Objective To study the influence of different positions in the isokinetic muscle test of knees by CON-TREX Biomechanical Test and Training System, so as to select the suitable conditions for forensic identification of muscle strength test. Methods Fifty-two healthy volunteers joined the isokinetic muscle strength test in unfixed and fixed position, respectively and in two kinds of angular speed (60°/s and 30°/s). The differences of peak torque (PT) and peak torque angle (PTA) between bilateral knee flexor and extensor were statistically analyzed. Results In the unfixed position, under the two speed, there was statistically significant difference in PT between bilateral knee flexor and extensor (P<0.05);while in the fixed position, under the two speed, there was no statistically significant difference (P>0.05). In any kind of conditions, the PTA of bilateral knee flexor and extensor did not have statistically signifi-cant difference(P>0.05). Conclusion The position of the subject influences the results of PT. So the po-sition of subject in knees isokinetic muscle test should be regulated.

Objective To investigate the difference of impulsiveness between patients of obsessivecompulsive disorder(OCD) and healthy controls.Methods Seventy-one patients who met the DSM-Ⅳ criteria for OCD,and sixty-five healthy controls were recruited.Impulsiveness and the severity of symptom were assessed with Barratt Impulsivity Scale (BIS-11) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and the end of 16th week treatment.Results Before treatment,attentional impulsivity scores(14(12,16)) and non-planning impulsivity scores (26 (23,28)) were significandy higher (all P＜ 0.01) in OCD patients compared with controls (12 (11,13),23 (20.5,26)).Mter treament,the reduction rate of attentional impulsivity was positively correlated with the reduction rate of Y-BOCS (r=0.443,P=0.018).Logistic regression analysis reported that with the total scores of BIS-11 increased,the effect of treatment was improved (β=-0.149,P=0.002).Conclusion Increased attentional and non-planning impulsivity are found in OCD.As the improvement of symptom,the scores of attentional impulsivity are also decreased.The high total scores of BIS-11 are correlated with the efficacy of treatment.

Background and purpose: With the development of therapy equipments and technology, the treatment for nasopharyngeal carcinoma(NPC) has entered into the era of precision radiotherapy, and setup errors have become a very important factor affecting treatment effects. The purpose of this study was to analyze the set-up errors detected by the kilovoltage cone beam CT(EPID) and the megavoltage electronic portal imaging device(CBCT) using 2 kinds of different immobilization techniques (pillow+head neck shoulder mask and vacuum bag+head neck shoulder mask) for NPC patients. Methods:A total number of 40 NPC patients were randomly assigned into 2 groups (pillow+head neck shoulder mask group and vacuum bag+neck shoulder mask group). Then each group was further divided into CBCT scan group and EPID group for veriifcation before treatment delivery. We matched the EPID images with the DRRs and acquired the set-up errors in x, y, z axis. Setup errors of CBCT were calculated according to its matched and planned CT images in left-right (x), superior-inferior (y) and anterior-posterior (z) directions. Paired t-test was used to evaluate the differences. Results:In the pillow+head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x (0.67±2.01)mm, y (0.51±1.71)mm and z (0.57±2.04)mm, respectively. The errors of EPID were x (0.69±2.19)mm, y (0.54±2.03)mm and z (0.61±2.11)mm. In the vacuum bag+head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x (0.42±1.81)mm, y (0.33±1.55)mm and z (0.50±1.75)mm, respectively. The errors of EPID were x (0.44±1.87)mm, y (0.43±1.70)mm and z (0.54±1.77)mm. The vacuum bag+head neck shoulder mask ifxed technique was more accurate when compared to the pillow + head neck shoulder mask ifxation method (P<0.05). Conclusion:CBCT and EPID were similar in detecting set-up errors for the NPC patients. However, the vacuum bag+neck shoulder mask ifxed technique was more accurate when compared to the pillow+head neck shoulder mask ifxation method.

Objective To study the application of isokinetic muscle testing in identification of the faked paralysis to provide scientific data for establishing a standard systemof muscle strength in forensic medicine identification. Methods Fifty-seven patients with bone fracture or nerve damage as damaged group and 128 normal subjects pretended paralysis as faked paralyzed group were included in this study. Isokinetic muscle testing was performed on bilateral knees of all subjects in the two groups. The peak torque (PT) and peak torque angle (PTA ) were compared between both sides in each group. The fea-tures of torque-time graph of two groups were classified. Results In the damaged group, the differences of PTbetween two sides of flexors and extensors were statistically significant (P<0.05), while the dif-ferences of PTA were not statistically significant (P>0.05). In faked paralyzed group, the differences of PTand PTA between two sides of flexors and extensors were both statistically significant (P<0.05). The torque-time graph of damaged knee presented mostly as single lead peak, while torque-time graph of the faked paralyzed knee presented mostly as multiple peaks. Conclusion The feature of torque-time graph could be useful to identify the faked paralyzed extremities in forensic authentication.

Objective To analyze relevant factors of cervical intraepithelial neoplasia residual or recurrence after loop electri‐cal excision procedure(LEEP) .Methods We observed the patients who were histopathologically confirmed CIN and treated with LEEP in our hospital from January 2006 to September 2012 ,and investigated the postoperative residual and recurrence .Then we an‐alysed relevant factors of residual or recurrence .Results (1)After at least 2 years of follow‐up ,26 cases showed residual or recur‐rence(the residual rate was 0 .97% and the recurrence rate was 4 .08% ) .(2)Overall severity of residual or recurrence had been re‐duced ,but the severity and recurrence of preoperative severity was positively correlated(r=0 .354 0 ,P<0 .05) .(3)Age ,smoking , preoperative high‐risk HPV load ,post‐operative the same type of HPV continuous infection ,endocervical involvement ,lesions in‐vo1ving quadrants ,and post‐operative TCT results between the recurrence group and non‐recurrence group were statistically signifi‐cant different(P<0 .05) .Conclusion CIN residual or recurrence after LEEP might be affected by many factors ,and the treatment should be individualized .

Objective To analyze reasons for unplanned return-to-theater obstetrical surgery in patients with placenta previa, and to propose a strategy for prevention.Methods Among 571 patients with placenta previa in the Department of Obstetrics, First Affiliated Hospital of Nanjing Medical University from January 2010 to January 2015, ten cases (1.75％) who had an unplanned return-to-theater obstetrical surgery were retrospectively analyzed.Results Seven out of the ten cases returned to the theater due to severe hemorrhage after cesarean section and hysterectomy or uterine artery embolization was performed.The rest three pregnancies were terminated at mid-term with amniotic injection of rivanol, two of which developed severe infection after the induction combined with uterine artery embolization followed by cesarean section,and the other one finally had an emergent hysterectomy due to severe postpartum hemorrhage after cesarean section because of intrapartum hemorrhage.Severe postpartum hemorrhage occurred in eight out of the ten cases, with a mean volume of (4 212± 1 651) ml.Blood loss between the original and return-to-theater surgery was (2 206± 736) ml.In these eight cases, the mean volume of erythrocyte suspension transfusion was (23.7±9.0) U, and [M(min-max)] 1 845(390 3 960) ml for plasma transfusion.Platelet transfusion was performed in five cases, cryoprecipitate transfusion in eight cases, serum albumin transfusion in six cases, and fibrinogen transfusion in five cases.The interval between original and return-to-theater surgery was 2.0(0.5-19.0) h.After the return-to theater surgery, the time of antibiotic use was (9.2±2.3) d, and the duration of hospital stays was (10.6±2.5) d.No patient required further re-operation, and all were discharged without long-term sequelae.All seven neonates had a good prognosis.Conclusions Severe postpartum hemorrhage in patients after initial operation because of placenta previa is the primary indication for unplanned return-totheater surgery.Closed postoperative monitoring, early recognition and expedite return-to-theater surgery are crucial to stop bleeding and save lifes.

Objective To study the whole-genome evolution of influenza B viruses prevalent in Qingdao from 2006 to 2011 .Methods RNA was extracted from influenza B viruses isolated in Qingdao from 2006 to 2011 .Each gene segment was amplified by reverse transcription polymerase chain reaction ( RT-PCR) and then sequenced .Gene sequences of each virus were determined and assembled by using Sequench -er software .A phylogenetic analysis for each gene segment was conducted by using MEGA 5.0 software pack-age.Results The phylogenetic tree of hemagglutinin ( HA) gene showed that 13 strains from 2006 to 2009 belonging to V1 clade of Victoria lineage were B/Malaysia/2506/2004-like viruses,and 12 strains from 2009 to 2011 belonging to the V2 clade of Victoria lineage were B/Brisbane/60/2008-like viruses.Moreover, strains of Yamagata lineage were all B/Florida/4/2006-like viruses including 5 strains of Y1 clade circulated from 2006 to 2008 and 7 strains of Y2 clade circulated from 2010 to 2011, respectively.The analysis of whole-genome evolution showed that 3 viruses of V2 clade presented 5+3 reassortment and 1 virus presented 1+7 reassortment.All reassortant strains matched with the vaccine strains of the present and previous season . The Yamagata and Victoria lineage strains belonged to genotype 2 and genotype 15,respectively.Compared with vaccine strains , the HA1 protein of Victoria lineage strains showed mutations at amino acid sites of H14Q, L58P, N129S, I146V, N171D and R279K, while R48K, K88R, P108A, N116K, S150I, N165Y, D196N,N202S and S229G amino acid mutations were mainly detected in Yamagata lineage strains .The sites 116 and 129,150,165,196 and 202 located in the 120,150,160 and 190 loops,respectively,which had been previously determined to be the hotspots under positive selection .Conclusion Both Yamagata and Victoria lineages of influenza B viruses were prevalent in Qingdao and evolved continuously from 2006 to 2011 .The selective pressure that a vaccine would provide was only to virus strains belonging to the same lineage ,sug-gesting a bivalent vaccine may be better for the induction of protective immunity .

OBJECTIVE: To analyze the clinical features of severe acute pancreatitis (SAP) in aged patients, and to explore the measures of its diagnosis and treatment. METHODS: The clinical data of 100 aged patients (55-85 years old) with SAP admitted from January 2003 to December 2005 were reviewed and compared with those of 221 non-aged SAP patients (11-54 years old) admitted at the same period. RESULTS: Totally 112 times of onset occurred in 100 aged patients, and the main causes for senile SAP were biliary diseases and hyperlipemia. Both acute physiology and chronic health evaluation II (APACHE II) and Ranson scores of the aged patients with SAP were higher than those of the control group (P<0.05); while there was no significant difference in Balthazar score between the two groups(P>0.05). The incidences of low serum calcium, low albumin and high aspartate aminotransferase (P<0.05), liver, kidney or brain impairment as well as the mortality were higher in the senile SAP group than those in the control group (P<0.05). CONCLUSIONS: Biliary disease and hyperlipemia are the main causes of senile SAP, which lacks characteristic clinical symptoms and is often associated with multiple complications such as infection and lung, gastrointestinal tract, liver, kidney, and brain impairment. Individualized differential treatment with integrated traditional Chinese and Western medicine based on stage classification is an effective approach.

Background and purpose: Phosphatase and tensin homologue deleted on chromosome 10 (PTEN) gene is a kind of tumor suppressors, which has been reported to be underexpressed in endometrial carcinoma (EC) tissues by several reports. However, the biological effects and possible mechanisms of PTEN on EC have been known less. In this study, we tried to investigate the effects and possible mechanisms of PTEN on the invasion and migration of endometrial carcinoma cells and to provide a potential target for endometrial carcinoma therapy. Methods:The recombinant plasmid pIRES2-ZsGreen1-PTEN was rebuilt by gene recombination technology;The plasmid was transferred into HEC-1B cells and the cells transfected with pIRES2-ZsGreen1 plasmid were used as control;The expression of PTEN was observed by fluorescence microscope and Western blot assay;Cell migration and invasion was determined by the wound healing assay, transwell migration and invasion assays respectively;The Western blot analysis was performed to detect the expression of ATP-dependent tyrosine kinase (AKT), phosphorylated-AKT (p-AKT) and matrix metalloproteinase-2 (MMP-2). Results:The agarose gel electrophoresis showed a stripe of 1.2 kb which was same to PTEN cDNA;The sequence analysis showed the PCR products owned the same sequence with the coding region of PTEN cDNA in GenBank, suggesting the recombinant plasmid was constructed successfully;The green light of cells observed by fluorescence microscope and the Western blot analysis showed the expression of PTEN was upregulated in the cells transfected with the recombinant plasmid, suggesting the plasmid expressed successfully in HEC-1B cells;The wound healing assay as well as transwell migration assay showed ectopic expression of PTEN suppressed cell migration;The invasive capacity of HEC-1B cells was significantly decreased upon transfection with PTEN plasmid compared to control and untreated groups;Moreover, compared with the control groups, the expression of p-AKT and MMP-2 was downregulated, while there was no significant alteration of the expression of AKT. Conclusion:PTEN could suppress cell migratory and invasive ability of endometrial carcinoma cells by suppressing the phosphorylation of AKT followed by the decrease of MMP-2.

Objective To investigate the effects of lipoxin A4 ( LXA4 ) on inflammatory related factors induced by uric acid( UA) in human umbilical vein endothelial cells( HUVECs) . Methods HUVECs were treated with 5, 25, and 50 ng/ml LXA4 prior to exposure to 12 mg/dl UA. Tumor necrosis factor-alpha(TNF-α), interleukin ( IL)-1β, and IL-6 were analyzed with ELISA and realtime PCR. The phosphorylation levels of p38 mitogen-activated protein kinases( MAPK) and NF-κB/p65 were observed with Western blot. Results Stimulation of HUVECs with 12 mg/dl UA markedly increased TNF-α, IL-1β, and IL-6 production(P<0. 01). Pretreatment with LXA4 significantly inhibited UA-induced production of TNF-α, IL-1β, and IL-6 in a concentration dependent manner(P<0. 01). The mRNA expressions of TNF-α, IL-1β, and IL-6 in response to UA were also decreased by LXA4(P<0. 05). Western blot analysis showed that the phosphorylation levels of p38 MAPK and NF-κB/p65 were significantly raised by 12 mg/dl UA in HUVECs(P<0. 05), but attenuated significantly in the presence of 50 ng/ml LXA4. Conclusion LXA4 may inhibit the expressions of inflammatory related factors induced by UA via reducing p38 MAPK and NF-κB/p65 phosphorylation and play a role in anti-inflammation.