Clinical, neuroimaging, and pathologic studies suggested that a variety of nonmotor symptoms, such as olfactory dysfunction, dysautonomia, and mood and sleep disorders, can precede the typic motor features of Parkinson disease (PD) by years and, perhaps, even decades. The period when these symptoms arise can be referred as the premotor phase of the disease. This paper reviewed the conception, clinical manifestation, pathology, diogose of the premotor phase of early Parkinson disease.

Objective To evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of Neer three-part fractures of the proximal humerus in young adults. Methods A retrospective analysis was performed of the 46 patients aged < 65 years with Neer three-part fracture of the proximal humerus from March 2010 to December 2016. MIPPO with locking proximal humerus plate ( LPHP ) was used in 23 of them who were 12 men and 11 women with an average age of 41. 6 ± 1. 2 years; open reduction and internal fixation ( ORIF ) with LPHP was used in the other 23 patients who were 14 men and 9 women with an average age of 42. 2 ± 1. 6 years. The 2 groups were compared in terms of operation time, intraoperative bleed-ing, fracture healing time and shoulder function by Neer scoring at the last follow-up. Results The average follow-up ( 13. 4 ± 1. 2 months ) for the MIPPO groups was not statistically different from that for the ORIF group ( 14. 2 ± 2. 4 months ) ( P > 0. 05 ) . The MIPPO group reported significantly shorter operation time ( 105 ± 15 min ) , significantly less intraoperative bleeding ( 140 ± 50 mL ) , significantly shorter fracture healing time ( 4. 2 ± 0. 6 months ) , and significantly higher shoulder Neer scores ( 88. 6 ± 3. 4 ) than the ORIF group ( 120 ± 20 min, 320 ± 40 mL, 5. 4 ± 1. 2 months, and 81. 6 ± 2. 2, respectively ) ( P <0. 05 ) . The complication rate ( 4. 3％, 1/23 ) for the MIPPO group was not significantly different from that for the ORIF group ( 17. 4％, 4/23 ) ( P >0. 05 ) . Conclusion MIPPO with LPHP may be obviously advantageous over ORIF with LPHP in the treatment of proximal humeral fractures in young adults.

Objective To evaluate the effect of gastric compound on patients with middle-late gastric cancer of spleen deficiency and stasis toxin. Methods Ninety patients with middle-late gastric cancer of spleen deficiency and stasis toxin were randomly divided into combined group, chemotherapy group, and gastric compound group, 30 cases in each group. Patients in the combined group were treated with gastric compound and chemotherapy;patients in the chemotherapy group were treated with placebo;patients in the gastric compound group were treated with gastric compound. The changes of QLQ-C30 scale integral, fatigue scale intergral, TCM symptom intergral, Karnofsky integral, and toxic and side effects of digestive tract and myelosuppression were observed to evaluate the effect of gastric compound on quality of life in patients. Results The changes of QLQ-C30 scale integral, fatigue scale intergral, TCM symptom intergral, Karnofsky intergal in combined group were better than those in chemotherapy group and gastric compound group, with statistical significance (P<0.05). The changes of fatigue scale intergral and TCM symptom intergral in gastric compound group were better than those in chemotherapy group, with statistical significance (P<0.05). The myelosuppression and toxic and side effects of digestive tract of combined group was lighter than those of chemotherapy group, with statistical significance (P<0.01). Conclusion Gastric compound combined with chemotherapy can improve quality of life in patients with middle-late gastric cancer of spleen deficiency and stasis toxin, and reduce myelosuppression and toxic and side effects of digestive tract.

Obje:ctive To establish an optimized method to isolate, culture and identify human umbilical cord mesenchymal stem cells (hUCMSCs) in vitro and induce their osteogenic and adipogenic differentiation. Methods The hUCMSCs were isolated from human umbilical cord by digestion with collagenase. After serial subcultivation in vitro, the stem cells were passaged. Morphologic appearance of hUCMSCs was observed under an optical microscope and atomic force microscope. The proliferation rate was measured by MTT assay. Cell cycle and surface antigens were measured by flow cytometry. The osteogenic and adipogenic differentiation was tested and evaluated by specific staining methods. Results The isolation of hUCMSCs by digestion with collagenase was efficient. After seeded for 24 hours, the adherent cells showed spindle shape and fibroblast cell-like shape and the size of hUCMSCs was homogeneous. The similar growth curves of passage 3 and 7 exhibited a great potential for proliferation. Flow cytometry analysis revealed that CD29, CD44 and CD105 were highly expressed on the surface of passages 3 cells, but the expression was negative for CD34, CD45 and HLA-DR. After culture in inducing medium, the cells were successfully induced into osteogenic and adipogenic lineages. These cells were highly positive for alkaline phosphate staining and also showed mineralization presented with von kossa staining after 4 weeks' culture induction of osteogenic differentiation. Furthermore, liquid vacuoles were detected by oil red O staining after 3 weeks' culture induction of adipogenic differentiation. Conclusion An in vitro method for isolation and purification of hUCMSCs from human umbilical cord has been established. The cultured cells were composed of only undifferentiated cells and their biological properties were stable. The hUCMSCs are expected to be a new type of stem cells of tissue engineering.

Objective:To measure the salary satisfaction level of medical staff in county-level public hospitals and provide reference for the design of policy reforms. Method:Eight county-level public hospitals were investigated. All analyses were performed using SPSS 19. 0 via statistical description and binary logistic regression. Results: The total salary satisfaction of the medical staff was 48 . 8%, and the average score was 54 . 05 ± 18 . 04 . The welfare satis-faction is the lowest (38. 8%), and the average score is 7. 98 ± 3. 51. Logistic regression analysis shows that the ac-ademic degree, department category, working hours per week, acceptance of bribes, and officially budgeted posts are the main factors affecting overall compensation satisfaction. Conclusion:The overall salary satisfaction level of medi-cal staff in county-level public hospitals is very low, and the welfare satisfaction is the lowest. Establishing the rea-sonable level of compensation, the rise of compensation, and the welfare mechanism are feasible choices to improve salary satisfaction.

Objective To assess the effective length of jejunal graft when the 3~(rd) intestinal artery is u- tilized as vascular pedicle and afford a reliable theoretic base for clinical esophageal reconstruction.Methods In 32 formalin preserved and 21 fresh cadaver specimens,the diameter of 1st to 5th intestinal arteries and diameter of arterial arches are measured with linear calibre.Measure the length of jejunum that can be harves- ted as graft when the arches are extended.In the 21 fresh specimens,the 1st,2nd,4th and 5th intestinal ar- teries are ligated,acetic ester stained with red dye were injected into the lumen of 3rd intestinal artery via catheter.Extent of distribution of the arteries to the jejunum was observed.And then red ABS solution was in- jected into the 3rd intestinal artery to make into cast specimen.The blood supply distribution of jejunum through 3rd intestinal artery-arterial arch and communicating system were observed again.Results The di- ameter of the 3rd intestinal artery was the largest among the 1st to 5th intestinal arteries.The length of jejunum vascularized by 3rd intestinal artery can be as long as (142.2?62.3) (69.0～206.60cm) in acetic ester in- filtrated specimens.While in ABS east specimen,the average available extent of donor jejunum was(30.8?7.3) (23.0～37.3cm).Conclusion As observed by this applied anatomy study,the jejunum graft vascu- larized by 3rd intestinal artery alone has sufficient length to meet the need of esophageal reeonstrution.

OBJECTIVETo elucidate the necessity of No.14v lymph node dissection in D2 lymphadenectomy for advanced gastric cancer.

METHODSClinicopathological data of 131 cases of advanced gastric cancer receiving D2 or D2+ plus No.14v lymph node dissection were reviewed retrospectively. Clinicopathological factors associated with No.14v lymph node metastasis were analyzed and prognostic value of No.14v lymph node metastasis was evaluated.

RESULTSOf the 131 patients, 24 (18.3%) had positive No.14v lymph node. The incidence of 14v metastasis was associated with tumor location, tumor size, depth of invasion, N staging, TNM staging, No.1, No.6, and No.8a lymph nodes metastasis. Tumor location and N staging were independent risk factors for No.14v metastasis (all P<0.05). The 5-year survival rate was 8.3% and 37.8% in patients with and without No.14v metastasis respectively. The difference was statistically significant (P<0.01). Multivariate analysis revealed that metastasis of No.14v was an independent prognostic factor for advanced gastric cancer after D2 lymphadenectomy (P=0.029, RR=1.807, 95%CI:1.064-3.070).

CONCLUSIONSFor advanced middle and lower gastric cancers, especially those with larger size, serosa invasion and possibility of No.6 lymph node metastasis, it is necessary and feasible to remove the No.14v lymph node.

Adult ; Aged ; Female ; Humans ; Lymph Node Excision ; methods ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; surgery

Objective To explore the correlation between environmental selenium(Se) levels and cognitive ability among rural elderly population, and the effect of Se on cognitive skill of the elderly. Methods Two study sites(Zichuan district and Gaomi city of Shandong) with different environmental Se levels were selected according to rural elderly people ≥ 65 years were extracted by stratified random sampling method in each site. A retrospective survey was carried out using dietary intake questionnaire for the elderly for the past 1 year, and their daily total Se intake was calculated. Questionnaire was also used to obtain cognitive skill information in the elderly people. The Community Screening Instrument for Dementia, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test, the Indiana University (IU) Story Recall Test, the Animal Fluency Test, and the IU Token Test were applied to assess the cognitive ability. Se level in these samples was analyzed. Correlation between the Se levels of environment and those of human body were analyzed statistically. Results There were 0.163), (0.405 ± 0.086)]mg/kg and nail Se[(147.44 ± 17.42), (117.38 ± 22.48)μg/L]between the two groups (U = 31.59, 25.00, 23.67, all P ＜ 0.01 ). There were positive correlation among the nail Se, environmental Se and Se in all subjects(r = 0.51,0.46, 0.60, all P ＜ 0.01 ). The differences of the CSID total score, the CERAD Word List Learning Test, the CERAD Word List Recall Test and the IU Story Recall Test between the two sites were statistically significant(F = 2.56, 9.18, 7.48, 4.42, all P ＜ 0.05), excluding the Indiana University Story Recall Test.After eliminating possible confounding factors, the Se levels and the CSID total score, the IU Story Recall Test, the Animal Fluency Test and the IU Story Token Test had a significantly positive correlation (r = 0.076, 0.138, 0.042,0.107, P ＜ 0.05 or ＜ 0.01 ), excluding the CERAD Word List Learning Test. Conclusions This study supports the hypothesis that a life long low Se level is associated with lower cognitive ability. The cognitive abilities in the elderly population lived in areas with high environmental selenium levels are significantly higher than that of the elderly lived in areas with low environmental selenium levels.

OBJECTIVETo explore the treatment on teeth transposition of maxillary canine and lateral incisor in order to improve the clinical treatment effect.

METHODSEleven patients with transposition maxillary canine and lateral incisor were treated with the method: Expand space, artificial reverse occlusion of transpositional lateral incisor to give way, transpositional lateral canine distalization and controlling root, mesial movement of lateral incisor with tongue arch, interactive controlling roots and retention with tongue fixed retaining appliance.

RESULTSEleven patients had satisfactory treatment effect, with tidy dentition and parallel teeth roots of transpositional canine and lateral incisor.

CONCLUSIONSeries orthodontic treatment on teeth transposition of maxillary canine and lateral incisor can effectively improve the clinical treatment effect and shorten the treatment time.

Cuspid ; Humans ; Incisor ; Malocclusion

Objective To develop an effective real time PCR method for genotyping mitochondrial aldehyde dehydrogenase-2(ALDH2)Glu504Lys polymorphism based on the hydrolysis probes.Methods The Mg~(2+)and probe concentration were optimized,the precision and sensitivity were also checked.The genotypings by this method were confirmed by the direct sequencing of amplified PCR products.Results The optimized Mg~(2+)and probe concentration were 2.5 mmol/L and 1.0 ?mol/L,respectively.The inter- group(n=20)and intra-group(n=20)CVs of Ct were 1.38% and 1.48 %,respectively.The method could detect human DNA in the range of 5.0?10~2-5.0 ?10~6 pg per 25 ?l reaction.The results from 150 individuals by this genotyping method are in full concordance with that by direct PCR products sequencing.Conclusion The combined merits of reliability,flexibility and simplicity should make this method suitable for routine clinical testing and cost-efficient large-scale genotyping.