Objective: To review the research progress of wrist arthroscopy assisted treatment of distal radius fractures. Methods: To summarize and describe the anatomical characteristics and fracture classification of the distal radius, indications and contraindications of wrist arthroscopy-assisted treatment, surgical methods, and associated soft tissue injuries, and summarize the advantages and disadvantages of the operation through a large number of literature at home and abroad on the treatment of distal radius fractures assisted by wrist arthroscopy. Results: Wrist arthroscopy as a minimally invasive technique for the treatment of distal radius fractures, compared with traditional surgery, can accurately observe intra-articular damage and perform operations under the microscope to avoid secondary damage to blood vessels, nerve, and tendon, etc., and can achieve one-stage repair and reconstruction by repairing the ligament, trigonal fibrocartilage complex, and carpal dislocation. It has the advantages of less trauma, fast postoperative recovery, extensive indications, fewer complications, and satisfactory effectiveness. Conclusion: Wrist arthroscopy has advantages that traditional X-ray film, CT, MRI, and arthrography examinations do not have. Moreover, wrist arthroscopy has achieved satisfactory effectiveness in the adjuvant treatment of intra-articular distal radius fractures.

Objective To discuss the postoperative complications of hypertensive intracerebral hemorrhage treated with freehand drilling skull minimally invasive puncture drainage therapy .Methods The clinical data of 158 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed .The incidence rate ,causes and preventative measures of the postoperative complications of hypertensive intracerebral hemorrhage treated with free -hand drilling skull minimally invasive puncture drainage therapy were analyzed .Results 10 cases of scalp bleeding , 4 cases of epidural hemorrhage , 9 cases of puncture pathway bleeding , 24 cases of secondary bleeding , 1 case of intracranial infection,3 cases of low intracranial pressure ,5 cases of pneumoencephalos and 2 cases died.Conclusion Freehand drilling skull minimally invasive puncture drainage leads to less complications and so far it is a safe and effective therapy for hypertensive intracerebral hemorrhage .

Objective To investigate the activation of nuclear factor-κB(NF-κB),which was stimulated by angiotensin-Ⅱ(AngⅡ)through classical pathway in human pulmonary microvascular endothehal cells(HPMEC).Method The experiment was divided into two groups:in Ang Ⅱ group,HPMECS were incubated with 10-6mol/L AngⅡ for 0,0.5,1,2 and 4 hours,respectively;in losartan group,HPMEC was pretreated with 10-6mol/L losartan(inhibitor of AngⅡ type 1 receptor)for 1 hour,and then stimulated with 10-6mol/L AngⅡ for 2 hours,and the nucleax protein and the cell plasma protein were prepared by lysis and centrifugation.Electrophoretic mobility shift assay(EMSA)was used to detect the NF-κB DNA binding activity.The inhibitor of κBa(IκBα)was detected by Western blotting.The data were expressed as(x±s)and analyzed with one way analysis of variance.A P value less than 0.05 indicated significant difference.Results Compared with the activity of NF-κB at 0 h (100.0±25.1)after AngⅡstimalation,the activity increased significantly at 0.5 hour(144.5±16.1,P＜0.05),and reached peak value at 2 hours(270.1±27.2,P＜0.05).The concentration of IκBα at 0 hours was 44.4%±2.1%,decreased markedly at 0.5 hours(38.9%±3.6%,P＜0.05),and to the lowest level at 2hours(32.6%±2.3%,P＜0.05).The activity of NF-κB(115.4±10.7)and the concentration of IκBα(43.6%±3.7%)in losartan group had ilo significant difference with AngⅡ group at 0 h(P＞0.05).The activity of NF-κB and the concentration of IκBα in losartan group had significant difference with AngⅡ group at 2hours.Conclusions NF-κB can be activated through classical pathway,which stimulated by AngⅡ in HPMEC.

Objective To investigate the carcinogeic role of miR-365 in cuntanerous squamous cell carcinoma (cSCC).Methods Normal HaCaT cells were divided into control and irradiation groups,the later was exposed by UVB irradiation (50 J/m2).MicroRNA expression profiles of the two groups were analyzed by microRNA array.The expression variations of miR-365 in HaCaT,A431,Tca8113 and HSC-1 cells were validated by qRT-PCR analysis.The colony-forming and invasion capacities were dectected by colony forming assay and Transwell migration assay in vitro,respectively.HaCaTpre-miR365-2 highly expressing miR-365 was constructed by retroviral vector infection.Tumorigenicity evaluation was carried out by subcutaneously inject of the cells at the right back flank of nude mice.Results There were 30 microRNAs differentially expressed in HaCaT cells after UVB irradiation and miR-365 was one of the most sensitive miRNAs(as high 6.7 times as control).Expression of miR-365 in all the cSCC cell lines A431,Tca8113 and HSC-1 were significantly higher than that in HaCaT cell,in which the maximum was A431 (15.67 ±1.12 times,P ＜ 0.01),and the minimum was TcaS113 (4.72 ± 0.85 times,P ＜ 0.05).Knockdown of miR-365 in cSCC cell lines significantly inhibited the colony forming ability (t =13.68,P ＜ 0.05) and cell migration (t =19.98,P ＜ 0.05) in vitro.HaCaT cells overexpressing miR-365 by transient transfection significantly increased the ability of colony formation (t =7.11,P ＜ 0.05) and cell migration (t =22.03,P ＜0.05) in vitro.In addition,HaCaTpre-miR-365-2 cell line stably expressing miR-365 could successfully establish tumors in nude mice.Conclusions MiR-365 is an oncogene for cutaneous squamous cell carcinoma.

In order to compensate for the deficiencies of current medical education, improve the comprehensive quality of medical students, the First Clinical College, Tongji Medical College of Huazhong University of Science and Technology took the lead in carrying out the health management practice of rela-tives and friends, and made a beneficial exploration of humanistic education for medical students. Relatives and friends were regarded as the specific practice objects, and by telephone and network at school, face-to-face communication during the vacation, medical students established, managed and track the health records of relatives and friends. The students could practice while learning, which made medical students, in im-proving the knowledge structure, enhance their emotional communication with friends and relatives, improve their doctor-patient communication ability, establish the concept of humanistic care, and cultivate their occupation moral respect for life and their dedication to medicine and the sense of responsibility and mission to the society. It provides a new strategy for medical humanities education.

Objective To review the experience on the surgical management for advanced gastric carcinoma with portal hypertension. Methods In this study, 14 advanced gastric carcinoma with portal hypertension patients were analyzed retrospectively, liver cirrhosis was found in 13 cases. In 10 esophageal variceal patients, 5 had upper gastrointestinal bleeding history. All of those cases were associated with different degree of hypersplenism. The tumours situated at the upper third of the stomach in 2 patients, middle and upper third in 2 and lower third in 10. Five patients underwent curative distal subtotal gastrectomy and splenectomy, 2 cases did radical distal subtotal gatrectomy and pericardial devascularizaion, 2 curative distal subtotal gastrectomy combined with splenic artery ligation,2 did total gastrectomy and pericardial devascularizaion,2 cases did radical proximal gastrectomy and pericardial devascularization and 1 patient did distal subtotal gastrectomy only. Results Three died from extensive wound bleeding, jejunal fistula and liver failure respectively. 3 patients were complicated by left subdiaphragmatic abscess, hepatic dysfunction and massive ascites individually. The morbidity and mortality rate were 42.86% and 21.43% respectively. Conclusion The surgical procedures for patients of advanced gastric carcinoma with portal hypertension caused a considerably high postoperative mortality and morbidity rate.

Objective To investigate the expressions of toll-like receptor 4 mRNA and nuclear factor-κB (TLR4-NF-κB) mRNA in lung tissue of rats with acute paraquat poisoning.Methods Thirty male SD rats were randomly divided into two groups,namely normal saline group (NS group,n =6) and the PQ groups (n =24).The rats of PQ group were administered with 20 mg/kg PQ by intraperitoneal injection to establish the models of PQ induced lung injury.The saline was administered once instead in normal saline group.The rats of PQ group were sacrificed separately at 6 h,12 h,24 h,48 h and 72 hours after modeling,while at 6 hours the rats of normal saline group was sacrificed.The expressions of TLR4 mRNA,NF-κB mRNA,and the levels of tumor necrosis factor-α and interleukin-6 in lung (serum) of rats were detected.Meanwhile,pathological changes of the lung tissue were examined under optical microscope.Results There were no histopathological changes such as alveolar edema,hemorrhage and inflammatory cell infiltration found in NS group other than in PQ group.At the 72 h,the expressions of TLR4 mRNA (9.61 ±0.21),NF-κB mRNA (5.62 ± 0.24),and the levels of TNF-α (153.08 ± 5.02) pg/ml,and interleukin-6 (230.08 ± 10.64) pg/mL in lung tissue of rats were significantly higher in PQ group than those in control group (P ＜ 0.01).Conclusions In rats after PQ poisoning,the expressions of TLR4 mRNA,NF-κB mRNA,and the levels of TNF-αand IL-6 were higher than those in normal rats,and the TLR4-NF-κB pathway could play an important role in lung injury of rats with PQ poisoning.

Objective To explore the feasibility and effectiveness of the revised OSCE stations.Methods 106 sstudents of grade 2008 and 2009 from Xinhua clinical medical school of Shanghai Jiaotong University School of Medicine were involved,32 of whom (experimental group) tool modified OSCE examination and 74 of whom (control group) tool traditional OSCE examination.The revised OSCE exam was the one which on the basis of original OSCE test station setup,improved the operating part of the test stand,adopted clinical cases as stem,asked the students to make possible diagnosis,and perform the corresponding operation.We evaluated the students based on the OSCE scores from the school exam and the overall performances in the national clinical skills competition.Comparison between the two groups was performed by using t test.Results All students who have received the new training methods agreed that it stood closer to the clinical setting.Revised-OSCE trained group of students test scores than traditional OSCE trained group of students,though it didn't have statistical significance.Students from the revised-OSCE group had the score of (80.50 ± 15.45),while the traditional group had the score of (78.30 ± 17.68).By taking the revised-OSCE trainings,all the students have improved their clinical skills and two years in a row to win the Shanghai Jiaotong University School of Medicine Clinical Skills Competition.Conclusions Case-based OSCE stations are well accepted.The new OSCE stations are much closer to clinical teaching and can make better objective assessment of students,so it plays a good role in improving medical students' overall performances.

Objective To explore neurocognitive characteristics of human immunodeficiency virus (HIV)-infected patients ,and to compare the efficacy of highly active antiretroviral therapy (HAART ) among patients with different cognitive functions .Methods Cognitive function was evaluated using the Montreal cognitive assessment (MoCA) Chinese version in 118 HIV-positive patients and 62 HIV-negative controls .Among 59 patients on HAART ,CD4 + T cell count and viral load were assessed at enrollment and one-year follow-up .The mean of measurement data was compared using t test ,and enumeration data was analyzed using chi-squared or Fisher exact test when appropriate .Univariate and multivariate analysis were examined using bivariate Logistic regression models .Results Compared with control group ,HIV-infected group was characterized by higher rate of neurocognitive impairment (46 .6% vs 12 .9% , t =20 .30 ,P< 0 .05) ,and generally lower MoCA subscores for visuospatial abilities ,the clock drawing test , naming ,attention ,abstraction and delayed recall (t= - 3 .761 , - 2 .638 , - 4 .263 , - 3 .769 , - 3 .858 and- 3 .111 ,respectively ,all P< 0 .05) .Among patients on HAART ,subjects who scored < 26 showed no significant differences in viral load at three time points (pre-HAART ,post-HAART at enrollment and one-year follow-up) with those who scored ≥ 26 (t = 0 .557 ,0 .737 and - 0 .758 ,respectively ,all P >0 .05) .The former group had lower CD4 + T cell counts both at enrollment ([286 ± 127]/μL vs [363 ± 160]/μL) and one-year follow-up ([334 ± 122]/μL vs [411 ± 152]/μL) than the latter group (t= - 2 .027 and - 2 .067 ,respectively ,both P < 0 .05 ) ,while there were no obvious differences of pretreatment CD4 + T cell counts ([135 ± 77]/μL vs [155 ± 80]/μL) and HAART duration ([22 .29 ± 21 .20] months vs [18 .74 ± 16 .63] months) between these two groups (t= - 0 .968 and 0 .702 ,respectively ,both P>0 .05) .Multivariate analysis revealed that age (OR = 1 .044 ,95% CI :1 .008 - 1 .081 , P < 0 .05) and education time (OR = 0 .820 ,95% CI :0 .723 - 0 .930 , P < 0 .05 ) were independent predictors for neurocognitive impairment among HIV-infected patients . Conclusions Neurocognitive impairment is common among HIV-infected patients ,which is characterized by poor performance in multiple domains , and patients with neurocognitive impairment performed poorly in immune recovery .MoCA could be a useful screening tool of cognitive function in HIV-infected patients . Neurocognitive function has no relationship with pre- and post-treatment viral levels .

Objective To investigate the difference of standard tangential field and multiple fileld radiotherapy in axillary lymph node after conserving surgery,to provide a reference for clinical treatment.Methods 20 cases of left breast cancer patients were selected,all patients underwent breast -conserving surgery,postoperative radiothera-py.All patients used standard radiotherapy wild tangent based and reverse -intensity modulated radiation therapy optimization.Armpit I,Ⅱ lymph nodes were used to calculate the extent of coverage of the original plan,target dose uniformity HI,dose conformal CI,dosimetric parameters were calculated.Results Under standard tangential field irradiation,I stand mean dose was (33.95 ±8.24)Gy,which was significantly higher than Ⅱ station (22.13 ± 6.67)Gy,and V50,V45,V40 were (22.45 ±6.32)%,(39.83 ±7.54)%,(49.65 ±8.31)%,which were higher than Ⅱ stand,I stand irradiation was significantly more,the differences were statistically significant (t =5.632,P =0.009;t =7.214,P =0.000;t =8.954,P =0.000;t =6.121,P =0.002).The whole breast irradiation armpit IMRT plan,19 patients (95.00%)reached 95% by volume APTV≥50Gy,coverage was better;but HI,CI were (1.11 ± 0.03),(1.36 ±0.07)respectively,which were significantly worse than the standard wild tangent,the differences were statistically significant (t =6.584,P =0.001;t =9.144,P =0.000).Under Hatano IMRT irradiation ipsilateral lung,heart suffered an average dose of (1 694.58 ±102.31)cGy,(645.54 ±74.44)cGy,which were significantly more than the standard tangential field irradiation,the differences were statistically significant (t =7.654,P =0.000;t =6.654,P =0.001).Conclusion Standard tangential field irradiation has poor coverage in Ⅱ axillary lymph node station,irradiation intensity modulated radiation has better coverage,but significantly increased the dose to normal tissues.