Transcription repressor ZHX2 is one of the members in ZHX protein family,which exists widely in human tissue and participates in the occurrence and development of various diseases.Researches show that ZHX2 is closely related to the occurrence and development of cancers,such as liver cancer,multiple myeloma,gastric cancer and colorectal cancer,which has the potential value of tumor treatment.

Notch signaling is an important evolutionarily conserved pathway involving the fate of cells translation. Additional?ly, this pathway also plays an important role in cartilage formation and maintenance of chondrocytes phenotype, regulation of the prolif?eration, maturation and balance of cartilage matrix metabolism. This paper reviews the composition and activation process of notch sig?naling, and its specific role in cartilage formation.

Objective To evaluate the value of echocardiography in investigation the failure of interventional therapy of VSDs and to increase the successful rate. Methods 15 cases with failure of VSD closure through interventional approach were undertaken measurement of major parameters of the defect on left ventriculography and then followed by Philips 5500 color Doppler US for repeated multi-direction tangential measuring of the size, morphologic change, relation with peripheral structure and individual valvular regurgitation. Results (1) Marginal membranous VSD 10 cases; membranance aneurysm 8 cases, ≥2 outlets 6 cases. Width of basal part of membranous aneurysm was 8 ～ 18 (10 ?2) mm with depth of 3 ～ 10 (6 ? 2) mm, distance from aortic valve was 0 ～ 6 (2 ? 1) mm and from tricuspid valve was 2 ～ 5 (2 ?1) mm; associated with slight tricuspid valvular regurgitation. Aortic valvular regurgitation 5 cases showed slight to mild amount and without membranous aneurysm occurred in 2 cases. (2) Intracristal VSD 5 cases showed the size of defect as 6 ～ 10 (7 ? 1) mm, with distances of 2 ～ 3 (1 ? 0.8) mm from pulmonary valve and 1 ～ 2 (1 ? 0.6) mm from aortic valve associated with slight regurgitation in 4 cases, slight tricuspid valvular regurgitation in 5 cases and aortic valvular prolapse in 4 cases. Conclusions Many factors can influence the direction tangential continuous scanning should be taken for accurate localization and measurement of VSD in order to select the very sight occludor providing high successful rate of occlusion and long term efficacy.

Objective To investigate complications and mortality of primary reamed intramedullary nailing for femoral shaft fractures in patients a ssociated with thoracic injuries. Methods A retrospective a nalysis of trauma data was performed and the case selection based on the followi ng criteria: (1) patient age of 17-65 years, (2) patients with multiple injury ( ISS≥16) as well as complicated thoracic trauma (AIS≥2), (3) hospitalization stay ≥48 hours, (4)no serious pre-existing medical diseases in history, (5) as sociated femoral shaft fractures treated with reamed intramedullary nailing, ext ernal fixation, plate, cast, traction and unreamed intramedullary nailing. The s elected patients were divided into two groups according to the interval from inj ury to operation, ie, those within 24 hours as Group A and beyond 24 hours as Gr oup B. Results During the study period, 96 patients met the criteria for the investigation. There were 57 patients in the Group A and 39 pa tients in the Group B. In two groups, there was significant difference in incide nce of open femoral shaft fractures (53% in the Group A and 31% in the Group B, ? 2=4.496, P

Objective To investigate the correlation between elasticity obtained with acoustic radiation force impulse(ARFI) and blood perfusion obtained with contrast enhanced ultrasound(CEUS) in renal carcinoma.Methods Tweenty-four patients with renal carcinoma confirmed by operation and pathology underwent ARFI and CEUS sequentially,got preliminary information of elasticity,size and border with virtual touch tissue imaging (VTI),shear wave velocity (SWV) of tumor and renal cortex at least 2centimeters from the tumor margin were measured with virtual touch tissue quantification (VTQ),and then the imaging characteristics were analyzed with time intensity curve (TIC).The elasticity obtained with ARFI were compared with the blood perfusion obtained with CEUS.ResultsTotally 24 cases included 18 renal cell carcinomas,3 papillary renal cell carcinomas,2 chromophobe cell renal carcinomas and 1 rena1collecting duct carcinoma.In VTI,18 appeared darker,4 appeared brighter,and 2 had the same brightness as renal cortex.The SWV of tumor and renal cortex were (2.47±0.61)m/s,(2.10±0.94) m/s,respectively,19 were stiffer than renal cortex (79.2％),among which 18 appeared hyper-enhancement and 1 appeared hypo-enhancement;5 were softer than renal cortex (20.8％),among which 2 appeared hyper-enhancement and 3 appeared hypo-enhancement in CEUS.Tumors with different elasticity had different enhancement,stiff cases appeared hyper-enhancement,soft cases appeared hypo-enhancement (P ＜ 0.05).Conclusions There is correlation between elasticity obtained with ARFI and blood perfusion obtained with CEUS in renal carcinoma

Objective To evaluate the clinical capability of young general practitioners (GPs) in communities in Shanghai.Methods A cross-sectional survey on clinical ability of young GPs was adopted from October to December 2014.Total 211 GPs aged (31 ± 2) years (25-35) from 17 districts of Shanghai participated in the study.Written examination and objective structured clinical examination (OSCE) was applied in the evaluation.Results All 211 GPs (63 male and 148 females) completed the assessment.The overall score of the assessment was (602 ± 83) and the pass rate was 62.6％ (132/211).In written examination the average score was (64 ±7) and the pass rate was 72.1％ (152/211).In OSCE,the highest score (80 ± 15) and pass rate (92.9％,196/211) was in CPR skill,followed by communication skill [average score:(76 ± 15) and pass rate:85.8％ (181/211)].The lowest average score was physical examination (47 ± 15) with a pass rate of 26.1％ (55/211),followed by electrocardiogram reading [average score:(84 ±31) and pass rate:39.8％ (84/211)].In basic operation station,the lowest score was using funduscope and gynecologial examination (29.8％ and 45.4％,respectively).Conclusion Young GPs in Shanghai communities basically master clinical skills,but also have some deficiencies,the training in certain skills need to be strengthened.

Objective This study was to analyze the early and long-term effect of completion pneumonectomy.Methods Retrospective analysis was made on the patients who underwent completion pneummonectomy in Shanghai Chest Hospital.Results There were totally 56 cases patients underwent completion pneumonectomy during January 2003 to July 2013.Among them,45 patients received CCP,and other 11 patients received RCP.CCP refers to the complete removal of lung tissue remaining after an initial ipsilateral partial pulmonary resection.RCP refers to the complete removal of residual lung due to the severe complications after pneumonectomy.The mortality and morbidity rate of CCP were 4.4％ and 33.3％ respectively.In the case of CCP,the incidence of benign lesions is significantly higher than the incidence of malignant tumor(80.0％ vs 27.5％,P =0.04).The mortality and morbidity rate of RCP were 27.3％ and 90.9％ respectively.In the case of RCP,higher postoperative mortality often occurs in aged patients (P =0.046) and patients with preoperatie mechanical ventilation (P =0.03).Overall five-year survival rate for patients with benign lesions was 80％,and for malignant lung cancer patients,the number was 30％.Survival time differs according to the TNM staging(a median of 60.0 months,35.0 months,10.0 months,stage Ⅰ,stage Ⅱ,stage Ⅲ,P ＜0.01),and survival rate was higher when the time interval(between the initial pulmonary resection and the completion pneumonectomy) ＞ 2 years(a median of 60.0 months,18.0 months,P ＜ 0.01).Conclusion Completion pneumonectomy is a high-risk surgery,especially RCP.Advanced age and preoperative mechanical ventilation are associated with higher postoperative mortality rate for RCP.As for CCP,higher postoperative risk exists in patients with benign lesions,but the survival rate is also higher.In patients with malignant lung tumor,survival rate is higher when the time interval (between the initial pulmonary resection and the completion pneumonectomy) ＞2 year.

Objective To evaluate the therapeutic effect of oral and external application of Chinese medicine combined with Ilizarov external fixator and the accordion technique for severe chronic osteomyelitis of the tibia.Methods A total of 78 patients with severe chronic osteomyelitis of the tibia were randomized into a routine treatment group and a combined treatment group, 39 in each group. All the patients in the two groups received external fixation by use of Ilizarov external fixator and the accordion technique. All the patients in the combined treatment group received oralGuyu decoction. The patients who had large wound received vacuum-sealing drainage in the routine treatment group, and vacuum-sealing drainage combined with external application ofShengji-Yuhong plaster in the combined treatment group. All the patients were treated for 8 weeks and followed up for 2 years. The time to wound healing and fracture healing, and the drainage time were compared between the two groups. Functional and radiologic findings were evaluated according to Paley's criteria. The functions of the knee joint and ankle joint were evaluated using the Hospital for Special Surgery (HSS) knee score and the scoring system of Baird and Jackson, respectively.Results The time to wound healing (17.33 ± 6.21 dvs. 22.27 ± 8.12 d;t=3.018,P=0.004) and the time to fracture healing (32.25 ± 6.02 weeks vs. 36.37 ± 7.75 weeks;t=2.623,P=0.011), and the drainage time (17.01 ± 4.66 dvs. 21.51 ± 5.23 d;t=4.012, P<0.001) in the combined treatment group were significantly shorter than those in the routine treatment group. According to Paley's criteria, the patients who achieved a score of excellent or good for fracture healing (84.6%vs. 53.8%;χ2=7.282,P=0.007) and function (92.3%vs. 66.7%;χ2=6.369,P=0.012) in the combined treatment group were significantly more than those in the routine treatment group. The scores of the HSS knee score (84.56 ± 7.42vs. 78.81 ± 5.33;t=3.391,P=0.002) and the scoring system of Baird and Jackson (85.01 ± 8.21vs. 79.21 ± 6.78;t=3.402,P=0.024) in the combined treatment group were significantly higher than those in the routine treatment group.Conclusion OralGuyu decoction and external application ofShengji-Yuhong plaster combined with Ilizarov external fixator and the accordion technique can promote recovery of the joint function, fracture healing and wound healing.

Objective To survey on utilization of hospital beds in rural and urban community health centers in Shanghai.Methods The hospital beds utilization was investigated in one rural and one urban community health service centers in Shanghai.The data of hospitalized patients in a selected day were surveyed with self-made questionnaire,including the demographic information of patients,the diseases category,the length of hospital stay,self-care ability of daily life (ADL score),the purpose of hospitalization,and the management after discharge.Results Patients aged over 60 y accounted for 100.0％ (138/138) in urban center and 98.7％ (76/77)in rural center.The three top disease categories were all cardio or cerebrovascular diseases in urban center accounting for 86.9％ (120/138),while those in rural center were hypertension,cerebral infarction and acute/chronic bronchitis (or tumor)accounting for 65.0％ (50/77).The mean length of hospital stay in urban and rural centers were 609.6 d and 253.8 d,respectively (F =2 604.00,P =0.000).Patients with severe dysfunction in urban and rural centers accounted for the 84.0％ (116/138) and 32.5％ (35/77),respectively (x2 =80.911,P=0.000).Patients not willing to be discharged in urban and rural centers accounted for 87.7％(121/138)and57.1％ (44/77),respectively in city and rural centers(P ＜0.05).Conclusions The wards in community health centers mainly serve the elderly patients.There are differences in purpose of hospitalization,length of hospital stay,ADL scores of patients between rural and urban community health centers.

Objective To discuss the effective factors and metastasis rules of cervical lymph node of papillary thyroid microcarcinoma,aimed to provide references for indications and range of lymph node dissection.Methods Reviewed the clinical information and pathological material of primary treatment of 1 180 cases of papillary thyroid microcarcinoma patients in China-Japan Union Hospital of Jilin University from June 2008 to December 2011 by retrospective analysis,futher summared cervical lymph node metastasis rules and effective factors.Results The lymph node metastasis rate of 1 180 patients with papillary thyroid microcarcinoma was 29.6％,which of these of the central and lateral region were 26.4％ and 15.2％.Central region lymph nodes metastasis rates in male and female were respectively 44.9％,21.8％ (P ＜ 0.05),and were 39.8％,9.0％ in lateral region (P ＜ 0,01).Lymph node metastasis rates of patients whose age ≤45years old and ＞45 years old were 30.3％,17.9％ (P ＜0.05).The lymph mode metastasis rate which diameter of tumour(D) ≤0.5 cm or 0.5 cm ＜ D ≤ 1 cm in central region were 20.2％,33.2％ (P ＜ 0.05).The lymph node metastasis rate of single and more nidi respectively were 15.7％,45.0％ in central region.The lymph node metastasis rate of tumors invasion or not were 44.4％ and 14.2％ in central region (P ＜0.05).The metastasis rates were 45.5％ and 4.3％ in the lateral region when the lymph node infringe or not in central region.Conclusions Lymph node metastasis happens relatively more common in papillary thyroid microcarcinoma patients with the factors such as male,young age,multiple nidi,long diameter of tumor and invasion of tumor envelope.So when doctors establish the indications and range of lymph node dissection,it's need to pay attention to the high risk factors seriously which effect lymph node metastasis of papillary thyroid carcinoma,and establish the lymph node dissection strategy individually.