Objective To evaluate the biomechanical effect of cortical screw support technique in fixation of the femoral neck fractures. Methods The models of subcapital femoral neck fracture were made in eight matched pairs of embamled cadaver femurs and decided into experiment group and control group (four pairs per group). The side of experiment group was fixed using three cannulated compression screws with cortical screw support and that of control group with conventional screw placement. The speci-mens in two groups were tested in aspects of torsion and axial loading. Results In axial load test at load of 600 N and 800 N, the displacements in cortical screw support group were (0.677±0.135) mm and (0.907±0.132) mm respectively, while those of femoral head in conventional screw placement group were (0.899±0.160) mm and (1.202±0.152) nun respectively (P <0.05). There was signifi-cant difference between the two groups (P < 0.05). The maximal vertical loading for failure of the fixa-tion was (2 782±228) N in cortical screw support group and (1 950±281) N in conventional screw placement group (P < 0.01). In torsibility test at 4° and 6° torsibility, the torque-moments of cortical screw support group were (10.406±1.515) Nm and (15.328 ±1.471) Nm respectively and those of conventional screw placement group (6.628±1.163) Nm and (9.072±1.570) Nm respectively, with statistical difference between two groups (P <0.01). The maximal torque-moment for failure of the fixa-tion was (25.437±5.213) Nm in cortical screw support group and (13.235±3.012) Nm in conven-tional screw placement group (P < 0.01). Conclusion Fixation of femoral neck fractures by using cortical screw support can significantly enhance anti-torsion and anti-compression of internal fixation.

Objective: To explore application value of brachial-ankle pulse wave velocity (baPWV) in physical examination in Shenyang district and its risk factors.Methods: A total of 1610 cases, who received regular physical examination in health management center of General Hospital of Shenyang Military Command and met enrollment standards, were selected.Bilateral baPWV and other indexes were measured in all subjects.Logistic regression analysis was used to assess relationship among age, body mass index (BMI), arterial blood pressure, blood biochemical indexes and baPWV.Results: Compared with women, there was significant rise in baPWV[(1361.03±244.72) cm/s vs.(1397.93±239.08) cm/s, P=0.003]in men.baPWV rose along with age increased despite male or female.Compared with normal baPWV group (<1400 cm/s), there were significant rise in age[(45.57±8.95) years vs.(57.07±10.50) years], BMI[(25.25±6.82) kg/m2 vs.(26.14±3.44) kg/m2], fasting blood glucose[FBG, (4.88±1.73) mmol/L vs.(5.43±2.02) mmol/L], low density lipoprotein cholesterol[LDL-C, (2.67±0.82) mmol/L vs.(2.84±0.77) mmol/L], total cholesterol[TC, (4.88±0.99) mmol/L vs.(5.13±0.98) mmol/L], triglyceride[TG, (1.73±1.65) mmol/L vs.(2.15±1.91) mmol/L], systolic blood pressure[SBP, (116.72±12.04) mmHg vs.(136.87±16.21) mmHg], diastolic blood pressure[DBP, (76.99±9.01) mmHg vs.(86.34±10.84) mmHg]and pulse pressure[PP, (39.72±8.32) mmHg vs.(50.53±14.17) mmHg]in elevated baPWV group (≥1400cm/s), P<0.01 all.Multivariable Logistic regression analysis indicated that age, FBG,TG, SBP, DBP and PP levels were independent risk factors for elevated baPWV (OR=1.549~5.943, P<0.05 or <0.01).Conclusion: In Shenyang district, baPWV is closely correlated with cardiovascular risk factors, and it possesses good application value in physical examination and early risk screening of cardiovascular diseases.

In recent years,the health care delivery system changes,the introduction of market mechanisms,as well as health system reform in the traditional medica and so on,have formed a strong spirit of challenge and made a great threat to the nature of medicine and values in the world.Therefore,it is important to teach reform on the physician-patient communication and built a harmonious society.This paper has analyzed the current status and causes of medical education in the spirit of the medical professionalism,and explored the teaching model.

Objective To compare the efficacy of concurrent chemoradiotherapy versus radiotherapy alone for T3-4 N0-1 M0 and T14 N2-3 M0 nasopharyngeal carcinoma (NPC) after induction chemotherapy.Methods From 2002 to 2005,400 patients with stage Ⅲ and Ⅳa NPC were randomly divided into 2 groups :induction chemotherapy followed by concurrent chemoradiotherapy group (IC/CCRT,201 patients),and induction chemotherapy followed by radiotherapy alone group (IC/RT, 199 patients).Subgroup analysis was conducted for 197 patients with stage T3-4N0-1M0 NPC and 203 with stage T1-4N2-3M0 NPC.Results The follow-up rate were 96.2%, with a median followg-up time of 3.9 years.For T3-4N0-1 M0 NPC patients in IC/CCRT group (104 patients) and IC/RT group (93 patients), the 3-year overall survival, disease-free survival, locoregional recurrence-free survival and distant metastasis-free survival rates were 84.0% and 85.9% (χ2=0.08,P =0.780) ,77.0% and 72.0% (χ2=0.44,P =0.510) ,89.5% and 92.3% (χ2=0.65 ,P = 0.420), and 84.9% and 77.0% (χ2= 1.59, P = 0.210), respectively; For T1-4 N2-3 M0 NPC patients in IC/CCRT group (97 patients) and IC/RT group (106 patients), the corresponding rates were 67.4% and 82.2% (χ2=3.48,P=0.060), 61.5% and 68.0% (χ2= 1.86,P=0.170), 86.2% and 87.0% (χ2=0.57 ,P =0.450) and 66.2% and 75.6% (χ2=2.07 ,P =0.150), respectively.Acute sideeffects were similar except more leucocytopenia in IC/CCRT group than IC/RT group.Conclusions Compared with IC/RT, IC/CCRT dose not improve the overall survival in patients with T3-4N0-1 M0 and T1-4 N2-3 M0 NPC.

Objective:To analyze the feature of cranial nerve involvement in nasopharyngeal carcinoma (NPC) and its relationship with the prognosis.Method:A total of 1892 patients who were diagnosed as NPC in our hospital from January 2002 to December 2003,of which the cranial nerve involvement was 183 (9.6%) patients, were analyzed the effect of cranial nerve involvement on the prognosis.Result:The percentage of cranial nerve involvement was 9.4%. The 5 year overall survival rate was 61.0%,disease free survival rate was 55.3%,local relapse free survival rate was 75.2% and distant metastasis free survival rate was73.4%.Periods of cranial nerve involvement,clinical stage,the diameter of the lymph nodes,involvement of cavernous sinus, and the level of the recovery of cranial nerve involvement were significantly associated with prognosis in univariate analysis(P<0.05).With multivariate analysis,the recovery level of cranial nerve involvement was the independent factor that affected the 5-year overall survival (RR=2.087). The diameter of the lymph nodes and involvement of cavernous sinus were the independent factors that affected the 5-year distant metastasis-free survival(RR=1.954 and 2.136,respectively).Conclusion:Periods of cranial nerve involvement and the level of the recovery of cranial nerve involvement were significantly correlated with prognosis. Involvement of cavernous sinus could increase the rate of distant metastasis.

Objcetive To investigate the protective effects of the nitroxides R-1 on human liver cells exposed to ionizing radiation.Methods Human liver cells L-02 were cultured and irradiated with 60Co γ-rays at the doses of 0,1,2,4,and 8 Gy,in order to screen the proper irradiation dose.WR2721 at the terminal concentration of 4 mmol/L was used as positive control.L-02 cells irradiated with 4 Gy were added with R-1 at the terminal concentration of 0.25 μmol/L at 30 min before irradiation or immediately after irradiation.MIT method was used to screen the proper conditions for follow-up experiment 72 h later.L-02 cell culture fluid was added with R-1 at the concentrations of 0,0.125,0.25,0.5,and 1 μmol/L,respectively for 30 min before irradiation at the doses of 0,1,2,4,and 8 Gy to ealculate clone formation rate at 10 d post-irradiation.L-02 cells were cultured and divided into 4 groups:control group without any treatment.drug group pretreated by 0.25 μmol/L R-1 only,irradiation group,irradiated at 4 Gy only,and drug + irradiation group with combination of 0.25 μmol/L R-01 and 4 Gy irradiation.The inverted microscopy and Hoechst 33258 staining and flow eytometry were used to observe the apoptosis of the cells at 24,48,and 72 h later.Results Nitroxides R-1 did not inhibit the viability of L-02 cell when its concentration was less than 1 μmol/L and it inhibited the L-02 cell growth when the concentration wu higher than 2 μmoL/L.The A value and colony formation rate of different concentration of R-1 groups were all higher than those of the irradiation group,and the effect of the 0.25 μmol/L drug concentration group was the most significant.Consequently,the concentration 0.25 μmoL/L was selected for follow-up experiment.Compared with the irradiation group,the L-02 cells of the pretreatment group showed solid adherence, increased refraction,clear outline,less apoptotic and dead cells at 4 Gy post-irradiation.Conclusions Nitroxides R-1 can protect the human liver cells from 60Coγ-ray induced injury effectively.The mechanism of its protective effect may be the reduction of apoptosis.

Objective To evaluate the impact of chemotherapy compliance on the therapeutic efficacy of induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus radiotherapy alone for patients with locally advanced nasopharyngeal carcinoma (NPC). Methods Based on intention to treat analysis (ITT) for 400 patients, 314 patients were analyzed by per protocol (PP) analysis. The patients were divided into induction chemotherapy plus concurrent chemoradiotherapy group (IC/CCRT, 127 patients) or induction chemotherapy plus radiotherapy group (IC/RT, 187 patients). The patients who completed 2 cycles of induction chemotherapy and at least 2 cycles of concurrent chemotherapy in the IC/CCRT group and the patients who completed 2 cycles of induction chemotherapy in the IC/RT group were analyzed. Radiotherapy was given by two-dimensional technique with γ-ray, X-ray and electron beams. The chemotherapy regimen was FUDR plus carboplatin for induction chemotherapy and carboplatin alone for concurrent chemotherapy. Results The follow-up rate was 96.2%. 295 patients were followed to at 3 years. Based on PP analysis, Grade 3/4 toxicity was found in 23.6% of the patients in IC/CCRT group and 13.4% in the IC/RT group (χ~2 =5,50,P=0.019). No grade 4 toxicity was found in the IC/RT group. The median follow-up time was 3.9 years, and no significant difference was found between the two groups in 3-year overall survival (78.1% : 84.6% ;χ~2 = 0. 61, P =0. 435), disease-free survival (74.3 % : 70.1% ;χ~2= 0. 12, P= 0.731), Iocoregional relapse-free survival (89.7% : 89.5% ; χ~2= 0. 10, P= 0.748), or distant metastasis-free survival (78.9%:76.5% ;χ~2=0.05,P=0.825). Conclusions With more severe toxicities, the IC/CCRT regimen does not improve the overall survival in locally advanced NPC patients compared with the IC/RT regimen.

OBJECTIVE: To analyze the feature of cranial nerve involvement in nasopharyngeal carcinoma (NPC) and its relationship with the prognosis. METHOD: A total of 1892 patients who were diagnosed as NPC in our hospital from January 2002 to December 2003, of which the cranial nerve involvement was 183 (9.6%) patients, were analyzed the effect of cranial nerve involvement on the prognosis. RESULT: The percentage of cranial nerve involvement was 9.4%. The 5 year overall survival rate was 61.0%, disease free survival rate was 55.3%, local relapse free survival rate was 75.2% and distant metastasis free survival rate was 73.4%. Periods of cranial nerve involvement, clinical stage, the diameter of the lymph nodes, involvement of cavernous sinus, and the level of the recovery of cranial nerve involvement were significantly associated with prognosis in univariate analysis(P < 0.05). With multivariate analysis, the recovery level of cranial nerve involvement was the independent factor that affected the 5-year overall survival (RR = 2.087). The diameter of the lymph nodes and involvement of cavernous sinus were the independent factors that affected the 5-year distant metastasis-free survival (RR = 1.954 and 2.136, respectively). CONCLUSION Periods of cranial nerve involvement and the level of the recovery of cranial nerve involvement were significantly correlated with prognosis. Involvement of cavernous sinus could increase the rate of distant metastasis.
Adolescent ; Adult ; Aged ; Cranial Nerves ; pathology ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; Neoplasm Staging ; Prognosis ; Young Adult

Objective:To investigate effect of reperfusion injury following different ischemic duration on skeletal muscle in rats.Methods:A model of ischemia/reperfusion injury (IRI) was established by unilateral clamping femoral artery and additional application of tourniquet in skeletal muscle of hind limbs in 35 male Wsitar rats. According to different ischemia time, the animals were assigned to 2-hour ischemia and 24-hour reperfusion (I2R24 group), 2.5-hour ischemia and 24-hour reperfusion (I2.5R24 group), 3-hour ischemia and 24-hour reperfusion (I3R24 group), 4-hour ischemia and 24-hour reperfusion (I4R24 group) and sham group, with 7 rats per group. At the end of reperfusion, gastrocnemious tissues and plasma samples were collected and analyzed. The ratio of wet ∶ dry weight (W/D) was used to measure muscle edema. The assay of 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) was conducted to evaluate muscle viability. HE staining was executed to observe histopathological changes. Immunofluorescence staining was performed to assess the levels of C1q, C3b/c, tissue factor (TF), fibrinogen (FN), bradykinin receptor 1 (BR1), BR2, vascular cell adhesion molecule-1 (VCAM-1), E-selectin, fibrinogen-like protein-2 (FGL-2) and myeloperoxidase (MPO) in muscle tissues. ELISA method was used to determine the concentrations of interferonγ (IFN-γ), interleukin7 (IL-7), IL-18, macrophage inflammatory1α (MIP-1α) and monocyte chemotactic protein 1 (MCP-1) in plasma.Results:With prolongation of ischemia time and subsequent reperfusion, tissue edema became severe gradually. The ratio of W/D was 5.3±0.2, 6.1±0.3, 6.9±0.2, 7.6±0.3 in I2R24, I2.5R24, I3R24 and I4R24 groups, higher than that in sham group (4.5±0.1) (all P<0.01). Muscle viability got decreased gradually. Muscle viability was (62.4±3.5)%, (45.3±3.3)%, (35.4±3.4)%, (27.1±5.9)% in I2R24, I2.5R24, I3R24 and I4R24 groups, lower than that in sham group［(93.8±7.2)%］(all P<0.01). Histopathological changes became aggravated gradually. The most severe group was I4R24 group, with the most severe myocyte injury, interstitial edema and extensive inflammatory infiltration, followed by I3R24, I2.5R24 and I2R24 groups in order. There was normal structure integrity and neatly arranged myocyte in sham group. Meanwhile, levels of C1q, C3b, FN, BR1, VCAM-1, E-selectin and FGL-2 got increased gradually. The highest levels for these factors were seen in I4R24 group, followed by I3R24 group, I2.5R24 group, I2R24 group and sham group in order. The rough ratio of the number of positive MPO cells/total cell number under high lens (×200) were increased gradually, with the highest level in I4R24 group, followed by I3R24 group, I2.5R24 group, I2R24 group and sham group in order. However, expression of TF and BR2 were not altered significantly among the groups. Plasma levels of INF-γ, IL-7, IL-18, MIP-1α and MCP-1 elevated gradually with prolongation of ischemia time (all P<0.01). The sequence was the sham group, I2R24 group, I2.5R24 group, I3R24 group and I4R24 groups for levels of these factors from low to high (all P<0.01). Conclusion:Reperfusion after prolongation of ischemia duration can increase the activation of complement, coagulation, kinin and endothelial cells as well as the release of inflammatory factors, and thus aggravate the degree of skeletal muscle tissue injury.

Objective:To study positive rates and typing of oligoclonal bands (OCB) in patients with neurological disorders, and to reveal the clinical significance and applicational value of OCB test.Methods:A retrospective analysis was performed on the detection results of 3 217 patients with neurological disorders who undertook both serum and cerebrospinal fluid OCBs in the First Hospital of Peking University from January 2012 to August 2022. According to the final diagnosis, the patients were divided into 13 groups including multiple sclerosis (479 cases), neuromyelitis optica spectrum disorders (935 cases), autoimmune encephalitis (192 cases), viral encephalitis (94 cases), nervous system complication after HSCT (232 cases), Guillain-Barré syndrome (644 cases), chronic inflammatory demyelinating polyneuropathy (157 cases), etc. Cerebrospinal fluid and serum OCBs were detected using isoelectric focusing electrophoresis combining immunofixation, then classified into Ⅰ-Ⅴ types according to the morphology. Consequently, positive rates and types were analyzed for each group. χ2 test was used for comparison between groups. Results:The positive rates of cerebrospinal fluid OCB in multiple sclerosis, nervous system complication after hematopoietic stem cell transplantation (HSCT), autoimmune encephalitis, viral encephalitis, neuromyelitis optica spectrum disorders, Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy were respectively 66.8% (320/479), 48.7% (113/232), 46.4%(89/192), 19.1% (18/94), 17.6% (165/935), 9.9% (64/644), 5.1% (8/157). For patients with multiple sclerosis, neuromyelitis optica spectrum disorders, viral encephalitis, and autoimmune encephalitis, Type Ⅱ bands took the majority of cerebrospinal fluid OCB-positive cases with the rates of 94.1% (301/320), 78.7% (70/89), 77.8% (14/18), and 77.6% (128/165) respectively, indicating intrathecal IgG synthesis; for patients with nervous system complication after HSCT, Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy, type Ⅳ bands took the majority of cerebrospinal fluid OCB-positive cases with the rates of 94.7% (107/113), 82.8% (53/64) and 100% (8/8), indicating no obvious intrathecal IgG synthesis. The positive rates of cerebrospinal fluid oligoclonal bands were significantly different among all groups (χ 2=1 268.31, P<0.001). Conclusion:The positive rates of cerebrospinal fluid oligoclonal bands are different among different neurological disorders, in which the positive rate of cerebrospinal fluid OCB is higher with type Ⅱ bands as the majority type in multiple sclerosis, which indicates that the detection and typing of cerebrospinal fluid OCB are helpful for the diagnosis of various neurological diseases, especially for multiple sclerosis.