From 1977 to 1990, 50 patients with renal cell carcinoma were given postoperative radiotherapy. The 3-,5- and 10-year survival rates were 60.0%,51.5% and 31.8%. The 5-year survival rate of StageⅠ～Ⅱ lesions was 69.2% and that of stageⅢ～Ⅳ lesions was 43.8%, which are better than those treated by surgery alone. Regional lymphatic metastasis, invasion of the nearby organs and vena caval cancerous thrombosis were the ominous signs, especially the former two. 83.3% of the patients died of distant metastasis. Lung was most common(58.3%)and then, bone metastasis (25.6%). The authors believe newer combination therapy against distant metastasis is needed to improve the results.

Objective To assess the value of S index and FIB-4 for diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB) by comparing with traditional indexes APRI and Forns.Methods A total of 361 patients with confirmed CHB from the First Hospital of Nanjing Medical University and Huashan Hospital Affiliated to Fudan University during January 2006 and December 2011 were enrolled in the study.The clinical,laboratory and pathological data of patients were collected.Four noninvasive score systems APRI,Forns,S index and FIB-4 were computed.With liver biopsy as the gold standard,the area under the ROC curve (AUROC) was used to assess the value of above 4 score systems in diagnosis of liver fibrosis,and Z test was performed to evaluate the effectiveness of above systems.Results The areas under ROC curve (AUCs) of APRI,Forns,S index and FIB-4 for significant fibrosis (≥S2) were (0.737 ±0.027),(0.716 ± 0.028),(0.745 ± 0.026) and (0.781 ± 0.025),respectively.When the cut off value of FIB-4 was set at 1.62,the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) for diagnosis of significant fibrosis were 59.3％,85.8％,89.4％ and 51.2％,respectively,which were better than Forn index (Z =3.28,P =0.001).While for S4 (cirrhosis) the AUCs of APRI,Foms,S index and FIB-4 were (0.687 ± 0.035),(0.792 ± 0.028),(0.863 ± 0.024) and (0.832 ± 0.025),respectively.When the cut off value of S index was set at 1.06,the sensitivity,specificity,PPV and NPV for diagnosis of cirrhosis were 77.9％,85.5％,59.4％ and 93.5％,respectively,which were better than APRI and Forns (Z =6.74 and 3.21,P ＜ 0.01).Conclusions APRI,Forns,S index and FIB-4 are simple and accurate methods for assessing liver fibrosis.FIB-4 and S index are better than APRI and Forns in diagnosis of significant fibrosis and cirrhosis,which may replace liver biopsy in certain extend.

Objective To explore the rationality of correcting urinary iodine (UI) concentration by using urine specific gravity (U-SG).Methods Weighing method and refractometer method were used respectively to measure specific gravity of 10-30 g/L mass concentration of different inorganic salts (sodium chloride,sodium sulfate,ammonium biphosphate) and organic matters(urea,glucose,glycine) aqueous solution,and urine plus 10-30 g/L sodium chloride or urea.UI concentrations in urine samples of 27 pregnant women respectively were expressed by direct method,weighing method U-SG correction and refractometer method U-SG correction.One random urine sample was collected for six batches in different seasons from children aged 8-10 and pregnant women for determination of U-SG and UI concentration.UI concentration was determined by arsenic cerium catalytic spectrophotometry (WS/T 107-2006).Results ①Measured by weighing method,specific gravity of inorganic salt (sodium chloride,sodium sulfate,ammonium biphosphate) aqueous solution was significantly greater than that of organic matters (urea,glucose,glycine) aqueous solution which had the same mass concentration.The specific gravity of 10 g/L sodium chloride aqueous solution was 1.008,and that of 30 g/L urea solution was 1.006.②Measured by weighing method,10 g/L sodium chloride was added to 3 urine samples separately.Accordingly the increases of USG were 0.006,0.008 and 0.007,respectively.Otherwise,the increases of U-SG were 0.003,0.002 and 0.004,respectively,when adding 10 g/L urea.~he median results of UI concentrations in urine samples from 27 pregnant women were 106.4,165.2 and 211.8 μg/L,respectively,expressing obtained by direct method,weighing method USG correction and refractometer method U-SG correction.④The determination results of six batches urine collected from children aged 8-10 in different seasons,the median results of U-SG measured by refractometer method were 1.019 0-1.021 2,the median UI concentration results obtained by direct method and refractometer method U-SG correction were 134.5-181.7 μg/L and 157.7-190.4 μg/L.The determination results of six batches urine samples of pregnant women in different seasons,the median results of U-SG measured by refractometer method were 1.013 4 -1.017 1,the median UI concentration results obtained by direct method and refractometer method U-SG correction were 96.2-138.9 μg/L and 135.2-181.6 μg/L.Conclusions The change of sodium chloride concentration in urine is the most important reason for the change of U-SG.In China,the main source of UI is the intake of edible iodized salt.Iodized salt intakes directly affect the U-SG and UI concentration.If the U-SG is used to correct the UI concentration,there will be a phenomena that the lower intake of iodized salt the lower U-SG.So the UI concentration was falsely increased significantly after correction.Conversely higher intakes of iodized salt caused higher U-SG.The UI concentration was falsely reduced significantly after correction.Therefore,U-SG cannot be used to correct the UI concentration.

Objective: To investigate the serum levels and clinical significances of microRNA-205 (miR-205) and microRNA-221 (miR-221) in patients with colon cancer. Methods: A total of 172 patients with colon cancer (colon cancer group), 130 patients with benign diseases of colon (benign lesion group) and 70 healthy persons (control group) admitted to Central Hospital of Western Hainan from January 2016 to December 2018 were selected. The serum levels of miR-205 and miR-221 in each group were detected, and their relationships with clinicopathological characteristics of patients with colon cancer were analyzed. The diagnostic values of the serum levels of miR-205 and miR-221 in colon cancer were analyzed by receiver operating characteristic (ROC) curve. Pearson correlation analysis was used to analyze the correlation between the serum levels of miR-205 and miR-221. Results: The serum levels of miR-205 in colon cancer group, benign lesion group and control group were 2.84±0.96, 1.16±0.27 and 1.05±0.23, with a statistically significant diffe-rence (F=10.113, P<0.001). The serum levels of miR-221 in the three groups were 1.95±0.74, 0.37±0.08 and 0.32±0.05, with a statistically significant difference (F=12.416, P<0.001). Further pairwise comparisons found that the serum levels of miR-205 and miR-221 in colon cancer group were significantly higher than those in benign lesion group and control group (all P<0.001). The serum levels of miR-205 and miR-221 in patients with colon cancer were related with TNM stage (t=5.412, P<0.001; t=6.103, P<0.001), degree of tumor differentiation (t=4.573, P=0.028; t=4.805, P=0.013) and with or without lymph node metastasis (t=5.837, P<0.001; t=7.410, P<0.001). ROC curve analysis showed that the optimal cut-off values of the serum levels of miR-205 and miR-221 for the diagnosis of colon cancer were 2.17 and 1.30, respectively. The area under the curve of the two combined diagnostic method for colon cancer was the largest (0.924, 95%CI: 0.865-0.983), with the sensitivity and specificity of 91.3% and 87.4%. The correlation analysis showed that the serum levels of miR-205 and miR-221 were positively correlated in patients with colon cancer (r=0.837, P<0.001). Conclusion The serum levels of miR-205 and miR-221 are significantly increased in patients with colon cancer, and the two combined detection has a high value for the diagnosis of colon cancer.

BACKGROUND:Intra-articular injection played an important role in the treatment of osteoarthritis and has more options with the development of novel drug delivery systems.The cartilage targeting function is aimed at the adhesion or retention of drugs in the cartilage layer to form a drug bank to achieve slow release and precise drug delivery. OBJECTIVE:To review various cartilage targeting biomaterials and their characteristics in the treatment of osteoarthritis by articular injection. METHODS:Using the term"osteoarthritis,drug carrier,drug delivery,cartilage targeting,penetrate"as key words,relevant articles were searched in CNKI,WanFang and PubMed databases.According to inclusion and exclusion criteria,67 articles were finally selected for further review. RESULTS AND CONCLUSION:The research on cartilage-targeting biomaterials is mainly divided into two directions.One is the combination of electrostatic interaction,such as the combination of positively charged biomaterials and negatively charged polysaccharides in cartilage.This kind of scheme is operable and easy to modify,but limited by the shortcomings of electrostatic interaction itself,it performs badly in advanced osteoarthritis.Another one is the specific binding of various components in cartilage which is strong and reliable,and related biomaterials have excellent performance in advanced osteoarthritis,which is an important direction for future cartilage-targeted therapy.

Objective:To investigate the willingness of medical students to work in primary health care institutions.Methods:A cross-section survey was conducted to investigate the willingness and the reasons, involving 597 undergraduate medical students and 2088 junior college students.Results:The employment willingness of undergraduate medical students was relatively low (14.9%), while the employment willingness of junior college students was high (56.02%). The top three factors of low employment willingness were: less opportunities for personal development, poor working environments and welfare. Moreover, the most effective method to cultivate medical students was developing a free training project for rural-oriented medical students, and the best method to attract medical students was formulating a more beneficial comprehensive policy.Conclusion:The willingness of clinical medical students to be employed in primary health care institutions is low for the time being. It is suggested to improve their willingness by improving welfare benefits, providing personal development opportunities, and strengthening social security.

Objective:To study the factors affecting the training quality satisfaction of the visiting physicians and to explore ways to improve the satisfaction and the training quality.Methods:The research data was collected by questionnaires and interview from 44 visiting physicians of hematology department in Peking University People's Hospital, and statistical analysis method was used to analyze the influencing factors of their satisfaction with training.Results:The higher the evaluation score of teaching activities, the tutor's professional knowledge and teaching ability was, the higher overall satisfaction was. Women had higher satisfaction than men. The older the physicians were and the shorter the training was, the higher the satisfaction was.Conclusion:In order to further improve the refresher training satisfaction of visiting physicians, we should carry out teaching activities with high quality, improve the teaching level and professional knowledge of tutors, strengthen scientific research training, and formulate personalized training plans for the visiting physicians.

Objective To observe the effect of exercise preconditioning (EP) on pressure overload-induced pathological cardiac hypertrophy and explore related mechanisms.Methods Ten-week-old male Sprague-Dawley rats (n =80) were randomly divided into four groups via random number table method: sham, TAC,EP + sham and EP + TAC.Two EP groups were subjected to 4 weeks of treadmill training, and followed by sham and TAC operations.Eight weeks after the surgery, mean arterial pressure (MAP), cardiac morphology, mRNA expressions of the B-type natriuretic peptide (BNP) and heat shock protein (HSP) 70 and protein expression of the BNP, heat shock transcription factor 1 (HSF1), HSP70, nuclear factor κB (NF-κB) p65, and interleukin-2 (IL-2) were examined.Results (1) Pathological cardiac hypertrophy index: eight weeks after TAC, MAP, heart size, HW/BW, cross-sectional area of the cardiomyocytes (CSA) and mRNA and protein expressions of BNP in the LV were all significantly higher in the TAC and EP + TAC groups than respective sham groups (all P ＜ 0.05).HW/BW, CSA, and mRNA and protein expressions of BNP in the LV were significantly lower in EP + TAC group than in TAC group (all P ＜0.05).(2) mRNA and protein expressions of HSF1 and HSP70 and nuclear HSF1 levels were significantly downregulated post TAC, however, EP treatment significantly increased the expression of HSFl and nuclear HSF1 levels in TAC rats (all P ＜ 0.05).(3) mRNA and protein expressions of NF-κB p65 and IL-2 were significantly increased in the TAC and EP + TAC groups compared with the respective sham groups (all P ＜ 0.05), which were significantly downregulated in EP + TAC group compared to TAC group (all P ＜ 0.05).Conclusions EP could effectively reduce the cardiac hypertrophic responses induced by TAC possibly through upregulating the expressions of HSF1 and HSP70 and inhibiting the expression of NF-κB p65 and its nuclear translocation.

Objective:To investigate the application value of transanal endoscopic partial intersphincteric resection for ultra-low rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 9 ultra-low rectal cancer patients undergoing transanal endoscopic partial intersphincteric resection at the First Affiliated Hospital of Xiamen University from December 2017 to August 2020 were collected. There were 8 males and 1 female, aged from 39 to 62 years, with a median age of 58 years. Observation indicators: (1) surgical and postoperative situations; (2) postoperative pathological examination; (3) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative tumor local recurrence and distant metastasis, survival of patients, ileostomy closure, anus function at 3 months after ileostomy closure, male urinary and sexual function and female sexual function at 6 months after rectal surgery. The follow-up was up to February 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1)Surgical and postoperative situations: all 9 patients underwent surgery successfully, without conversion to open surgery. Seven of the 9 patients underwent transanal endoscopic partial intersphincteric resection and the rest of 2 patients with tumor close to the dentate line underwent transanal endoscopic modified partial intersphincteric resection. The operation time and volume of intraoperative blood loss of 9 patients were (267±48)minutes and 50 mL(range, 30?60 mL), respectively. Five of the 9 patients underwent transanal specimen extraction, and 4 patients underwent specimen extraction by an abdominal incision. All 9 patients underwent transanal hand-sewn coloanal anastomosis and protective ileostomy, and two pelvic drainage tubes were indwelled. Transanal drainage tube was placed after anastomosis in 3 of 9 patients. Three cases had intraoperative adverse events and there were no intraoperative adverse event reported in the remaining 6 cases. The time to postoperative initial stoma exhausting and time to postoperative first semi-liquid food intake of 9 patients were 3 days(range, 2?4 days) and 5 days(range, 4?7 days), respectively. One case had Clavien-Dindo grade Ⅰ complication and 2 cases had Clavien-Dindo grade Ⅱ complication during postoperative 30 days and the rest of 6 cases had no postoperative complication. No anastomotic stricture, hemorrhage or urinary retention occurred in 9 patients. The duration of postoperative hospital stay and cost of hospitalization of 9 patients were 11 days(range, 9?23 days) and (6.8±1.3)×10 4 yuan, respectively. (2) Postoperative pathological examination: the diameter of tumor, the distance of distal resection margin, the number of lymph node dissected and the number of positive lymph node of 9 patients were (3.2±1.4)cm, 0.6 cm(range, 0.5?1.5 cm), 17±7 and 0(range, 0?7), respectively. The tumor histopathological type was adenocarcinoma with negative tumor nodule and nerve infiltration in all 9 patients. Only 1 case of 9 patients was found vascular tumor thrombus. The surgical specimens of all 9 patients showed negative for distal and circumferential margins and complete mesorectum. Results of postoperative pathological TNM staging showed that of 6 cases with preoperative T1-T2 staging tumors, 3 cases were classified as pT2N0M0 stage, and 3 cases were classified as pT2N1M0 stage, pT2N2M0 stage or pT3N1M0 stage, respectively. Three cases with preoperative T3 staging tumors were classified as ypT0N0M0 stage, ypT2N0M0 stage or ypT3N0M0 stage, respectively. (3) Follow-up: all 9 patients were followed up for 6 to 13 months, with a median follow-up time of 9 months. No local recurrence, distant metastasis or tumor-related death was found during follow-up. Of the 9 patients, only 1 case did not receive stoma closure and undergo anus function assessment, and the rest of 8 cases underwent stoma closure. Results of postoperative anus function assessment showed 5 cases of accessibility, 2 cases of mild impairment and 1 case of severe impairment. Results of urogenital function assessment showed 6 cases of the 8 male patients of mild impairment, 1 case of moderate impairment and 1 case of severe impairment in micturition function, respectively, and 3 cases of accessibility, 2 cases of mild impairment and 3 cases of moderate impairment in sexual function, respectively. The female patient underwent accessibility of sexual function and the six-item version of the female sexual function index was 25. Conclusion:Transanal endoscopic partial intersphincteric resection can be used for the treatment of ultra-low rectal cancer.

Objective:To evaluate the patch technique in repairing huge rotator cuff tear.Methods:A retrospective analysis was conducted of the 9 patients with huge rotator cuff tear who had been repaired with patch technique at Department of Orthopaedics, Guangzhou Red Cross Hospital from March 2017 to March 2019. They were 5 males and 4 females, aged from 53 to 79 years (average, 61 years). Shoulder movement limitation was found in 7 cases, night pain in 5, and positive Neer impingement sign and Hawkins sign in 7. By the Bigliani acromion classification, there were 6 cases of type Ⅱ and 3 cases of type Ⅲ. Comparisons were made between preoperation, 12 and 15 months postoperation in terms of scores of the visual analogue scale(VAS) and the University of California Los Angeles (UCLA) scoring system, and shoulder range of motion.Results:All the 9 patients were followed up for 15 to 24 months(mean, 18 months). Arthroscopy found tears in more than 2 tendons in all of them. The VAS scores were 6.7±1.6, 4.5±1.3 and 3.7±1.1 at preoperation, 12 and 15 months postoperation; the UCLA scores were 7.9±1.2, 21.5±4.1 and 23.9±4.3 at preoperation, 12 and 15 months postoperation. There were statistically significant differences in both the VAS and UCLA scores between preoperation, 12 and 15 months postoperation ( P<0.05). There were also statistically significant differences between the 3 groups in the shoulder range of motion at preoperation, 12 and 15 months ( P<0.05). MRI reexamination at 12 months postoperation showed minor re-tear < 3 cm in 2 patients. Conclusion:The patch technique is a reasonable and effective treatment to repair huge rotator cuff tears, resulting in good mid-term outcomes.