Polycyclic aromatic hydrocarbons (PAHs), as a kind of endocrine disruptors, can enter the fetus body cross the placental barrier from prenatal PAHs exposure to cause adverse birth outcomes. However, it is controversial association between prenatal PAHs exposure and low birth weight (LBW) of their infants. So the present study aimed to estimate the effects of prenatal PAHs exposure during the pregnancy on the risk of LBW in a Chinese cohort through modifying the DNA methylation states. A longitudinal prospective study with 407 pregnant women was established from May to October 2019. The prenatal PAHs exposure during the pregnancy was assessed using the internal dose such as the PAHs metabolites and PAH-DNA adducts in the umbilical cord blood. The methylation levels of genomic DNA and growth-related genes (IGF1 and IGF2) were assessed, while the expressions of these genes were both determined by RT-PCR and Elisa methods. The growth outcomes and relevant Z-scores were recorded at birth. The correlations between the DNA methylation status and concentrations of PAHs, expression levels of growth-related genes and body weight/WAZ were investigated as the measures. According to the PAH-DNA adducts, the subjects were divided into two groups: PAHs-exposed group (PAH-DNA adducts>0, n = 55) and non-exposed group (PAH-DNA adducts = 0, n = 352). Compared with the non-exposed group, it displayed marked decreased birth weight, and increased concentrations of PAHs and DNA methylation levels of the global genomic, IGF1 and IGF2 with their lower expressions in the PAHs-exposed group. These hypermethylation (global genomic, CpG14 and CpG15 of IGF1, and CpG14 of IGF2) were positively correlated with the contents of PAHs in the umbilical cord blood, and negatively correlated with the growth outcomes and their expressions. Totally, prenatal PAHs exposures may contribute to an increased risk of LBW of their infants by modulating the DNA methylation states of genomic DNA and growth-related genes (IGF1 and IGF2) in the umbilical cord blood, which could provide the prenatal prevention of PAHs exposure from possible environmental media except from the occupation and tobacco usage to ensure the health of their infants.

目的:讨论单孔胸腔镜肺叶切除及系统性淋巴结清扫手术对肺癌患者生活质量的影响.方法:选取我院的68例肺癌患者患者作为本文的研究对象,而后随机将其分为对照组(实施开胸手术)与研究组(实施单孔胸腔镜肺叶切除及系统性淋巴结清扫手术),评判标准:术中出血量、术后住院时间、淋巴结清扫数目、术后生活质量评分及术后第3日VAS评分.结果:研究组患者的术中出血量、术后住院时间、术后生活质量及术后第3日VAS评分指标明显优于对照组,P<0.05;两组患者的淋巴结清扫数目差异不显著,P>0.05.结论:单孔胸腔镜肺叶切除及系统性淋巴结清扫手术治疗方案的实施可明显提高患者的生活质量,促进其术后快速康复,值得推广.

目的:针对简易鼻塞式持续气道正压呼吸器治疗新生儿呼吸窘迫的临床效果进行分析.方法:本次选取2017年1月-2019年1月期间来我院就医的94例呼吸窘迫的新生儿患者进行研究,分为对照组(n=47例)和研究组(n=47例),其中对照组采用肺表面活性物质治疗,研究组采用简易鼻塞式持续气道正压呼吸器给养治疗,对两组患者治疗前后的血气动脉值进行对比.结果:两组患者在治疗前的血气动脉值没有对比意义,但是在治疗后对照组血气动脉值相比研究组明显较低,数据有对比意义,P<0.05.结论:使用简易鼻塞式持续气道正压呼吸器给养治疗对患者的治疗具有十分积极的效果,治疗后患儿不良反应方面的情况影响较小,值得在临床上进行应用.

Objective Study on expression changes in TGF-β1 signal pathway in atrial myocardium of patients with rheumatic heart disease and atrial ftbrillation (AF),to reveal the underlying mechanism of TGF-β1 signaling pathway downstream signal molecules in atrial fibrillation evolution.Methods Atrial tissue samples from 90 patients undergoing open-heart surgery were collected.Fifty patients had rheumatic heart disease and chronic persistent AF,and 40 patients had rheumatic heart disease but sinus rhythm.We detected the expression level of mRNA and protein of the signal factors in the TGF-β signaling pathway by real-time quantitative PCR and Western blot.Results Realtime-PCR results showed that compared with sinus rhythm group,the expression of ERK1/2 (P =0.007),P38 (P =0.028),connexin 43 (P =0.040) and N-cadherin (P =0.003) mRNA were up-regulated in AF group.JNK (P =0.210),Rac1 (P =0.463) atrial fibrillation group and sinus rhythm group had no significant difference.Western blot showed that the expression of Col Ⅰ (P ＜0.001),ERK1/2 (P =0.015),P38 (P=0.013),connexin 43 (P =0.036) and N-cadherin (P =0.003) were up-regulated in AF group compared with sinus rhythm group.JNK (P =0.081),Rac1 (P =0.753) atrial fibrillation group and sinus rhythm group were not significantly different.The results are consistent with mRNA expression.In addition,correlation analysis showed that the expression of the six detection factors were positively correlated with the expression of Col Ⅰ protein.The correlation coefficients were (0.578,0.353,0.568,0.345,0.488,0.490) and P values were (0.009,0.024,0.015,0.038,0.036,0.044),respectively.Conclusion Collagen Ⅰ fibers obviously accumulate in atrial tissue among those with rheumatic AF,which may correlate with the occurrence of AF.Overexpression of ERK1/2,P38 in non-Smad signal pathway and connexin 43.N-cadherin in CTGF downstream signal molecules in atria of patients with rheumatic heart disease and AF may be related to the occurrence and development of rheumatic heart disease AF.

青年自发性气胸其原因多是肺大疱破裂所致，保守治疗气胸复发率高。手术切除肺大疱，可以明显降低气胸复发率，其中胸腔镜肺大疱切除术具有创伤小、术后病人恢复快等特点，但仍有约5％的复发率［1－3］，本研究通过回顾性分析胸腔镜肺大疱切除术后气胸复发的原因，为手术治疗方法提供参考。

随着肺癌手术技术的进步和综合治疗的发展，肺癌患者术后长期生存者增加，以及高分辨率CT的应用和CT复查的普及，临床医师和病理医师对于第二原发肺癌（SPLC）认识的深入，近年来发现的异时SPLC患者逐渐增加[1]，对外科治疗提出了新的课题和挑战。现分析总结我们自2000年1月~2013年12月手术治疗的16例异时性肺癌患者的临床资料，以探讨异时性第二原发肺癌的诊断和手术方法。

目的：对比奈达铂联合化疗方案与顺铂联合化疗方案，在治疗肺腺癌中的差异。方法：64例不能手术Ⅲ期肺腺癌患者，分为奈达铂组30例，顺铂组34例。结果：64例患者均可进行疗效评价，两组患者的临床资料比较无明显差别。奈达铂组的有效率为53.0%，顺铂组为55.0%，两组差异无统计学意义(P﹥0.05)。奈达铂组胃肠道反应为36%，顺铂组胃肠道反应为67%，两组差异有统计学意义(P<0.05)。结论：在治疗肺腺癌方面，奈达铂联合化疗与顺铂联合化疗方案疗效相似，但胃肠道反应奈达铂组明显降低。

Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice,but precise mechanisms that lead to the start and persistence of AF have not been clarified. It has been observed that Atrial fibrosis concurs with AF, a phenomenon that contributes to the resistance to restore and maintain sinus rhythm ( SR ). The promotion of fibrosis involes in a variety of signaling systems, such as angiotensin Ⅱ, transforming growth factor-β1 and matrix metalloproteinases. We have reviewed the current understanding of the mechanisms underlying atrial fibrosis and its progression in this paper.