Objective To analyze the serumα1-antitrypsin (α1-AT) and α1-glycoprotein (α 1-AGP) in children with Wilms tumor,and to explore the clinical application value.Methods Thirtyeight children with Wilms tumor who received treatment from January 2007 to December 2010 were designed as observation group,38 healthy children were designed as control group.Fluorescence quantitative PCR was performed to analyze α 1-AT andα 1-AGP mRNA transcription levels of two groups,and ELISA was used to measure the serum concentration of α 1-AT and α 1-AGP.Results The mRNA levels of α 1-AT and α 1-AGP in observation group were 3.50 ± 0.37 and 2.10 ± 0.41,which were significantly higher than those in control group (0.90 ± 0.45,0.50 ± 0.24) (P =0.000,0.002).The levels of α 1-AT and α 1-AGP in observation group were (4516.8 ± 102.4),(1316.0 ± 27.3) g/L,which were significantly higher than those in control group [(2467.4 ± 23.8),(728.6 ± 9.4) g/L] (P =0.015,0.008).Conclusion To detect the levels of α 1-AT and α 1-AGP have the potential value for the diagnosis of Wilms tumor,which can be applied to early screening.

In order to improve the clinical skills of medical students,the First Clinical School of Tongji Medical College,Huazhong University of Science and Technology strengthened the construction of teaching base,teaching materials,teaching team,curriculum and assessment methods,and established a comprehensive experimental teaching system of clinical skills.

Objective: To study the glucose,insulin,Cpeptide response and relative safety after orally taking different doses of fructose in type 2 diabetes.Methods: 10 patients with type 2 diabetes,were given 50 g glucose,10 g fructose+40 g glucose,30 g fructose+20 g glucose,40 g fructose+10 g glucose,50 g fructose respectively,the serum glucose,insulin,C-peptide,lactic acid,uric acid,heart ratio and blood pressure were measured at 0 min,15 min,30 min,60 min,120 min and relative safety was observed at the same time.Results: The serum glucose,insulin,C-peptide were significantly lower than 50 g glucose group,the insulin,C-peptide decreased 14.30%,23.73%,40.42%,58.48% and 4.62%,14.32%,7.62%,29.33% in 10F+40G group,30F+ 20G group,40F+10G group and 50F group when compared with 50G group,which showed dose-response relationship.The glycemic index was 91.8,62.4,43.6,37.5 in 10F+40G group,30F+ 20G group,40F+ 10G group and 50F group.No adverse effect was observed during the test.Conclusion: It is beneficial to the protection ? cells of pancreas to orally take different doses of fructose.Fructose taken orally may influence the serum lactic acid.

Objective To observe the relationship between the integrity of Willis circle and aneurysm with MSCT angiography.Methods CTA data of 580 patients with intracranial vascular lesions were retrospectively analyzed.The morphological structure of Willis circle and the occurrence of aneurysm were observed based on axial thin-layer,VR,MIP and MPR images.According to the integrity,Willis circle were divided into type Ⅰ (Willis circle complete),type Ⅱ (the anterior circulation complete but the posterior circulation incomplete),type Ⅲ (the anterior circulation incomplete but the posterior circulation complete) and type Ⅳ (both the anterior and posterior circulation incomplete) for statistical analysis.Results For the classification of Willis circle,there were 118 cases of type Ⅰ (118/580,20.34％),344 of type Ⅱ (344/580,59.31％),25 of type Ⅲ (25/580,4.31％) and 93 cases of type Ⅳ (93/580,16.03％).The incidence of Ⅰ-Ⅳtypes of Willis circle with aneurysm accounted for 16.10％ (19/118),14.83％ (51/344),32.00％ (8/25) and 23.66％ (22/93),respectively.The incidences of aneurysm in patients with different types of Willis circlewere statistically significant (x2=8.013,P=0.046).There was statistical difference of the type of Willis circle between different genders (x2=12.631,P=0.006),and the incidence of aneurysm in females was higher than that in males (25.00％ [63/252] vs 11.28％ [37/328];x2 =18.80,P＜0.025).Conclusion Most Willis circle were not complete,and incomplete Willis circle aneurysm tended to occur in females with higher aneurysm rate.

Objective:To explore the diagnosis and treatment of the multi-segment injury of brachial plexus and provide reference for diagnosis and treatment in clinical practice.Methods:From October, 2012 to January, 2015, 24 patients (21 males and 3 females, aged 7-46, average at 25.06±13.01 years) who suffered multi segments injury of brachial plexus were treated by surgical operations. Time from injury to surgery was 7 days to 7 months, with (2.43±2.15) months in average. The general data, injuries and surgical procedures of the patients were recorded. Muscle strength grading was used to evaluate and analyse the curative effect.Results:Twenty-four cases were followed-up for 3.1-7.2 years, with 4.3 years in average. Of the patients, 58.3% of the injuries were caused by mechanical traction. Combined injuries were counted for 83.3%, of which 62.5% combined with ipsilateral limb fractures, 20.8% (5/24) involved in the root of brachial plexus, 79.2% (19/24) with upper part of the clavicle, 91.6% (22/24) with lower part of the clavicle, 16.7% (4/24) with branches of the brachial plexus and 91.7% (22/24) with injuries of 2 segments, 8.3% (2/24) with injuries of 3 segments. At the last followed-up, 55.0% of the patients achieved better than M 3 in total muscle strength. The excellent and good rate was 70.8% in neurolysis group and 42.9% in multiple segment injury group. Conclusion:The mechanism of multi segments injury of brachial plexus is special, and the actual injury is difficult to be located. For patients with multi segments injury, surgical operation should be carried out as early as possible, and the correct surgical procedure can only be determined after the exploration of all sections of the brachial plexus.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.