstract:Objective To put forward the problems in applying portable disposable low pressure vacuum drainage system for modified radical mastectomy and to propose the solutions. Methods We retrospectively analyzed the clinical data of 268 breast cancer patients who were treated with portable disposable low pressure vacuum drainage system after receiving modified radical mastectomy in Changhai Hospital from January 2013 to September 2013.Based on the use of ordinary vacuum ball, the patients were divided into dual-chamber group and single-chamber group. The incidence of bleeding at the puncture sites, volume of post-operation drainage, indwelling time of drainage tube, and hospitalization stay were recorded for the two groups. Results A total of 23 cases had puncture site bleeding, including 22 early bleeding and one delayed bleeding. For the dual-chamber group, the indwelling time of parasternal drainage tube was significantly shorter than that of axillary drainage tube median: 5.0 d vs 9.0 d, Z=-10.713, P=0.000). The drainage time (median: 9.0 d vs 10.0 d) and hospitalization stays (median: 9.0 d vs 9.0 d) of the two groups were not significantly different. It was found that 97.8% (262/268) of the patients in this study were discharged early with a drain, but with lack of discharge guidance. Conclusion Disadvantages of portable disposable low pressure vacuum drainage system include puncture site bleeding, drainage tube cannot be extubated independently and measurement cannot be done independently, and insufficient discharge guidance. Improvement of puncture device, use of double-lumen tube independent drainage, and improvement of discharge guidance should be made to improve the system.

Abstract:Objective To observe the possible bias in Graybiel's scoring system caused by change of complexion and sweating for grading of motion sickness in hot-humid environment, so as to make improvement to the system. Methods A total of 567 subjects received Collis rotating chair tests in room temperature environment, hot temperature environment, and hot-humid environment. The severity of motion sickness was graded by Graybiel's scoring system. Paired design was done among 4 groups (calculated with pallor and sweating, no pallor, no sweating, and no pallor no sweating). Results Graybiel's scores were significantly different under 3 different environments, either calculated with pallor and sweating, or without pallor, without sweating, or without both (P<0.01). The corresponding grades of Graybiel's score were also significantly different when calculated without sweating and without both pallor and sweating, but not when calculated without pallor. Conclusion Our findings suggest that changes of complexion should not be considered when calculating Graybiel's score in hot-humid environment so as to simplify the evaluating process.

Abstract:

Abstract:【】 目的 探讨心电图R波递增不良对前壁心肌梗死(MI)的诊断价值。方法：收集2010年—2013年本院心电图检查呈R波递增不良病人465例,排除左束支阻滞、预激综合征、左心室肥厚、心房颤动、肺源性心脏病的病例,应用心电图PRWP的常规诊断标准Marquette、Zema和10种新的心电图PRWP诊断标准诊断R波递增不良,对于符合入选研究的162例PRWP病例,加做下一肋间心电图检查。结果：由个体体型差异或导联误放引起的PRWP 60例,占37.03%,由急性前壁MI引起的PRWP 9例(5.56%),由陈旧性前壁MI引起的PRWP 93例,占57.41%。结论 心电图R波递增不良诊断前壁MI 建议加做下一肋间心电图以免误诊。