Objective To introduce and analyze the status of tumor multidisciplinary team (MDT) model application in primary hospitals.Methods MDT discussion decision-making and implementation of Nanpi People's Hospital from June 2013 to July 2015 were retrospectively analyzed.Results A total of 251 cases were recruited into the MDT discussion.Among them,233 primarily diagnosed cases reached MDT decision-making and 159 cases took the decision,118 cases achieved the purpose (74.2％),41 cases failed (25.8％).Yet in 74 cases not following the decision,11 cases achieved the desired purpose (14.9％),while 63 cases didn't meet the desired purpose (85.1％),the difference was statistically significant (x2 =71.97,P ＜ 0.01).Ultrasound interventional biopsy,enhanced CT scan,CT guided puncture,intraoperative frozen section examination in malignant tumor patients had significantly increased after MDT applied,the difference was statistically significant (all P ＜ 0.05).The annual new rural cooperative medical system referral rate in malignant tumor patients dropped sharply (x2 =19.86,P ＜ 0.01) Conclusions Doctors and cancer patients can benefit from MDT diagnosis and treatment model,which is worth generalization.

Biopsy ; Endopeptidase K ; Fluorescent Antibody Technique ; Glomerulonephritis, IGA ; pathology ; Glomerulonephritis, Membranous ; pathology ; Humans ; Kidney ; pathology ; Lupus Nephritis ; pathology ; Paraffin Embedding ; Staining and Labeling

Objective To investigate the changes in serum level of microparticles (EMPs) in mice with ventilator-induced lung injury (VILI), and explore its significance in VILI. Methods Forty-eight grade SPF male C57BL/6J mice were randomly divided into two groups, with 24 mice in each group: the mice in mechanical ventilation (MV) group were given high tidal volume (VT 30 mL/kg) MV for 4 hours after tracheal intubation, and those in spontaneous breathing group were spontaneously breathed for 4 hours. The apical blood of 12 mice in each group were collected, and serum levels of interleukins (IL-1β, IL-6) and tumor necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA), and serum EMPs levels were determined by flow cytometer. The correlations between EMPs and IL-1β, IL-6, and TNF-α were analyzed by linear regression analysis. The lung tissues of other 12 mice in each group were harvested, and wet/dry weight (W/D) ratio was assessed. After hematoxylin-eosin (HE) staining, the morphological changes in lung tissue were observed under light microscope. After double staining of uranium acetate and lead citrate, the ultrastructural changes in lung tissue were observed with electron microscope. Results Compared with spontaneous breathing group, the levels of lung W/D ratio in MV group was significantly increased (5.47±0.14 vs. 4.34±0.11), the levels of IL-1β, IL-6, TNF-α and EMPs were also significantly increased [IL-1β (ng/L): 42.4±4.4 vs. 7.7±3.6, IL-6 (ng/L): 1 239.5±66.3 vs. 21.7±4.6, TNF-α (ng/L):237.6±25.8 vs. 37.1±19.1, EMPs (cells/μL): 28.6±1.8 vs. 5.9±1.8, all P < 0.01]. It was shown by correlation analysis that EMPs were positively related with IL-1β, IL-6, and TNF-α (r value was 0.968, 0.932, 0.945, respectively, all P = 0.000). It was shown by fitting linear regression analysis that when EMPs increased by 1 cell/μL, IL-1β increased by 2.4 ng/L [95% confidence interval (95%CI) = 1.9-2.8, P < 0.001], IL-6 increased by 34.5 ng/L (95%CI = 25.1-44.0, P < 0.001), and TNF-α increased by 13.6 ng/L (95%CI = 10.3-16.9,P < 0.001). It was shown by light microscope that the structure of lung tissue and alveolar of mice in spontaneous breathing group appeared normal, while the shrinks of alveolar and disappearance of alveolar architecture were found in MV group. It was shown by electron microscopy that alveolar wall edema and thickening and broken alveolar septa were found in MV group, by contrast, the structure of alveolar was normal in spontaneous breathing group. Conclusion 30 mL/kg VT ventilation for 4 hours could induce VILI with increase in EMPs, suggesting EMPs closely related to VILI, and EMPs level may be putative biomarker of VILI.

Objective To compare the effects of propofol and sevoflurane on oxidative stress re-sponses in patients undergoing one-lung ventilation. Methods Eighty American Society of Anesthesiolo-gists physical statusⅠorⅡpatients with lung cancer, aged 42-53 yr, weighing 52-83 kg, scheduled for e-lective pulmonary lobectomy performed via a thoracoscope, were divided into 2 groups ( n=40 each) using a random number table method: group propofol and group sevoflurane. Propofol was intravenously infused at 4-10 mg·kg-1 ·h-1 in group propofol. In group sevoflurane, 1％-3％ sevoflurane was inhaled. Forced expiratory volume (FEV), forced vital capacity (FVC), FEV in first second (FEV1), FEV∕FVC, and maximal expiratory flow ( MEF) were measured at 24 h after operation. Blood samples were obtained from the median cubital vein for determination of the levels of plasma malondialdehyde ( MDA) , catalase ( CAT) and superoxide dismutase ( SOD) and expression of NOX2 and NOX4 subunits-containing NADPH oxidase, SP-D and CC16 ( by Western blot) . Results Compared with group sevoflurane, FEV, FVC, FEV1, FEV∕FVC and MEF were significantly increased, the activity of plasma SOD and CAT was increased, MDA con-centration was decreased, the expression of NOX2 and NOX4 subunits-containing NADPH oxidase and SP-D was down-regulated, and the expression of CC16 was up-regulated in group propofol (P<0. 05). Conclu-sion Propofol provides better efficacy in protecting lung function of patients undergoing one-lung ventilation when compared with sevoflurane, which is related to inhibiting oxidative stress responses.

Objective: To describe the current situation of leisure time physical activity, sedentary behavior, and sleep duration of children and adolescents aged 6-14 in Beijing, and provide a reference basis for guiding school age children to carry out reasonable physical activities and formulating effective intervention measures. Methods: A multistage stratified cluster random sampling method was used to investigate the nutritional and health status of 3 460 students in the first,third,fifth and seventh grades. Through the questionnaire surveys, the basic information of children and families and the activity information of children physical activity, sedentary behavior, and sleep were collected and statistically analyzed. Results: The results showed that the median time of children daily leisure time physical activity (LTPA) was 20.0 (8.6, 38.6) min, children in suburb areas (18.6 min) and seventh grade (14.3 min) had shorter LTPA time( Z/H =5.12，119.11， P <0.01). The average daily sleep duration of children was (8.71 ± 0.76) h, the proportion of school age children with insufficient sleep reached 54.7%. With an increase in grades, the incidence of insufficient sleep increased significantly ( χ 2=407.13， P <0.01). The median daily sedentary time of children was 195.7(145.0, 255.7 ) min, and 84.5% of children engaged in more than two hours of sedentary behavior every day. Urban (202.9 min) and obese children (210.4 min) had longer sedentary behavior time, and with the increase in grade, the daily sedentary behavior time of children gradually increased ( Z/H =5.04，14.83，637.98， P <0.01). Conclusion Children and adolescents aged 6-14 years in Beijing have less LTPA time, too much sedentary time, and insufficient sleep duration. Grade is an important factor affecting physical activity, sedentary behavior, and sleep duration of children, and body shape may be related to their sedentary behavior and sleep time.It is suggested that targeted policies should be adopted for children of different grades to increase their physical activity and reduce their sedentary behavior to promote their healthy development.

Objective: To explore the surgical methods for children with contracture deformity on hands after burn. Methods: From January 2014 to January 2018, 33 pediatric patients, a total of 42 hands with scar contracture deformities were reviewed. There were 24 males and 9 females, aged from 11 months to 6 years and 7 months. Among them, 20 hands were volar metacarpophalangeal joint contractures, 9 were volar interphalangeal joint contractures, 7 were dorsal metacarpophalangeal joint contractures (3 claw-shaped hands), 3 were hand back contractures, and 3 were palm contractures. Of the 42 hands, 36 hands were repaired with full-thickness skin grafts or split-thickness skin grafts, after the removal of contracted scar, and 6 hands were repaired with abdominal skin flaps, due to the tendon or bone exposure after the scar removal. Results: Skin grafts on 31 hands were all survived after 2 weeks. However, the survival area of 3 skin grafts was about 90%, and 2 skin grafts survived about 80%. All of them healed well after dressing changing. The 6 hands repaired with abdominal skin flap healed well too. After 1-2.5 years of follow-up, finger scar contracture occurred in 4 hands with skin grafting, and they were performed scar excision and sheet skin grafting. Three hands were treated with Z-plasty, due to web space contracture. The function of other hands were normal, without contracture or deformity. The skin color and texture were similar to the surrounding skin, with limited pigmented. Scars on the edge of skin grafts was not obvious. Patients and their families were satisfied. Conclusions The sheet skin graft is the main method for postburn scar contracture in children′s hands. The abdominal skin flap should be considered, if tendon or bone is exposed, especially for large wound or multiple sites.

BACKGROUNDThe lung and esophagus are always damaged during radiation on thoracic tumors to a certain extent. This study is to report the incidence of radiation pneumonitis and radiation esophagitis and to analyze the factors as predictors of radiation toxicity in the treatment of three-dimensional conformal radiotherapy (3DCRT) for lung cancer.

METHODSBetween March 1999 and September 2003, 112 lung cancer patients treated with 3DCRT were reviewed at this Hospital. This population consisted of 87 men and 25 women, including 97 cases of non-small cell lung cancer and 15 of small cell lung cancer. The median age was 64 years old. Radiotherapy was delivered at 2Gy fraction, 5 fractions per week. The median total dose was 60Gy.

RESULTSGrade 2 or more acute radiation pneumonitis developed in 7.1% (8/112) of patients while grade 2 or more late radiation pneumonitis appeared in 1.8% (2/112) of patients. Acute radiation esophagitis was observed in 8.9% (10/112) of patients with grade 2. No clinical and physical factor was relative to acute radiation pneumonitis by univariate and multivariate analysis. In the entire population, the univariate analysis revealed that many parameters (pre-treatment weight loss more than 5%, chemotherapy and concurrent chemotherapy) were significantly associated with acute radiation esophagitis. Multivariate analysis revealed that pre-treatment weight loss more than 5% was the most important risk factor for acute radiation esophagitis (P= 0.016).

CONCLUSIONSNo clinical and physical factor is relative to acute radiation pneumonitis and pre-treatment weight loss more than 5% is the most important risk factor for acute radiation esophagitis in this study.

Objective: To observe the effects of minimally invasive tangential excision in treating deep partial-thickness burn wounds on trunk and limbs in pediatric patients in the early stage post burn. Methods: Clinical data of 40 children with deep partial-thickness burn wounds on trunk and limbs, admitted to our burn ward from January 2016 to June 2017, conforming to the study criteria, were retrospectively analyzed. They were divided into conventional treatment group (CT, n=19) and minimally invasive tangential excision group (MITE, n=21) according to the different treatments. The patients in group CT were treated with eschar-reserving therapy firstly. When tangential excision was performed, the roller knife was used, and no necrotic tissue left on the wound bed was considered the proper depth of excision. Razor-thickness skin grafting was performed to cover the wound when adipose tissue exposed markedly after tangential excision. Dressing change was performed within 48 h after the operation and repeated every 2 days. Unhealed wounds were covered by razor-thickness skin grafting. The patients in group MITE were treated with tangential excision in the early stage post burn. The tangential excision was operated with electric dermatome, and the thickness was set at 0.1 mm to excise the surface of eschar until the sporadic punctate hemorrhage on wound surface was observed and some necrotic tissue was left on the wound bed. Porcine acellular dermal matrix was applied after tangential excision. The first dressing change was often performed about 1 week after the operation. Razor-thickness skin grafting was performed to cover the unhealed wounds. The length of wound healing, high fever, antibiotic usage, and hospital stay, times of later operation, and hospitalization expenses of patients in the 2 groups were recorded. The excisional eschar and wound bed tissue of patients in group MITE were harvested for pathological observation. Data were processed with t test and Fisher′s exact probability test. Results: (1) There were no statistically significant differences in length of high fever and length of hospital stay and hospitalization expenses between patients in the 2 groups (t=-1.67, -1.93, 0.31, P>0.05). The lengths of wound healing [(24.8±2.5) d] and antibiotic usage [(4.4±0.7) d] of patients in group MITE were significantly shorter than those in group CT [(33.3±2.5) and (7.0±0.7) d, t=-2.44, -2.44, P<0.05], and times of later operation of patients in group MITE [(0.29±0.14) times] were significantly less than those in group CT [(0.79±0.21) times, t=-2.03, P<0.05]. (2) The thickness of the excisional eschar of patients in group MITE was about 150 μm. The eschar has epidermis and upper dermis. Some necrotic tissue was left on the wound bed. Conclusions The treatment for pediatric deep partial-thickness burn wounds on trunk and limbs with minimally invasive tangential excision using electric dermatome in the early stage post burn can accelerate wound healing, shorten length of antibiotic usage, and reduce times of later operations.

Transcranial magnetic stimulation (TMS) combined with electroencephalography(EEG) has become an important tool in brain research. However, it is difficult to remove the large artifacts in EEG signals caused by the online TMS intervention. In this paper, we summed up various types of artifacts. After introducing a variety of online methods, the paper emphasized on offline approaches, such as subtraction, principal component analysis and independent component analysis, which can remove or minimize TMS-induced artifacts according to their different characteristics. Although these approaches can deal with most of the artifacts induced by TMS, the removal of large artifacts still needs to be improved. This paper systematically summarizes the effective methods for artifacts removal in TMS-EEG studies. It is a good reference for TMS-EEG researchers while choosing the suitable artifacts removal methods.

BACKGROUND:Irreducible femoral neck fracture was difficult to obtain anatomic reduction.As a new type of internal fixation,the femoral neck system is still blank for the treatment of non-anatomical reduced femoral neck fractures. OBJECTIVE:To explore the biomechanical stability of femoral neck system internal fixation under nonanatomical reduction in the treatment of femoral neck fractures based on finite element analysis. METHODS:CT data of the hip joint of a healthy female adult were obtained.Anatomical reduction of femoral neck fracture models with Pauwels angles of 30°,50°,and 70° were established using Mimics 21.0,Geomagic Wrap 2021,and SolidWorks 2020.The fracture proximal ends of the three anatomical reduction models were shifted upward by 2 mm along the fracture line,and three positive buttress models with different Pauwels angles were obtained.In the same way,three negative buttress models were acquired by shifting downward by 2 mm.SolidWorks 2020 was used to make the femoral neck system internal fixation,and the nine femoral neck fracture models were assembled with the femoral neck system.Then Ansys 19.0 was used for finite element analysis.The displacement distribution and maximum displacement,stress distribution and maximum stress of the femur and femoral neck system were recorded under 2100 N stress. RESULTS AND CONCLUSION:(1)When Pauwels angles were 30°,50°,and 70°,the maximum stresses of the femoral neck system appeared to be concentrated at the junction of the sliding hip screw and anti-rotation screw.The maximum femur stresses appeared to be concentrated in the medial cortex of the femur.The maximum displacement was concentrated at the upper of the femoral head and femoral neck system.(2)When Pauwels angles were 30° and 50°,the maximum displacement and maximum stress of the femoral neck system and femur were:negative buttress>anatomical reduction>positive buttress.(3)When Pauwels angle was 70°,the maximum displacement and maximum stress of the femoral neck system were:negative buttress>anatomical reduction>positive buttress;the maximum displacement and maximum stress of the femur were:negative buttress>positive buttress>anatomical reduction.(4)With the increase of Pauwels angle,the biomechanical advantage of the positive buttress was weakening.However,it was better than a negative buttress.When Pauwels angle was 30°,positive buttress was more stable than anatomical reduction.When Pauwels angle was 50°,the biomechanical difference between positive buttress and anatomical reduction became smaller.When Pauwels angle was 70°,the stability of anatomical reduction was slightly better than positive buttress.(5)If it was difficult to achieve anatomical reduction of femoral neck fracture during operation,but the positive buttress had been displaced within 2 mm,the femoral neck system could be used to offer stable mechanical fixation.It is necessary to avoid negative buttress reduction.