Objective To explore the significance on expression of mdr-1, P-gp and DNA heteroploidy in invasive bladder carcinoma. Methods The expressions of mdr-1 and P-gp were detected by RT-PCR and immunohistochemistry(SP) method, and DNA ploidy by flow cytometry method in 26 cases of invasive bladder carcinoma tissues, which were compared with those in 10 normal bladder tissues. At the same time, the flow cytometry was used to determine DNA heteroploidy. Results A of mdr-1 in the neoadjuvant chemotherapy CR, PR, non-respond and control group were (0.61±0.75), (0.71±0.11), (1.68±0.28) and (0.745±0.13),respectively (P＜0.05). Positive rates of P-gp had significant differences between CR, PR and non-respondgroup and control group (P ＜0.05). Positive rates of DNA heteroploid in the above groups were 50 %, 45 %,69 % and 10 %, respectively (P ＜0.05). Conclusion The detections of mdr-1, P-gp and of DNA heteroploid contribute to evaluate neo-adjuvant chemotherapy effects of invasive bladder carcinoma.

Objeetive To investigate the outcome of microvascular reconstruction of the tongue with anterolateral thigh flaps in the treatment of middle-late stage tongue cancer patients. Methods From December 2003 to March 2007,nine patients underwent simultaneous reconstruction of the tongue and oral floor defects with anterolateral thigh flaps after resection of squamous cell carcinoma of tongue.The flaps ranged from 7 cm×10 cm to 10 cm×12 cm in size,and were adjusted to the defect of the tongue and oral floor.The vascular pedicle included descending branch of the lateral femoral circumflex artery and the accompanying veins.The outcome of reconstruction was evaluated by follow-up examinations,considering the contour and mobility of the reconstructed tongues,the swallowing function and the speech function.Results All of the donor sites were closed directly,with minimal donor-site morbidity. All patients recovered unevenffully from surgery,with no immediate postoperative complications:no flap necrosis,no wound infection or wound dehiscence.The transplanted flaps survived well.The average follow-up period was 18 months.During the follow-up period there was no tumor recurrence and the contour of the reconstructed tongues showed sufficient bulk.The patients demonstrated good mobility of the reconstructed tongue.The swallowing and speech function recovered satisfactory.Two months postoperatively the patients were able to ingest a solid or semisolid diet,and six months postoperatively the patients developed intelligibe language.Conclusion The anterolateral thigh flaps are suitable and reliable for the microsurgical reconstruction of the large defects caused by middle-late stage tongue cancer.

Objective To evaluate the efficacy and safety of amrubicin for small-cell lung cancer (SCLC ) . Methods PubMed ,Embase ,the Cochrane Library and CNKI were searched to collect amrubicin data in the treatment of SCLC .A Meta-analysis was performed over the published clinical trials .The efficacy and safety of amrubicin were evaluated based on overall survival (OS) ,progression-free survival (PFS) ,overall response rate (ORR) and toxicity .Results Our anal-ysis for 6 clinical trials indicated that amrubicin had significantly higher ORR than control group [RR 1 .72 ,95% CI (1 .39 , 2.14) ,P=0 .000] ,the OS ,PFS and toxicity were no-inferior to the control group(P=0 .405 ,P=0.456) .Conclusion Am-rubicin can be considered as a good second-line treatment for relapsed SCLC .

ObjectiveTo investigate the clinical features and treatment of ascending paralysis after thoracolumbar fracture.MethodsThree male patients with 2 fracture levels at T12 and one at L1 were retrospectively studied.Their mean age was 41.3 years(range,39-42 years).All 3 cases were undertaken open decompression,reduction and internal fixation.Paralysis level began to ascend at 2-5 days after injury,with 2 cases up to C2,3 and 1 case up to T7.Two patients suffered irritating pain over the paralysis level before onset of ascending.Postoperative MRI images demonstrated well reduction and no compression of spinal cord.In the early phase after ascending,MRI obviously showed swelling in spinal cord and long T1 and long T2 signals shaped patchy and stripy distribution in the central area.One patient's MRI displayed that the spinal cord shrinked 16 days after trauma with abnormal high signal in the central area.ResultsTwo cases died of respiratory muscle paralysis and 1 case suffered paraplegia with no recovery 5 years after surgery.ConclusionAscending paralysis after thoracolumbar fracture is a rare complication with very poor prognosis.MRI is available for evaluating operational effects and affected level.The exact mechanism and effective treatment are still unclear and need further investigated.

Objective To evaluate the roles of high-resolution computer tomography (HRCT) and bron- choalveolar lavage (BALF) in the diagnosis of connective tissue diseases associated with interstitial lung disease (CTD-ILD). Methods Clinical data of chest HRCT and BALF of patients with CTD-ILD from January 1997 to December 2007 in in-patient department of Peking University First Hospital, were retrospectively analyzed. Results ①Among 46 cases with the picture of chest HRCT, 19 (41.3%)showed usual interstitial pneumonia(UIP) -like pattern and 18 (39.1%) showed lobular and interlobular septa thickening. 8 (8/17) of ANCA vasculitis (AASV) and 5 (5/9) of rheumatoid arthritis (RA) manifested as UIP-like patterns respectively. In polymyositis/dermatomyositis(PM/DM) and Sjogren's syndrome (KS) patients, the organizing pneumonia(OP)-like pattern and lymphocytic interstitial pneumonia(LIP)-like pattern were 2/4 and 2/4 respectively. ②Among 32 cases undergoing BAL, 10/10 patients with AASV-ILD all showed that neutrophils were dominant in BALF, while, the other 22 patients showed that the ratio of neutrophils elevation (14/22, 63.6%) and the ratio of lymphocytes elevation (18/22, 81.8%) were comparable, and there were 12/22(54.5%)patients with both types of cell elevation. Among 13 cases with iymphocytes elevation in BALF who performed analysis of sub-type lymphocytes, 10/13 cases showed decreased CD4/CD8 ratio, 3/13 cases showed increased CD4/CD8 ratio which were all related with SS. ③Among 15 patients undertaken HRCT and BALF detection together, 7/7 UIP-like cases showed the ratio of neutrephils elevation in BALK While in non-UIP-like cases, 5/8 showed the ratio of lymphocytes elevation. Conclusion ①UIP-like patterns and patterns of lobular and interlobular septa thickening are the most common imaging features of HRCT in CTD-ILD, the former are mostly seen in AASV and RA. OP-like patterns and LIP-like patterns are commonly seen in PM/DM and SS respectively. ②Tbe increased neutrophil percentage is dominant in BAL fluid of patients with AASV-ILD, while the others show that the ratio of neutrophil and lymphocyte elevation are comparable, lymphocytes subtype analysis shows decreased CD4/CD8 ratio is dominant in CTD-ILD patients with lymphocytes increased. There is a significant relationship between increased CD4/CD8 ratio and SS-LIP. ③All of the cases with UIP-like patterns show the ratio of neutrophils elevation in BALF. While the ratio of lymphocytes elevation is dominant in non-UIP-like cases.

Objective:To observe the effect of electromyographic biofeedback on the wrist dirsiflexion function of the patients with cerebral infarction at different Brunnstrom stages, and to clarify the treatment of electromyographic biofeedback,and to provide basis for its clinical application.Methods:A total of 100 cerebral infarction patients were selected.Among them 54 BrunnstromⅠ-Ⅱ patients were randomly divided into treatment group (n= 32)and control group (n = 22),and another 46 Brunnstrom Ⅲ patients were randomly divided into treatment group (n=23)and control group (n=23).The patients in four groups were treated with the same routine stroke rehabilitation therapy while the patients in treatment groups still received the electromyographic biofeedback therapy additionally.The maximum electromyographic contraction of muscle,active range of movement (AROM) and Fugl-Meyers Assessment (FMA)of the extension of wrist joint were evaluated before treatment and 4 and 8 weeks after treatment,respectively.Results:The maximum electromyographic contraction values of muscle of the patients in BrunnstromⅠ-Ⅱ treatment group and control group were significantly improved 8 weeks after treatment (P <0.05),and the value in treatment group was higher than that in control group (P <0.05).The maximum electromyographic contraction value of muscle in Brunnstrom Ⅲ treatment group began to improve 4 weeks after treatment compared with before treatment (P < 0.05) and it was significantly higher than that in control group (P <0.05).The maximum electromyographic contraction value of muscle in Brunnstrom Ⅲ control group began to improve 8 weeks after treatment (P <0.05).The AROM in Brunnstrom Ⅰ-Ⅱ treatment group began to improve 8 weeks after treatment (P <0.05)and it was significantly higher than that in control group (P <0.05)while the AROM in control group had no significant change (P >0.05).The AROM in Brunnstrom Ⅲ treatment group and control group were significantly improved 4 weeks after treatment (P < 0.05 or P < 0.01 ), and the value in treatment group was significantly higher than that in control group (P < 0.05).The FMA in BrunnstromⅠ-Ⅱtreatment group and control group were significantly improved 8 weeks after treatment (P <0.05),while the value in treatment group was higher than that in control group (P <0.05);the FMA in Brunnstrom Ⅲ treatment group began to improve 4 weeks after treatment (P < 0.05)and it was significantly higher than that in control group (P <0.05). The FMA in control group began to improve 8 weeks after treatment (P <0.05). Conclusion:Electromyographic biofeedback can increase the strength and improve the body function of the patients with cerebral infaction.

Objective To investigate the immediate oral feedback after objective structure clinical examination (OSCE) for postgraduate year 1 & 2 surgery residents (PGY1 & 2).Methods 37 PGY1 and 38 PGY2 wereevaluated.The examination was composed of 6 stationsand limited to15 minutes per station.Each station was evaluated by centesimal system score.Immediate oral feedback was given in the last2 minutes.A questionnaire was given to each resident and examiner at the end of OSCE.All data analyses were conducted using SPSS version 22.0,repeated measures ANOVA and LSD test were used,and correlations were tested by the Pearson correlation test.Results The average scores for PGY1 & 2 were (68.97 ± 5.40) and (68.35 ± 5.00),the between-and inter-round differences in average score were not statistically significant.There was no significant correlation about theevaluation of the residents' performance during OSCE between the examiners and the residents.The necessity and effectiveness of immediate oral feedback were confirmed by both the examiners and the residents.Conclusions Immediate oral feedback isfeasible with limited impact on OSCE score,but the plan should be furtherrefined.Follow-up study isnecessary to identify the long-term effect on the clinical competency.

Mastery learning is a competency-based mixed education method, which divides complex medical education contents into several teaching units according to the degree of difficulty and sets minimum passing standard for each teaching unit. Formative assessment was used to evaluate whether the learners had reached the mastery standard and finally mastered the knowledge through pass-continue or fail-repeat approach. The learners who had reached the mastery standard were usually able to use their knowledge more freely in clinical practice, and were able to accomplish more complex tasks through their own judgment with less supervision.