Objective To evaluate impacts of acute hypervolemic hemodilution (AHH) and intra-operative cell salvage (ICS) with 6％ volume fraction of hydroxyethyl starch (HES) on hemodynamics,blood saving efficiency and renal function of orthopedic surgery patients.Methods A total of 58 patients from orthopedic surgery were involved and randomly divided into AHH + ICS group (30 cases) and control group (28 cases).Changes of hemodynamic indices (HR,MAP and CVP) and renal function indices (BUN,BCr,UCr and ALB) in both groups were compared before operation (T0),immediately after operation (T1) and at postoperative 4 hours (T2),1 day (T3) and 2 days (T4).CCr was counted and intraoperative blood conservation was observed at each time point as well.Results HR,MAP and CVP of the two groups had no significant differences.Both groups showed some drop of HR (P ＜ 0.05),but an increase of MAP and CVP at T1-T4 (P ＜ 0.05),in contrast with levels at TO.BUN,BCr and ALB also showed insignificant differences between groups or within group at each time point.CCr in the control group showed no significant difference at each time point.On the contrary,CCr in the AHH + ICS group had a fall at T1-T4 and was declined to the lowest level at T2.CCr in the AHH + ICS group showed a recovery at T3-T4 and its level at T4 was still lower than that at TO,with no significant difference.CCr in the two groups showed insignificant difference at TO,but its level in the AHH + ICS group was lower than that in the control group at T1-T4,at T2 in particular (P ＜0.01).Moreover,CCr in the two groups was still significantly different at T4 (P ＜ 0.05).Renal function indices of the two groups were all within normal range at each time point.Intraoperative blood loss and unrine volume of the two groups had no significant differences,but intraoperative fluid requirement,allogenic blood transfusion volume and transfusion rate of AHH + ICS group were notably lower than those of control group (P ＜ 0.05 or P ＜0.01).Conclusions AHH plus ICS using HES are safe,effective and promising integrated blood conservation measures,which significantly reduces intraoperative allogenic blood transfusion volume and transfusion rate and has few impacts on fundamental vital signs and renal function.However,prolonged use of large dose of HES may do harm to renal function and therefore should be carefully considered in treatment of patients with severe renal dysfunction.

Objective To investigate the roles of phosphatidylinositol 3 kinase (PI3K) and phosphorylated Akt (P-Akt) in the pathogenesis of cervical squamous cell carcinoma and condyloma acuminatum.Methods Immunohistochemistry and Western blot were used to detect the expressions of PI3K and P-Akt in tissue specimens from the lesions of 30 cases of cervical squamous cell carcinoma,30 cases of condyloma acuminatum and the prepuce of 15 normal human controls.The average optical density and gray scale values were calculated and analyzed by t test and F test respectively.Results The expressions of PI3K and P-Akt were observed in only the basal layer of the epidermis of control specimens,but in the whole epidermis of condyloma acuminatum tissue specimens.Cervical squamous cell carcinoma tissue specimens displayed a stronger expression of PI3K and P-Akt compared with the control and condyloma acuminatum tissue specimens.As immunohistochemistry revealed,the average absorbance value for PI3K and P-Akt was 0.28 ±0.05 and 0.20 ± 0.07 respectively in cervical squamous cell carcinoma tissue specimens,0.22 ± 0.04 and 0.17 ± 0.03 respectively in condyloma acuminatum tissue specimens,and 0.16 ± 0.04 and 0.10 ± 0.02 respectively in the control tissue specimens; significant differences were observed in the expressions of PI3K and P-Akt among the three groups of tissue specimens (F =44.87,20.64,respectively,both P ＜ 0.01 ).The results of Western blot were consistent with those of immunohistochemistry,and there was a significant difference in the gray scale value for PI3K and P-Akt between cervical squamous cell carcinoma,condyloma acuminatum and control tissue specimens (3.48 ± 0.48 vs.1.99 ± 0.11 vs.1.00 ± 0.03,F=354.83,P＜ 0.01; 3.33 ± 0.26 vs.1.96 ± 0.11 vs.1.00 ± 0.03,F=302.33,P＜ 0.01 ).Conclusions The PI3K/Akt signaling pathway is abnormally activated in condyloma acuminatum and cervical squamous cell carcinoma,and human papilloma virus may cause the abnormal proliferation of infected epithelium likely by affecting the upregnlated expression of PI3K/P-Akt.

ObjectiveTo analyze the correlation between primary tumor volume (PTV) and prognosis of nasopharyngeal carcinoma ( NPC ) treated by intensity-modulated radiotherapy ( IMRT ).Methods330 NPC patients treated by IMRT were included.Pretreatment computerized tomography image were input into tree-dimensional treatment-planning system,in which the primary tumor volume were calculated automatically.The receiver operating characteristic curve was used to determine the best cut-off point of PTV.Within the framework of UICC 2002 T stage,The PTV was divided into four groups:V1 ＜ 10cm3,V2 10-25 cm3,V3 ＞ 25-50 cm3 and V4 ＞ 50 cm3.Kaplan-Meier and Logrank test was used to analyze the survival,Cox proportion risk regression model were used to analysis the correlation between PTV and prognosis.ResultsThe mean PTV for all NPC patients was ( 34.2 ± 27.1 ) cm3 with the range of 0.4- 153.7 cm3.The 3-year overall survival for V1,V2,V3 and V4 stage were 88.6％,90.0％,91.2％ and 74.2％,respectively (x2 =12.83,P =0.005 ).There was no significant difference among V1,V2 and V3in terms of overall survival ( x2 =1.96,P =0.376).The 3-year distant metastasis-free survival and diseasesfree survival or overall survival were decrease in PTV ＞50 cm3 and PTV≤50 cm3 (77.4％:89.9％,x2 =7.24,P=0.007and 64.5％:85.1％,x2 =13.95,P=0.000 or 74.2％:90.3％,x2 =11.76,P=0.001).Multivariate analysis revealed that PTV was a adverse prognostic factors for overall survival (x2 =0.00,P =2.580).ConclusionOur data showed that the primary tumor volume had significantly impacted on the prognosis of NPC patients treated by intensity modulated radiotherapy.

Through analyzing the connotation and current situation of the innovation ability training,the paper lists the main problems existing in the cultivation of medical students' innovation ability.With medical undergraduate education as the starting point,it summarizes the experience and practice of strengthening the cultivation of medical undergraduates' innovation ability from the following aspects as set-ting up the innovation education idea,promoting the innovation of teaching contents with minus three,three bases,three stresses,promoting the reform of teaching methods with innovation as the core,constructing new type teachers staff with science and education as one,improving training system innovation,accelerating the construction of integrated test system,and establishing and improving the innovation of educational system and mechanism and so on.

Objective To evaluate the impact of reducing clinical target volume (CTV) on the efficacy of intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) . Methods Between August 2003 and March 2007, 380 NPC patients were treated with IMRT with reduced CTV.CTV1, defined as high risk region, included GTV +5 - 10 mm margin and the entire nasopharyngeal mucosa +5 mm submucosal volume; CTV2, designed for potentially involved regions, included the nasopharyngeal cavity (limited to the posterior part of nasal cavity only), maxillary sinus (limited to 5 mm anterior to the posterior nasal aperture and maxillary mucosa), pterygopalatine fossa, posterior ethmoid sinus,parapharyngeal space, skull base, anterior third of clivus and cervical vertebra, inferior spheniod sinus and cavernous sinus and internal group of retropharyngeal lymph nodal regions from the base of skull to cranial edge of the second cervical vertebra. The prescription dose was: GTV 66. 00 -69. 75 Gy/30 - 33 f, CTV1 60. 00 -66. 65 Gy,CTV2/CTVN 54. 0 -55.8 Gy. 308 patients with stage Ⅲ or Ⅳ diseases also received cisplatin-based neoadjuvant chemotherapy. Results The follow-up rate was 100%. 145 patients were followed-up to 3 years. The 3-year estimated local control, regional control, metastasis-free survival,disease-free survival and overall survival rates were 94. 9%, 97.4%, 86. 2%, 80. 9% and 89. 0%,respectively. Multivariate analysis revealed that N-classification was a significant prognostic factor for metastasis-free survival (x2 = 20. 80, P = 0. 001), N-classification (x2 = 18. 30, P = 0. 003) and age (x2 =7. 31, P =0. 004) were independent prognostic factors for overall survival. Grade 2 xerostomia was observed in 5.6% of the patients after two years of IMRT, no Grade 3 or 4 xerostomia was observed. Local, regional,and distant failures were developed in 4. 2%, 2. 6% and 12. 1% of the patients, respectively. Conclusions The IMRT approach with reduced CTV2 provids a favorable outcome for NPC with acceptable toxicities.

Objective To investigate the changes of peripheral insulin resistance after lipid infusion and the effect of N-acetylcystein(NAC) intervention.Methods Thirty-seven normal male SD rats,eight weeks old,were randomly divided into three groups,FFA group,NS group and NAC group(using into NAC 300 mg/(kg?d) two weeks before infusion).Catheters were implanted into right atrium via the jugular vein and left carotid artery.A technique for a 48-h infusion in unrestrained rats was used for triglyceride and heparin or saline infusion.The infusion period started on day 2 after surgery.48-h after infusion,we determined free fat acid(FFA),nitrotyrosine,malonaldehyde(MDA),reduced glutathione hormone(GSH) level in plasma.The glucose infusion rat(GIR) was measured by hyperinsulinemia euglycemic clamp to evaluated the perpherial insulin resistance.The expressions of IRS-1,IRS-2 gene in muscle were detected by real time PCR.Results(1)The FFA,nitrotyrosine and MDA con-centrations in FFA group were higher than that in NS group,but GSH level in plasma was lower.NAC intervention could reverse these effects.(2)GIR was decreased significantly in FFA group as compared with NS group[(8.34?1.8)mg/(min?kg)] vs[(13.56?1.7)mg/(min?kg)],(P

Objective To evaluate the dosimetric characteristics of hippocampal formation (HF) in the intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods Fifty-nine NPC patients underwent IMRT.Simultaneous integrated boost technology was used to determine the doses for the target areas.The dose ranges of the HF were collected by dose-volume histogram.The influence of T stage on the exposure doses ( Dmax,Dmean,D20,V10,V20,V30,and V40 ) were compared.Results The maximum dose for the HF (Dmax) ranged from 11.1 to 78.2 Gy(F =24.2,P ＜0.05) and the Dmean ranged from 3.2 to 44.6 Gy ( F =16.3,P ＜ 0.05 ).The Dmax and Dmean of the T1-2 stage patients were (40.8 ±9.4) Gy and ( 12.5 ±5.1 ) Gy,respectively,both significantly lower than those of the T3-4 stage patients [ (58.6± 14.8) Gy,(20.9± 9.3 ) Gy].The mean exposed volume of the T4 stage patients was significantly larger than that of the T1 and T2 stages patients.Conclusions In the IMRT of NPC,the HF receives rather high irradiation dose.T stage is the main factor influencing the dose,especially T3 and T4 stages deserve serious attention.

Objective:To investigate the similarities and differences of chondrolaryngoplasty between female and transgender women.Methods:We enrolled 23 patients with chondrolaryngoplasty in Peking University Third Hospital from March 2016 to September 2019, with age from 18- 37 y/o (average at 26. 87±5. 54 y/o) ; employing eleven-point Likert scale to conduct an average 14mths follow-up. We assigned patients into female (n=11) and transgender women(n=12) groups, using SPSS 22. 0 tool to process and analyze data. Paired sample t test is conducted to compare pre- and postoperative differences, while independent sample t test is to compare between groups; p value less than 0. 05 is considered to have statistical significance.Results:Satisfaction with surgery is 95. 65% (22/23 patients) ; satisfaction with appearance of laryngeal prominence is 82. 61% (19/23 patients ). After operation, the Self-Estimate Laryngeal Prominence Score improves from 6. 57±2. 45 to 2. 22±2. 09; the Social Ability Restriction Score improves from 6. 30±3. 02 to 1. 52±2. 54; the Phycological Burden Score decrease from 7. 70±2. 44 to 1. 83±2. 62; all data have statistical significances ( P<0. 01). The improvement of previous two scores is greater in transgender women group with statistical significances ( P< 0. 05). Conclusions:Chondrolaryngoplasty can remarkably improve the appearance of laryngeal prominence of patients; Transgenders women can obtain better social and phycological improvement than female patients after chondrolaryngoplasty.

Objective:To investigate the similarities and differences of chondrolaryngoplasty between female and transgender women.Methods:We enrolled 23 patients with chondrolaryngoplasty in Peking University Third Hospital from March 2016 to September 2019, with age from 18- 37 y/o (average at 26. 87±5. 54 y/o) ; employing eleven-point Likert scale to conduct an average 14mths follow-up. We assigned patients into female (n=11) and transgender women(n=12) groups, using SPSS 22. 0 tool to process and analyze data. Paired sample t test is conducted to compare pre- and postoperative differences, while independent sample t test is to compare between groups; p value less than 0. 05 is considered to have statistical significance.Results:Satisfaction with surgery is 95. 65% (22/23 patients) ; satisfaction with appearance of laryngeal prominence is 82. 61% (19/23 patients ). After operation, the Self-Estimate Laryngeal Prominence Score improves from 6. 57±2. 45 to 2. 22±2. 09; the Social Ability Restriction Score improves from 6. 30±3. 02 to 1. 52±2. 54; the Phycological Burden Score decrease from 7. 70±2. 44 to 1. 83±2. 62; all data have statistical significances ( P<0. 01). The improvement of previous two scores is greater in transgender women group with statistical significances ( P< 0. 05). Conclusions:Chondrolaryngoplasty can remarkably improve the appearance of laryngeal prominence of patients; Transgenders women can obtain better social and phycological improvement than female patients after chondrolaryngoplasty.

Objective To compare the dosimetric difference among plans designed by 4-field,6-field TomoDirect and TomoHelical techniques in Tomotherapy system for left-breast cancer patients with radiotherapy after breast-conserving surgery.Method A total of 16 patients with left-breast cancer following breast-conserving surgery and intensity-modulated radiation therapy were enrolled in this retrospective study.The 4-field TomoDirect (TD4),6-field TomoDirect (TD6),and TomoHelical (TH) techniques were applied to design simulation plans in tomotherapy system for each patient,respectively.The differences of dose distribution and treatment parameters were analyzed in this study.Results Three plans all met the clinical requirement.Thereinto,TD4 was superior to TH in the dose limitation of organs at risk (OARs),especially the max dose of cord and right-breast,thc 5 Gy radiation volume of lung,and the mean dose of heart(F =595.60,129.24,60.44,65.37,P ＜ 0.05),but inferior to TH in dose homogeneity (HI) and conformity (CI) (F =2.78,60.93,P ＜ 0.05).However,TD6 improved TD4's HI and CI when delivered the lower OARs dose compared to TH.Meanwhile,the number of monitor units was less in TD technique and reduced the treatment times (F =24.89,3.75,P ＜ O.05).Conclusions For the radiotherapy of left-breast cancer patients after breast-conserving surgery,TD6 technique appeared to be superior,with the lower radiation dose of OARs compared to TH technique,and the better target's HI and CI in comparison with TD4 technique,especially in patients with early stage breast cancer.