Objective:To explore the results of different methods for managing multivariate missing data. Methods: Case deletion, simple imputation and multiple imputation were compared when used for analyzing the clinical data of 925 liver cancer patients with medium multivariate missing data. Results: There were differences among the 3 methods. When ?=0.05, the risk factors influencing patients' survival time were clinical staging,history of hepatic cirrhosis, portal vein tumor thrombas, and levels of g-GT and WBC with multiple imputation, and were TNM staging, lipiodol dose, AST and ALP with case deletion. The 3 more factors of simple imputation were TNM staging, ALP and AFP compared with multiple imputation. Conclusion: Simple imputation is superior to case deletion in management of multivariate missing data but tends to make standard error smaller and P value lower. Multiple imputation is more reasonable and scientific than the other 2 methods.

Objective To analyse the clinical features of pelvic insufficiency fractures (PIF) in patients with cervical cancer after radiotherapy and explore the risk factors affecting its occurrence .Methods 55 cases of patients with cervical cancer that used radia-tion therapy as a single treatment were chosen in our hospital from February 2007 to May 2010 and the clinical features were ana-lysed;The fractures of spine ,sacrum ,sacroiliac joint ,ilium and pubis and femoral were observed and the density of fifth lumbar (L5 ) vertebrae ,left and right sacrum were detected via the CT or MRI (Hounsfield Unit)after 2-year follow-up ,the different factors on the incidence of PIF were explored .Results 12 cases (19 sites) of patients in 55 patients occured PIF after follow-up 2years ,the cumulative incidence was 21 .82% ;the distribution of PIF parts were followed :lumbar vertebrae had 5 cases ,sacral had 5 cases ,pu-bis had 4 cases ,sacroiliac joint had 2 cases ,iliac had 2 cases and femoral head had 1 case .The incidence rate of PIF that density of fifth lumbar vertebrae was ≤130 HU and >130 HU were 16 .36% and 5 .45% respectively ,the PIF′incidence rate that density of left side of sacrum was≤ -35 HU and > -35 HU were 18 .18% and 3 .64% respectively ,the incidence rate of PIF that density of right side of sacrum was ≤ -35 HU and > -35 HU were 20 .00% and 1 .82% respectively ,the density of the three parts all had statistical difference on the incidence of PIF (P<0 .05) .Univariate analysis showed that menopausal status and the average density of CT had statistical effects on PIF (P<0 .05);Multiple analysis showed that the average density of CT was the independent factors affecting PIF′incidence after radiotherapy .Conclusion The patients with cervical cancer may occur pelvic insufficiency fracture af-ter radiotherapy ,and its incidence is related to menopausal status and bone mineral density .

BACKGROUND:At present, the methods of treating unstable comminuted radial head fractures contain open reduction and internal fixation and metal prosthesis replacement. There were success cases treated by the two methods, but some shortcomings simultaneously existed.
OBJECTIVE:To compare the clinical therapeutic effects of replacement of the radial head with metal prosthesis with open reduction and internal fixation for the treatment of unstable comminuted radial head fractures.
METHODS:A prospective randomized control ed analysis was performed in 45 cases of unstable comminuted radial head fractures. These cases received open reduction and internal fixation and metal prosthesis replacement. This study compared the Broberg and Morrey elbow joint function score and the incidence of complications after fixation, and performed statistical analysis.
RESULTS AND CONCLUSION:The subjects were fol owed up for 1-5 years, averagely 2.8 years. According to Broberg and Morrey scores, the average score was 90.1 and the incidence of complications was 13.6%in the prosthesis replacement group. The average score was 76.8 and the incidence of complications was 47.9%in the open reduction. Significant differences were visible between the two groups (P<0.01). Compared with the open reduction group, prosthesis replacement for unstable comminuted radial head fractures obtained better joint function and lower incidence of complications.

BACKGROUND:Mason II type and III type radial head fractures with massive bone are mainly treated by open reduction and metal fixation, but metal implants have to be removed in the second operation, which increased patients’ travail and financial burden. Absorbable screw/rod also can be used to treat radial head fractures, and has its special advantages due to the low price and no second operation. OBJECTIVE:To compare the clinical therapeutic effects of absorbable rod and Herbert screw for the treatment of Mason II or III type radial head fractures. METHODS:A total of 80 patients with Mason II and III type radial head fractures were equal y assigned to experimental and control groups. They received open reduction and internal fixation. The experimental group was treated with absorbable rod and the control group received Herbert screw. RESULTS AND CONCLUSION:A total of 79 patients were fol owed up for averagely 34 months. No significant difference in average operative time, fracture healing time, Broberg and Morrey elbow scores and incidence of complications was detected between the experimental and control groups (P>0.05). However, treatment costs were lower in the experimental group than in the control group (P<0.05). Results indicated that the therapeutic effects between absorbable rod and Herbert screw for Mason II or III type radial head fractures were similar. However, absorbable rod for radial head fractures can avoid the second operation for removal of the implant. Therefore, we recommend absorbable rod in the choice of internal fixation materials.

Objective To evaluate the effect and mechanism of bone morrow MSCs transplantation in swine with AMI by cell biology and molecular imaging methods including PET/CT, SPECT, and MRI. Methods Twenty?four Chinese mini?swine ( ( 25 ± 5 ) kg ) were randomly divided into 2 groups: MSCs group ( n=12) and control group ( n=12) . Myocardial infarction was induced in swine hearts by occlusion of the LAD. Thirty minutes later, the MSCs group received autologous MSCs transplantation through in?tramyocardial injection into the peri?infarcted areas (2×107,2 ml) and the control group was subjected to cell culture medium in the same way. At the 1st and 4th weeks after MSCs transplantation, myocardial glu?cose metabolism, myocardial perfusion and cardiac function were evaluated in the two groups through PET/CT, SPECT and MRI. The minimum FDG mean signal intensity ( MSI ) , summed MSI, SRS, SRS%, LVEF, ESV, stroke volume ( SV) and cardiac output ( CO) were calculated. On the 4th week, HE and Masson′s Trichrome stains were performed. Mann?Whitney u test and non?parametric Wilcoxon test were used. Results (1) As evaluated by PET in the 1st week, the MSI and summed MSI in MSCs group were less than those in control group ( 22. 10 ± 3. 18 vs 35. 70 ± 3. 02, z=-2. 65; 1 013. 50 ± 29. 37 vs 1 084. 00 ± 21?15, z=-1.97;both P<0.05) . Compared to the minimum MSI and summed MSI in the 1st week, those in MSCs group increased significantly (34.00±4.25, z=-2.81;1 075.50±28.30, z=-2.80;both P<0?01) in the 4th week. SRS and SRS% decreased in the 4th week compared to those in the 1st week (20.20±2.24 vs 23.80±1.58, (29.80±3.31)% vs (35.10±2.34)%;both z=-2.08, both P<0.05). The averaged MSI in left ventricular infarction area (MSI<70) also increased (56.25±3.54 vs 48.14±2.71;z=-2.80, P<0.01). The a?bove?mentioned parameters had no statistically significant differences in the 4th week compared to those in the 1st week in the control group (all P>0.05). (2) In the 1st week, the perfusion variables had no signifi?cant differences between the two groups ( P>0.05) . There was no significant difference in any perfusion vari?ables between the 1st and 4th weeks in the two groups, respectively (P>0.05). (3) As evaluated by MRI, the cardiac functional parameters had no significant differences between the two groups at the 1st week. In the MSCs groups, LVEF increased significantly ((54.41±2.62)% vs (47.54±2.43)%;z=-2.60, P<0.01) and ESV reduced significantly ((22.85±1.91) vs (27.07±1.67) ml;z=-2.70, P<0.01) in the 4th week com?pared to those in the 1st week; SV and cardiac CO in the 4th week also increased significantly ((29.35± 1?84) vs (26.52±1.46) ml, (2.23±0.14) vs (1.96±0.13) L/min;z=-2.09 and -1.99, both P<0?05). In the control group, there were no significant differences in the cardiac functional parameters between the 1st and 4th weeks ( all P>0.05) . Conclusions Four weeks after MSCs transplantation for AMI, cardiac func?tion and myocardial glucose metabolism improved significantly but without significant myocardial perfusion improvement. Therefore, the cardiac function improvement might be associated with increased myocardial glucose metabolism.

BACKGROUND:The therapeutic regimen of intraarticular calcaneal comminuted fractures commonly selects plate and screw fixation. However, for case of posterosuperior calcaneal fracture, the weakness of achil es tendon stretch and plate screw fixation results in difficulty or maintenance of reduction. OBJECTIVE:To investigate the therapeutic effects of open reduction and internal fixation with steel screw and Steinmann pins for comminuted calcaneal intra-articular and posterosuperior fractures. METHODS:From December 2009 to December 2013, forty patients with fractures of comminuted calcaneal posterosuperior fractures were randomly divided into two groups. In the control group, patients were treated by open reduction and internal fixation by plate screw only. In the experimental group, patients were treated by open reduction and internal fixation by combination of plate screw and Steinmann pin. The Gissane and Bohler angles of the calcaneus were measured from lateral radiograph before and 4 weeks after surgery, and the MARYLAND score was assessed at the last fol ow-up. Gissane and Bohler angle and MARYLAND score were compared in each group and among different groups. RESULTS AND CONCLUSION:Al patients were fol owed up for 9-23 months. BOHLER and GISSANE angles were significantly bigger at 4 weeks after surgery compared with pre-treatment in both groups (P<0.05). BOHLER and GISSANE angles were significantly bigger in the experimental group than in the control group at 4 weeks after surgery (P<0.05). During final fol ow-up, the average score by MARYLAND Foot Score was 78 in the experimental group and 67 in control group, with their excellent and good rate of 80%and 73%. The excellent and good rate was significantly higher in the experimental group than in the control group (P<0.05). These data indicated that open reduction and internal fixation with combination of plate screw and Steinmann pin has better efficacy in treatment of the comminuted calcaneal intra-articular and posterosuperior fractures compared with plate and screw fixation alone. Their fixation is firm. Functional exercise can be performed earlier. Postoperative recovery of function of the affected limbs is better than plate and screw fixation alone.

Objective To study the incidence and clinical significance of the herniation pits of the femoral neck.Methods 600 cases(299 men,301 women,18～82 years)were collected.The incidence,radiologic finding and clinical significance of the herniation pit of the femoral neck were analysed.Results Of 1200 hip joints in 600 cases,there was 58 cases(64 sides)(5.3%)with herniation pits of the femoral neck,including 39 men(68.7%)and 19 women(31.3%),the lesions localized in the left joint in 25 eases(39.1%),in the right joint in 27 cases(42.2%)and in bilateral joints in 6 cases(18.7%).There were a obvious significant differences on both sexes,and no significant differences on age groups.On X-ray film,the lesions appeared as a round radiolucency with thin clear sclerotic rim.Conclusion The incidence of the herniation pit of the femoral neck is 5.3%,which has a typical X-ray feature,and may indicate the femoroacetabular impingement.

Objective:To analyze the trend of medication use in patients with ulcerative colitis (UC) in recent ten years in at Xijing Hospital, Air Force Military Medical University.Methods:From 2010 to 2019, the clinical data of 1 425 patients diagnosed with UC in the Department of Gastroenterology at Xijing Hospital, Air Force Medical University, were retrospectively collected. According to the period of medication, the UC patients were divided into year 2010 to 2014 group and year 2015 to 2019 group. The general information and the medication trend of year 2010 to 2014 group and year 2015 to 2019 group were analyzed. And then according to gender and age (<40 years old and ≥40 years old), patients were divided into subgroups and analyzed. Independent sample t test and chi-square test were used for statistical analysis. Results:The number of UC patients of year 2010 to 2014 group and year 2015 to 2019 group was 369 and 1 056, respectively. The percentages of patients in remission of the two groups were 9.5% (35/369) and 12.0% (127/1 056), respectively; the percentages of mild patients were 40.4% (149/369) and 41.6% (439/1 056), respectively; the percentages of moderate patients were 37.4% (138/369) and 28.9% (305/1 056), respectively; the percentages of severe patients were 12.7% (47/369) and 17.5% (185/1 056), respectively. There was no significant difference in the proportion of UC patients with different degrees between year 2010 to 2014 group and year 2015 to 2019 group ( P>0.05). There were no significant differences in the age and proportion of female between the year 2010 to 2014 group and year 2015 to 2019 group ((46.2±15.3) years old vs. (44.6±30.6) years old; 45.8%, 169/369 vs. 44.8%, 473/1 056; both P>0.05). The utilization rates of 5-aminosalicylic acid (5-ASA), glucocorticoid, immunosuppressants, and biological agents of the year 2015 to 2019 group were all higher than those of the year 2010 to 2014 group (96.8%, 1 022/1 056 vs. 90.0%, 332/369; 29.9%, 316/1 056 vs. 14.6%, 54/369; 8.4%, 89/1 056 vs. 2.4%, 9/369; 4.8%, 51/1 056 vs. 0.5%, 2/369, respectively), and the differences were all statistically significant ( χ2=26.766, 33.256, 15.315 and 14.038, all P<0.01). Within each of the year 2010 to 2014 group and the year 2015 to 2019 group, there were no significant differences between the female and male in the age, utilization rates of 5-ASA, glucocorticoid, immunosuppressants and biological agents ((47.2±13.6) years old vs. (45.3±16.5) years old, (43.1±12.9) years old vs. (45.8±39.5) years old, 88.8%, 150/169 vs. 91.0%, 182/200; 96.8%, 458/473 vs. 96.7%, 564/583; 13.6%, 23/169 vs. 15.5%, 31/200; 28.3%, 134/473 vs. 31.2%, 182/583; 2.4%, 4/169 vs. 2.5%, 5/200; 7.0%, 33/473 vs. 9.6%, 56/583; 0 vs. 1.0%, 2/200; 5.3%, 25/473 vs. 4.5%, 26/583; all P>0.05). In the patients aged≥40 years old of the year 2010 to 2014 group, the proportion of females was higher than that of the patients aged <40 years old (50.2%, 121/241 vs. 37.5%, 48/128), and the utilization rate of 5-ASA in patients aged ≥40 years old was lower than that of patients aged <40 years old (85.9%, 207/241 vs. 97.7%, 125/128), and the differences were statistically significant ( χ2=5.438 and 12.824, P=0.020 and P<0.01). In the year 2010 to 2014 group, there were no statistically significant differences in the utilization rates of glucocorticoid, immunosuppressants and biological agents between patients aged ≥40 years old and patients aged <40 years old (13.7%, 33/241 vs. 16.4%, 21/128; 2.1%, 5/241 vs. 3.1%, 4/128; 0 vs. 1.6%, 2/128; all P>0.05). In the year 2015 to 2019 group, the utilization rate of biological agents in patients aged≥40 years old was lower than that in patients aged<40 years old (3.7%, 23/630 vs. 46.5%, 198/426), and the difference was statistically significant ( χ2=4.721, P=0.030). In the year 2015 to 2019 group, there were no statistically significant differences in female proportion, utilization rates of 5-ASA, glucocorticoid, immunosuppressants and biological agents between patients aged≥40 years old and patients aged <40 years old (43.7%, 275/630 vs. 46.5%, 198/426; 96.0%, 605/630 vs. 97.9%, 417/426; 29.7%, 187/630 vs. 30.3%, 129/426; 8.6%, 54/630 vs. 8.2%, 35/426; all P>0.05). Conclusions:Compared with year 2010 to 2014, the number of UC patients remarkably increased in the year 2015 to 2019 in the Department of Gastroenterology, Xijing Hospiatal, Air Force Medical University. The utilization rates of 5-ASA, glucocorticoid, immunosuppressants and biological agents all increased in UC patients. The medication trends of UC patients with different gender were almost the same. The medication trends of UC patients with different age were different.

Objective:To study the effects of different calcium ion concentrations on epithelial mesenchymal transformation (EMT) of human peritoneal mesothelial cell (HPMC) via endoplasmic reticulum stress (ERS).Methods:HPMC cell line HMrSV5 was cultured in vitro and treated in groups. The cells in the control group, high calcium group 1, and high calcium group 2 were treated with medium containing calcium ion concentrations of 1.25, 1.75, and 2.25 mmol/L, respectively. The solvent control group was treated with medium containing 1.25 mmol/L physiological calcium ion concentration and 0.1% dimethyl sulfoxide (DMSO), the high calcium+solvent group was treated with medium containing 2.25 mmol/L calcium ion concentration and 0.1% DMSO, the high calcium+4-phenylbutyric acid (4-PBA) group was treated with medium containing 2.25 mmol/L calcium ion concentration and 1 mmol/L ERS inhibitor 4-PBA, and each group was treated for 48 hours. Morphological changes of cells in each group were observed under light microscope. The expressions of epithelial cell phenotype marker zonula occluden-1 (ZO-1) and mesenchymal cell phenotype marker α-smooth muscle actin (α-SMA) in the cells were observed by immunofluorescence staining. The expressions of EMT marker genes E-cadherin, ZO-1, α-SMA and Vimentin were detected by fluorescence quantitative polymerase chain reaction (PCR). The expressions of ERS marker proteins phosphorylated protein kinase R-like endoplasmic reticulum kinase (p-PERK), phosphorylated eukaryotic initiation factor 2α (p-eIF2α), transcription activating factor 4 (ATF4) and C/EBP homologous protein (CHOP) were detected by Western blotting. Results:Compared with the control group, the morphology of HMrSV5 cells became slender and fibrotic, the fluorescence intensity of ZO-1 increased, and the fluorescence intensity of α-SMA decreased in high calcium 1 and high calcium 2 groups, indicating that the cells transformed from epithelial cells to mesenchyme cells. The mRNA expressions of E-cadherin and ZO-1 were significantly decreased, while the mRNA expressions of α-SMA and Vimentin and the protein expressions of p-PERK, p-eIF2α, ATF4 and CHOP were significantly increased, moreover, the expressions of the above marker genes or proteins in the high calcium 2 group was more obvious than those in the high calcium 1 group [E-cadherin mRNA (2 -ΔΔCt): 0.53±0.05 vs. 0.75±0.09, ZO-1 mRNA (2 -ΔΔCt): 0.42±0.06 vs. 0.69±0.06, α-SMA mRNA (2 -ΔΔCt): 1.81±0.16 vs. 1.32±0.14, Vimentin mRNA (2 -ΔΔCt): 2.05±0.22 vs. 1.48±0.16, p-PERK protein (p-PERK/β-actin): 0.81±0.09 vs. 0.59±0.06, p-eIF2α protein (p-eIF2α/β-actin): 0.87±0.10 vs. 0.50±0.06, ATF4 protein (ATF4/β-actin): 0.93±0.10 vs. 0.72±0.06, CHOP protein (CHOP/β-actin): 0.79±0.09 vs. 0.46±0.04, all P < 0.05]. Compared with the solvent control group, the morphological changes of cells, the expressions of EMT marker genes and ERS marker proteins after high calcium ion concentration of 2.25 mmol/L were consistent with those in the high calcium 2 group than control group. Compared with the high calcium+solvent group, the cell morphology recovered the characteristics of polygonal and pebble-like epithelial cells in the high calcium+4-PBA group, the fluorescence intensity of ZO-1 increased, the fluorescence intensity of α-SMA decreased, and the mRNA expressions of E-cadherin and ZO-1 in the cells were significantly increased [E-cadherin mRNA (2 -ΔΔCt): 0.86±0.09 vs. 0.57±0.04, ZO-1 mRNA (2 -ΔΔCt): 0.81±0.06 vs. 0.48±0.05, both P < 0.05], the mRNA expressions of α-SMA and Vimentin and the protein expressions of p-PERK, p-eIF2α, ATF4 and CHOP were significantly decreased [α-SMA mRNA (2 -ΔΔCt): 1.21±0.13 vs. 1.77±0.15, Vimentin mRNA (2 -ΔΔCt): 1.30±0.14 vs. 1.94±0.20, p-PERK protein (p-PERK/β-actin): 0.38±0.04 vs. 0.92±0.11, p-eIF2α protein (p-eIF2α/β-actin): 0.34±0.05 vs. 1.05±0.13, ATF4 protein (ATF4/β-actin): 0.57±0.06 vs. 0.97±0.11, CHOP protein (CHOP/β-actin): 0.51±0.04 vs. 0.90±0.12, all P < 0.05]. Conclusion:High calcium ion concentrations of 1.75 mmol/L and 2.25 mmol/L promote EMT of HPMC via activating ERS.