[Objective] To evaluate the clinical efficacy of treatment of humeral shaft fracture with revolving intramedullary nails.[Method]Sixty-two cases with fracture of hume ral shaft were treated by revolving intramedullary nails between January 2000 and February 2006.Their were 38 male cases and 24 female cases.Their average age was 36.9(ranged 20～58).Fifty-fous cases were closed fractures,and eight cases were opened.Sixty-two cases with fracture of humeral shaft according to AO classification,41 cases were type A,15 cases were type B,6 cases were type C.Sixty-two patients with the humeral shaft fracture were treated with limited open reduction and minimally invasive internal fixation with revolving intramedullary nails.Scientific and rational rehabilitative treatment was carried out in each case after the operation.All patients were follow-up between 14 months and 30 months.The average follow-up period was 24 months.[Result]The fracture union occurred in sixty-two patients.The average healing time was 15 weeks.According to Rodriquez-Merchang shoulder functional score system,the excellent result was achieved in 36 patients,good in 20 and fair in 6.The excellent and good rate was 90.3%.All cases got good function recovery.The effects were satisfactory.There were no complications in all cases,such as infection,iatrogenic fracture,shortening,break of nail,fat embolism syndrome and peripheral nerve injury.[Conclusion]Revolving intramedullary nails for treatment of humeral shaft fracture is effective with litter interference with the blood supply of the bone fracture and with stable immobilization.Due to the abutment of the longitudinal bars along the entire length of the medullary canal wall,highly resistant to the rotational strength was achieved.The advances of revolving intramedullary nails are convenient in operative procedure with little invasive of operation,early function exercise,high raito of fracture healing and safety compared with the normal operative therapy.The operation indication and timing should be controlled strictly.The manipulation should be familiar.This kind of treatment is worth to be recommended.

Objective To study the results of treatment of open fracture of tibia and fibula by external fixation with unilateral multifunction external fixation apparatus(UMEFA) and plaster in different period. Methods 89 cases with open fracture of tibia and fibula had got reduction and external fixation with UMEFA and then divided into two groups, group A of 53 cases followed by external fixation with UMEFA, 8 cases of them were forced to remove UMEFA because of complications, the other 45 cases followed by external fixation with UMEFA till bone union, group B of 36 cases were removed UMEFA and changed with plaster when the skin was healed, the sweal was eliminated and the bone was steady. Compared and analyzed the results by complication, healing time and quality.Results In group B, there was less complications(P

AIM To establish a new, simple, stable and classical experimental model of acute edematous pancreatitis. METHODS Male mice were injected intraperitoneally 2?200 mg?(100 g) -1 body weight of L-arginine in an 1 h interval, as a 20% solution in 0.15 mol?L -1 NaCl. Control mice received the same quantity of 0.15 mol?L -1 NaCl. The mice were killed at 6, 12, 24, 48, 72 h following L-arginine administration. The serum amylase level, wet/dry weight ratio of the pancreas, histologic were assessed. RESULTS The serum level of amylase was significantly elevated at 6 h,reached the peak level at 24 h, normalized at 72 h. Histologic examination revealed interstitial edema and inflammatory cell infiltration reached the peak level at 24 h and decreased at 48,72 h. The wet/dry weight ratio of the pancreas changed in accordance with the interstitial edema. CONCLUSIONS The present study has demonstrated that the administration of excessive doses of arginine induces a new, noninvasive experimental model of acute edematous pancreatitis.

Objective To evaluate the prognostic impact of MRI-detected prevertebral space involvement in nasopharyngeal carcinoma (NPC) treated with radiotherapy and chemotherapy.Methods A retrospective analysis was performed on the clinical data of 333 patients who had newly diagnosed biopsyproven NPC without distant metastasis from 2005 to 2007.All patients underwent MRI scans of the nasopharynx and neck and were treated with two-and three-dimensional radiotherapy without or without chemotherapy.The Kaplan-Meier method was used to calculate overall survival (OS),distant metastasis-free survival (DMFS),and locoregional relapse-free survival (LRFS),and the log-rank test was used for survival difference analysis;the Cox proportional hazards regression analysis was used to assess the prognostic value of prevertebral space involvement.Results The follow-up rate was 95.2％.Prevertebral space involvement was seen in 139(41.7％) of these patients.The patients with prevertebral space involvement had significantly higher T stage and clinical stage than those without prevertebral space involvement (x2 =90.41,P =0.000;x2 =54.03,P =0.000).The 5-year OS,DMFS,and LRFS for NPC patients with and without prevertebral space involvement were 58.8％ vs.77.5％ (x2 =11.95,P =0.000),77.8％ vs.85.0％(x2=2.56,P=0.110),and 88.3％ vs.91.8％ (x2=1.51,P=0.220),respectively.After adjusting for N stage,a significant difference was still seen between the two groups with regard to 5-year OS (x2 =9.93,P =0.002).The multivariate analysis showed that prevertebral space involvement was not the independent prognostic factor for OS,DMFS,and LRFS (x2 =0.43,P =0.512 ; x2 =0.08,P =0.783 ; x2 =0.00,P =0.971).Conclusions The frequency of prevertebral space involvement is very high in NPC.The OS for the patients with prevertebral space involvement is significantly lower than those without prevertebral space involvement.But prevertebral space involvement is not the independent prognostic factor in NPC patients.

Objective To investigate the prognostic value of maximum diameter in axial plane of primary tumor (MDAPPT) on MRI in nasopharyngeal carcinoma (NPC).Methods From 2005 to 2007,333 patients with newly diagnosed and biopsy-proven NPC without distant metastasis,who underwent MRI scans of the nasopharynx and neck,were included in our study.MDAPPT was measured on MRI.The univariate analysis with the log-rank test and multivariate analysis with the Cox proportional hazards model were used to analyze the relationship between MDAPPT and prognosis.Results The median values of MDAPPT in patients with T1,T2,T3,and T4 NPC were 21.2,30.0,38.0,and 52.3 mm,respectively.For all patients with a MDAPPT of ≤30 mm,＞ 30-50 mm,and ＞ 50 mm,the 5-year overall survival (OS) rates were 81.3％,70.1％,and 51.5％,respectively (P =0.000) ; the 5-year progression-free survival (PFS) rates were 81.3％,70.0％,and 48.9％,respectively (P =0.000) ;the 5-year distant metastasisfree survival (DMFS) rates were 85.5 ％,86.5 ％,and 67.2 ％,respectively (P =0.000) ; the 5-year local relapse-free survival (LRFS) rates were 97.7％,91.5％,and 83.3％,respectively (P =0.013).The multivariate analysis showed that MDAPPT was a prognostic factor for PFS and DMFS.For the T3-T4 patients with a MDAPPT of ≤50 mm and ＞50 mm,the 5-year OS rates were 69.4％ and 52.2％ (P =0.004),the 5-year PFS rates were 68.0％ and 49.6％ (P =0.001),and the 5-year DMFS rates were 84.0％ and 66.8％ (P=0.001).In the patients with a MDAPPT ≤30 mm,the 5-year LRFS rates for those with T1,T2,T3,and T4 NPC were 10 0 ％,9 5.8 ％,9 6.3 ％,and 10 0 ％,respectively (P =0.6 4 3).Conclusions MDAPPT is a prognostic factor for PFS and DMFS in NPC,and it is an important prognostic factor in patients with T3-T4 NPC.In the NPC patients with a small MDAPPT,local control rate varies little in different T stages.

Objective To explore the effects of different hemodialysis ways on insulin resistance (IR) in non-diabetic renal disease patients with maintenance hemodialysis.Methods A total of 101 cases of non-diabetic renal disease patients with maintenance hemodialysis in Xuzhou Central Hospital from January 2014 to January 2015 were selected and divided into three groups:high-flux hemodialysis (HFHD) group,low-flux hemodialysis (LFHD) group and hemodialysis filtration (HDF) group.Patients in the three study groups were treated with HFHD,LFHD and HDF,respectively.After 6 months of hemodialysis treatment,clinical data and biochemical indicators were compared among the three groups,and Pearson correlation analysis and multivariate logistic regression analysis were used to explore the correlated factors of homeostasis model insulin resistance index (HOMA-IR).Results The levels of parathyroid hormone (PTH) in the HDF group and HFHD group were significantly lower than that in the LFHD group (P＜0.05),while the urea clearance index (Kt/V) values were significantly higher than that in the LFHD group (P＜ 0.05).The β2-microglobulin (β2-MG),fasting insulin (FINS) levels and HOMR-IR in the HDL group were significantly lower than those in the HFHD group and LFHD group (P＜0.05),and β2-MG clearance rate (β2-MGCR) in the HDF group was significantly higher than that in the HFHD group and LFHD group (P＜0.001).Pearson correlation analysis showed that HOMA-IR was positively correlated with BMI (r=0.346,P=0.014),and was negatively correlated with β2-MGCR and HDL-C (r=-0.412,P=0.002;r=-0.204,P=0.042).Multivariate logistic regression analysis showed that BMI and HDF were independent factors affecting HOMA-IR values (OR=1.538,95％CI 1.364-1.759,P=0.021;OR=0.137,95％CI 0.045-0.632,P=0.012).Conclusion Compared with HFHD and LFHD,HDF can alleviate IR in non-diabetic renal disease patients with maintenance hemodialysis,which is of great significance for clinical treatment.

Objective:To study the potential effects of intensity modulated radiation therapy (IMRT) on clinical efficacy,oral mucosa reaction and immunological foundation;and to explore the effect of immunological changes on clinical efficacy and oral mucosa reaction in patients with nasopharyngeal carcinoma.Methods:A total of 200 patients with nasopharyngeal carcinoma,who came from First Department of Nasopharyngeal Radiotherapy,the First People's Hospital of Foshan from October 2008 to November 2011,were selected.The patients were treated with nasopharyngeal radiotherapy,and divided into an observation group and a control group (n=100 in each group).The control group underwent common conventional two-dimensional radiotherapy treatment,while the observation group underwent IMRT.The 5-year survival rates and recurrence rates were recorded at follow-up.After the radiotherapy,the oral mucosa in the patients were evaluated by the classification standard of acute radioactive mucositis by American Radiotherapy Oncology Group (RTOG),and the number of T lymphocyte subsets before and after treatment was detected.Results:There were significant difference in non-regional-recurrence survival rate,disease-free survival rate,local recurrence rate between the above 2 groups (all P＜0.05),but no significant difference in the distant metastasis-free survival rate (P＞0.05).The acute oral mucosa reactions of grade 1,2,3,4 in the control group were 8.00％,20.00％,12.00％,7.00％,respectively,and those were 7.00％,22.00％,15.00％,1.00％ respectively.There was no significant difference in the acute response of oral mucosa in grade 1,2 and 3 in the 2 groups (all P＞0.05),but there was significant difference in the grade 4 (P＜0.05).There were significantly difference in CD8+,CD4+/CD8+ and CD4+ T lymphocyte subsets before and after treatment in the above 2 groups (all P＜0.01);there were also significantly difference after treatment between the observation group and the control group (all P＜0.01).Conclusion:In the process of treatment in patients with nasopharyngeal carcinoma,the use of IMRT on the basis of chemotherapy is more effective than the conventional two-dimensional radiotherapy,which can reduce the proportion of grade 4 (severe) acute oral mucosa reaction.It may be related to the protective effect of IMRT on immune function in the patients.

Targeting immune checkpoints such as programmed cell death protein 1 (PD-1) and programmed death ligand-1 (PD-L1) have been approved for treating melanoma, gastric cancer (GC) and bladder cancer with clinical benefit. Nevertheless, many patients failed to respond to anti-PD-1/PD-L1 treatment, so it is necessary to seek an alternative strategy for traditional PD-1/PD-L1 targeting immunotherapy. Here with the data from The Cancer Genome Atlas (TCGA) and our in-house tissue library, PD-L1 expression was found to be positively correlated with the expression of ubiquitin-specific processing protease 7 (USP7) in GC. Furthermore, USP7 directly interacted with PD-L1 in order to stabilize it, while abrogation of USP7 attenuated PD-L1/PD-1 interaction and sensitized cancer cells to T cell killing