Objective To evaluate the effects of glutamine on immune function in elderly patients with malnutrition.Methods Twenty-four elderly patients with malnutrition were equally randomized divided into glutamine group and control group.Patients in both two groups were administered with enteral nutrition containing equal nitrogen and calorics for consecutively 7 days.In the glutamine group,patients were also supplied with oral glutamine (7.5g tid).Changes of plasma IgG,IgA,and IgM levels,percentages of T-lymphocyte subsets (CD3,CD4,CD8),and CD4/CD8 ratio were determined before and after treatment.Results Plasma IgG and IgA lev-els,percentages of CD3 and CD4,and CD4/CD8 ratio were significantly higher in glutamine group than in control group (P<0.05 or P<0.01).Conclusion Glutamine can improve the immune function in elderly patients with malnutritiop and promote their recovery.

Objective To investigate the effects of preoperative biliary drainage ( PBD ) on the morbidity and mortality of pancreaticoduodenectomy in patients with malignant obstructive jaundice in the lower bile duct. Methods Clinical data of 74 cases undergoing pancreaticoduodenectomy from Jan. 2000 to Dec. 2005 with preoperative total bilirubin level over 85 μmol/L were collected and retrospectively analyzed. Comparison was performed between patients receiving PBD and those not. Before surgery. The parameters sincluding perioperative situation, in-hospital death rate, post-operative complications and were calculated to evaluate the influence of pre-operative biliary drainage on the outcomes. Univariate analysis and Logistic analysis were used to identify the risk factors for post-operative complications. Results Forty (40/74) cases received PTCD procedure. The total bilirubin was significantly reduced from (338. 10±88. 38 )μwnol/L to ( 228. 50±82.24) μ,mol/L in PTCD population and was significantly lower than ( 328. 60±93. 02) μmol/L of the non-PTCD group. There was no significance between the two groups in terms of total complications and individual complication Logistic regression analysis showed that preoperative TB over 340 μmol/L and blood loss over 600 ml were important risk factors for post-operative complications. Conclusion High pre-operative total bilirubin over 340 μmol/L increases the risk of post-operative complications in the patients with malignant jaundice. Preoperative biliary drainage is useful to reduce the total bilirubin and improve the hepatic function of the patients. Prolonged pre-operative biliary drainage could be considered in the patients with high preoperative bilirubin,poor nutritional condition and impaired coagulation to enhance the tolerance of surgery.

Objective: To translate Millon Clinical Multiaxial Inventory Ⅲ (MCMI-Ⅲ) into Chinese, and then test its reliability and validity. Methods: MCMI-Ⅲ was administered to patients with mental disorders and normal people. Some subjects completed SAS, SDS, HAMA and HAMD simultaneously. 7-14 days later, some subjects completed the Chinese version of MCMI-Ⅲ again. Results: Cronbach’s alpha and the split-half reliability of MCMI-Ⅲ was 0.957 and 0.919, respectively. The mean Cronbach’s alpha, split -half and test -retest reliability of the subscales were 0.72, 0.70, 0.71 respectively. Most of the items correlated significantly (P

Objective To evaluate the ability of further discriminating diagnosis of the headchest lead electrocardiogram (HCECG) in elderly patients with abnormal Q waves in routine lead electrocardiogram (RLECG) in inferior lead. Methods The 55 male patients, aged 65-88 years,with abnormal Q waves in both lead Ⅲ and aVF were selected and divided into two groups: myocardial infarction (MI) group and non-MI group, according to if the patient had a history of acute MI. All the patients accepted examination of coronary computed tomographic angiography (CTA) and ultrasound cardiogram, those with Wolff-Parkinson-White syndrome and myocardial hypertrophy were excluded.The 30 individuals of control group had no abnormal Q waves in lead Ⅱ , Ⅲ and aVF. HCECG and RLECG were recorded simultaneously in respective groups and occurrence rate of Q waves in correlative leads Ⅱ, Ⅲ, aVF and HL3, H0, HR3 were matched and compared, sensitivity and specificity were compared in respective leads. Results There were serious stenosis in 22 patients (100%) in MI group, and there were mild stenosis in 10 (30. 3%) and moderate stenosis in 23 patients (69.7%) in non-MI group. There was no significant difference between HCECG and RLECG in occurrence rate of Q waves in MI group (P＞ 0. 05 ). Non-MI group left anterior axillary line, Ⅱ ,Ⅲ, right anterior axillary line, near the anterior midline, aVF without Q wave and exclusion of old MI diagnostic specificity were 100%, 97.0%(32/33), 97.0% (32/33), 15.2% (5/33), 100%, 39.4%( 13/33)respectively. Conclusions Pseudo-changes are rarely found in HCECG and there is a higher degree of conformity in HCECG with coronary lesions, therefore HCECG may be used to discriminate whether the inferior abnormal Q waves occurred in RLECG are truly abnormal or not.

Objective To explore the effects of exercise on the levels of neurotrophin-3 (NT-3) in the skeletal muscles of streptozotocin-induced diabetic rats. Methods The rats were divided into an 8-week exercise group (A), a 4-week exercise group (B), a diabetes control group (C), an exercise group (D) in which no dia-betes was induced, and a control group (E). The rat model of diabetes was induced in the rats of groups A, B and C by intra-abdominal injection of streptozotocin (STZ) at 55 mg/kg. The exercising rats were forced to swim for 60 minutes once daily, 5 days a week. The levels of NT-3 in skeletal muscles were measured with an enzyme-linked immunosorbent assay. Cadual nerve conduction velocity (CNCV) in all of the rats was evaluated at the beginning, and after 4 and 8 weeks of swimming exercise. Results NT-3 levels in the skeletal muscles in group C were sig-nificantly lower than in groups A, D and E. There was no statistically significant difference in NT-3 levels between groups B and C. The NT-3 levels showed a significant positive correlation with CNCV at the 8th week. Conclu-sions The increase in NT-3 levels of skeletal muscles induced by exercise could contribute partially to the im-provement of diabetic neuropathy.

Objective:To investigate the differences in efficacy, survival outcomes, and acute and late toxicities for patients with local/regional advanced nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) in combination with che-motherapy (CT) and by IMRT alone. Methods:A total of 72 newly diagnosed local/regional advanced NPC patients were randomly subjected to IMRT/RT+adjuvant CT (after radiotherapy, RT) (n=42) or IMRT+adjuvant CT (after RT) (n=30). The Kaplan-Meier meth-od was used to analyze the two-year local/regional control rates, distant metastasis-free survivals, and overall survivals. The acute and late radiation toxicities were evaluated based on the toxicity criteria of the Radiation Therapy Oncology Group and European Organiza-tion for Research and Treatment of Cancer. Results:A median follow up period of 13.5 months was included in the study. The one-year and two-year local/regional control rates, distant metastasis-free survivals, and overall survival in the IMRT group were 95.0%, 80.0%, and 95.0%, and 80%, 60.0%, and 75.0%, respectively. For the IMRT+CT group, such rates were 100%, 96.4%, and 96.4%, and 100%, 92.9%, and 92.9%, respectively. The two-year local/regional control rate and distant metastasis-free survivals in the IMRT+CT group were higher than those in the IMRT group (P<0.05). Most patients had grade 1 to grade 2 acute radiation toxicities and grade 0 to grade 1 late radiation toxicities (P>0.05). No patient showed a grade 4 acute or late toxicity. The blood and gastrointestinal toxicity rates were high in the IMRT+CT group (P<0.05). Conclusion:The IMRT+CT treatment has potential advantages over the IMRT in the treatment of local/regional advanced NPC patients in terms of local/regional control and overall survival. The blood and gastrointestinal toxicity rates in the IMRT+CT group were higher than in the IMRT group but still within a tolerable range.

Objective To explore the altered functional connectivity of the amygdala in adolescents with internet gaming disorder (IGD) using resting state functional connectivity (rsFC) and dynamic functional connectivity (dFC) analysis.Methods Thirty adolescents with IGD (IGD group) and 30 demographically matched healthy controls (HC group) were recruited.The right and left amygdala were selected as seed regions,the rsFC and dFC between 2 groups were calculated.The regions showing altered connectivity in IGD were adopted as ROIs for correlation analysis.Results Compared to HC group,IGD group had higher rsFC with the right amygdala over the right inferior temporal,middle temporal gyrus,middle frontal gyrus,lower rsFC with the right amygdala over the left inferior temporal,superior temporal and the right inferior occipital gyrus,superior occipital gyrus.The IGD group had lower rsFC with the left amygdala over the right rectal gyrus and thalamus.Compared to HC group,the IGD group showed higher dFC variance with the left amygdala over the right middle temporal and the left media frontal gyrus,and lower dFC variance over the right precuneus,inferior parietal lobe,posterior cingulate and the left postcentral gyrus.The IGD group showed higher dFC variance with the right amygdala over right middle frontal gyrus and lower dFC variance with the right amygdala over the right middle temporal,the left media frontal gyrus and paracingulate cortex,inferior parietal lobe.The rsFC between the left amygdala and right rectal gyrus was negatively correlated with Chinese Internet Addiction Scale (CIAS) scores.The dFC variance between the left amygdala over the left postcentral gyrus was positively correlated with CIAS scores.The dFC variance between the left amygdala and the right inferior parietal lobe were negatively correlated with CIAS scores.Conclusion The amygdala participates in the development of IGD.

Objective: To evaluate the self awareness of professional competencies and its development of teachers for health in primary and secondary schools in Shanghai, so as to provide a reference for development of professional competencies and future specialized development. Methods: A survey was conducted among 1 722 teachers for health in primary and secondary school by the professional competency questionnaire. Results: Most of the teachers for health had bachelor s degrees (65.6%) and junior professional titles (43.4%), the full time teachers accounted for 66.5%, the percentage of teaching health education courses was 69.8 %, 7.7% took part in the formal class of schedule; the two top scorers were the dimension of "professional ethic as a teacher" and "school public health prevention and control" (4.68±0.43, 4.55±0.47); the two lowest scorers dimensions were related to school health education with increasing standard deviation (3.96±0.66, 3.91±0.65); the mean of self rated competency of the 6-14 years working experience group was slightly higher in all dimensions, that of 15 years or above group was lower than 6-14 years group in the total system and the dimensions of professional ethic as a teacher and emergency handling of accidents, and in responsing specific health problems dimension, the mean of 15 years or above group lower than that of 1-5 years group ( P <0.05). Conclusion The entry threshold of teachers for health in primary and secondary school is a critical consideration; Teachers competency preparations are satisfying in professional ethics and school public health prevention/control; meanwhile, the overall health education competencies were insufficient, and noticeable differences in the competency level among teachers are observed. It suggest drawing up entry qualifications and professional standards for health education teachers to guide the teacher s learning and improvement, calling for facilitating the professional promotion of teachers at the government s policy level.

Objective: To study the protective effect of melatonin (MT) against lead-induced neurotoxicity. Methods: PC12 cells were divided in four groups (control, 25 μmol/L PbAc, 50 μmol/L MT and 25 μmol/L PbAc+50 μmol/L MT) . After treatment, cell viability was detected by cell counting kit-8 (CCK-8) assay and cytotoxicity LDH assay were used to evaluate cell damage rate. The expression of Cleaved-Caspase-3 and cytochrome C (cyto C) was detected by immunofluorescence (IF) . ROS levels were measured by DCFH method. GSH contents and SOD activities were detected after whole cell protein was extracted. Results: Compared with control group, 25 μmol/L PbAc caused significantly decreased cell viability, GSH contents and SOD activities, while increased cell damage rate and ROS level significantly (P<0.05) . 25 μmol/L PbAc could also increase the protein level of cleaved-caspase-3 and cyto C in cytoplasm. Compared with 25 μmol/L PbAc group, 50 μmol/L MT+25 μmol/L PbAc caused significantly increased cell viability, GSH contents and SOD activities, while decreased cell damage rate and ROS level significantly (P<0.05) . Compared with 25 μmol/L PbAc group, 50 μmol/L MT+25 μmol/L PbAc decreased the protein level of cleaved-caspase-3 and cyto C. Conclusion Melatonin could attenuate PbAc-induced oxidative stress and cell death and promote cell survival.

Objective To observe the clinical efficacy and safety of apatinib in the treatment of advanced malignant tumors and to analyze the prognostic indicators affecting the survival of patients.Methods A total of 100 patients with advanced malignant tumors who were treated with apatinib at Jinan Central Hospital Affiliated to Shandong University from February 2015 to July 2018 were enrolled and their data were analyzed retrospectively.The clinical efficacy was evaluated and the related adverse reactions were recorded.Single and multiple factor analyses were pefformed by Cox regression model.The predictive factors of progression-free survival (PFS) and overall survival (OS) were analyzed.Results One-hundred patients with advanced malignant tumors who were treated with second-line and above treatment were collected.All patients were assessable for response,no complete response was observed,22 patients (22％) achieved partial remission,58 patients (58％) in stable disease,and 20 patients (20％) appeared progressive disease.The objective response rate was 22％ (22/100),the disease control rate was 80％ (80/100),the median PFS was 3.6 months (95％ CI:2.7-4.5 months),and the median OS was 7.0 months (95％ CI:4.7-9.3 months).Univariate analysis showed that Eastern Cooperative Oncology Group (ECOG) score (HR =0.340,95％ CI:0.211-0.546,P ＜0.001),tumor primary site (HR =1.757,95％ CI:1.053-2.932,P =0.031),neutrophil to lymphocyte ratio (NLR) (HR =0.389,95％ CI:0.227-0.666,P =0.001),hemoglobin (HR =1.696,95％ CI:1.023-2.813,P =0.041) and proteinuria (HR =1.790,95％ CI:1.105-3.155,P =0.044) were related to PFS;age (HR =2.082,95 ％ CI:1.320-3.285,P =0.002),ECOG score (HR =0.206,95％ CI:0.123-0.344,P＜0.001),tumor primary site (HR=1.784,95％CI:1.077-2.954,P=0.025),NLR (HR=0.410,95％CI:0.238-0.704,P =0.001),hemoglobin (HR =1.958,95％ CI:1.175-3.264,P =0.010) and albumin (HR =0.467,95％ CI:0.277-0.787,P =0.004) were related with OS.Multivariate analysis showed that PFS was related to ECOG score (HR =0.254,95％ CI:0.123-0.523,P ＜ 0.001) and NLR (HR =0.378,95％CI:0.161-0.888,P =0.026),and OS was related to ECOG score (HR =0.147,95％ CI:0.067-0.326,P ＜0.001),NLR (HR =0.327,95％ CI:0.140-0.765,P =0.010) and hemoglobin (HR =1.975,95％ CI:1.101-3.543,P =0.022).In term of safety,the most common adverse events among 100 cases of treated patients with advanced malignant tumors were hypertension (53,53 ％),anorexia (51,51％),fatigue (51,51％) and anemia (50,50％),among which the most common ones of grade 3 and 4 were hypertension (10,10％),thrombocytopenia (8,8％),leukopenia (7,7％) and hand-foot syndrome (6,6％).Conclusion Apatinib has certain clinical efficacy and manageable adverse events in the treatment of advanced malignant tumors at and above second-line treatment.ECOG score and NLR are independent predictors of PFS and OS in patients with advanced malignant tumors treated with apatinib.