Objective To investigate the clinical efficacy of surgical treatment for stage Ⅳ gastric cancer after conversion therapy.Methods The retrospective cohort study was conducted.The clinicopathological data of 50 stage Ⅳ gastric cancer patients who were admitted to the First Affiliated Hospital of Dalian Medical University between January 2012 and June 2016 were collected.All the 50 patients who were diagnosed with single distal metastasis underwent chemotherapy.After chemotherapy,21 patients with operation indication receiving gastrectomy (R0 or R1 resection) were allocated into the conversion surgery group and 29 without operation indication continuing to chemotherapy were allocated into the chenotherapy group.Patients received S-1 + oxaliplatin or S-1 + docetaxel regimen.Patients underwent open distal or total gastrectomy.Observation indicators:(1) response assessment of chemotherapy (complete remission,partial remission,stable disease and progressive disease),grading of of adverse reactions;(2) intra-and post-operative situations of conversion surgery group:operation procedures,intraoperative situations (operation time,volume of blood loss,number of lymph node dissected and surgical margin) and postoperative situations (complications and duration of hospital stay);(3)comparison of follow-up and survival between the 2 groups;(4) prognostic factors analysis affecting stage Ⅳ gastric cancer patients.Follow-up using outpatient examination,correspondence and telephone interview was performed to detect postoperative survival of patients up to September 2016.Survival time was from operation to the last follow-up or death.Measurement data with normal distribution were represented as x±s.Comparison of count data and univariate analysis were done using the chi-square test.Ordinal data were analyzed by the nonparametric test.The survival rate was calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Multivariate analysis was done using the COX regression model.Results (1) Response assessment of chemotherapy:of 50 patients,24 received S-1 + oxaliplatin regimen and 26 received S-1 + docetaxel regimen.Twenty-one patients in the conversion surgery group underwent chemotherapy,with negative peritoneal metastasis,N2 and below of lymph node metastasis (No.16 lymph node disappeared or reduced),invasive depth ＜T4b and narrowing or disappeared hepatic metastasis.A median preoperative chemotherapy cycle was 4.2 cycles (range,2.0-9.0 cycles).Chemotherapy reaction of 21 patients:15 had partial remission and 6 had stable disease.Twenty-nine patients without operation indication in the chemotherapy group didn't receive surgery.The median cycle of first-line chemotherapy was 5.5 cycles (range,2.0-10.0 cycles).Chemotherapy reaction of 29 patients:13 had partial remission,11 had stable disease and 5 patient had progressive disease.Chemotherapy adverse reactions of 50 patients:26 had reduced white blood cells (WBCs),including 6 with grade Ⅲ-Ⅳ of adverse reactions;29 had reduced neutrophils,including 12 with grade Ⅲ-Ⅳ of adverse reactions;18 had anemia,including 6 with grade Ⅲ-Ⅳ of adverse reactions;12 had reduced platelets,including 2 with grade Ⅲ-Ⅳ of adverse reactions;27 had apositia,including 5 with grade Ⅲ-Ⅳ of adverse reactions;7 had stomatitis;9 had diarrhea;3 had elevated serum creatinin;4 had hand-foot syndrome;3 had abnormal sensory nerve.There was no chemotherapy-related death.(2) Intra-and post-operative situations of conversion surgery group:of 21 patients in the conversion surgery group,8 underwent radical total gastrectomy + D3 lymph node dissection,6 underwent radical distal gastrectomy + D3 lymph node dissection and 7 underwent radical distal gastrectomy + D2 lymph node dissection (including 4 combined with resection of hepatic metastatic tumors and 1 combined with radiofrequency ablation of hepatic metastatic tumor).Operation time,volume of blood loss,number of lymph node dissected and recovery time of gastrointestinal function of 21 patients were (216±31)minutes,(128±52)mL,31±8 and (3.0± 0.7)days,respectively.There were 17 patients receiving R0 resection and 4 receiving R1 resection (3 with positive gastric margin and 1 with positive hepatic margin).There was no death.Seven of 21 patients with complications were cured by conservative treatment,including 2 with pancreatic fistula,1 with intra-abdominal hemorrhage,1 with intestinal obstruction,1 with pneumonia,1 with intra-abdominal infection and 1 with wound infection.Duration of hospital stay of 21 patients was (13.0±3.0) days.(3) Comparison of follow-up and survival between the 2 groups:50 patients were followed up for 6-46 months,with a median time of 24 months.The 3-year cumulative survival rates in the conversion surgery and chemotherapy groups were respectively 33.3％ and 6.9％,with a statistically significant difference between the 2 groups (x2 =7.678,P＜0.05).Results of further analysis showed that R0 resection of 17 patients and R1 resection of 4 patients in the conversion surgery group were respecgtively (25.3±2.8)months and (8.3±0.9)months,with a statistically significant difference between the 2 groups (X2=16.242,P＜0.05).(4) Prognostic factors analysis affecting stage Ⅳ gastric cancer patients:results of univariate analysis showed that T stage,N stage,response assessment of chemotherapy,surgery after chemotherapy and degree of tumor radical resection were related factors affecting prognosis of stage Ⅳ gastric cancer patients (X2 =5.288,12.645,25.581,8.372,12.001,P＜0.05).Results of multivariate analysis showed that R1 resection after conversion therapy was an independent risk factor affecting prognosis of stage Ⅳ gastric cancer patients (HR=14.021,95％ confidence interval:1.928-10.938,P＜0.05).Conclusion Radical resection after conversion therapy can increase survival rate of stage Ⅳ gastric cancer patients,and R1 resection after conversion therapy is an independent risk factor affecting poor prognosis of stage Ⅳ gastric cancer patients.

Attention-deficit/hyperactivity disorder (ADHD)is one of the most common comorbidities of ASD.This article reviews the assessment tools and clinical research (prevalence,clinical characteristics and treat-ment)and fundamental research (iconography,genetics,neurophychology,electronerophysiology)of ASD with ADHD according to lately related articles.The findings suggested that there was lack of researches on treatment and iconography of ASD with ADHD and the conclusions were inconformity.Furthermore,most of the objects in these researches were children of normal intelligence.Thus future research should expand its objects to patients of adult and children with mental retardation and do further explore in iconography and treatment.

Objective To study the identification of rare Nocardiaotitidiscaviarum and its drug sensitivity .Methods Morpho-logical ,physiological and biochemical phenotype identification methods combined with 16S rRNA sequence analysis were employed to identified the bacteria strains .Broth method was used to detect their drug sensitivity .Results The clinically isolated Nocardia strain was identified as Nocardiaotitidiscaviarum which was resistant to piperacillin ,erythromycin ,ceftazidime ,cefoperazone ,gen-tamicin ,cefoxitin ,piperacillin/tazobactam ,and was sensitive to vancomycin ,levofloxacin ,imipenem ,etimicin ,ciprofloxacin ,amika-cin ,sulfamethoxazole .Conclusion 16S rRNA gene sequence analysis can be used to identify Nocardia otitidiscaviarum ,and sulfa drugs shows good therapeutic effect .

Objective:To compare the effects of rotational night shifts on the micturition patterns of fe-male nurses.Methods:A total of 58 nurses without lower urinary tract symptoms were recruited,who worked in the Peking University People’s Hospital during January and June in 2014.The nurses aged 20 -43 years were divided into two groups,the night-shift group (n =28)and the non-shift group (n =30).The alcohol or coffee intaking were forbidden.In the night-shift group,nurses had worked on rota-tional shifts for at least 6 months.Their average age was (26.75 ±4.11)years.In the non-shift group, nurses took regular day-time work,whose average age was (27.80 ±5.60)years.A voiding diary was kept for 7 consecutive days at the end of 6 months,starting 2 days before their night duties until 4 days after completion of their night duties.For comparison,the non-shift group with regular shifts completed a 7-day voiding diary.In the 7-day recording voiding diary,the nurses were required to have the normal in-take of liquid about 1 500 -2 000 mL/d.The frequency volume charts of nocturia,the 8-hour interval urine production and frequency were compared between the two groups.Results:Nocturia frequency was increased in the night-shift group [0.5 (0 -2.4)]compared with the non-shift group [0 (0 -2),P =0.02].The volume of nocturia was increased in the night-shift group [125 mL (0 -660 mL)]compared with the non-shift group [0 mL (0 -340 mL),P <0.01].The 8-hour interval indices showed that urine production changed with shift (P <0.01).In the consecutive 7 days,the nocturnal volume of the night-shift group increased on the day after night shift.When the night-shift nurses returned to daytime duty, the volume of urine decreased but nocturnal urine production remained high,and the frequency of noctu-ria also increased significantly (P <0.05).Compared with the 8-hour interval indices,the night-shift group’s voiding volume [(542.35 ±204.66)mL]and voiding frequency (2.24 ±0.69)were more than those of the non-shift group at the afternoon time (from 2 pm to 10 pm).During the 8 h interval night time (from 10 pm to 6 am),the volume of nocturia in the night-shift group [(309.74 ±162.74) mL]was more than that in the non-shift group [(199.38 ±153.98)mL,P =0.01];the frequency of nocturia in the night-shift group (1.31 ±0.52)was increased than that in the non-shift group (0.82 ± 0.55,P <0.01).Conclusion:The rotational shifts affect the micturition patterns of nurses who go through the night shift work,which increases the volume and frequency of the nocturia.

As one of the species of soil-transmitted helminths (STH), hookworm infection is widely prevalent in tropical and subtropical developing countries. Hookworm is harmful to human health mainly including anemia, digestive tract symptoms, female infection can also cause menopause, abortion, infection in infants and young children can lead growth retardation. With the development of economy and implementation of mass drug administration strategies, the infection of hookworm in human body has decreased continuously, but there are still a large number of mild infection cases which clinical symptoms are not obvious, easy to cause missed diagnosis and misdiagnosis. Several zoonotic hookworm species can cause large-scale infections in cats, dogs and other animals, so as to increase the risk of human hookworm infection. Therefore, it is important to find a highly sensitive and rapid detection techniques to identify hookworm species. In this paper, the existing detection techniques of hookworm were reviewed and their application were prospected to provide ideas for hookworm detection at present situation.

Objective: To investigate the incidence of CMV infection(CMV-I) and CMV related diseases (CMV-D) after allogeneic hematopoietic stem cells transplantation in 70 consecutive allogeneic hematopoietic stem cells transplantation(allo-HSCT) patients and to search for the optimal prophylactic strategy.Methods: Blood samples were monitored using the CMV pp65 antigenemia assay.Of the 70 patients observed,30 patients with chronic myeloid leukemia［CML:CP(27),AP(2),BC(1)］,12 with acute myeloblastic leukemia(AML),10 with acute lymphoblastic leukemia(ALL)and other cases were NHL(3), AA(5), MDS(7), SCLC with pancytopenia (1),CLL(1), and MF (1). Sixty six patients received HLA - identical siblings transplantation and four received tranplants from their HLA- haploidentical donors. Seventy cases included allo-PBPCT (64 cases) , allo-BMT (4 cases) and allo-PB+BMT (2). Before transplantation, all patients and donors received CMV serological examination except 4 pairs of donors/recepients. All 66 patients (3 cases were CMV IgM positive) and 64/66 donors were CMV IgG positive. Results：After transplantation, 64/70 patients developed CMV viremia during monitoring period. Forty three of 70 patients developed CMV-D.Thirty five of them suffered from CMV-associated interstitial pneumonia(CMV-IP). The high peak levels of CMV antigenemia were associated with development of CMV disease　. Close correlation was found between acute graft vs host disease(GVHD) and CMV disease. The patients were followed up for 2 to 24 months. The patients who received preemptive therapy(group A)had significantly better outcome than CMV disease group(group B, P=0.0001). Conclusions: The results suggest that CMV antigenemia has high predictive value for subsequent CMV disease and CMV pp65 antigenemia -guided early therapy has particular advantage for avoiding morbidity and mortality caused by CMV disease.

Background and objective Apolipoprotein E is a constituent of lipoproteins with considerable variation due to cysteine-arginine exchanges. We investigated the relationship between apo E gene polymorphism and the occurrence of coronary artery disease(CAD) in the older population of northern China. Methods The distribution of the HhaI polymorphisms of the apolipoprotein E gene was determined among 55 patients with CAD (CAD group), which was compared with that of 36 elderly subjects without CAD(control group). Results Genotype distributions at both sites (apo E gene 112-bp and 158-bp sites ) were different between the CAD and control groups. The CAD group had lower apolipoprotein Eε2frequencies than the control group (P＜0.05). Conclusion Individuals with apolipoprotein Eε2are likely to have a reduced risk of developing coronary artery disease as demonstrated by elderly subjects in Northern China.

Objective To investigate the drug-resistance of Pseudomonas aeruginosa which producing K lebsiella pneumoniae carbapenemases(KPC) .Methods Pseudomonas aeruginosa strains were derived from two sputum samples .VITEK 2 COMPACT Automated Microbial Identification/Susceptibility Analyzer was employed to identify the bacterial strains .Polymerase chain reaction (PCR) and gene sequencing were adopted to identify the genotypes of KPC enzyme ,Broth dilution method was used to measure the minimal inhibitory concentration(MIC) of antimicrobial agents .Results Both Pseudomonas aeruginosa strains were resistant to β-lactam antibiotic and levofloxacin ,and were intermediary to ciprofloxacin ,and sensitive to gentamicin ,netilmicin ,tobramycin ,colistin and multi-polymyxin B .One of them was sensitive to tigecycline .Carbapenemase produced by the two stains was not metal β-lacta-mase ,with the subtype of KPC-2 .Mating experiments failed to prove the bla K PC gene could be transferred to E .coli J53 .Conclu-sion Appearance of KPC-producing Pseudomonas aeruginosa poses serious challenges to clinical anti-infective therapy .

Hearing Loss, Sensorineural ; genetics ; Humans

OBJECTIVETo evaluate the outcome of Titanium elastic intramedullary nailing (TEN) for the treatment of displaced midclavicular fractures.

METHODSBetween February 2010 and February 2013, 62 patients with displaced midclavicular fractures were treated by TEN, including 27 males and 35 females with an average age of 37.6 years old ranging from 15 to 67 years. The course of disease was from 1 to 9 days (means 2.7 days). Thirty-nine cases were treated by closed reduction and 23 cases by assistant small incision. Based on OTA (the Orthopaedic Trauma Association classification) classification, 31 cases of simple fractures involved 5 cases of 06-A1,15 cases of 06-A2,11 cases of 06-A3; 31 cases of wedge fractures involved 4 cases of 06-B1,12 cases of 06-B2,15 cases of 06-B3. Postoperative pain relief were evaluated by VAS score,and operation time,fracture healing time were recorded. After 6 weeks and after removing internal fixation shoulder joint function was evaluated by Constant score, and shoulder joint function were assessed by Herscovici score after 6 weeks.

RESULTSExcept 2 cases were lost to follow-up, 2 cases did not remove internal fixation, 3 cases' fractures were nonunion, the remaining 55 patients received follow-up for an average time of 11.4 months. The average preoperative VAS score was 5.20±0.71, and it turned to be 1.550.59 at 3 days after operation. The average operative duration was 40 min (15 to 65 min). The average bone healing time was (2.71±0.54) months (2 to 5 months). No difference about bone healing time was found between simple fractures and wedge fractures,and between the patients treated by closed reduction and assistant small incision. According to Herscovici standard, the shoulder function was excellent in 49 cases, good in 4, fair in 1, and poor in 1. Simple fractures achieved better Constant score than wedge fractures at 6 weeks postoperatively, whereas no difference was found at 4 weeks after fixation removal.

CONCLUSIONTitanium elastic nails (TEN) for treatment of displaced midclavicular fractures has advantages of good clinical effect,rapid pain relief,fast recovery of shoulder joint function. For OTA classification type B patients with comminuted fracture can replace steel to achieve very good effect, but to grasp the appropriate.

Adolescent ; Adult ; Clavicle ; injuries ; surgery ; Female ; Fracture Fixation, Intramedullary ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged