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    Editorial
    Impact of new staging of non-small cell lung cancer on clinical practice
    HAN Bao-hui, SUN Jia-yuan
    2011, 31 (3):  253. 
    doi: 10.3969/j.issn.1674-8115.2011.03.001

    Abstract ( 2022 )   PDF (3613KB) ( 2018 )  

    TNM staging of lung cancer serves as standard to guide clinical practice. There are greater changes in TNM staging from the six edition to the seventh edition published in 2009 by UICC/IASLC. T staging and M staging are revised in the seventh edition of TNM staging based on the findings from the follow-up of 81 015 cases of lung cancer. The seventh edition of TNM staging is more consistent with the survival curves of lung cancer. In this paper, the main contents of the seventh TNM staging and the possible impact on clinical practice are introduced.

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    Roles of endothelial progenitor cells in endothelial regeneration after vascular injury associated with percutaneous coronary intervention
    FANG Wei-yi, ZHANG Min
    2011, 31 (3):  256. 
    doi: 10.3969/j.issn.1674-8115.2011.03.002

    Abstract ( 1731 )   PDF (5271KB) ( 1696 )  

    Percutaneous coronary intervention (PCI) has significantly improved myocardial perfusion and clinical outcomes in patients with ischemic heart diseases in recent years. Adverse cardiac events after PCI continue to be problematic despite advances in stent design and adjunctive pharmacotherapy. Endothelial regeneration is a key component of an effective response to vascular injury associated with PCI. Endothelial progenitor cells (EPCs) recently emerged as an important component of response to vascular injury, having the potential to accelerate vascular repair through rapid reendothelialization. The roles of circulating EPCs in response to vascular injury may serve as effective strategies to enhance vascular repair after PCI. The elucidation of biological characteristics of EPCs and mechanism of EPCs in PCI-associated vascular injury may help to develop an effective treatment modality to manage the complications associated with PCI.

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    New approaches for individual treatment of advanced non-small cell lung cancer
    LU Shun
    2011, 31 (3):  261. 
    doi: 10.3969/j.issn.1674-8115.2011.03.003

    Abstract ( 2237 )   PDF (4143KB) ( 2367 )  

    Lung cancer continues to be the leading cause of cancer death worldwide, and non-small cell lung cancer is the most common type of lung cancer. Despite many clinical trials of platinum-based chemotherapy in combination with various drugs, the median survival time of patients with non-small cell lung cancer remains poor. The overall 5-year survival rate of patients with advanced non-small cell lung cancer is approximately 15%, and has improved only marginally in recent years. A recent milestone in this field has been the development of molecular-targeting drugs, among which gefitinib and erlotinib targeting the epidermal growth factor receptor (EGFR) have improved the efficacy of therapy for non-small cell lung cancer. Anti-angiogenetic drug, such as bevacizumab, has been used in the treatment of non-small cell lung cancer. Moreover, the discovery of echinoderm microtubule-associated protein-like 4/anaplastic lymphoma kinase(EML4-ALK) fusion gene has contributed to the marvelous progress in research of lung cancer. In this review, the drugs used in individualized treatment of advanced non-small cell lung cancer, such as EGFR-tyrosine kinase inhibitors and EML4-ALK fusion gene inhibitors are introduced.

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    Clinical implications of 7th edition of UICC TNM staging system for esophageal squamous cancers
    FANG Wen-tao
    2011, 31 (3):  265. 
    doi: 10.3969/j.issn.1674-8115.2011.03.004

    Abstract ( 2121 )   PDF (6655KB) ( 1829 )  

    The 7th edition of International Union Against Cancer (UICC) TNM staging system for esophageal cancers has been markedly revised in 2009 based on the former edition, and its clinical significance needs to be evaluated so as to better direct therapeutic management of the disease in China. Experience in selective three-field lymph node dissection from Shanghai Chest Hospital, Shanghai Jiaotong University indicates that the new staging system can effectively predict long-term prognosis for thoracic esophageal squamous cancers. Depth of tumor invasion and extent of lymph node involvement are the two most important prognostic factors. Squamous carcinomas located at thoracic esophagus predominate in Chinese patients. As the majority of Chinese patients tend to have locally advanced diseases, much effort is needed to increase the accuracy of preoperative staging, and to include effective induction therapies into a multidisciplinary setting so as to improve surgical outcomes.

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    Original article (Basic research)
    Expression of pentraxin 3 protein in rabbit atherosclerosis plaques
    LIU Hua, FANG Wei-yi, YUAN Fang, et al
    2011, 31 (3):  271. 
    doi: 10.3969/j.issn.1674-8115.2011.03.005

    Abstract ( 1939 )   PDF (5077KB) ( 1450 )  

    Objective To investigate the expression of pentraxin 3 (PTX3) in rabbit atherosclerosis plaques and normal artery tissues. Methods Sixteen New Zealand rabbits were randomly divided into normal diet control group (n=8) and high-fat diet group (n=8), and were fed with standard diet (100 g/d) and high-fat diet (100 g/d) for 16 weeks, respectively. At the eighth and sixteenth week of the study, the formation of atherosclerosis plaques in high-fat diet group was observed by ultrasonography. At the sixteenth week of the study, rabbit aortas of high-fat diet group were obtained, and the formation of atherosclerosis plaques was observed by sudan Ⅲ staining. The expression of PTX3 mRNA and protein in atherosclerosis plaques of high-fat diet group and normal artery tissues of normal diet control group was detected by Real-Time PCR and Western blotting, respectively. Results At the sixteenth week of the study, the formation of atherosclerosis plaques in high-fat diet group was confirmed by both ultrasonography and histological observations. The relative expression of PTX3 mRNA and protein in atherosclerosis plaques of high-fat diet group was significantly higher than that in normal artery tissues of normal diet control group [(2.815±0.531) vs (1.022±0.175) and (0.470±0.056) vs (0.248±0.053)](P<0.01). Conclusion The expression of PTX3 is significantly increased in atherosclerosis plaques, and PTX3 is one of the important inflammatory factors involved in the development of atherosclerosis plaques.

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    Effects of rapamycin on growth and proliferation of human non-small cell lung cancer cell line A549
    LI Wen-yan, ZHU Jun
    2011, 31 (3):  275. 
    doi: 10.3969/j.issn.1674-8115.2011.03.006

    Abstract ( 2407 )   PDF (4968KB) ( 1371 )  

    Objective To investigate the effects of rapamycin on the growth and proliferation of human non-small cell lung cancer cell line A549. Methods A549 cells were cultured with 0 (negative control group), 0.01, 0.02, 0.05, 0.1, 0.2, 0.5, 1 and 5 μmol/L rapamycin (rapamycin intervention group) for 24 h, 48 h and 72 h, and cell viability was detected by MTT assay. A549 cells were cultured with 0 (negative control group), 0.01, 0.05, 0.1, 0.5 and 1 μmol/L rapamycin (rapamycin intervention group) for 48 h, cell morphology was observed by light microscopy, and cell cycle was analysed by flow cytometry with PI simple staining. Results MTT assay revealed that the cell growth inhibition rate in rapamycin intervention group was significantly higher than that in negative control group (P<0.05), and the cell growth inhibition rate was most significant after culture with 5 μmol/L rapamycin for 72 h. Compared with negative control group, A549 cells tended to maintain a round shape by contracting the pseudopod, and the gaps between cells enlarged after culture with different concentrations of rapamycin for 48 h. Cell cycle detection indicated that compared with negative control group, the percent of cells in G0/G1 phase significantly increased, and the percent of cells in S phase significantly decreased in rapamycin intervention group (P<0.05). Conclusion Rapamycin has significant inhibitory effects on the growth and proliferation of human lung cancer cell line A549 in a time- and concentration-dependent manner.

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    Improvement of rat model of orthotopic left lung transplantation
    ZHU Hong-wei, WU Jing-xiang, XU Mei-ying
    2011, 31 (3):  279. 
    doi: 10.3969/j.issn.1674-8115.2011.03.007

    Abstract ( 1462 )   PDF (7854KB) ( 1174 )  

    Objective To improve the cuff-like vessel anastomosis technique-based rat model of lung transplantation, and establish a simple and stable rat model of orthotopic left lung transplantation. Methods Based on preliminary experiments, improvement was made from cuff-like vessel anastomosis technique-based rat model of lung transplantation on the following aspects: lungs were extracted from donors through median sternotomy, and were perfused through cut at the cone of the pulmonary artery with low pressure; blood vessel clamps were used to fix the rear part of pipe; micro left auricular clamps were used to clamp lung hilum instead of removing “sick lung” to complete tallies; respiratory tract management was enhanced. The new model was evaluated by successful rate of operation, time of operation, transplanted lung function and pathological changes. Results Ten consecutive rat models of orthotopic left lung transplantation were completed, with the successful rate of 80%. The time of donor lung perfusion-harvest, donor lung vessel anastomosis and recipient vessel anastomosis was (12±2) min, (18±3) min and (31±3) min, respectively. The oxygenation index 15 min after reperfusion was significantly higher than that 30 min after single lung ventilation (P<0.05). The typical pathological changes of ischemia-reperfusion injury were confirmed by pathological examinations 2 h after reperfusion. Conclusion The improved rat model of orthotopic left lung transplantation has been successfully established, which is simple and effective.

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    Original article (Clinical research)
    Preliminary establishment and application of a new method for detection of EGFR mutations based on suspension array technology
    LOU Jia-tao, WU Chuan-yong, XUE Jian, et al
    2011, 31 (3):  284. 
    doi: 10.3969/j.issn.1674-8115.2011.03.008

    Abstract ( 2178 )   PDF (7718KB) ( 1166 )  

    Objective To explore a new method for detection of epidermal grouth factor receptor (EGFR) mutations based on suspension array technology, which can be used to detect and analyse EGFR mutations associated with EGFR tyrosine kinase inhibitors (TKI) in tissues of non-small cell lung cancer (NSCLC). Methods Sixty-one patients with NSCLC confirmed by imageology and pathology were selected, and the fresh tumor tissues were collected after operation for DNA extraction. The multiplex amplifications of exons 18-21 containing 8 EGFR mutations occurring in high frequency were performed by polymerase chain reaction (PCR), followed by ligation of the PCR products with a series of special probes using ligase detection reaction (LDR), then the LDR products were detected by suspension array technology platform. The results were compared with that from direct sequencing for confirming EGFR mutations. Results Nineteen EGFR mutations in 61 tissue samples of NSCLD (31.1%) were detected using multiplex PCR-LDR combined with suspension array technology, including 1 E746-A750 del (1) deletion mutation and 1 E746-A750 del (2) deletion mutation in exon 19, 1 T790M point mutation in exon 20, and 14 L858R point mutation and 2 L861Q point mutation in exon 21. These EGFR mutations were verified by direct sequencing. Conclusion A new method for detection of EGFR mutations with high throughput and specificity has been established by PCR-LDR combined with suspension array technology, which can be used for accurate identification of 8 EGFR mutations occurring in high frequency simultaneously, and might be useful in detection of EGFR mutations for patients with NSCLC prior to targeted therapy with EGFR-TKI.

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    Expression of ERCC1, RRM1 and BRCA1 in tissues of advanced non-small cell lung cancer
    GAO Zhi-qiang, HAN Bao-hui, SHEN Jie, et al
    2011, 31 (3):  290. 
    doi: 10.3969/j.issn.1674-8115.2011.03.009

    Abstract ( 2360 )   PDF (6783KB) ( 1487 )  

    Objective To investigate the expression of DNA repair gene family members of ERCC1, RRM1 and BRCA1 in tissues of advanced non-small cell lung cancer (NSCLC), and explore its clinical significance. Methods The expression of ERCC1, RRM1 and BRCA1 protein in 122 cases of advanced NSCLC was detected by immunohistochemical methods. The relationship between the expression of ERCC1, RRM1 and BRCA1 protein and the clinical characteristics, response to chemotherapy and prognosis were explored. Results The positive expression of ERCC1, RRM1 and BRCA1 protein in 122 cases was 47.5%, 35.2% and 46.7%, respectively. There was no significant correlation between the positive expression of ERCC1 and RRM1 protein and gender, age, smoking status, ECOG physical status scale score, clinical stages and histological types  (P>0.05), and the expression of BRCA1 protein in females (63.6%) was significantly higher than that in males (40.4%). There was no significant difference in response rates to chemotherapy, median survival time and 1-year survival rate between patients with positive expression of ERCC1 and BRCA1 protein and those with negative expression of ERCC1 and BRCA1 protein (P>0.05). Patients with positive expression of RRM1 protein had significantly lower response rates to chemotherapy and 1-year survival rate than those with negative expression of RRM1 protein (P<0.05). Conclusion The expression of RRM1 protein in cancer tissues is closely related to the response to chemotherapy and prognosis in patients with advanced NSCLC.

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    Expression of p21, p53 and c-erbB-2 in tissues of non-small cell lung cancer and its clinical significance
    SONG Yi-yi, GU Ai-qin, HAN Bao-hui
    2011, 31 (3):  295. 
    doi: 10.3969/j.issn.1674-8115.2011.03.010

    Abstract ( 1962 )   PDF (5324KB) ( 1443 )  

    Objective To investigate the expression of p21, p53 and c-erbB-2 in tissues of non-small cell lung cancer (NSCLC), and explore its clinical significance. Methods The clinical data and paraffin tissue samples of 207 patients with NSCLC confirmed by postoperative pathology were collected. The expression of p21, p53 and c-erbB-2 protein in tissues of NSCLC was detected by immunohistochemical method, the correlation among the expression of p21, p53 and c-erbB-2 protein was analysed, and the relationship between the expression of p21, p53 and c-erbB-2 protein and clinicopathological characteristics was explored. Results The expression of p21 was significantly positively related to that of p53 in tissues of NSCLC (r=0.245,P<0.01). The positive expression rates of p21, p53 and c-erbB-2 in tissues of NSCLC were 54.11%, 38.16% and 32.85%, respectively in 207 patients, and patients with poor differentiation, medium differentiation and lymph node metastasis had significantly higher expression than those with high differentiation and no lymph node metastasis (P<0.05). Patients with history of smoking, central type and squamous carcinoma had higher positive expression rates of p21 and p53, and females and those with no history of smoking, peripheral type and adenocarcinoma had higher expression rates of c-erbB-2 (P<0.05). The 5-year survival rates of patients with positive expression of p21, p53 and c-erbB-2 in tissues of NSCLC were significantly lower than those with negative expression (P<0.05). Conclusion p21, p53 and c-erbB-2 may play important roles in development and progression of NSCLC, which may serve as predicators for prognosis.

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    Effects of intracoronary and intravenous application of tirofiban on platelet aggregation rate
    SONG Jie, QIU Xing-biao, YE Ying, et al
    2011, 31 (3):  299. 
    doi: 10.3969/j.issn.1674-8115.2011.03.011

    Abstract ( 1776 )   PDF (2865KB) ( 1269 )  

    Objective To investigate the effects of intracoronary and intravenous application of tirofiban on platelet aggregation rate (PAR) in patients with acute coronary syndrome (ACS). Methods Eighteen patients with ACS undergoing percutaneous coronary intervention(PCI) were randomized into intracoronary tirofiban bolus group (group IC, n=9) and intravenous tirofiban bolus group (group IV, n=9). The changes of PAR at different time points after tirofiban application in two groups and the differences in the degree of PAR decrease between two groups were analysed, and the prevalences of bleeding and thrombocytopenia were also recorded. Results PAR decreased after treatment with tirofiban in both groups, and there were significant differences between PAR after treatment and that before treatment (P<0.05). In coronary artery, the trend of PAR decrease in group IC was more significant than that in group IV (P=0.062). In peripheral vessel, there was no significant difference in the degree of PAR decrease between two groups (P>0.05). There was no significant difference in the prevalences of bleeding and thrombocytopenia between two groups (P>0.05). Conclusion Both intracoronary and intravenous application of tirofiban can effectively decrease PAR in coronary artery and peripheral vessel, and may not increase the risk of bleeding.

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    Effects of standardized secondary prevention on lifestyle of patients with acute coronary syndrome
    HAN Wen-zheng, ZHANG Min, WANG Jun, et al
    2011, 31 (3):  302. 
    doi: 10.3969/j.issn.1674-8115.2011.03.012

    Abstract ( 1369 )   PDF (3391KB) ( 1422 )  

    Objective To investigate the effects of standardized secondary prevention on lifestyle of patients with acute coronary syndrome. Methods Two hundred and forty-nine patients with acute coronary syndrome were randomly divided into standardized follow-up group (n=116) and routine follow-up group (n=133). Patients in standardized follow-up group were followed up every 3 months, and lifestyle education of secondary prevention was carried out during the follow-up, including smoking quitting, exercise, body weight control, drug use standardization and pressure regulation. Patients in routine follow-up group were followed up every 6 months. At the time points of 6 months of follow-up and 1 year of follow-up, the conditions of smoking quitting, exercise, body weight control and ultimate events (cardiac death, non-lethal myocardial infarction and revascularization of targeted vessels) were compared between groups. Results Two hundred and eighteen patients completed the 6-month follow-up, and 103 patients finished the 1-year follow-up. After follow-up for 6 months or 1 year, the percents of unsuccessful smoking quitting in standardized follow-up group were significantly lower than those in routine follow-up group (P<0.01), and the percents of successful exercise in standardized follow-up group were significantly higher than those in routine follow-up group (P<0.05 or P<0.01). One year after follow-up, the percent of overweight in standardized follow-up group was significantly lower than that in routine follow-up group (P<0.05), and there was no ultimate event in both groups. Conclusion Standardized follow-up can effectively improve the lifestyle of patients with acute coronary syndrome.

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    Clinical analysis of gefitinib in treatment of elderly patients with advanced non-small cell lung cancer
    GU Ai-qin, GAO Zhi-qiang, WANG Hui-min, et al
    2011, 31 (3):  305. 
    doi: 10.3969/j.issn.1674-8115.2011.03.013

    Abstract ( 2514 )   PDF (4340KB) ( 1776 )  

    Objective To evaluate the efficacy and safety of gefitinib in the treatment of elderly patients with advanced non-small cell lung cancer (NSCLC). Methods Eighty-seven patients with NSCLC (stage ⅢB to stage Ⅳ) were treated with gefitinib (250 mg/d) until disease progression or development of intolerable toxicity. Results The overall response rate and disease control rate were 31.0%(27/87) and 77.0%(67/87), respectively. The median progression-free survival time and median survival time was 6.6 months and 12.3 months, respectively. One year survival rate was 52.9%. The response rate and disease control rate of those with adenocarcinoma and no history of chemotherapy were significantly higher than those with non-adenocarcinoma and history of chemotherapy (P<0.05). The disease control rates of females and non-smokers were significantly higher than those of males and smokers (P≤0.01). The median progression-free survival time of those with ECOG performance status scale score of 0-1, adenocarcinoma, no smoking and response to gefitinib treatment was significantly longer than that of those with ECOG performance status scale score ≥2, non-adenocarcinoma, smoking and no response to gefitinib treatment (P<0.01). The median survival time of those with ECOG performance status scale score of 0-1 and response to gefitinib treatment was significantly longer than those with ECOG performance status scale score ≥ 2 and no response to gefitinib treatment (P≤0.001). The most common adverse effects were rash (56.3%) and diarrhea (36.8%). Conclusion Treatment with gefitinib is effective and tolerable for elderly patients with advanced NSCLC.

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    Role of surgical resection in comprehensive treatment for patients with non-small cell lung cancer and solitary brain metastasis
    BAI Hao, HAN Bao-hui
    2011, 31 (3):  309. 
    doi: 10.3969/j.issn.1674-8115.2011.03.014

    Abstract ( 2221 )   PDF (4369KB) ( 1288 )  

    Objective To investigate the role of surgical resection in comprehensive treatment for patients with non-small cell lung cancer (NSCLC) and solitary brain metastasis. Methods The clinical data of 18 patients with NSCLC and solitary brain metastasis were retrospectively analysed. All patients received both whole brain radiotherapy and chemotherapy after surgical resection of brain metastasis, and 10 of them underwent primary lung tumor resection. Results The median survival time of the patients was 20.8 months, and the 1-year, 2-year and 3-year survival rates were 83.3%, 48.8% and 13.9%, respectively. For the patients with or without primary lung tumor resection, the median survival time was 20.5 months and 25.5 months, respectively (P=0.536). Conclusion Surgical resection of brain metastasis may improve survival of patiens with NSCLC and solitary brain metastasis, while the benefit of primary lung tumor resection on survival of patients is uncertain.

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    Evaluation of left ventricular systolic dysfunction by mitral annular displacement in patients with cardiac hypertrophy and remodeling
    WU Wei-hua, HUANG Yan, LU Jing, et al
    2011, 31 (3):  313. 
    doi: 10.3969/j.issn.1674-8115.2011.03.015

    Abstract ( 1673 )   PDF (4397KB) ( 1590 )  

    Objective To investigate the value of mitral annular displacement (MAD) by two-dimensional speckle tracking in evaluating left ventricular systolic dysfunction in patients with cardiac hypertrophy and remodeling. Methods Eighty-six patients with cardiac hypertrophy (left ventricular wall thickness ≥12 mm) and normal left ventricular ejection fraction (LVEF) (>50%) were selected. Philips Sonos iE33 ultrasound device was used for examinations. Relative wall thickness (RWT) was calculated by M mode ultrasound, and two-dimensional and real-time three-dimensional (RT3D) images were obtained at the apical four-chamber view. The related parameters of MAD (mitral annular middle displacement and left ventricular longitudinal fractional shortening) and LVEF measured by RT3D images (RT3D-LVEF) were obtained using on-line QLAB 6.2 software. Three dimensional myocardial remodeling parameters were calculated, including left ventricular end-diastolic volume index (LVEDVI) and left ventricular mass index (LVMI). Patients with cardiac hypertrophy, RWT<0.45 and normal LVMI were classified into hypertrophic normal geometric group (HNG group), and the rest of patients were studied as hypertrophic remodeling group (HR group). Another 46 age-matched healthy volunteers were served as normal control group. Results RT3D-LVEF of HNG group, HR group and normal control group were normal, and there was no significant difference among groups (P>0.05). MAD and LVEDVI in HR group were significantly lower than those in HNG group and normal control group (P<0.01 or P<0.05), while there was no significant difference in MAD and LVEDVI between HNG group and normal control group (P>0.05). Bland-Altman analysis indicated that MAD had a better repeatability. Conclusion MAD can evaluate left ventricular dysfunction earlier than LVEF in patients with cardiac hypertrophic and remodeling.

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    Application of near-infrared spectroscopy and bispectral index in monitoring of cerebral oxygen balance during surgery with deep hypothermic circulatory arrest
    WU Jing-xiang, SHEN Yao-feng, CHEN Xu, et al
    2011, 31 (3):  317. 
    doi: 10.3969/j.issn.1674-8115.2011.03.016

    Abstract ( 1916 )   PDF (5534KB) ( 1374 )  

    Objective To investigate the application of near-infrared spectroscopy and bispectral index (BIS) in monitoring of cerebral oxygen balance during surgery with deep hypothermic circulatory arrest (DHCA). Methods Twelve patients undergoing aortic reconstructive surgery with DHCA were included in this study. BIS, tissue oxygenation index (TOI) and mean arterial pressure (MAP) were recorded before anesthesia (T0), 30 min after anesthesia (T1), after aortic occlusion and cardiac arrest (T2), 5 min after circulatory arrest (T3), 30 min after circulatory arrest (T4), 10 min after circulatory restoration (T5), cardiac rebeating (T6), 10 min after extracorporeal circulation withdrawl (T7), 30 min after extracorporeal circulation withdrawl (T8) and at the end of operation (T9), mixed venous oxygen saturation (SvO2)was detected at the time points of T1 to T9, and postoperative consciousness state was observed. The relationship between TOI and MAP, BIS and SvO2 was analysed. Results In 8 of all the 12 patients, BIS varied from 20 to 50 and TOI changed from 55% to 75% during anesthesia, and BIS was 0 and TOI maintained above 58% during circulatory arrest. All these 8 patients came to consciousness on the first day after surgery. Another 2 patients who experienced relative massive hemorrhage and TOI lower than 55% for more than 30 min during operation did not regain consciousness 5 d after operation. One patient with a history of TOI less than 55% (for less than 10 min) was re-sedated due to restlessness on the first day after operation, and came to consciousness on the following day. The other patient died 4 h after operation. Correlation analysis revealed that TOI had no linear correlation with MAP and BIS, and TOI was significantly positively related to SvO2 (r=0.581 9, P<0.05). Conclusion Near-infrared spectroscopy combined with BIS can be used for dynamic monitoring of cerebral oxygen balance during surgery with DHCA and comprehensive evaluation of cerebral protection during operation, and TOI may be significantly positively related to SvO2.

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    Effects of anesthesia with propofol and sevoflurane on postoperative cognitive function of elderly patients undergoing thoracic surgery
    SHEN Yao-feng, WU Jing-xiang, XU Mei-ying
    2011, 31 (3):  322. 
    doi: 10.3969/j.issn.1674-8115.2011.03.017

    Abstract ( 1988 )   PDF (4332KB) ( 1774 )  

    Objective To investigate the effects of anesthesia with propofol and sevoflurane on postoperative cognitive functions in elderly patients undergoing thoracic surgery. Methods Sixty elderly patients undergoing selective thoracic surgery were randomized into propofol group (anesthesia with propofol and fentanyl, n=30) and sevoflurane group (anesthesia with sevoflurane and fentanyl, n=30). The durations of operation and one-lung ventilation, volume of blood loss during operation and time of spontaneous eye opening and extubation were recorded. The cognitive function was assessed before operation and 1 h, 3 h, 6 h, 24 h and 72 h after operation by mini-mental state examination (MMSE), and the levels of serum S100β protein were detected before anesthesia and 1 h after operation by ABC-ELISA method. Results There was no significant difference in durations of operation and one-lung ventilation and volume of blood loss during operation between two groups (P>0.05). The time for spontaneous eye opening and extubation in sevoflurane group was significantly longer than that in propofol group (P<0.05). There was no significant difference in MMSE score between two groups before operation, while MMSE scores significantly decreased in both groups 1 h and 3 h after operation (P<0.05). MMSE scores in sevoflurane group were significantly lower than those in propofol group 1 h, 3 h and 6 h after operation (P<0.05), and MMSE scores recovered to those before operation in propofol group and sevoflurane group 6 h and 24 h after operation, respectively. The levels of serum S100β protein after operation were significantly higher than those before operation in two groups(P<0.05), and the level of serum S100β protein in sevoflurane group was significantly higher than that in propofol group after operation (P<0.05). Conclusion Anesthesia with propofol and sevoflurane may lead to short-term postoperative cognitive dysfunction in elderly patients undergoing thoracic surgery, and patients using propofol could recover from postoperative cognitive dysfunction faster.

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    Value of dual-phase multislice CT in comprehensive assessment of acute myocardial infarction
    GUAN Shao-feng, FANG Wei-yi, QU Xin-kai, et al
    2011, 31 (3):  326. 
    doi: 10.3969/j.issn.1674-8115.2011.03.018

    Abstract ( 1782 )   PDF (7047KB) ( 1391 )  

    Objective To determine the value of multislice CT (MSCT) in early comprehensive assessment of acute myocardial infarction (AMI) after interventional therapy. Methods Eighteen patients with AMI undergoing percutaneous coronary intervention (PCI) were selected. All patients received dual-phase MSCT one week after treatment. The distribution and enhancement patterns of early perfusion defect (ED), late enhancement (LE), and residual perfusion defect (RD) on MSCT images were analysed. The infarction volume, left ventricular ejection fraction (LVEF) and ventricular wall segmental motion determined by MSCT were compared with area under the curve of serum creatine phosphokinase (CPK) and LVEF and ventricular wall segmental motion measured by transthoracic echocardiography (TTE). Results Seventeen cases of ED were detected on early phase of scan, and both the sensitivity and specificity were 94% in diagnosis of myocardial infarction. Three enhancement patterns were observed on delayed phase of scan: isolated subendocardial LE, subendocardial RD and subepicardial LE, and subendocardial RD. Infarction volume assessed on delayed phase was significantly correlated with area under the curve of serum CPK (r=0.840), LVEF determined by MSCT and TTE (r=0.800) and ventricular wall segmental motion disorders measured by TTE and MSCT (r=0.814)(P<0.001 for all). Conclusion Different enhancement pattern can be observed on dual phase MSCT in patients with AMI after PCI. Assessment of myocardial attenuation on MSCT gives additional information of the location and extent of infarction after reperfusion. Cardiac function and wall motion information can be obtained by one MSCT exam, which is well correlated with findings from TTE. MSCT is suitable for comprehensive assessment of AMI.

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    Analysis of early postoperative complications in elder patients with lung cancer undergoing sleeve resection or pneumonectomy
    PAN Xu-feng, CAO Ke-jian, GENG Jun-feng, et al
    2011, 31 (3):  331. 
    doi: 10.3969/j.issn.1674-8115.2011.03.019

    Abstract ( 2480 )   PDF (3961KB) ( 1371 )  

    Objective To investigate the prevalences of postoperative complications in elder patients with lung caner undergoing sleeve resection or pneumonectomy, and explore the related risk factors. Methods The clinical data of 78 patients with lung cancer aged more than 70 years were collected. Among the 78 patients, 55 underwent sleeve resection of bronchus (sleeve resection group) and 23 received pneumonectomy (pneumonectomy group). The preoperative data, perioperative conditions and prevalences of postoperative complications were compared between groups, and the risk factors related to complications were analysed. Results There was no significant difference in prevalence of postoperative arrhythmia between groups (P>0.05). The frequency of aspiration of sputum with bronchoscopy in sleeve resection group was significantly higher than that in pneumonectomy group (P<0.05). Statistical analysis revealed that the occurrences of postoperative respiratory tract complication and postoperative arrhythmia were not significantly related to the surgical procedures (P>0.05), while preoperative lung function of forced expiratory volume in one second (FEV1) was independent risk factor for postoperative arrhythmia in elder patients with lung cancer (P=0.015). Conclusion Sleeve resection of bronchus and pneumonectomy do not have significant effect on postoperative complications in elder patients with lung cancer. More attention should be paid to postoperative airway management for patients undergoing sleeve resection of bronchus, and poor lung function is risk factor for postoperative arrhythmia.

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    Evaluation of surgical outcomes by right ventricular function parameters in patients with functional tricuspid regurgitation
    FANG Liang, ZHANG Wei, YE Wei, et al
    2011, 31 (3):  335. 
    doi: 10.3969/j.issn.1674-8115.2011.03.020

    Abstract ( 1725 )   PDF (3934KB) ( 1262 )  

    Objective To evaluate the clinical outcomes by right ventricular function parameters in patients with functional tricuspid regurgitation (TR) treated with tricuspid annuloplasty, and explore the relationship among the parameters. Methods Patients with functional TR having moderate or more severe regurgitation treated with tricuspid annuloplasty were selected as study objective. Ten patients underwent modified De Vega annuloplasty (suture annuloplasty group), and another 10 patients were managed with MC3 valve ring annuloplasty (artificial valve ring annuloplasty group). The right ventricular function parameters of patients were recorded before and after operation, including diastolic tricuspid annuloplasty diameter (DTV), myocardial performance index (MPI), right ventricular systolic shift from the long axis (RVLX), right ventricular outflow tract shortening (RVOTFS), systolic TR area to right ventricular area (STR/SRA), right atrial diameter (RA) and right ventricular diameter (RV). Parameters before operation and after operation were compared between groups, and the relationship among parameters was explored. Results STR/SRA, DTV and RA in both groups significantly improved after operation. The improvement of RA in artificial valve ring annuloplasty group was more significant than that in suture annuloplasty group. The correlation analysis revealed that RA was positively related to DTV both before operation and after operation (r=0.45,P<0.05;r=0.47,P<0.001), while there was no significant relationship between DTV and STR/SRA (P>0.05). Conclusion Tricuspid annuloplasty for functional TR is of clinical importance. Artificial valve annuloplasty works better than suture annuloplasty in RA improvement. RA is related to DTV, and can serve as an evaluation parameter for TR degree before operation and surgical outcomes.

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    Analysis of influencing factors for quality of life of patients with non-small cell lung cancer
    PAN Yan, XU Yun-hua, WANG Wei-min, et al
    2011, 31 (3):  339. 
    doi: 10.3969/j.issn.1674-8115.2011.03.021

    Abstract ( 1985 )   PDF (3871KB) ( 1160 )  

    Objective To investigate the influencing factors for quality of life of patients with non-small cell lung cancer. Methods The scoring of quality of life of 154 patients with non-small cell lung cancer was investigated with FACT-L scale (Chinese version 4.0), and the influencing factors were analysed. Results For the 154 patients with non-small cell lung cancer, the scores of lung cancer-related symptoms in males and patients aged more than 60 years were significantly lower than those in females and patients aged no more than 60 years (P<0.01). Among patients with different educational background, the scores of quality of life of those with junior college education were the highest. The scores of quality of life decreased with the incomes. The scores of lung cancer-related symptoms and total scores of scale in patients with chemotherapy and smoking habit were significantly lower than those without chemotherapy and smoking habit (P<0.05). Conclusion For the management of non-small cell lung cancer, more attention should be paid to the elder and poor patients and those treated with chemotherapy. Essential intervention may help to improve the quality of life.

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    Occlusion of atrial septal defect utilizing occluder devise via minimally invasive right chest |approach
    LI Feng, LI Wei, KANG Ning, et al
    2011, 31 (3):  343. 
    doi: 10.3969/j.issn.1674-8115.2011.03.022

    Abstract ( 1638 )   PDF (3724KB) ( 1089 )  

    Objective To evaluate atrial septal defect (ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2-3 cm incision was made in the fourth right intercostal space. Utilizing transesophageal or transthoracic echocardiography, the occluder was released using a monotube unit. Results All patients were occluded successfully. No patient required open surgery utilizing extracorporeal circulation. There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a  minimal surgical incision is safe, less invasive, and has excellent outcomes.

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    Analysis of valve-sparing aortic root replacement with Valsalva graft
    CHEN Xiao-zhong, ZHOU Rui, REN Shu-nan, et al
    2011, 31 (3):  346. 
    doi: 10.3969/j.issn.1674-8115.2011.03.023

    Abstract ( 2184 )   PDF (4019KB) ( 1320 )  

    Objective To investigate the outcomes of valve-sparing aortic root replacement with Valsalva graft in treatment of aortic root aneurysm. Methods The clinical data of eight patients with aortic root aneurysm undergoing valve-sparing aortic root replacement with Valsalva graft were retrospectively analysed.Results There was no death during the hospital stay. The mean time of cardiopulmonary bypass was (266.4±60.1) min (158 to 357 min), and the mean time of aortic cross clamping was (200.6±47.9) min (136 to 286 min). Deep hypothermic circulatory arrest was performed in 1 patient. The major complications included bleeding in 4 patients and mediastinitis in 1 patient. Patients were followed up for (22.3±12.6) months (2 to 38 months). There was no death during the follow-up. At the end of the follow-up, there was no or trivial aortic incompetence in 7 patients, 1 patient had moderate aortic regurgitation postoperatively and a second aortic valve replacemnt was performed. Conclusion Valve-sparing aortic root replacement with Valsalva graft may yield favourable early and mid-term outcomes in treatment of aortic root aneurysm.

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    Effects of pulmonary resection on right ventricular function in patients with lung cancer
    CHEN Ming, FANG Wen-tao, WU Wei-hua, et al
    2011, 31 (3):  349. 
    doi: 10.3969/j.issn.1674-8115.2011.03.024

    Abstract ( 1783 )   PDF (3798KB) ( 1582 )  

    Objective To investigate the effects of pulmonary resection on right ventricular function in patients with lung cancer. Methods Forty-seven patients with lung cancer undergoing pulmonary resection were divided into lobectomy group (n=32) and pneumonectomy group (n=15). Real-time three-dimensional echocardiography were preformed before operation, 3 d and 8 d after operation to obtain the data of right ventricular end-diastolic volume index (RVEDVI), right ventricular ejection fraction (RVEF), mean pulmonary artery pressure (mPAP) and heart rate (HR), and arterial oxygen pressure (PaO2) was monitored simultaneously. Results Three days after operation, mPAP, HR and RVEDVI significantly increased, and RVEF significantly decreased in two groups (P<0.05), and the changes were more significant in pneumonectomy group. PaO2 after operation was significantly lower than that before operation in pneumonectomy group (P<0.05), while the decrease in PaO2 after operation was not statistically significant in lobectomy group (P>0.05). Eight days after operation, all parameters recovered to those before operation in lobectomy group, while there were still significant differences between all parameters before operation and those after operation in pneumonectomy group (P<0.05). Conclusion Right ventricular function may decrease after pulmonary resection, especially in patients treated by pneumonectomy. Sleeve resection of bronchus and pulmonary artery is recommended instead of pneumonectomy to achieve the better outcome.

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    Analysis of clinical characteristics and treatment of intrathoracic sarcoidosis
    JIANG Yin-ling, ZHAO Heng, NIU Yan-jie, et al
    2011, 31 (3):  353. 
    doi: 10.3969/j.issn.1674-8115.2011.03.025

    Abstract ( 1978 )   PDF (4465KB) ( 1577 )  

    Objective To investigate the clinical characteristics,diagnosis, treatment and prognosis of intrathoracic sarcoidosis. Methods The clinical data of 55 patients with intrathoracic sarcoidosis were collected, and the clinical characteristics, treatment process and prognosis were retrospectively analysed. Results Among the 55 patients, females were more than males, and patients aged between 51 and 60 years accounted for the majority. There was no specific manifestation, and cough was the most common symptom, while some patients were free from symptoms. Thirty-nine patients received treatment with glucocorticoids. Four of the 39 patients aggravated during tapering of glucocorticoids, and got better after treatment with a larger dose and tapering moderately. One of the 39 patients relapsed 4 years after glucocorticoids withdrawl, and no longer relapsed for 6 years after a second treatment with glucocorticoids. The adverse effects in patients treated with glucocorticoids were obesity, peptic ulcer and osteoporosis, while no life-threatening complications occurred. Conclusion The main clinical manifestation of intrathoracic sarcoidosis is cough, and the adverse effects should be intensively monitored for the long-term use of glucocorticoids.

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    Clinical characteristics and prognosis of small-cell carcinoma of esophagus
    GAO Lan-ting, LV Chang-xing, WANG Jia-ming, et al
    2011, 31 (3):  357. 
    doi: 10.3969/j.issn.1674-8115.2011.03.026

    Abstract ( 1934 )   PDF (3297KB) ( 1291 )  

    Objective To investigate the clinical characteristics and prognosis of small cell carcinoma of sophagus. Methods Fifteen patients with small cell carcinoma of esophagus diagnosed by X-ray, chest CT and esophagoscopy and confirmed by pathology were selected, and the clinical characteristics and prognosis were analysed. Results The median survival time of these 15 patients was 8.82 months, and the survival time ranged from 29 d to 26 months. The 6-month survival rate was 53%, 1-year survival rate was 20%, 2-year survival rate was 7% and 3-year survival rate was 0. The median survival time of patients with single operation, single chemotherapy and comprehensive treatment was 8 months, 4.1 months and 11.83 months, respectively. Conclusion The optimal therapy for small cell carcinoma of esophagus remains undetermined. Comprehensive treatment with chemotherapy and radiotherapy may yield longer survival time than single treatment.

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    Original article (Public health administration)
    Practice and exploration of clinical skill training for post-graduates of clinical speciality degree
    XU Lei, HUANG Qi-min
    2011, 31 (3):  360. 
    doi: 10.3969/j.issn.1674-8115.2011.03.027

    Abstract ( 892 )   PDF (5316KB) ( 1470 )  

    Objective To explore the effects of clinical skill training in post-graduates with clinical speciality degree. Methods One hundred post-graduates with clinical speciality degree in Shanghai Chest Hospital were randomly divided into two groups, with 50 post-graduates in each group. One group of post-graduates were managed with residents' training, while the other with traditional clinical training. Clinical skills were compared between two groups before and after training by examinations. The knowledge and idea of residents' training were obtained from 200 residents and instructors through questionnaire survey. Results It was revealed by the examinations that the scores of comprehensive theory and clinical skills in post-graduates with residents' training were significantly higher than those in postgraduates with traditional clinical training [(90.53±3.17) vs (80.23±4.42) and (89.46±3.78) vs (80.50±4.16),P<0.001 for both]. However, there was no significant difference in scores of major English ability and profession morals between two groups [(90.43±3.18) vs (90.58±3.43) and (89.06±3.57) vs (90.47±3.15),P>0.05 for both]. The questionnaire survey indicated that most post-graduates considered residents' training could improve the clinical skills. Conclusion Residents' training is helpful to improve the clinical skills for postgraduates with clinical speciality degree.

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    Economic analysis and feasibility of ambulatory chemotherapy for lung cancer
    FENG Yun, LU Shun, XU Lei, et al
    2011, 31 (3):  365. 
    doi: 10.3969/j.issn.1674-8115.2011.03.028

    Abstract ( 1061 )   PDF (3484KB) ( 1655 )  

    Objective To explore the new method to achieve higher turnover rate of wards and less medical cost for treatment of lung caner, in order to accommodate with the limited medical resources. Methods Analysis of medical cost, time of hospitalization and prevalences of chemotherapy-related adverse effects were performed in 249 patients with ambulatory chemotherapy (ambulatory chemotherapy group) during January 2009 to April 2009 in Lung Tumor Clinical Medical Center, Shanghai Chest hospital, Shanghai Jiaotong University, and 827 patients with routine chemotherapy during the same period were served as control group. Results The mean time of hospitalization and total medical cost of ambulatory chemotherapy group were significantly lower than those of control group (4.30 d vs 13.7 d and 6 751.87 yuan vs 14 198.03 yuan, P<0.01 for both). The chemotherapy-related adverse effects were similar in both groups, with the prevalence of leukopenia being higher and that of vomiting being lower in ambulatory chemotherapy group (P<0.01 for both). Conclusion Ambulatory chemotherapy can reduce the time of hospitalization and medical cost, and is recommended as the new model for treatment of lung cancer.

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    Review
    Roles of microRNA in diagnosis, therapy and prognosis of lung cancer
    WU Chuan-yong, XUE Jian, LOU Jia-tao
    2011, 31 (3):  368. 
    doi: 10.3969/j.issn.1674-8115.2011.03.029

    Abstract ( 1406 )   PDF (5416KB) ( 1958 )  

    Lung cancer is the leading cause of death from cancer worldwide. Although the molecular network of lung carcinogenesis has been partly known at the levels of genes and proteins, the high mortality is not markedly changed. microRNAs (miRNAs), a large class of short endogenous non-coding RNAs, act as post-transcriptional regulators for target gene expression by binding to partially complementary 3-untranslated regions of target mRNAs. miRNAs have multiple functions in lung development, and abnormal expression of miRNAs could lead to lung tumorigenesis. The different expression profiles of miRNAs in lung cancer, and the stability of miRNAs in serum, all together make them as new potentially clinical biomarkers for diagnosis and prognosis of lung cancer. Moreover, miRNAs play important roles in oncogenesis and development of lung cancer acting directly as oncogenes or tumor suppressor genes, regulating the expression of carcinogenic and tumor suppressive miRNAs as a new method in the treatment of lung cancer. This review focuses on the function of miRNAs in the diagnosis, prognosis and therapy of lung cancer.

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    Research progress of molecular diagnostics of lung cancer
    XUE Jian, LOU Jia-tao
    2011, 31 (3):  373. 
    doi: 10.3969/j.issn.1674-8115.2011.03.030

    Abstract ( 1424 )   PDF (5458KB) ( 2466 )  

    As a complement to imaging and cytology-based screening strategies, molecular diagnostics of lung cancer include not only the early detection but also the prognosis index and prediction of target therapy. In this paper, gene mutation, prediction of target therapy, miRNA, cancer stem cells and methylation in molecular diagnostics of lung cancer are reviewed.

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    Brief original article
    Clinical analysis of 34 cases of pulmonary pure ground-glass opacity
    ZHONG Chen-xi, GU Zhi-tao, FANG Wen-tao, et al
    2011, 31 (3):  378. 
    doi: 10.3969/j.issn.1674-8115.2011.03.031

    Abstract ( 1165 )   PDF (2927KB) ( 1371 )  

    Objective To investigate the clinicopathological characteristics, surgical procedures and prognosis of pulmonary pure ground-glass opacity (pGGO). Methods The clinical data of 34 patients with pGGO were collected, and the gender constitution, smoking status, surgical procedures, lesion size, histological types of tumor, lymph node metastasis and prognosis were retrospectively analysed. Results The numbers of females and non-smokers were significantly larger than those of males and smokers (P<0.05, P<0.01). Nineteen of the 34 patients received local resection (wedge resection or segment resection, video-assisted thoracoscopic surgery in 18), and the other 15 patients underwent lobectomy. Pathological examinations after operation revealed that there were 21 cases of bronchioloalveolar carcinoma and 13 cases of atypical adenomatous hyperplasia, and there was no lymph node metastasis. The diameters of bronchioloalveolar carcinoma lesions were significantly longer than those of atypical adenomatous hyperplasia lesions (P<0.05), while there was no significant difference in lesion size between cases of local resection and those of lobectomy. Patients were followed up for 3 months to 5 years, and all survived, with no recurrence and distant metastasis. Conclusion The majority of patients with pGGO are females and nonsmokers. The diameters of bronchioloalveolar carcinoma lesions are longer than those of atypical adenomatous hyperplasia lesions. Local resection under video-assisted thoracoscopic surgery is recommended for treatment of pGGO.

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    Clinical analysis of transcatheter occlusion of huge pulmonary arteriovenous fistula in 9 patients
    WANG Cheng, PAN Xin, MA Jian-wei, et al
    2011, 31 (3):  381. 
    doi: 10.3969/j.issn.1674-8115.2011.03.032

    Abstract ( 1235 )   PDF (3871KB) ( 1345 )  

    Objective To summarize the procedures and outcomes of interventional therapy for huge pulmonary arteriovenous fistula. Methods The treatment procedures of 9 patients with huge pulmonary arteriovenous fistula whose inlet blood vessels were larger than 5 mm in diameter were retrospectively analysed. The appearance, size and route of the fistula were learned by right heart catheterization and pulmonary arteriography before interventional therapy, the inlet vessels to be occluded were determined, and the diameters were accurately measured. The occlusion was performed with Amplatzer Plug or domestic PDA occluders. Results The number of inlet blood vessels was 11 in 9 patients, and all the occlusion was successfully performed. Six Amplatzer Plug and 4 domestic PDA occluders were placed. Femoral arterial oxygen saturation significantly increased to the normal level. Conclusion Transcatheter occlusion of huge pulmonary arteriovenous fistula with inlet blood vessel larger than 5 mm in diameter by Amplatzer Plug or domestic PDA occlude is an effective and safe interventional therapy.

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    Technique and method
    Comparison study of effects of application and safety of double-lumen endobronchial tubes
    ZHU Hong-wei, WU De-hua, ZHANG Xiao-feng, et al
    2011, 31 (3):  384. 
    doi: 10.3969/j.issn.1674-8115.2011.03.033

    Abstract ( 863 )   PDF (3274KB) ( 1424 )  

    Objective To compare the effects of clinical application and safety between domestic and imported double-lumen endobronchial tubes. Methods Sixty patients undergoing selective thoracic operations with one-lung ventilation were divided into three groups according to the use of different doublelumen endobronchial tubes: group A (domestic Tuoren-brand double-lumen endobronchial tube, n=20), group B (imported Portex-brand double-lumen endobronchial tube, n=20) and group C (imported Tyco-brand double-lumen endobronchial tube, n=20). The intubation time and number of placement attempts, the number of bronchofibroscopy after changing position and the level of pulmonary collapse state were recorded. The changes of inspiratory peak pressure (Ppeak) and pulmonary dynamic compliance (Cdyn) at different time points of supine position and lateral position with two-lung ventilation, 15 min and 30 min after one-lung ventilation and 5 min after two-lung ventilation were observed, and the prevalences of hoarseness and sore throat 24 h after operation were assessed. The parameters recorded or observed were statistically analysed. Results There was no significant difference in the intubation time and number of placement attempts, number of bronchofibroscopy after changing position, level of pulmonary collapse state, changes of Ppeak and Cdyn at the same time points and prevalences of hoarseness and sore throat among three groups (P>0.05). Conclusion There is no significant difference in effects of clinical application and safety among domestic and imported double-lumen endobronchial tubes. The domestic double-lumen endobronchial tube is highly cost-effective.

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