Objective To investigate the effects of treatment of proximal humeral fracture in the elderly with anatomical plate internal fixation.Methods Twenty-seven cases of proximal humeral fractures received operative treatment with anatomical plate.According to Neer classification,there were 18 patients with three-part fractures of the bone,there were 9 patients with four-part fractures of the bone.Results Twenty-seven patients were followed up for 6-24 months.According to the evaluation of Herscovici scales,the result were excellent in 17 cases,and good in 8,92.6％ (25/27) of all reductions were excellent or good.The excellent and good rate of Constant-Murley score was 88.9％(24/27 ).Conclusion It is an ideal way to treat the displaced proximal humeral fracture with anatomical plate,which can provide rigid fixation,it allows early functional treating.

Objective To study the effect of new barrel theory in improving evaluation of hospitalized patients. Methods Eight hundred hospitalized patients from September 2012 to August 2013 were randomized equally into the control group and the observation group.The last one or two items affecting patient satisfaction from the control group were used as objectives to be improved.Causal effect analysis was done pertinent to the items and the worksheet was bettered and improved and then enforced.The two groups were compared after intervention with new barrel theory in terms of satisfaction of patients during admission and discharge. Result The satisfaction of patients in the observation group during admission and discharge was significantly better than that in the control group(P<0.05).Conclusion The new barrel theory used to detect the flaws in nursing service and improve the workflow can improve assessment from the patients so that the management quality can be enhanced.

Objective: To evaluate the impairment of semantic memory in Alzheimer's disease.Methods: 22 Alzheimer's disease patients were examined by means of a longitudinal study and compared with 22 normal elders.Two semantic tasks,lexical decision task and semantic knowledge task were used,to evaluate the integrity of the same concepts.Results: In each session,the MMSE scores of the Alzheimer's disease group were significantly worse(P

Objective To evaluate the efficiency and toxicities of Gemcitabine combined with S -1 cap-sule in the treatment of advanced esophageal cancer .Methods Twenty-nine patients with advanced esophageal cancer were treated with S-1 capsule 80 mg/m2 ,twice daily for 14 days and Gemcitabine (1 000 mg/m2 ) was in-travenously administrated on day 1 and 8.The chemotherapy was repeated every 21 days.After two consecutive treatment circles ,the short term efficacy ,adverse effects and follow -up condition were evaluated .Results One case showed complete remission (CR),11cases showed partial remission (PR),9 cases showed stable disease (SD),8 cases showed progressive disease(PD).The responsive rate(CR+PR)was 41.4%;the illness control rate(CR+PR+SD)was 72.4%.The major adverse events were myelosuppression ranging from grade Ⅰto Ⅲ, hand-foot syndrome,disgusting and the damage of liver function .Some patients displayed the damage of liver function.The median time to progress ( mTTP) was 6.9 months.The median 1-year survival rate was 64.3%. Conclusion The combination of Gemcitabine and S -1 capsule is an effective and well -tolerated method for the patients with advanced esophageal cancer .

Objective To study the relationship between nitric oxide(NO)and some cytokines and the pathogenesis of vitiligo.Methods Nitric acid reductase assay and ELISA were used to determine the serum levels of NO,and IFN-?,IL-10and IL-12in32patients with vitiligo,compared with18normal controls.The levels of these molecules in suction blister fluids,including involved skin and uninvolved skin from20patients,were also determined.Results The serum levels of NO and IFN-?in vitiligo patients were significantly higher than those in controls,and the serum level of IL-10in the patients was significantly lower than that in controls.The serum level of IFN-?in generalized type of vitiligo and the serum level of NO in localized type of vitiligo in active stage were higher than those in stable stage.The NO level in suction blister fluid of localized vitiligo of involved skin was significantly higher than that of uninvolved skin.Conclusion These findings suggest that NO,IFN-?and IL-10might be involved in the pathogenesis of vitiligo.

Objectives To explore the effects of budesonide (BUD) on airway remodeling and the levels of transforming growth factor-β1 (TGF-β1) in bronchoalveolar lavage fluid (BALF) and its expression in lung tissue of asthmatic rats. To provide a theoretical basis for the intervention and treatment of asthma. Methods Sixty healthy adult male Wistar rats were randomly divided into 3 groups: control group, asthma model group and BUD treated group, 20 rats in each group. A rat asthma model was established by ovalbumin (OVA) challenging. BUD treated group was treated with inhaled BUD 1 mg/kg in 30 min per serving every other day for two weeks. After OVA challenge finished, the rats were anesthetized and sacrificed for BALF and lung tissue collection. The level of TGF-β1 in BALF was measured by enzyme-linked immunosorbent assay. TGF-β1 expression and collagen deposition in the lung tissue were tested with immunohistochemical determination and Masson stain respectively. The computer image analysis system was used for measuring respiratory bronchiole smooth muscle thickness (μm) and the extent of epithelial damage score and other indicators of airway remodeling. Results Compared with that in the control group, TGF-β1 in BALF and lung tissue of asthma model group increased and were correlated significantly with the indicators of airway remodeling (P < 0.01) ;while that of BUD treated group reduced statistically significant than model group (P < 0.05). Pathology examination on asthma rat airway epithelial tissue showed the thickness of airway smooth muscle, the airway deposition of collagen in BUD treated group reduced obviously than asthma model group. Conclusions The expression of TGF-β1 in the rat asthma airway worsens the airway remodeling. The effects of BUD on ameliorating the progression of airway remodeling may be partially made by reducing the expression of TGF-β1. (J Clin Pediatr,2010,28(2):173-177)

Objective:To investigate the present situation of humanity education for medical students and to provide theoretical evidence for establishing appropriate interventions. Methods:This paper surveyed and analyzed the present situation of humanity education for medical students in a medical university using questionnaires. Re-sults:18. 7% of medical students entirely remembered the specific content of Hippocratic Oath, 7. 3% of medical students had never heard about the concepts such as humanistic quality, 31. 7% of medical students had never bor-rowed humanity and social science books from the school library, 79. 3% of medical students thought it necessary to strengthen humanity education. Some results showed that there were significant differences in different grades and specialties. Conclusion:It is necessary to further strengthen humanity education for medical students, improve the quality of humanity curriculum, and make a fusion of humanity education and the medical professional education. At the meantime, the humanity courses should be increased and the educational program should be diversified.

Objective:To analyze the expression of MUC15 and PI3K/Akt in gastric carcinoma and its association with clinicopathologi-cal characteristics and prognosis. Methods:The expression of MUC15 and Akt was detected in 144 cases of gastric carcinoma tissues and corresponding para-carcinoma tissues by tissue microarray and immunohistochemistry. Results:The positive expression rate of MUC15 in gastric carcinoma was 79.8%, higher than that of para-carcinoma tissues (22.2%, P<0.01). The positive expression rate of Akt protein in gastric carcinoma was 80.6%, higher than that of para-carcinoma tissues (16.7%, P<0.01). The expression of MUC15 and Akt was statistically associated with the grades of differentiation, invasion depth, lymphatic metastasis, TNM stage of tumor tissues (P<0.05), and the positive correlation between the two protein expression that appear in the gastric tumor tissue (P=0.001). Univariate survival analysis showed that the over-expression of either MUC15 or Akt was inversely correlated with the survival time (P<0.05 and P<0.01, respectively). Cox multiple regression analysis indicated that patients with over-expression of both MUC15 and Akt had the worst prognoses (HR=3.115, P<0.05). Conclusion:MUC15 may be involved in the occurrence, development, invasion, and metastasis of gastric cancer through the PI3K/Akt cell signaling pathway, and the expression of MUC15 combined with Akt is a powerful predictor for the prognosis of gastric cancer.

Objective To improve the awareness of fetal cardiac rhabdomyomas (CRs) and investigate a better model for prenatal diagnosis and treatment through analyzing imaging findings and prognosis.Methods A retrospective study was conducted on 23 cases of CRs which were diagnosed by ultrasound in Obstetrics and Gynecology Hospital of Fudan University from January 2008 to November 2015.General conditions,imaging features,prognosis and follow-up data of the 23 cases were described.Results The average gestational age of the 23 fetuses at diagnosis was (29.8±4.1) (22.4-35.7) weeks.Seventeen out of the 23 gravidas received prenatal multidisciplinary consultation.Among all 23 gravidas,three (13％) were lost to follow-up,12 (52％) decided to terminate the pregnancy,and the other eight (35％) continued to term pregnancy and their babies were followed up for three years.Of these eight cases,two cases received prenatal brain MRI and no tuberous sclerosis complex (TSC) was detected,no CRs was identified during the follow-up,and their physical and mental developments were both normal.One case was diagnosed with suspected subependymal nodules by prenatal brain MRI in our hospital,but the MRI images was normal when scanned in the other hospital,and follow-up data revealed neither CRs nor abnormal physical and mental developments.Four cases did not received prenatal brain MRI,but the MRI images of neonatal brains indicated TSC,besides,follow-up data showed that seizures were observed,physical developments were all normal,but three of the four cases had mental retardation;CRs disappeared in only two of the four cases.One case had neither prenatal nor neonatal MRI,but follow-up data showed that CRs had disappeared and physical and mental developments were both normal.Conclusions Prenatal diagnosis of fetal tuberous sclerosis is crucial to the prognosis of CRs.Prenatal ultrasonography in combination with cranial MRI improves the accuracy of prenatal diagnosis of CRs complicated with TSC and assists in clinical decision-making and prognosis analysis.

Objective To investigate the relationship between the level of circulating CD133+/KDR+ endothelial progenitor cells (EPCs) and outcome in patients with acute ischemic stroke.Methods Inpatients with first-ever ischemic stroke within 24 hfrom the onset and age-and sex-matched healthy subjects were enrolled in the study.The demographic and clinical data of the patients were collected.The level of CD133+/KDR+ EPCs was detected by flow cytometry.All patients were followed up at 90 d.The modified Rankin Scale was used to evaluate the clinical outcome,0-2 was defined as good outcome and >2 was defined as poor outcome.Results A total of 126 consecutive patients with first-ever ischemic stroke within 24 hfrom the onset and 60 age-and sex-matched healthy subjects were enrolled.In patients with ischemic stroke,33 (26.19%) were large artery atherosclerosis (LAA),74 (58.73%) were small artery occlusion (SAO),19 (15.08%) were cardioembolism (CE);82 (65.08%) had good outcomes and 44 (34.92%) had poor outcomes.The number of circulating EPCs at baseline in patients of the LAA subtype (0.071%±0.018%),CE subtype (0.068%±0.16%) and SAO subtype (0.118%±0.12%) was significantly lower than that in the control group (0.246%±0.052%;all P<0.05),and the CE subtype (P=0.028) and LAA subtype (P=0.037) were significantly lower than the SAO subtype;the CE subtype was lower than the LAA subtype,but the difference was not statistically significant (P=0.762).The proportions of patients with LAA subtype (40.91% vs.18.29%;χ2=7.577,P=0.006) and CE subtype (29.55% vs.7.32%;χ2=11.049,P=0.001) and atrial fibrillation (29.55% vs.10.98%;χ2=6.582,P=0.009),and age (69.64±9.62 years vs.61.12±7.31 years;t=5.570,P<0.001),and baseline NIHSS score (14.16±4.22 vs.6.96±2.04;t=12.919,P<0.001),baseline systolic blood pressure (176.06±13.42 mmHg vs.164.12±11.69 mmHg,1 mmHg=0.133 kPa;t=5.187,P<0.001),low-density lipoprotein cholesterol (2.92±0.52 mmol/L vs.2.49±0.36 mmol/L;t=5.447,P<0.001),fasting blood glucose (8.76±2.88 mmol/L vs.6.82±2.24 mmol/L;t=4.185,P<0.001),C-reactive protein (7.62±1.82 mg/L vs.4.57±1.58 mg/L;t=9.790,P<0.001),and D-dimer (1.14±0.08 mg/L vs.0.97±0.22 mg/L;t=4.946,P<0.001) levels in the poor outcome group were significantly higher than those in the good outcome group,while the proportion of the SAO subtype patients (29.55% vs.74.39%;χ2=23.759,P<0.001),high-density lipoprotein cholesterol (0.94±0.68 mmol/L vs.1.16±0.14 mmol/L;t=2.829,P=0.005),and baseline EPCs (0.069%±0.018% vs.0.098%±0.021%;t=7.755,P<0.001) were significantly lower than those in the good outcome group.Multivariate logistic regression analysis showed that the higher baseline NIHSS score (odds ratio 1.242,95% confidence interval 1.126-1.372;P<0.001),CE subtype (odds ratio 3.460,95% confidence interval 1.312-5.146;P=0.016),and the lower baseline EPCs (odds ratio 1.632,95% confidence interval 1.006-3.024;P<0.001) were the independent risk factors for poor outcome in patients.Conclusion s The level of circulating EPCs was decreased significantly in patients with acute ischemic stroke,and the lower level of baseline EPCs was an independent predictor of poor outcome in patients with ischemic stroke at 90 d.