Objective:To investigate the value of ultrasound in evaluating pathologically complete response(pCR) of neoadjuvant chemotherapy(NAC) for breast cancer.Methods:A retrospective analysis was performed in 67 breast cancer patients who received NAC in the Second Affiliated Hospital of Harbin Medical University from January 2018 to December 2019. Ultrasound examination was performed before and after NAC, and two-dimensional, color and elastic images were stored for subsequent analysis. According to the operation pathological results after NAC, the patients were divided into two groups, pCR group and npCR group, using the Miller-Payne criteria as the evaluation criteria. Chi-square test was used to compare the ultrasound characteristics of breast masses in pCR group and npCR group before NAC. The accuracy, sensitivity, specificity, positive predicative value(PPV) and negative predicative value(NPV) of pCR were analyzed using ROC curve. The difference of pCR estimated by ultrasound in different molecular types was also analyzed.Results:①Of the 67 patients, 16 achieved pCR and 51 achieved npCR. Among the 16 pCR patients, 11(68.8%) were evaluated correctly and 5(31.2%) were wrong.Among the 51 npCR patients, 49(96.1%) were evaluated correctly and 2(3.9%) were wrong. ②There was no statistically significant difference between pCR and npCR in ultrasound features of pre-NAC breast masses( P>0.05). ③After the whole process of NAC, the accuracy, sensitivity, specificity, PPV and NPV were 89.6%, 68.8%, 96.1%, 84.6%, and 90.7%, respectively; The area under ROC curve was 0.824. ④The diagnostic efficiency of pCR estimated by ultrasound was higher for Luminal B and HER-2 breast cancer. Conclusions:The accuracy of pCR after NAC evaluated by ultrasound is 89.6%, with different diagnostic efficiency in different molecular types.

Objective To observe analgesia effect of morphine hydrochloride and hydromorphone hydrochloride in patients after transurethral resection of prostate. Methods Patients after transurethral resection of the prostate (TURP) were randomly divided into 2 groups, morphine hydrochloride group (n=45) and hydromorphone hydrochloride group (n=47). Analgesia, sedation efficacy and adverse reactions were evaluated at 6 and 24 h after they received epidural postoperative analgesia by using VAS score and Ramsay score. Results In 6 h, hydromorphone hydrochloride group had a better pain tolerance and feeling than morphine hydrochloride group (P<0.05) [(2.9±0.3) score vs.(1.3±0.2) score, (2.4±0.3) score vs. (0.9±0.2) score].However, in 6-12 h, the results were on the contrary (P<0.05) [(3.4±0.3) score vs.(5.4±0.3) score, (3.3±0.2) score vs. (5.7±0.4) score].After 24 h, there was no difference between the two groups (P>0.05).There were no differences in adverse reactions between the two groups ( P>0. 05 ) . Conclusion Hydromorphone has a better effect than morphine in epidural analgesia in 6 h.

Objective:To explore the effects of caffeine on the prevention of Alzheimer's disease (AD).Methods:Use Ethanol as a solvent to extract the caffeine in tea and then injecting 5％ D-galactose saline solution 1ml/d/kg to establish aging model mice.Divide mice randomly into experimental group (high-dose/low-dosecaffeine),positive control group,negative control group,and normal con-trol group (NS) and injecting appropriate drugs for consecutive four weeks.Test superoxyde dismutase (SOD) and malondialdehvde (MDA) periodically.Take mice's hippocampus and use Western blotting to detect the expression of brain derived neurotrophic factor (BDNF) and extracellular signal-regulated kinasesl/2 (p-ERK1/2).Results:The expression of BDNF and p-ERK1/2,negative control group is less than low-dose experimental group and positive control group (P＜0.01);The p-ERK1/2 expression of injecting D-galactose mice was significantly lower than normal group,negative control group compared weth the normal group,the differencd was significant (P＜0.05).The level of SOD in model group was significantly lower than that in normal control group,high,low dose caffeine group and positive control group (P＜0.01),but the level of MDA is opposite.Conclusions:Caffeine can delay aging process by increasing the level of SOD in aging mice,and enhancing the expression of BDNF and P-ERK1/2.Caffeine does a lot to prevent AD.

Per2 gene plays one of the most critical roles of clock gene which modulates circadian rhythm both in the physiological, biochemical and behavioral processes of organisms. The distributions of per2 gene include suprachiasmatic nucleus of the hypothalamus, central nucleus of amygdala, bed nucleus of the stria terminalis, hippocampus and other components of limbic system; it affects the emotional and visceral activities through participating in the system of circadian rhythm. The central per2 gene regulates the hypothalamus-pituitaryadrenal axis through integration of light input, steroid hormones and other neurotransmitters integration, acting on the target organs, and presentes a circadian rhythm of movement. This article reviewed the morphology and biology of per2 gene, and its participation in limbic system regulating the circadian rhythm of motional and visceral activities.

Objective To evaluate the effect of virtual reality on motor function in patients with stroke. Methods PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals and Wanfang Data were searched for the randomized controlled trials (RCTs) of virtual reality on motor function in patients with stroke from the date of establishment to January 2013. The included studies were evaluated according to the method recommended by the Cochrane Collaboration. RevMan 5.0 software was used to analyze the extracted data. Results 20 trials were included (13 trials about the upper extremity function and 7 trials about the lower extremity function). Compared with conventional training, the virtual reality training significantly increased the score of Fugl-Meyer assessment (FMA) (WMD=4.27, 95%CI: 2.47~6.06, Z=4.67, P<0.00001) and Box and Block Test (BBT) (WMD=9.29, 95% CI: 5.24~13.34, Z=4.50, P<0.00001). However, the results of Berg balance scale (BBS) (WMD=1.63, 95% CI: -0.83~4.09, Z=1.30, P=0.20) and walking speed (WMD=0.01, 95%CI: -0.14~0.17, Z=0.18, P=0.86) were not statistically significance for the lower extremity function. According to the Jadad Score of included studies, 16 of them were of low quality and only 4 of them were of high quality. Conclusion The virtual reality training could improve the upper extremity function in patients with stroke, but not for the lower extremity function.

Objective To compare the clinical efficacies of Qin’s scalp eight-needle acupuncture versus conventional scalp acupuncture in treating cancer pain. Method Sixty cancer pain patients with clinically or pathologically diagnosed malignant tumors were allocated, using a random number table, to a treatment (Qin’s scalp eight-needle acupuncture) group of 30 cases and a control (conventional scalp acupuncture) group of 30 cases. The treatment group received Qin’s scalp eight-needle acupuncture at selected points every other day and the control group, conventional scalp acupuncture every other day. One course of treatment consisted of 10 days. Result Cancer pain was relieved, analgesic dosage decreased, adverse reactions to analgesics reduced and quality of life raised significantly in the treatment group compared with the control group. Conclusion Qin’s scalp eight-needle acupuncture is effective in treating cancer pain.

BACKGROUND:Bone marrow mesenchymal stem cel s transplantation can inhibit experimental emphysema inflammatory reaction and apoptosis, and has been experimental y confirmed to treat severe lung function impairment. OBJECTIVE:To explore the inhibitory effects of bone marrow mesenchymal stem cel s transplantation via different ways on inflammatory reaction and apoptosis due to experimental emphysema. METHODS:Female Wistar rats were randomly divided into control group, intravenous group and endotracheal group fol owing model establishment using fumigation plus intratracheal instil ation of porcine pancreatic elastase. In the latter two groups, bone marrow mesenchymal stem cel s from male rats were injected via the tail vein and the trachea, respectively. In the control group, rats were given PBS via he tail vein and trachea. At 14 days after transplantation, pathological changes of rat lung tissues were observed, cel apoptotic index in alveolar wal cel s and tumor necrosis factorαlevel in the bronchoalveolar lavage fluid were detected. RESULTS AND CONCLUSION:Compared with the control group, in the intravenous and endotracheal groups,the pathological changes of lung tissues were relieved, tumor necrosis factorαlevel and apoptosis index were reduced significantly (P<0.01);but there were no differences between the intravenous and endotracheal groups (P>0.05). These findings indicate that bone marrow mesenchymal stem cel s transplantation via the tail vein and trachea both can exert obvious therapeutic effects on emphysema. Moreover, cel transplantation via the tail vein is more convenient and easier than that via the trachea in the treatment of emphysema.

BACKGROUND:Bone marrow mesenchymal stem cells transplantation can change the surrounding microenvironment through paracrine mechanisms, and can be employed for treatment of serious damage to lung function through the promotion of angiogenesis, inhibition of apoptosis and maintaining functional stability of autonomic nervous system. OBJECTIVE:To observe the inflammatory reaction in experimental emphysema and inhibition of apoptosis through bone marrow mesenchymal stem cells transplantation.
METHODS:Twenty-four Wistar female rats were randomly divided into three groups:healthy control group, model group and experimental group. In the latter two groups, smoking and endotracheal instil ation of porcine pancreatic elastase were performed to establish emphysema models. After modeling, bone marrow mesenchymal stem cells were injected via tail vein in the experimental group. Pathological changes of the lung, the level of tumor necrosis factor-alpha and cellnumber in the bronchoalveolar lavage fluid as wel as apoptotic index in lveolar wal s were detected after celltransplantation.
RESULTS AND CONCLUSION:In the model and experimental groups, pathological changes of lung tissues were observed to different extent. The lung pathological changes were slighter in the experimental group than the model group (P<0.01). The level of tumor necrosis factor-alpha and apoptotic index in lung tissue were lower in the experimental group than the model group (P<0.01). These findings indicate that bone marrow mesenchymal stem cells can improve emphysema pathological y through inhibition of inflammatory response and apoptosis in experimental emphysema.

Intertrochanteric femoral fractures are common in clinical practice and the key to treatment is timely stable fixation and early rehabilitation to prevent bedridden complications. At present, the failure of common internal fixation system in the treatment of unstable intertrochanteric femoral fractures is not rare. The authors think that for the normal anatomical type of leverage structure of human proximal femur, pivot can bear weight and complete multidirectional activities because its pivot is close to the center of the body. The intertrochanteric femoral fractures destroyed the trabecular structure on the tension side and pressure side. At the same time, the physiological lever of the proximal femur was destroyed. The cause for the failure of the existing internal fixation is the inability to reconstruct the physiological pivot. Based on the anatomical and biomechanical characteristics of the proximal femur, the author reviewed the previous literatures and analyzed the problems in the treatment of intertrochanteric femoral fractures, and for the first time raised the " lever-pivot balance" theory for the treatment of intertrochanteric femoral fractures. This theory opens a new way for solving the problems in treatment of intertrochanteric femoral fractures.

Objective:To investigate the characteristics of postoperative internal fixation failures of femoral intertrochanteric fractures and analyze the related reasons using the leverage-balance-reconstruction theory.Methods:A retrospective case series study was performed for 40 patients suffering from implant failure after internal fixation of femoral intertrochanteric fractures admitted to Peking University People's Hospital from January 1999 to December 2019. There were 20 males and 20 females, aged from 43 to 92 years [(74.1±11.5)years]. The patients were assigned to extramedullary fixation (extramedullary fixation group, 17 patients) and intramedullary fixation (intramedullary fixation group, 23 patients). Complications associated with internal fixation were recorded, including internal fixation cutout, coxa vara deformity of hip joint, internal fixation withdrawal, femoral heck shortening and internal fixation breakage. Based on the lever-balance-reconstruction theory, the failure reasons of internal fixation were analyzed in combination with the change of arm length and outward shift of fulcrum measured before operation, after internal fixation and after fixation failure.Results:Among 40 patients, internal fixation cutout occurred in 18 patients, coxa vara deformity of hip joint in 37, internal fixation withdrawal in 29, femoral neck shortening in 37 and internal fixation breakage in 3. In extramedullary fixation group, the lengths of primary power arm and resistance arm were (8.0±1.0)mm and (59.4±10.9)mm, the lengths of power arm and resistance arm after fixation were (72.7±21.7)mm and (8.9±7.4)mm, the lengths of power arm and resistance arm after fixation failure were (50.3±14.9)mm and (33.6±17.6)mm. In intramedullary fixation group, the lengths of primary power arm and resistance arm were (6.7±0.6)mm and (49.8±9.9)mm, the lengths of power arm and resistance arm after fixation were (51.5±7.0)mm and (19.8±5.9)mm, the lengths of power arm and resistance arm after fixation failure were (41.6±9.6)mm and (32.4±7.7)mm. In each group, the lengths of power arm and resistance arm after internal fixation showed significant differences from that of normal ones and from that after fixation failure ( P<0.05). The length of power arm in extramedullary fixation group was larger than that in intramedullary fixation group ( P<0.05). The shortening of power arm in extramedullary fixation group was larger than that in intramedullary fixation group after fixation failure ( P<0.05). Conclusions:The extramedullary and intramedullary fixation of femoral intertrochanteric fractures result in the displacement of reconstruction fulcrum. The shortening of power arm is observed after fixation failure. The leverage-balance-reconstruction theory is helpful to analyze the cause of complications. The power arm after extramedullary fixation is longer than that after intramedullary fixation and is therefore more prone to fixation failure. The primary cause of postoperative internal fixation complications is to achieve a new balance of leverage.