We find that there is a correlation among thesize of ventricular septal defect (VSD) (X_2), PaO_2(X_3), V. /V. (X_7) and pulmonary systolic pressure(Y_1), diastolic pressure (Y_2), mean pressure (Y_3)by multivariate stepwise regression analysis, andso there are their parameters in the regression e-quations. The regression equations are Y_1 = 13. 24+ 0. 22X_2 - 0. 09X_3 + 0. 14X_7; Y_2 = 0. 65 + 0. 24X_2+ 0. 12X_7; Y_3 = 3. 54+ 0. 17X_2 + 0. 16X_7. But thecourse of the disease, ∑9 leads QRS dimension,R. /R., L. /L. are non-dominant factors, and sothere are not their parameters in the regression e-quation. The above-mentioned equations mayavoid the patients. with mild, moderate pulmonaryhypertension to have invasive examination, and re-duce its complications.

Objective To study the therapeutic effect of pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet on patients with bile duct Ⅲ of sphincter of Oddi dysfunction (SOD) after cholecystectomy.Methods 72 patients who had a diagnosis consistent with bile duct Ⅲ of SOD seen from February 2010 to February 2013 in our hospital were randomly divided into the control group and the treatment group.Patients in the control group were given pinaverium bromid for 3 months while patients in the treatment group were,in addition to pinaverium bromid,given oryz-aspergillus enzyme and pancreatin tablet.Relief of abdominal pain,abdominal distention and recurrence of the above symptoms after drug withdrawal were studied.Results The scores on abdominal pain in the treatment group before and after treatment were 7.5 ± 1.1 and 3.0 ± 1.6 (P ＜ 0.05) while the scores in the control group were 7.4 ± 1.1 and 5.0 ± 1.4 (P ＜ 0.05),respectively.Alleviation of abdominal pain in the treatment group was superior to the control group (P ＜ 0.05).The scores on abdominal distention in the treatment group before and after treatment were 5.4 ± 0.6 and 1.6 ± 0.5 (P ＜ 0.05) while the scores in the control group were 5.2 ± 0.5 and 4.7 ± 0.8 (P ＞ 0.05),respectively.Alleviation of abdominal distention in the treatment group was superior to the control group (P ＜0.05).The scores of abdominal pain and distention in half year after 3 months' therapy in the treatment group were 3.1 ± 1.7 and 1.7 ± 1.1,respectively,which obviously were lower than the control group (5.4 ± 1.4 and 5.0 ± 0.6,P ＜ 0.05).Conclusions Pinaverium bromid and oryz-aspergillus enzyme and pancreatin tablet could effectively alleviate abdominal pain and distention in patients with bile duct Ⅲ of SOD after cholecystectomy and the recurrence rates of symptoms were significantly lower.

Objective To compare the clinical efficacy and the adverse reaction of transcatheter arteri-al chemoembolization( TACE)alone and combined with stereotactic body radiation therapy( SBRT)in patients with primary hepatic carcinoma by a Meta-analysis. Methods PubMed,Cochrane Library,EMBase,Ovid, MEDLIN,CNKI,CBMdisc,VIP and Wanfang were searched to identify the controlled clinical trials of TACE and SBRT for primary hepatic carcinoma. The obtained data were analyzed using Review Manager version 5. 2 provided by Cochrane Collaboration. To analysis the short-term effect of TACE alone or combined with SBRT, the rate of local tumor control and the difference of one,two,three and five-year survival rate. Results A total of 1 143 patients from 10 controlled clinical trials were involved according to the inclusion criteria. The Meta-analysis showed that TACE and SBRT group significantly increased the short-term effective rate,the rate of local tumor control,l-,2-,3-and 5-year overall survival rates(RR=1. 43,95%CI:1. 32-1. 56,P﹤0. 000 01;RR=2. 09,95%CI:1. 63-2. 69,P﹤0. 000 01;RR=1. 31,95%CI:1. 21-1. 42,P﹤0. 000 01;RR=1. 46, 95%CI:1. 23-1. 72,P﹤0. 000 01;RR=1. 76,95%CI:1. 14-2. 71,P=0. 01;RR=2. 29,95%CI:1. 22-4. 32, P=0. 01). There was no statistically significant difference between the two groups on adverse events such as leucopenia(RR=0.97,P =0. 61),thrombocytopenia(RR =0. 99,P =0.85),hemoglobin decrease(RR =0. 95,P=0. 63),nausea and vomiting(RR=1. 00,P=0. 98),liver function damage(RR=0. 98,P=0. 87). Conclusion Compared with TACE,TACE combined with SBRT can increase the short-term effective rate,the rate of local tumor control,the 1-,2-,3-and 5-year overall survival time of the patients,and does not increase the incidence of adverse reaction. However high-quality trials with large sample sizes are still needed to verify the long-term efficacy and safety.

Objective:To investigate the inhibitory effects of different concentrations of chlorhexidine in the development of peri-odontitis models in rats.Methods:periodontitis models were established by the ligation of bilateral first molars and orally challenge with P.gingivalis W83.0.05%,0.1%,0.2% and 0.5% chlorhexidine were used to wash the periodontal pocket and oral mucosa of the rats.4 weeks later,absolute real time quantitative PCR was used to count the copy of P.gingivalis W83 in rat periodontal pockets.Scanning electron microscopy was used to observe the distribution of P.gingivalis W83 on rat teeth surface.Immunohisto-chemical technique was used to detect the expression of TNF-αin gingival tissue of the rats.Results:0.2% and 0.5% chlorhexi-dine reduced the copy of P.gingivalis W83 on teeth surface and in periodontal pockets (P <0.05);0.1% -0.5% chlorhexidine reduced the expression of TNF-αin gingival tissue (P <0.05).Conclusion:0.1% -0.2% chlorhexidine can inhibit the develop-ment of chronic periodontitis in rats.

BACKGROUND:There are currently various surgical methods of patel a fracture, and they have advantages and disadvantages, thus cannot wel meet the requirements of patients.
OBJECTIVE:To evaluate biomechanical properties of internal fixation plate to treat patel ar fracture and to provide theoretical evidence for clinical application.
METHODS:According to the statistics of patel a in the Chinese population, a titanium al oy spider internal fixation plate was designed and manufactured for the treatment of patel ar fractures. Knee joint specimens in six fresh cadavers were randomly divided into two groups and the comminuted fracture model of patel a were established. The models were fixed with internal fixation plate of patel a and NiTi patel ar concentrator. Biomechanical tests were carried out to compare the biomechanical properties.
RESULTS AND CONCLUSION:Both the two fixation methods could meet the 1-kN quadriceps femoris contraction. The internal fixation plate of patel a was superior to NiTi patel ar concentrator in the patel ar isolation shift, muscle strength and joint strength, as wel as mechanical properties of patel a-point surface. There were significant differences between the two groups (P<0.05). The internal fixation plate of patel a is designed in accordance with the anatomical and biomechanical properties of the patel a, the fixation strength can completely meet clinical requirement and deserve further application.

Objective To investigate the status on children of 3-14 years old who suffered from cerebral palsy in Liaoning province. Methods One thousand three hundred and twenty-three cases of children with cerebral palsy of 3-14 years old who received rehabilitation in city hospital, county hospital and community hospital were investigated from January 2013 to October 2016 in 14 cities in Liaoning Province. The proportion of cerebral palsy children in 3-4 years old, 4-5 years old, 8-9 years old, 5-6 years old , 6-7 years old and 7-8 years old was about 10%, and in the other age the proportion was about 7%. The proportion of men and women generally was 4:1;neonatal convulsion (252 cases, 19%), premature delivery (230 cases , 17.3%) and low birth weight infant (187 cases, 14.1%) were main risk factors and accounted for more than 10%. Spastic type cerebral palsy accounted for the highest proportion (54.35%, 719 cases)and ataxia cerebral palsy accounted for the lowest proportion (2.95%). In complications , lower intelligence accounted for the highest proportion (50.34%, 666 cases), followed by the language barrier (43.99% , 582 cases), and the other complications accounted for less than 10%.;gross motor function classification in most studied children was stageⅡ(35%) and stageⅢ(32.50%); 6.95% patients could go to school, and 84.96% patients had health insurance. Patients coming from city accounted for 69.01%, and patients coming from rural area accounted for 30.99%. Mothers′ education below primary school was 4.16% . 36.05% children received rehabilitation in comprehensive hospital, 60.09%in children′s hospital and 3.85%in maternal and child health hospital. Conclusions Spastic cerebral palsy is the main type of children with cerebral palsy in Liaoning.High risk factors include neonatal convulsions, premature birth and low birth weight infants. Most patients complicate with low intelligence and language barriers.This paper can be used as the basis of further research on prevention and treatment

Objective To explore the effects of acupuncture and individualized occupational therapy on the rehabilitation of patients with unilateral spatial neglect ( USN ) after stroke.Methods Stroke patients with hemiplegia were evaluated by neuropsychological tests,including line bisection,a cancellation test,clock drawing,and figure and shape copying.Sixty-nine right hemispheric stroke patients identified with USN were randomly assigned to 3 groups:20 patients as a control group received conventional rehabilitation therapy ; another 22 patients as an occupational group received type-specific individualized occupational therapy combined with conventional rehabilitation therapy; the remaining 23 patients as an acupuncture combined with occupational therapy group received acupuncture in addition to both conventional rehabilitation therapy and occupational therapy.These three groups were evaluated with neuropsychological tests and the modified Barthel index (MBI) before and after treatment.Results ①MBI scores in the occupational therapy group and the combined group were significantly higher after treatment,but no significant difference was observed in the control group.②The increased MBI scores in the combined and occupational groups were higher than those in the control group.At the same time the increase in MBI scores in the combined group was significantly greater than in the occupational therapy group.③The assessment results with both line bisection and cancellation tests in all three groups were significantly different after treatment.The line bisection results in the occupational therapy group and the combined group were significantly better than in the control group.The cancellation test results in the combined group were significantly better than in the control group.Conclusion These findings show that acupuncture combined with occupational therapy can have a positive effect on neglect recovery and greatly improve the daily life of USN patients.

OBJECTIVETo compare the CC-chemokine ligand 18 (CCL18) expression in the serum and malignant pleural effusion (MPE) of NSCLC patients and explore its regulatory effect on differentiation of monocyte-derived dendritic cells (Mo-DC).

METHODSCCL18 levels in the serum and MPE from 62 NSCLC patients were quantitated by immunoassay. CCL18 in sera from 26 healthy individuals, 28 exudative pleural effusions from inflammatory pulmonary diseases and 17 transudative pleural effusions from non-inflammatory diseases were used as control. Mo-DC was generated by culturing NSCLC-derived monocytes with GM-CSF and IL-4 in the presence or absence of CCL18. The mean fluorescent intensity (MFI) of CD14, CD80, CD83, CD86 and HLA-DR were analyzed by flow cytometry (FCM). Mo-DC was then co-cultured with purified T cells and the percence of CD25(+)FoxP3(+) cells was assayed by FCM.

RESULTSCCL18 levels in the sera of NSCLC patients and healthy individuals were (132.70 ± 15.52) ng/ml and (18.44 ± 0.99) ng/ml, respectively (P < 0.001). The levels of CCL18 in MPE, exudative PE and transudative PE were (155.6 ± 13.58) ng/ml, (190.4 ± 22.33) ng/ml and (20.89 ± 3.03) ng/ml, respectively. CCL18 in the MPE was significantly higher than that in transudates (P < 0.001), however, no significant difference was observed between CCL18 expression in exudative PE and MPE (P = 0.172). Of note, a moderate positive correlation (r = 0.421, P < 0.01) was observed between CCL18 levels in the paired MPE and serum of NSCLC. In the healthy control group, Mo-DC cultured in the presence of CCL18 showed 31.4 ± 15.8 (MFI) of CD14 expression, which was significantly higher than that in Mo-DC cultured in the absence of CCL18 (18.5 ± 8.9, P < 0.05). In contrast, the expressions of MFI of CD80, CD83, CD86 and HLA-DR were significantly decreased upon CCL18 induction (P < 0.05). In the NSCLC group, GM-CSF+IL-4+CCL18 induced a MFI of 45.2 ± 13.8 of CD14 expression in Mo-DC, which was also significantly higher than that of GM-CSF+ IL-4 induction (22.6 ± 10.5, P < 0.01). Similarly, the expressions of MFI of CD80, CD83, CD86 and HLA-DR were significantly decreased in the presence of CCL18 (P < 0.05). Furthermore, the MFI of CD14, CD83, CD86 and HLA-DR had significant differences between GM-CSF/IL-4/CCL18-induced Mo-DC derived from NSCLC patients and healthy control (P < 0.05). Finally, CD4(+) T cells co-cultured with NSCLC-derived, GM-CSF/IL-4/CCL18-treated Mo-DC had significantly higher percent of CD25(+)FoxP3(+) cells compared with that of CD4(+) T cells stimulated with Mo-DC induced by GM-CSF/IL-4(P < 0.01).

CONCLUSIONSCCL18 is present at a high level in MPE and serum of NSCLC patients complicated with pleural effusion and a moderate positive correlation exists between CCL18 levels in the two fluids. CCL18 inhibits maturation of Mo-DC, which consequently stimulates T cells to differentiate into CD25(+)FoxP3(+) regulatory T cells.

Carcinoma, Non-Small-Cell Lung ; metabolism ; Cell Differentiation ; Chemokines ; Chemokines, CC ; metabolism ; Coculture Techniques ; Dendritic Cells ; metabolism ; Flow Cytometry ; Granulocyte-Macrophage Colony-Stimulating Factor ; metabolism ; Humans ; Interleukin-4 ; metabolism ; Ligands ; Lung Neoplasms ; Monocytes ; physiology ; Pleural Effusion ; T-Lymphocytes, Regulatory

Objective:To analyze the level and latent categories of the training needs of the nursing staff of the social volunteer teams in Jiangsu Province, and to provide basis for the targeted training.Methods:From March to July in 2018, 224 elderly care teachers from 13 social volunteer teams of 100 Red Cross societies in Jiangsu Province were surveyed for the knowledge of the care for the aged and the needs of training by the self-designed questionnaires. A total of 207 valid questionnaires were collected, with an effective recovery rate of 92.4%. SPSS 21.0 and Latent GOLD 5.1 software were used for description analysis, hierarchical clustering and latent category analysis.Results:The number of answer of "very need" to knowledge and skills among the aged care teachers for the elderly, such as psychological care, elderly volunteer services and recreational activities for the elderly, was 196, 196 and 193, with a proportion of 94.7%, 94.7% and 93.2%, respectively. Cluster analysis showed that training needs could be divided into four aspects: life care knowledge and skills, health care knowledge and skills, psychological care knowledge and skills, and spiritual comfort knowledge and skills. The results of latent category analysis showed that the aged care teachers could be divided into three groups based on their different training needs: high demand group for overall knowledge and skills, partial demand group for overall knowledge and skills, and high demand group for medical care and psychological care knowledge and skills. The corresponding latent probability of the three groups were 80.2%, 13.0%, 6.8%, respectively.Conclusion:The training for the aged care of social volunteer teams should pay attention to the teaching of spiritual comfort knowledge and skills for the elderly. The training program should be oriented to the multi-level and individualized needs of the teachers, so as to meet the needs of the aged care teachers for their own development.

[摘 要] 以免疫检测点抑制剂（ICI）为代表的免疫治疗是晚期非小细胞肺癌（NSCLC）治疗的重要手段之一，它们通过释放免疫检查点介导的免疫抑制，恢复机体免疫平衡，提高了抗肿瘤有效率，使晚期NSCLC患者的预后得到了显著改善。然而，晚期NSCLC的ICI治疗过程中仍然存在许多尚未解决的问题。本文将围绕ICI治疗晚期NSCLC的全程管理展开论述，包括ICI治疗疗效预测、特殊人群筛查、药物选择、新型药物研发，以及ICI治疗停止后的重启、耐药及免疫相关不良反应（irAE）的处理等，以期为晚期NSCLC患者的ICI治疗提供指导。