Objective To explore the diagnosis and treatment for primitive neuroectodermal tumor of the adrenal gland.Methods The clinical data of 2 patients with primitive neuroectodermal tumor of the adrenal gland were retrospectively analyzed.Literatures about diagnosis and treatment of primitive neuroectodermal tumor arising from the adrenal gland were also reviewed.Results B type ultrasonography and computer tomography scans showed a cystic and solid soft tissue masses about 3 cm (patient 1) and 15 cm (patient 2) in maximum diameter with rough border.Surgeries were performed successfully in 2 patients.The diagnosis of primitive neuroectodermal tumor arising from the adrenal gland was confirmed by histopathology and immunohistochemistry.During follow up,evidences of tumor recurrence were not found in the first patient.However,the second patient had diffuse retroperitoneal lymph node metastasis 3 months after surgery.Then,the patient died 6 months after surgery.Conclusion The primitive neuroectodermal tumor of the adrenal gland is extremely rare with highly malignant and poor prognosis.Its diagnosis is based on histopathology and immunohistochemistry.Multimodal therapeutic regimens including surgery,combination with chemotherapy and radiotherapy were recommended.

Graphene/Room temperature ionic liquids ( GN/IL ) nanocomposite was prepared by grinding graphene and ionic liquid 1-butyl-3-methylimidazolium bromide ( BMIMPF6 ) which mixed together in appropriate proportion. Atomic force microscopy ( AFM ) was utilized to characterize the formation of the GN-ILs. Due to the synergistic effect between ionic liquids and graphene, the nanocomposite exhibited excellent performance toward H2 O2 reduction. A novel uric acid ( UA) electrochemical sensor was fabricated based on uricase-GN/IL modified glassy carbon electrode. The experimental results showed that the response displayed a good linear response toward UA in the concentration range from 0. 002-4. 5 mmol/L. The corre1ation coefficient was 0. 995 and the detection limit was 0. 85 μmol/L. The easily prepared electrochemical sensor had favorable stability and selectivity and could be applied to the quick determination of UA in human serum, thus providing a new UA detection method for clinical trial.

[Objective]To discuss the effective treatment of complicate intertrochanteric hip fracture.[Method]Thirty-five cases with complicate intertrochanteric hip fracture.The class of fracture,surgery method,operating time,complicatico,union rate of fracture were amounted statisti cally.[Result]All the 35 cases were surgical treated,l 4 cases with PFN(priemeral femur nail),21 cases with DHS(dynamic hip screw)with mean time of operation 1.8 h(1.5~3 h),mean amount of blood loss during operation 300 ml(150~500 ml),mean time in bed 2.4 monthes (1.2~3 monthes),mean following-up time 12 months(6~16months).Thirty-one cases got union,3 cases union time delayed,1 case nounion,union rate was 88.5%.Four cases suffered hip iversion( 11.4%),the screw in the neck removed in 6 cases(8.5%),5 cases feeled pain in hip( 14.2% ).[Conclusion]The complicate intertrochateric hip fracture is a kind of fracture which can not be treated easily.Using PFN and DHS can not control the stability effectively.Additional fixation of the greater trochantar fracture is necessary.Added out-fixation and avoid early bearing are useful.

[Objective]To evaluate the effect of nonoperative and operative treatment in calcaneal fractures.[Method]Operative effect of 38 cases of calcaneal fracture of all kinds(42 foots)were analyzed.Accordind Essex-Loprestis classification,6 foots suffered type I tongue fracture,28 foots suffered compressed fracture(type Ⅱ),8 foots suffered serious comminuted fracture(type Ⅲ).All patients underwent open reduction interal fixation by Buttress plate(AO calcaneal fracture plate or simulated AO calcaneal fracture plate made domestically) from the extended "L" lateral approach.Postoperatively,no patient needed plaster fixation.All patients started non-weight-bearing fuctional exercise at 2-3days,gradual weight-bearing walking at 6-8 weeks.The result of operated group was compared with nonoperative treatment group.The follow-up period was from 10 months to 36 months,with an average of 17monthes.[Result]Assessed the effect by Maryland foot score,the base line included every foot.Total excellent and good rate in operative group was 93%,it was 100% in type I fracture group,96% in type Ⅱ fracture group,75% in type Ⅲ fracture group.The result of nonoperative treatment group was:total excellent and good rate was 67%,it was 92% in type I fracture group,77% in type Ⅱ fracture group,there was not excellent and good patients in type Ⅲ fracture group.[Conclusion]It is important to regain the flatness of subtalar joint and calcaneocuboid joint,maintain the normal shape of foot.The authors recommend that type Ⅱ and type Ⅲ fractures of calcaneus according Essex-Loprestis classification were treated with open reduction and interal fixation by Buttress plate.By selecting the appropriate approach,proper reducting and postoperative treating rightly,it is an ideal measure to treat calcaneal fracture by selection of treatment method acciding to patient's individual status and fracture type.

[Objective] To investigate the clinical significance of changes in serum biochemical factors in trauma patients,and to improve the initial determination of the injury degree and rescue ratio.[Method]From April 2002 to December 2004,48 trauma patients were divided into two groups of serious and slight injury by ISS score.The author monitored the concentration of serum GLU,CR,BUN,LDH,CK,CKMB,LDL,GPT,GOT,IgG,IfA,IgM,C3,C4,CRP and the WBC,PLT,BT(body temperature)at the first day and after 3,7,14 days,recorded the therapy method and results.The difference between the two groups was compared by statistic method.[Result]In 48 patients,There were 12 in slight injury group,36 in serious injury group.The concentration of GLU,LDH,CK,CKMB,CRP in serious group was more than that in slight group,but the concentration of LDL,IgG,IgA,IgM,C3,C4 was lower(P0.05).There were 6 patients suffered MODS,2 cases suffered ARDS,3 patients suffered upper digestive tract bleeding,2 cases combined with infection,1 case suffered DIC,and I death in serious group;there was 1 MODS,1 infection and no death in slight group.[Conclusion]The combined use of the AIS-ISS90 score and serum biochemical factors is advantageous to the determination of injury degree and prognosis.

Objective To investigate the effect of psychological intervention combined with gliclazide and sitagliptin on the treatment of poorly obese obese patients with type 2 diabetes mellitus. Methods 96 obese patients with type 2 diabetes mellitus who had poor control of blood glucose after insulin treatment were randomly divided into control group and experimental group,48 cases in each groups. Gliclazide and sitagliptin (FBG), glycosylated hemoglobin (HbA1c), 2h postprandial blood glucose (2hPG), fasting insulin (FIns) were measured before and after 15 weeks of treatment in the control group. situation. Results FBG, HbA1c, 2hPG and FIns were significantly lower in the experimental group than in the control group (P<0.05). Conclusion The combination of gliclazide and sitagliptin on the treatment of poorly obese type 2 diabetes mellitus with insulin treatment can significantly reduce the blood glucose level of patients and promote it.

OBJECTIVE:To investigate the effects of Xuebijing injection on inflammatory factors,oxidation stress level and thrombosis risk in patients with acute non-ST elevation myocardial infarction(NSTEMI). METHODS:A total of 130 NSTEMI pa-tients selected from our hospital during May 2015-Aug. 2016 were divided into control group and observation group according to random number table,with 65 cases in each group. Control group was given routine treatment as lowering blood pressure,lower-ing lipid,anticoagulation and antiplatelet. Observation group was additionally given Xuebijing injection 50 mL,ivgtt,q12 h,on the basis of control group. Both groups were treated for a week. The levels of inflammatory cytokines(TNF-α ,IL-6,IL-10, hs-CRP),SOD,MDA,MMP-9,platelet aggregation rate and fibrinogen were observed in 2 groups before and after treatment. The treatment course,the occurrence of MACE and bleeding event were also recorded. RESULTS:Before treatment,there was no statistical significance in the levels of inflammatory factors,SOD,MDA,MMP-9,platelet aggregation rate or fibrinogen between 2 groups(P>0.05). After treatment,the levels of TNF-α,IL-6,hs-CRP,platelet aggregation rate or fibrinogen in 2 groups were decreased significantly,while the level of IL-10 was increased significantly;the improvement of above indexes in observation group was significantly better than control group. The levels of SOD and MMP-9 in 2 groups were increased significantly,while the level of MDA was decreased significantly. The level of SOD in observation group was significantly higher than control group, while the level of MDA was significantly lower than control group,but the level of MMP-9 was significantly lower than control group,with statistical significance (P<0.05). There was no statistical significance in the incidence of MACE (16.92% vs. 20.00%)or bleeding event(4.62% vs. 7.69%)between 2 groups(P>0.05). CONCLUSIONS:Xuebijing injection shows signifi-cant therapeutic efficacy for NSTEMI,effectively inhibits inflammation,and oxidative stress and reduces the risk of thrombosis with good safety.

Objective To observe the effect of long-term intensive glucose control therapy on diabetic retinopathy in outpatients with type 2 diabetes mellitus.Methods Forty-nine patients with type 2 diabetes mellitus were randomly assigned to participate in the trial from 2002 to 2007,receiving either intensive (24 cases) or standard glucose control (25 cases).The patients were examined by the same ophthalmologists to identify any new diabetic retinopathy (DR).After 5 years of intensive glucose control,all of the patients were asked to attend our clinic every 6 months,but no attempts were made to maintain their previously assigned therapies.Hemoglobin A1c (HbA1 c) was measured regularly.In November of 2009,a retinal examination was carried out by the same ophthalmologist who worked in the trial.The visual acuity,lens,vitreous body and fundus were examined after pupil dilation to identify diabetic retinopathy (DR).Fundus fluorescein angiography and retinal laser photocoagulation were carried out when necessary.Results In the second year after enrollment in the trail,the median HbA1c level of the intensive-therapy group was significantly lower than that of the standard-therapy group [(6.3 ± 0.6) ％ vs.(7.2 ± 1.2) ％,t =2.09,P ＜ 0.05],and was maintained in a controlled level throughout the following 4 years.During the post-trial monitoring,no new case of of macula edema or diabetic associated blindness occurred in either intensive or standard-therapy group,the whole occurrence of micro-aneurysms,fundus hemorrhage,as well as those who needed retinal laser photocoagnlation and lowering in visual acuity in intensive-therapy group was lower than that in the standard-therapy group (3 vs.14,1 vs.7,2 vs.4,3 vs.11,respectively ;9 vs.36,totally,x2 =4.719,P ＜ 0.05).During the first post-trial monitoring,there was no difference in median HbAlc level between intensive-therapy group and standard-therapy group [(7.2 ± 1.1) ％ vs.(7.3 ± 1.3) ％,t =0.25,P =0.806],which was sustained in the following years.In the trail,no new case of fundus hemorrhage or diabetic associated blindness occurred in intensive-therapy group during the five-year period of therapy.Number of new episodes of micro-aneurysm,macula edema were less in intensive-therapy group than that in standard-therapy group,number of new episodes of lowering in visual acuity,and those who needed retinal laser photocoagnlation,were significantly less in intensive-therapy group than that in standardtherapy group(15 vs.25,4 vs.23,Z =-4.459,P ＜ 0.05) during five-year follow-up.Conclusions The benefit of reduced incidence of diabetic retinopathy in intensive glucose can be maintained because of the legacy effect.

Objective:To explore the influence of tumor cells on CD4~+ CD25~+ Treg cells via TLRs.Methods:The numbers changes of CD4~+ CD25~+ Treg cells in the co-culture system of Lewis lung cancer cells and splenic lymphocytes were detected by flow cytometry;The expression of Foxp3 and TLR1-9 mRNA after co-culture were detected by RT-PCR;TLR9 expression on Lewis lung cancer cells was blocked by TLR9 receptor antagonist chloroquine.Results:Compared with control group,the number of CD4~+ CD25~+ Treg cells and Foxp3 mRNA expression were significantly increased in the co-culture group (P＜0.05).The expression of a variety of TLRs were affected by the co-culture of lymphocytes with Lewis lung cancer cells,and TLR9 mRNA expression was significantly increased compared with that of the control group (P＜0.05);Blocking TLR9 of Lewis lung cancer cells significantly reduce CD4~+ CD25~+ Treg cells and Foxp3 mRNA (P＜0.05).Conclusion:Lewis lung cancer cells could increase both number and function of CD4~+ CD25~+ Treg cells through inducing TLR9 expression in immunocells.This might be one of mechanisms of tumor-induced immune tolerance,and by which to contribute to the occurrence and progression of tumors.

Objective:To explore the influence of tumor cells on CD4+CD25+Treg cells via TLRs.Methods:The numbers changes of CD4+CD25+Treg cells in the co-culture system of Lewis lung cancer cells and splenic lymphocytes were detected by flow cytometry;The expression of Foxp3 and TLR1-9 mRNA after co-culture were detected by RT-PCR;TLR9 expression on Lewis lung cancer cells was blocked by TLR9 receptor antagonist chloroquine.Results:Compared with control group,the number of CD4+CD25+Treg cells and Foxp3 mRNA expression were significantly increased in the co-culture group(P