Objective To assess the usefulness of the MSCTA with 3D reconstruction to epigastric tumors in interventional treatment.Methods MSCTA were performed in 27 cases of epigastric tumors before and after interventional treatment.3D reconstruction were taken for blood vessels with technique of MIP(maximum intensity projection)and VRT(volume rendering technique).Results 42 times MSCTA and 3D reconstruction were performed in 27 cases of epigastric tumors.We discovered 5 feeding arteries with mutation in abdominal cavity,7 collateral branches formed after embolization and 2 abnormal courser of celiac artery.The display of vasculative with MSCTA was better than that of DSA.Conclusion 3D-MSCTA for epigastric tumors not only can show directly and clearly the stereo-anotomic images of the tumor feeding vessels but also provide guidance for planning the treatment.

BACKGROUND: Recent literatures have showed that percutaneous kyphoplasty can effectively avoid nerve damage, pulmonary embolism, and insufficient vertebral height and other security risks when bone cement is infused into affected vertebrae in percutaneous vertebroplasty. OBJECTIVE: To compare the effect of percutaneous kyphoplasty and percutaneous vertebroplasty in repair of osteoporotic vertebral compression fractures. METHODS: A total of 106 patients with senile osteoporotic vertebral compression fractures were randomly divided into trial group and control group (n=53 per group). Patients in the trial group were treated with percutaneous kyphoplasty, and those in the control group treated with percutaneous vertebroplasty. Al patients were fol owed up for 6 months after repair. The vertebral compression deformation, bone cement distribution, midline vertebral bone cement condition, vertebral height restoration, bone cement leakage, vertebral kyphosis, progressive spinal col apse, nerve damage, as wel as visual analog scale scores and Oswestry disability index scores in these two groups were compared. RESULTS AND CONCLUSION: Compared with the control group, there was less bone cement leakage and vertebral compression deformation in the trial group. Moreouer, in the trial group, bone cement distributed uniformly, vertebral height restoration was good and effective, pain was obviously relieved, and the probability of vertebral kyphosis, progressive spine col apse and nerve damage was significantly reduced (al P < 0.05). These results suggest that percutaneous kyphoplasty can effectively relieve the pain of patients with osteoporotic vertebral compression fractures, restore vertebral body height and reduce the incidence of complications, which effectively guarantees the postoperative restoration of motor function.

Objective To evaluate the clinical value and safety of angiography and embolization in the treatment of pulmonary sequestration causing massive haemoptysis. Methods Though digital subtraction angiography(DSA), abnormal arteries were demonstrated in 12 cases with massive haemoptysis. All the abnormal arteries were embolized by gelatin sponge plus silk thread sterilized with high temperature and pressure. Results Among 12 cases of the pulmonary sequestration, 26 abnormal arteries were discovered, originating from thoracic aorta and presenting enlargement, twisting and irregular diameter with strands of middle and distal arterial segments associated with abundant vasculature network. There were several arteries supplying the lesion in 11 cases, and massive haemoptysis were stopped after embolization. Follow up for 6 to 18 months, no recurrence and no complication occurred. Conclusion Arterial angiography and embolization with gelatin sponge plus silk thread for treating pulmonary sequestration with massive hemoptysis possesses high clinical efficiency and safety.

Objective To improve the mode of clinical medicine postgraduates for specialty degree by OSCE. Methods Clinical medicine postgraduates for specialty degree of Grade 2010 and 2011 were enrolled as research objects. The OSCE scores of the students of Grade 2010 were analyzed and the problems in clinical skills training were summarized. In the last year of clinical training for the clinical medical students of Grade 2011, the reform of clinical skills training was implemented with such improvement measures as publishing last year achievement, analyzing OSCE assessment, strength-ening the supervision of the department of clinical skill training, strengthening the examination as-sessment efforts and organizing collective training. And finally the OSCE scores of the students of Grade 2011 were compared with the scores of the students of Grade 2010. SPSS 19.0 was used to analyze the OSCE scores. Quantitative data were expressed as x±s. T test and Chi-squared test were em-ployed to do statistical analysis, with the inspection level of α=0.05. Result The graduate exami-nation OSCE scores of clinical medicine professional master's degree postgraduates of Grade 2010 display that the failure rate of SP, Physical, Surgical Operation, CPR and Case analysis are more than 5%. After the improvement of clinical skill training, using independent samples t test and chi square test, and contrasting grade 2010, the failure rate of the OSCE score of Grade 2011 in physical examination, surgical operation, site emergency station, CPR station, and case analysis station is significantly improved (P<0.05). Conclusions Improving the mode of clinical skill training by OSCE and performance analysis can effectively enhance clinical competence.

Objective To investigate the role of vitamin D in the synthesis and degradation of aggrecan in rat articular chondrocytes at cellular level. Methods Rat articular chondrocytes were stimulated by IL-1α, IL-1β and TNF-α, respectively. Normal and inflammatory chondrocytes were treated with different doses of vitamin D, respectively. CCK8, Flow cytometry, real time-PCR and western blot analysis were used to examine the proliferation activity and apoptosis level of chondrocytes, and the expression of aggrecan, ADAMTS-4 and ADAMTS-5 at both mRNA and protein levels. Results IL-1α,IL-1β and TNF-α significantly decreased the proliferation activity and increased the apoptosis level of the chondrocytes. Furthermore, IL-1α, IL-1β and TNF-α significantly decreased the expression of aggrecan, and increased the expressions of ADAMTS-4 and ADAMTS-5 at both mRNA and protein levels in the chondrocytes. 1α,25 (OH)2D3supplementation significantly increased the proliferation activity and decreased the apoptosis level of chondrocytes stimulated by IL-1α, IL-1β and TNF-α in a dose-dependent manner, but not affected the normal chondrocytes. Meanwhile, 1α,25(OH)2D3also significantly increased the expression of aggrecan, and decreased the expressions of ADAMTS-4 and ADAMTS-5 at both mRNA and protein levels in the chondrocytes under inflammatory conditions. Conclusions Vitamin D may promote the anabolism of aggrecan and inhibit aggrecanase activity in chondrocytes under inflammatory conditions, which may impact overall protection for articular cartilage.

Objective: To evaluate the efficacy and safety of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in prophylaxis neutropenia after chemotherapy in patients with lymphoma. Methods: This was a multicenter, single arm, open, phase Ⅳ clinical trial. Included 410 patients with lymphoma received multiple cycles of chemotherapy and PEG-rhG-CSF was administrated as prophylactic. The primary endpoint was the incidence of Ⅲ/Ⅳ grade neutropenia and febrile neutropenia (FN) after each chemotherapy cycle. Meanwhile the rate of antibiotics application during the whole period of chemotherapy was observed. Results: ①Among the 410 patients, 8 cases (1.95%) were contrary to the selected criteria, 35 cases (8.54%) lost, 19 cases (4.63%) experienced adverse events, 12 cases (2.93%) were eligible for the termination criteria, 15 cases (3.66%) develpoed disease progression or recurrence, thus the rest 321 cases (78.29%) were into the Per Protocol Set. ②During the first to fourth treatment cycles, the incidences of grade Ⅳ neutropenia after prophylactic use of PEG-rhG-CSF were 19.14% (49/256) , 12.5% (32/256) , 12.18% (24/197) , 13.61% (20/147) , respectively. The incidences of FN were 3.52% (9/256) , 0.39% (1/256) , 2.54% (5/197) , 2.04% (3/147) , respectively. After secondary prophylactic use of PEG-rhG-CSF, the incidences of Ⅳ grade neutropenia decreased from 61.54% (40/65) in the screening cycle to 16.92% (11/65) , 18.46% (12/65) and 20.75% (11/53) in 1-3 cycles, respectively. The incidences of FN decreased from 16.92% (11/65) in the screening cycle to 1.54% (1/65) , 4.62% (3/65) , 3.77% (2/53) in 1-3 cycles, respectively. ③The proportion of patients who received antibiotic therapy during the whole period of chemotherapy was 34.39% (141/410) . ④The incidence of adverse events associated with PEG-rhG-CSF was 4.63% (19/410) . The most common adverse events were bone pain[3.90% (16/410) ], fatigue (0.49%) and fever (0.24%) . Conclusion During the chemotherapy in patients with lymphoma, the prophylactic use of PEG-rhG-CSF could effectively reduce the incidences of grade Ⅲ/Ⅳ neutropenia and FN, which ensures that patients with lymphoma receive standard-dose chemotherapy to improve its cure rate.

Objective To investigate dynamic change of cadmium body burden and renal dysfunction among residents living in cadmium?polluted areas. Methods From April to July of 2011, the cadmium?polluted areas of northern Guangdong province in China was chosen as the study site. Based on the levels of cadmium pollution in soil and rice, the survey areas were divided into low exposed group (average concentration of cadmium was 0.15-0.40 mg/kg, 0.5-1.0 mg/kg in rice and soil, respectively) and high exposed group (average concentration of cadmium was >0.40 mg/kg, >1.0 mg/kg in rice and soil, respectively). Stratified random sampling and cluster sampling method of epidemiological investigations were carried out among 414 local residents who lived in cadmium exposure areas for more than 15 years, aged above 40, and without occupational cadmium exposure, including 168 and 246 residents in low and high exposed group, respectively. From March to June of 2014, 305 respondents of those who participated in 2011 were successfully traced, including 116 and 189 respondents in low and high exposed group, respectively. We used health questionnaires to acquire their health status. Home?harvested rice and vegetable samples were collected using quartering method for detection of cadmium level, including 190 rice samples, 161 vegetable samples in 2011 and 190 rice samples, 153 vegetable samples in 2014. Urine specimens of residents were collected for the detection of urinary cadmium and creatinine as well as renal dysfunction biomarkers, namely, N?acetyl?beta?D?glucosamidase (NAG) andβ2?microglobulin (β2?MG), respectively. In 2011 and 2014, Chi?square test was used to investigate the differences of abnormality of cadmium concentration in rice, vegetables and urinary cadmium,β2?MG,and NAG that were expressed as odds ratio (OR) and 95%confidence intervals (95%CI). Results In 2011 and 2014, cadmium concentration P50 (P25-P75) in rice was 0.43 (0.17-1.10) mg/kg,and 0.42 (0.20-1.14) mg/kg, respectively (Z=-0.77, P=0.440). In 2011 and 2014, cadmium concentrations P50 (P25-P75) in vegetables were 0.13 (0.07-0.34) mg/kg,and 0.25 (0.12-0.59) mg/kg, respectively, with abnormal rates of 38.5%(62/161) and 60.8%(93/153), respectively. In 2014, both average concentration and abnormal rate of cadmium in vegetables were higher than those in 2011 (Z=-4.69,P<0.001 andχ2=15.58, P<0.001). Concentrations of urinary cadmium P50 (P25-P75) in high exposed group were 7.90 (3.96-14.91)μg/g creatinine, 8.64 (4.56-17.60)μg/g creatinine in 2011 and 2014, respectively. Contrary to that in 2011, urinary cadmium of high exposed group was significantly increased in 2014 (Z=-2.80 ,P=0.005). In 2011 and 2014, concentrations of β2?MG, NAG P50 (P25-P75) were 0.15 (0.07-0.29)μg/g creatinine, 0.15 (0.07-0.45)μg/g creatinine,and 7.12 (5.05-10.65) U/g creatinine, 13.55 (9.1-19.84) U/g creatinine, respectively, with abnormal rates of 7.5% (23/305), 15.1% (46/305) ,8.2%(25/305) , and 33.8% (103/305), respectively. Compared with baseline in 2011, average concentrations ofβ2?MG, NAG significantly increased in 2014 (Z=-2.263,P=0.024 and Z=-12.52,P<0.001), and abnormal rates ofβ2?MG, NAG were also higher in 2014 (χ2=15.61,P<0.001 andχ2=64.72,P<0.001), with odds ratio (OR) of 2.00 (95%CI:1.23-3.24) and 4.12 (95%CI:2.87-5.92). Conclusion Environmental cadmium pollution of crops such as rice and vegetables in survey areas continued to remain high. Body burden of cadmium might kept at sustainably high levels and renal dysfunction was worsened after continuous, long?term cadmium exposure. Our results suggested that NAG might be more sensitive than β2?MG to serve as an indicator for an individual's future tubular function.

Objective To investigate dynamic change of cadmium body burden and renal dysfunction among residents living in cadmium?polluted areas. Methods From April to July of 2011, the cadmium?polluted areas of northern Guangdong province in China was chosen as the study site. Based on the levels of cadmium pollution in soil and rice, the survey areas were divided into low exposed group (average concentration of cadmium was 0.15-0.40 mg/kg, 0.5-1.0 mg/kg in rice and soil, respectively) and high exposed group (average concentration of cadmium was >0.40 mg/kg, >1.0 mg/kg in rice and soil, respectively). Stratified random sampling and cluster sampling method of epidemiological investigations were carried out among 414 local residents who lived in cadmium exposure areas for more than 15 years, aged above 40, and without occupational cadmium exposure, including 168 and 246 residents in low and high exposed group, respectively. From March to June of 2014, 305 respondents of those who participated in 2011 were successfully traced, including 116 and 189 respondents in low and high exposed group, respectively. We used health questionnaires to acquire their health status. Home?harvested rice and vegetable samples were collected using quartering method for detection of cadmium level, including 190 rice samples, 161 vegetable samples in 2011 and 190 rice samples, 153 vegetable samples in 2014. Urine specimens of residents were collected for the detection of urinary cadmium and creatinine as well as renal dysfunction biomarkers, namely, N?acetyl?beta?D?glucosamidase (NAG) andβ2?microglobulin (β2?MG), respectively. In 2011 and 2014, Chi?square test was used to investigate the differences of abnormality of cadmium concentration in rice, vegetables and urinary cadmium,β2?MG,and NAG that were expressed as odds ratio (OR) and 95%confidence intervals (95%CI). Results In 2011 and 2014, cadmium concentration P50 (P25-P75) in rice was 0.43 (0.17-1.10) mg/kg,and 0.42 (0.20-1.14) mg/kg, respectively (Z=-0.77, P=0.440). In 2011 and 2014, cadmium concentrations P50 (P25-P75) in vegetables were 0.13 (0.07-0.34) mg/kg,and 0.25 (0.12-0.59) mg/kg, respectively, with abnormal rates of 38.5%(62/161) and 60.8%(93/153), respectively. In 2014, both average concentration and abnormal rate of cadmium in vegetables were higher than those in 2011 (Z=-4.69,P<0.001 andχ2=15.58, P<0.001). Concentrations of urinary cadmium P50 (P25-P75) in high exposed group were 7.90 (3.96-14.91)μg/g creatinine, 8.64 (4.56-17.60)μg/g creatinine in 2011 and 2014, respectively. Contrary to that in 2011, urinary cadmium of high exposed group was significantly increased in 2014 (Z=-2.80 ,P=0.005). In 2011 and 2014, concentrations of β2?MG, NAG P50 (P25-P75) were 0.15 (0.07-0.29)μg/g creatinine, 0.15 (0.07-0.45)μg/g creatinine,and 7.12 (5.05-10.65) U/g creatinine, 13.55 (9.1-19.84) U/g creatinine, respectively, with abnormal rates of 7.5% (23/305), 15.1% (46/305) ,8.2%(25/305) , and 33.8% (103/305), respectively. Compared with baseline in 2011, average concentrations ofβ2?MG, NAG significantly increased in 2014 (Z=-2.263,P=0.024 and Z=-12.52,P<0.001), and abnormal rates ofβ2?MG, NAG were also higher in 2014 (χ2=15.61,P<0.001 andχ2=64.72,P<0.001), with odds ratio (OR) of 2.00 (95%CI:1.23-3.24) and 4.12 (95%CI:2.87-5.92). Conclusion Environmental cadmium pollution of crops such as rice and vegetables in survey areas continued to remain high. Body burden of cadmium might kept at sustainably high levels and renal dysfunction was worsened after continuous, long?term cadmium exposure. Our results suggested that NAG might be more sensitive than β2?MG to serve as an indicator for an individual's future tubular function.