Objective To determine the efficacy and safety of reamed versus nonreamed intramedullary nailing for femoral fractures in adults on the rates of nonunion, the rates of implant failure, the rates of pulmonary implications, infections, the time of union, et al. Methods According to Cochrane Systematic Review, Medline, Embase, Cochrane Library and CBM disc were searched for RCTs without limitation of language, and gray literatures had been also searched, furthermore, the bibliographies of retrieved papers and content experts were consulted for additional references. Methodology quality of literatures used simple evaluate method the Cochrane Collaboration recommended, which was graded to A, B, C. Data was extracted by two reviewers for inclusion using the designed extraction form. Revman 4.2.3 the Cochrane Collaboration provided were used for data management and analysis, and obtained evidences for the efficacy and safety of reamed versus nonreamed intramedullary nailing for femoral fractures in adults. Results Five RCTs were included by total retrieve and riddling. For methodology quality of literatures, one was A scale, two was B, and two was C. The combined results showed that reamed intramedullary nailing for femoral fractures in adults reduce the rates of nonunion RR=0.38, 95% CI(0.17, 0.88), P=0.02 , implant failure RR=0.45,95% CI (0.21,1.00), P=0.05 and the time to union WMD=-10.90,95% CI (-18.16,-3.64), P=0.003 . Conclusion To compare with nonreamed intramedullary nailing for femoral fractures in adults, reamed intramedullary nailing can reduce the rates of nonunion. However, the relation between reaming or not and implant failure, the time to union, pulmonary complications, infection etc needs further study.

A method was developed for simultaneous determination of pyrrolizidine alkaloids and isoquinoline alkaloids in honey by dispersive solid phase extraction and high performance liquid chromatography-tandem mass spectrometry ( QuEChERS-HPLC-MS/MS) . The honey samples were extracted with acetonitrile solution and cleaned up with PSA absorbent. Agilent Poroshell 120 SB-C18 chromatographic column was used to separate alkaloids with high sensitivity and satisfactory resolution. The identification and quantification were achieved by using electrospray ionization in positive ion mode ( ESI+) with multiple reaction monitoring (MRM). Matrix-matched calibration curves with good correlation coefficients (R2>0. 99) were obtained in the concentration range of 0. 1-100 μg/L. The recoveries of the spiked samples at 1-100 μg/kg were in the range of 70% to 110% with the RSD of intra-day and inter-day lower than 15% and 20%, respectively. The limits of detection ( LOD) and limits of quantification ( LOQ) for all alkaloids were 0. 3 and 1. 0 μg/kg, respectively. This method was successfully applied to the simultaneous determination of pyrrolizidine alkaloids and isoquinoline alkaloids for quantification and confirmation in honey samples.

Objective To prospectively study the dynamic variation of vascular endothelial growth factor (VEGF),the short-term efficiency and the tolerability of the esophageal cancer patients treated by radiotherapy combined with thalidomide.Methods The serum samples of 86 esophageal cancer patients were collected before,during and after the radiotherapy.The VEGF levels were assayed by enzyme-linked immunosorbent assay (ELISA).3 patients interrupted the treatment because of intolerance radiotherapy.Based on the changes of VEGF level,32 esophageal cancer cases whose VEGF levels increased or remained were assigned to the group to which thalidomide was given during the whole course of radiotherapy.The rest 51 patients whose VEGF level decreased received radiotherapy without thalidomide during the whole course.In addition,30 healthy cases were included in control group.Then the efficiency and safety of the introduction of thalidomide in radiotherapy were investigated. Results The VEGF levels of 86 esophageal cancer cases were significantly higher than the 30 healthy control cases ( t =5.07,P ＜ 0.01 ),which were also correlated with the primary tumor size ( t =4.55,P ＜ 0.01 ),lymph node metastasis ( t =7.50,P ＜0.01 ),histological type( F =3.40,P ＜ 0.01 ) and clinical stage ( t =2.52,P ＜ 0.0 l ).However,it was irrelevant to the lesion site,distant metastasis,X-ray pathologic type,gender or age ( P ＞ 0.05).For the thalidomide involved group, the VEGF level after radiotherapy was significantly lower than during radiotherapy (t =2.37,P ＜0.05 ) with an effective rate of 71.88％.For the rest 51 cases without using thalidomide,the effective rate was 78.43％ yet there was no significant difference between the VEGF levels during and after radiotherapy ( t =0.18,P ＞ 0.05 ).62.50％ patients reported symptoms of dizzy and burnout after using thalidomide,while this incidence was 15.69％ for the rest patients (x2 =19.28,P =0.000).For the groups with or without thalidomide combination,the sleepiness incidences were 18.75％and 1.96％,respectively (x2 =5.168,P =0.023 ); the Ⅲ - Ⅳ grade esophagitis incidences were 12.50％ and 11.76％,respectively (x2 =0.061,P =0.806) ; the Ⅱ - Ⅳ grade leukocyte decrease incidences were 6.25％ and 9.80％,respectively (x2 =0.026,P =0.872) ; the Ⅲ - Ⅳ grade platelet descend incidences were 3.13％ and 5.88％,respectively (x2 =0.002,P =0.965 ) ; the Ⅲ - Ⅳ grade nausea and vomiting incidences were 9.38％ and 27.45％,respectively (x2 =2.913,P =0.088 ). No anaphylaxis was observed. Conclusions Thalidomide can decrease the VEGF expression level of esophageal cancer patients.Patients treated with thalidomide show good tolerance and compliance.

Objective To investigate the changes and clinical value of serum vascular endothelial growth factor (VEGF) level before,during and after radiotherapy in patients with esophageal carcinoma.Methods The sera of 67 esophageal carcinoma patients and 30 healthy control cases were collected.The VEGF level in serum samples were measured with enzyme-linked immunosorbent assay (ELISA) method.The relations among VEGF level changes,clinical stages and radiotherapy effect were analyzed.Results The VEGF levels of patients with esophagus cancer before,during and after radiotherapy were significantly higher than those in control group ( F =11.65,P ＜ 0.01 ).The VEGF level after radiotherapy was significant lower than that before radiotherapy ( F =10.72,P ＜ 0.01 ).The average VEGF level of patients with T3 and T4 was significantly higher than that of control group ( F =14.10,P ＜ 0.01 ).The average VEGF level of patients with N1 and N2 was significantly higher than that of control group( F =8.64,P ＜0.01).In 62 patients,the serum VEGF level increased in 21 cases but decreased in 41 cases after radiotherapy.With difference in radiotherapy efficiency of 61.90％ and 90.24％,respectively(x2 =6.08,P＜ 0.05).The average VEGF level during and after radiotherapy for 50 cases of CR + PR were significantly lower than that before radiotherapy( F =7.98,P ＜ 0.01 ).Conclusions Monitoring the serum VEGF level of patients with esophagus cancer can help evaluate the radiosensitivity,which has a significance in predicting the prognosis of radiotherapy.

AIM: To investigate the effects of sodium ferulate on cholesterol and triglyceride metabolism in atherosclerosis with hyperlipidemia.METHODS: The rabbit model of atherosclerosis was produced by feeding high lipid forages.RAW264.7 foam cell and HepG2 injured cell models were established by incubation with oxidized low density lipoprotein(ox-LDL).The atherosclerotic plaque area was measured,and serum lipids were detected.The cellular lipid accumulation was examined by oil red O staining.The cellular contents of total cholesterol and cholesterol ester were quantified by high performance liquid chromatography.The hepatic lipase(HL) mRNA expression was determined by RT-PCR.RESULTS:(1) Compared with hyperlipid group,the aorta atherosclerosis plaque area and the serum triglyceride level were significantly decreased in sodium ferulate-treated rabbits,but the serum cholesterol level showed little change.(2) Compared with ox-LDL group,the HL mRNA expression in HepG2 cells was enhanced significantly in sodium ferulate-treated group,but the cellular contents of total cholesterol and cholesterol ester in RAW264.7 foam cells showed little change.CONCLUSION: Sodium ferulate inhibits the formation of atherosclerotic plaque in high-cholesterol-fed rabbits aorta.This antiatherosclerotic function may reduce serum triglyceride level through enhancing the expression of HL mRNA without influencing serum cholesterol level and foam cell formation.

Objective To investigate the effectiveness of problem-based learning in the biochemistry teaching in merging class of minority and Han students.Methods Totally 460 clinical medical students were divided into PBL group which contained 252 students and the traditional teaching group which involved 208 students,respectively.According to each team of seven to eight students,minority and Han students randomly arranged.Control group used classroom teaching mode,experimental group in addition to classroom lectures,had additional 12 hours of PBL teaching,but the theory classes for the two groups of students were taught by the same six teachers with rich teaching experience,and the teaching content and teaching material selection were also the same.At the end of the course,the learning outcomes were evaluated by using descriptive analysis and t test (α=0.05) based on the combination of theoretical examination,experimental practice and the questionnaire survey method.Results Compared with the traditional teaching group,the final scores were higher than those of PBL group (84.72 ± 6.99 and 80.34 ± 7.12,P＜0.05).There were also statistically significant between two groups according to different nationality(Minority:85.65 ± 5.27 and 79.70 ± 7.14;Han:83.91 ± 8.26 and 80.95 ± 7.08;P＜0.05),and interestingly the increased ratio of scores was higher in minority than that in Han.The questionnaire surveys indicated that the PBL teaching method could enhance professional and comprehensive qualities of students and more than 81.83％ students were satisfied with the new teaching mode.Conclusions The combination of tradition and PBL-based teaching methods improved the quality of biochemistry teaching of clinical medicine in merging class of minority and Han students in Xinjiang Medical University.

Objective : To explore the correlation between air pollution and outpatient visits,and to provide evidence for health risk assessment of air pollutants and intervention. Methods : The data of air pollutants and outpatient visits in 2016 in Zhoushan Hospital were collected,and the outpatient volume on the days when the concentration of air pollutants reached and exceeded the standard were compared. Spearman rank correlation analysis was used to explore the relationship between outpatient volume and the concentration of air pollutants. Results : In 2016,the median（inter-quartile range）of daily outpatient volume in Zhoushan Hospital was 3 304（1 638）person-times. O3,PM2.5 and PM10 were the primary air pollutants in Zhoushan in 2016. The average daily outpatient volume of internal medicine,circulatory system,other diseases and all when the air was polluted at light level or above were higher than those when the air quality was good（P< 0.05）. CO concentration was positively correlated with the average daily outpatient volume of respiratory system and circulatory system（P< 0.05）,was negatively correlated with the average daily outpatient volume of all（P< 0.05）. O3-8 h concentration was positively correlated with the average daily outpatient volume of internal medicine,other diseases and all（P< 0.05）,and was negatively correlated with the average daily outpatient volume of respiratory system and pediatrics（P< 0.05）. SO2 concentration was negatively correlated with the average daily outpatient volume of respiratory system,skin and subcutaneous tissue（P< 0.05）. The concentration of NO2,PM10 and PM2.5 were positively correlated with the average daily outpatient volume of respiratory system and pediatrics（P< 0.05）. Conclusion The main air pollutants in Zhoushan were O3,PM2.5 and PM10. When they exceed the limits,the outpatient volume would increase.

Objective: To understand the concentrations and source of SO42-,NO3-,Cl- and NH4+ in atmospheric PM2.5 in Zhoushan,and to provide reference for controlling PM2.5 and formulating effective environmental protection measures. Methods: Monitoring sites in new districts of Zhoushan were set up to continuously collect PM2.5 from 10th to 16th of each month and under the hazy weather during 2015-2016（AQI > 200）. The mass concentration of PM2.5 was measured by weighing method,and the concentrations of SO42-,NO3-,Cl- and NH4+ in PM2.5 components was detected by ion chromatography. Results: The average daily concentration of PM2.5 in Zhoushan from 2015 to 2016 was（40.91±27.39）μg/m3. The concentration of the four water-soluble non-metal ions in PM2.5 components was 3.56-103.03 μg/m3,with an average of（23.06±20.00）μg/m3,accounting for about 56.64% of PM2.5 contents. The average monthly concentration of SO42- was the highest[（10.35±6.48）μg/m3],while the average monthly concentration of Cl- was the lowest [（0.49±0.73）μg/m3]. The concentration of the four ions was the highest in winter[（37.56±27.74）μg/m3]and the lowest in summer[（12.32±5.88）μg/m3]. The differences between different seasons was statistically significant（P<0.05）. The highest concentration of NO3- occurred in winter,which was（14.48±13.28）μg/m3. The concentration ratio of NO3- to SO42- ranged from 0 to 2.58,with an average of 0.55. There were 28 days（14.74%）with the ratio greater than one,22 days of which was in winter. Conclusion The concentration of SO42- was the highest and Cl- was the lowest in atmospheric PM2.5 in Zhoushan. The highest concentration of the four ions occurred in winter. The concentration of NO3- in winter was higher than that of SO42-,suggesting that motor vehicle exhaust might be the main source of PM2.5 in winter.

Objective Wnt signaling plays an important role in the development and progression of renal cell carcinoma (RCC).This study aimed to evaluate the effects of the Wnt signaling inhibitor 15-oxospiramilactone on the proliferation , migration, cell apoptosis, and cycles of the human RCC cell line 786-0, and to investigate the possible mechanisms of this small molecule acting on RCC in ivtro. Methods We treated 786-0 cells with DMSO ( blank control group ) and 15-oxospiramilactone at the concentrations of1.25μmol/L (low 15 -OSL), 2.5μmol/L (medium 15-OSL), and 5μmol/L (high 15-OSL), respectively, for 72 hours.Then we observed the changes in the proliferation and migration of the 786-0 cells by MTT and scratch-wound assay and determined their apopto-sis and cycles by Annexin V-FITC/PI assay and flow cytometry . Results 15-oxospiramilactone significantly inhibited the growth of the 7860-cells, with the IC 50of 1.088 μmol/L at 72 hours, and decreased their migration distance (P<0.05).After 36 hours of treatment, the apoptosis rates of the 786-0 cells in the low, medium, and high 15-OSL groups were (12.17 ±0.56), (18.54 ± 1.07), and (50.74 ±1.28) %, respectively, significantly increased as compared with (7.85 ±0.42) %in the blank control group (P<0.05), and in an obviously concentration-dependent manner.15-oxospiramilactone remarkably reduced the number of cells in the G0/G1 phase and increased that in the G 2/M phase (P<0.05). Conclusion 15-oxospiramilactone can significantly inhibit the pro -liferation and migration and induce the apoptosis of 786-0cells in vitro.It may be a potential anti-RCC agent.

Introduction to the theories on improving coordination level of the new rural cooperative medical system,including the risk theory,great number rule,fair theory,demand theory and supply theory which are cornerstones of enhancing the NRCMS improving the pooling level.The paper also probed into the practices of improving the pooling level of the NRCMS,including the models of high level,middle level and low level pooling.These theories and practices can help the localities better design and manage the pooling level of the NRCMS.