Objective To study the expression difference of the insulin-like growth factor-I (IGF-I)and IGF-binding proteins-3,4,5(IGFBP-3,4,5)in the peripheral and local areas in senile hip fracture and discuss the correlation between the expression and the fracture types. Methods The study involved the senile patients (over 65 years) with hip fractures to compare the expressions of peripheral and local IGF-I and IGFBP-3,4,5 and observe the correlation between expression and fracture type.Results The serum and local specimens of 46 patients were collected,with lower level of BMD,IGF-I and IGFBP-3,5 in the intertrochanteric fracture group than the femoral neck fracture group(P<0.001)and with higher level of serum and local IGFBP-4 in the intertrochanteric fracture group than the femoral neck fracture group (P<0.001).Only local IGFBP-4 mRNA had positive correlation with serum markers (R=0.544,P<0.001). Conclusions The expression difference of IGF-I and IGFBP in the peripheral and local serum may be one of pathogenesis leading to different types of hip fractures.Except for the IGFBP-4,the other factors may affect the bone metabolism of the senile hip fractures through different regulatory mechanisms.

Objective To explore the methods for endoscopy nasal microsurgery and multiple techniques in treatment of nasopharyngeal angiofibromas. Methods CT, MRI and digial substraction angiography (DSA) and endoscopic examination had been used. ALL 12 patients accepted preoperative feeding artery embolum, hypotention anesthesia and injected adrenaline-lidocaine. Microelectrotomy-electrocoagulation had been used to remove tumor. Results All patients were treated by endoscopic nasal surgery. No complications had occurred. No recurrence were found in follow-up period. Conclusion The important factors to reduce amount of introperative bleeding are to select proper operative patients and use multiple techniques. Endoscopy nasal surgery has dominance in reducing complications, wound, tumor recurrence, operative time and nasal function.

Objective To study the change of rats serum malondialdehyde (MDA) and the expression levels of 4-hydroxy acid nonene (4-HNE) and 8-hydroxy uridine (8-OHdG) of articular cartilage under low selenium (Se) and T-2 toxin poisoning,to explore oxidative damage of articular cartilage in rats.Methods Thirtytwo healthy male SD rats were divided into two groups by weight which were normal diet group and Se-deficiency group,16 rats in each group.Rats in normal diet group was fed with selenium 101.5 μg/kg diet,and rats in Sedeficiency group was fed with selenium 1.1 μg/kg diet for 30 d.Normal diet group was divided into control group and T-2 toxin group,and low selenium diet group was randomly divided into Se-deficiency group and Se-deficiency plus T-2 toxin group,8 rats in each group.After that,rats in T-2 toxin and Se-deficiency plus T-2 toxin groups were administrated intragastrically with T-2 toxin (100 mg/kg) everyday for 30 d.Rats were put to death,the left knee was taken and stained with hematoxylin-eosin and Safranin-Fast green,pathological changes of rat's knee joint cartilage were observed under light microscopy,expression levels of 8-OHdG and 4-HNE in rat's articular cartilage cells were determined by immunohistochemical method and rat's MDA content was determined by glucosinolates barbituric acid method.Results Chondronecrosis in deep zone of articular cartilage of knee joint stained with hematoxylin-eosin was seen in Se-deficient plus T-2 toxin diet group under light microscope.Significantly less Safranin-Fast green staining was observed in the cartilage of knee joints in the Se-deficient plus T-2 toxin diet group compared to the control group.Compared with control group [(3.41 ± 2.48)％,(2.28 ± 1.74)％],8-OHdG and 4-HNE in Se-deficient plus T-2 toxin group [(62.61 + 10.97)％,(75.03 ± 7.92) ％] positive expression rate increased significantly (F =16.24,18.61,all P ＜ 0.05).Comparison of serum MDA content in each group,the difference was statistically significant (F =4.32,P ＜ 0.05).The Se-deficiency group [(2.803 ± 0.163) μmol/L] was compared with control group [(1.873 ± 0.475) μmol/L] that the contents of serum MDA were increased.The T-2 toxin group [(2.890 ± 0.453) μmol/L] was compared with control group [(1.873 ± 0.475) μmol/L] that the content of serum MDA was increased (P ＜ 0.05).The Se-deficiency plus T-2 toxin group [(3.521 ± 0.292) μmol/L] was compared with Sedeficiency group and control group that the contents of serum MDA were increased (all P ＜ 0.05).Conclusions The marker of peroxidation products are increased in articular cartilage of SD rats under the condition of Sedeficiency and T-2 toxin poisoning.The cartilage damage and chondronecrosis due to Se-deficiency and T-2 toxin poisoning are related to oxidative damage.

Objective To investigate the ability of linked color imaging(LCI)for diagnosing Helicobacter Pylori(Hp)infection compared with conventional white light imaging(WLI). Methods We prospectively collected subjects who underwent gastroscopy. Images under both WLI and LCI were recorded and analyzed. Software was used to measure pixel brightness for red(R),green(G),blue(B)of endoscopic images from suspected lesion sites. Biopsies were taken from these sites and Warthin-Starry silver staining was used to detect if Hp was present. R/(G+B)value was used to construct receiver operating characteristic curve(ROC)to predict Hp infec-tion and the area under curve(AUC),cut-off point,sensitivity,as well as specificity were calculated with the patho-logy as the gold standard. Results Forty-seven subjects(23 men,24 women;23 Uygur subjects,24 Han subjects) were included in a mean age of 49 years old. Ninety-one biopsies were obtained. Forty-four biopsies (48.4%)were Hp positive according to the pathology. The AUC of LCI was 0.616,with the cut-off point at 0.967 and sensitivity at 0.955 and specificity at 0.298. The AUC of WLI was 0.529,with cut-off point at 2.638 and sensi-tivity at 0.455 and specificity at 0.766. The AUC of Han and Uygur subjects were 0.650 and 0.549 by LCI. The AUC of atrophy gastritis subjects and non-atrophy gastritis subjects were 0.628 and 0.603. Conclusion LCI was superior to WLI in predicting Hp infection. LCI may act as an objective and quantified endoscopic diagnostic meth-od in Hp infection.

Objective To investigate the diagnostic value of the K-ras mutations in FNA samples for early detection of pancreatic cancer. Methods FNA samples of 27 patients with pancreatic cancers, 9 patients with other malignant tumors and 14 patients with non malignant pancreatic mass (NMPM) were collected. DNA was extracted, and K-ras gene was amplified through PNA-mediated PGR clamping, the products were sequenced to determine the mutation type. Results The positive rate of K-ras mutations in pancreatic cancers,other malignant tumors and NMPM were 88.9%, 44.4%, 35.7%. There was significant difference in K-ras gene mutations in FNA samples between pancreatic cancer and other malignant tumors ( P = 0. 013 ) and NMPM ( P = 0. 001 ). The sensitivity, specificity, positive predictive value, negative predictive value,accuracy of K-ras mutations in FNA samples of pancreatic cancers were 88.9%, 55.6%, 85.7%, 62.5%,80.6% when compared with other malignant tumors, and the difference between the two groups was significant (P =0. 013) ;Those were 88.9%, 64.3%, 82.8%, 75.0%, 80. 5% when compared with NMPM, and the difference between the two groups was significant ( P = 0. 001 ). When cytology of FNA samples and K-ras mutations was combined, the positive rate of pancreatic cancer was up to 96.3%. Conclusions The detection of K-ras mutations in EUS-FNA samples helped improve the positive diagnostic rate of pancreatic cancer.

Objective: To evaluate the safety and feasibility of hybrid thoracoscopic surgery and catheter ablation in treating the patients of long-standing persistent atrial fibrillation (AF) with preliminary experience. Methods: A total of 15 consecutive relevant patients treated in our hospital by hybrid thoracoscopic surgery and catheter ablation from 2014-04 to 2016-03 were studied. The average AF time was (4.0±3.9) years including 13 male. All patients received thoracoscopic surgical ablation including pulmonary vein isolation, left atrial (LA) posterior wall isolation, Waterston's groove Ganglionated plexi ablation by bipolar radiofrequency ablation clamp and LA appendage removal, Marshall ligament dividing. Then establishing LA 3D-modeling, based on LA 3D voltage mapping, catheter ablation was conducted to reinforce surgical ablation or modification in order to confirm bidirectional blocking. Meanwhile, LA ridge and mitral isthmus ablation was performed, some patients received LA anterior wall and tricuspid isthmus ablation. The patients were followed-up at 3, 6 and 12 months after the procedure. Results: 13 patients were restored to sinus rhythm after the procedure and no operative complications occurred. The average follow-up time was (12.1±11.5) months. 2 patients with recovered sinus rhythm had re-catheter ablation since atrial flutter at 3 months post-procedure and sinus rhythm was restored. The overall success rate was 86.7% (13/15), no patient had anti-arrhgthmia medication. Conclusion: Hybrid thoracoscopic ablation and catheter ablation have been a minimally invasive, safe and effective method in treating the patients of long-standing persistent AF.

Objective To investigate the differences of measurement of gross target volume (GTV)between endoscopic ultrasonography ( EUS )-based ( GTVEUS ) and computed tomography ( CT ) -based (GTVCT) method for thoracic esophageal squamous cell carcinoma. Methods EUS was performed on 36consecutive patients with thoracic squamous cell carcinoma, and the superior and inferior boarders of the tumor defined by EUS were marked with hemoclips. The CT planning scan was then performed with the patient in supine position, and the GTVCT and GTVEUS were contoured respectively. The lengths ( LCT and LEUS) and spatial locations of longitudinal GTVCT and GTVEUS were compared. Results The mean LCT and LEUS were (7. 79 ± 3. 15 ) cm and (7. 42 ± 2. 72) cm, respectively ( t = 0. 82, P ＞ 0. 05 ), with a correlation coefficient of 0. 61 (P ＜0. 001 ). Locations of longitudinal GTVCT and GTVEUS were compared in 34cases, with 2 excluded for invisualization on CT. The mean conformal index (CI) was (0. 79 ± 0. 18 ), and spatial variations were found in 71% patients, with 8 patients at proximal end and 21 others at distal end.There was no clip placement associated complication. Conclusion Endoscopic hemoclips placement is safe and reliable. EUS can provide additional information to CT in defining longitudinal GTV in thoracic esophageal squamous cell carcinoma, especially in superficial and submucosal carcinomas.

Objective To evaluate the impact of total parenteral nutrition(TPN)on nutrition status and inflammatory markers in hospitalized fasted patients with inflammatory bowel disease(IBD).Methods A retrospective study was performed and 82 hospitalized fasted IBD patients [male/female=58/24,(39.4±14.5)years] who received TPN entered the study.Among them,38 patients had ulcerative colitis(UC)and 44 patients suffered from Crohn`s disease(CD).Clinical data(gender,age,duration of disease,history of disease,prednisone,immuno-suppressor,and antibiotics)were obtained from medical records.Nutritional parameters,C-creative protein(CRP),and erythrocyte sedimentation rate(ESR)before and after TPN were also obtained.Average caloric supplementation by TPN was(4 437.3±1 199.1)kJ/d and the nitrogen amount was(9.9±1.7)g/d.Median PN length was 15 days(7-54 days).67 IBD patients received a TPN formula with glutamine(≥14 d,25 patients vs.0-14 d,42 patients)and 15 IBD subjects received TPN without glutamine.Malnutrition was diagnosed by body mass index(BMI)and serum albumin level.Results The prevalence of undernutrition was 90.2％(74/82)in the study population.CD patients had a significantly longer history of disease [84(3-288)months vs.24(1-324)months,P<0.001] and a significantly lower BMI [(15.6±1.8)kg/m2 vs.(19.1±3.5)kg/m2,P<0.001] compared with those in UC patients.TPN improved nutritional parameters [serum albumin:(28.7±6.6)g/L before TPN vs.(31.7±5.8)g/L after TPN,P<0.001;pre-albumin:(174.1±85.5)mg/L before TPN vs.(227.2±82.8)mg/L after TPN,P<0.001].Conclusions TPN improves nutritional status in hospitalized fasted IBD patients.However,prospective randomized controlled trials are required to estimate the role of low-to-middle dosage of glutamine in IBD patients.

Objective To compare the clinical significance of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting prognosis of patients with hepatocellular carcinoma (HCC).Methods The clinical data of 661 patients with HCC were retrospectively analyzed.Routine peripheral blood test results were used to calculate the NLR and PLR,and the receiver operating characteristic (ROC) curves were drawn.Using the thresholds of NLR and PLR,the patients were divided into the low NLR group and the high NLR group,and the low PLR group and the high PLR group.Overall survival (OS) and disease free survival (DFS) were evaluated by the Kaplan-Meier method.Independent prognostic predictors were determined by the Cox proportional hazard model.Results The NLR and PLR thresholds were 2.790 and 99,respectively.Analysis of the ROC curves showed higher NLR and PLR were significantly associated with poorer OS and DFS (all P ＜ 0.05).Multivariate analysis showed that NLR was an independent risk factor of OS and DFS (both P ＜ 0.05).The results remained unchanged when the NLR was further analyzed by applying different cut-off values of 2.810 and 3.In subgroup analysis,NLR remained an independent factor of Barcelona Clinical Liver Cancer staging system (BCLC) 0/A/B (P ＜ 0.05 for all measurements).Conclusion An elevated preoperative NLR could be a better prognostic predictor for HCC patients in comparison with PLR,especially for BCLC 0/A/B patients.

Objective To study the clinical application of Fuji intelligent color enhancement ( FICE) on the diagnosis of vocal leukoplakia and esophageal diseases. Methods A total of 50 patients suspected with vocal leukoplakia by electronic laryngoscopy were enrolled for undergoing meticulous examination of vocal cords and esophagus using FICE from January 2014 to January 2016. The diagnostic value of FICE for vocal leukoplakia were analyzed. Results Among the 50 patients, 50 lesions were found using laryngoscopy and 52 lesions were found using FICE. There were significant differences between FICE mode and white light mode on the capillary pattern score and lesion boundary resolution score ( all P<0. 05) . The diagnostic coincidence rate of FICE mode with pathology was higher than that of white light mode [ 89. 4％ ( 42/47 ) VS 68. 1％ ( 32/47 ) , P = 0. 01 ] . Among the 50 patients suspected with vocal leukoplakia, 31 combined with gastroesophageal reflux disease, and were given proton-pump inhibitor treatment. In the follow-up after three months, lesions of 16 cases alleviated, 13 cases disappeared, and 2 cases had no significant changes. Conclusion FICE has a higher clinical value than conventional laryngoscopy and white light endoscopy on the diagnosis of vocal leukoplakia.