The incidence of local recurrence after wide local excision and radiation of soft tissue sarcoma (STS) ranges from 5％ to 20％.The optimal management of locally recurrent STS must be individualized.Approaches for retreatment include wide local re-excision followed by a variety of radiation which include external-beam radiation,brachytherapy and intraoperative electron radiotherapy.Following retreatment,the likelihood of ultimate local control ranges from 37％ to 100％.However,each radiation technique could produce severe side effects,and so for selected patients,repeat irradiation may be unnecessary.

Objective To investigate the effects of micronutrients selenium(Se), vitamin E(VE), vitamin C(VC) and magnesium(Mg) on levels of TXA 2, PGI 2 in plasma of rats with hyperlipidemia induced by high fat and high cholesterol diet. Methods Sixty Wistar juvenile rats were randomly divided into five groups. Each group was fed with normal diet, high fat and high cholesterol diet (HFD), HFD+Se+VE+VC, HFD+Mg, and HFD+Se+VE+VC+Mg, respectively. After eight weeks, the rats were sacrificed for the detection of levels of lipid, TXA 2 and PGI 2 in the blood. Result Micronutrient complex (Se, VE, VC, and Mg) can significantly inhibit the increase of blood triglycerol, total cholesterol, LDL C and TXA 2 induced by HFD and can significantly increase HDL C. Conclusion Micronutrient complex (Se, VE, VC, and Mg) has the lipid lowering effect and can decrease TXA 2/PGI 2 ratio, which is beneficial to the prevention of atherosclerosis.

ObjectiveTo explore the relationship between the different body mass index (BMI) ranges and all cause mortality in hemodialysis (HD) patients. MethodsEligible studies assessing the effects of BMI ranges on all-cause mortality(published from 1966 to 2012 )were searched, using hemodialysis/haemodialysis and obese/body mass index/overweight andmortality/surwival/reverse epidemiology/obesity paradox in PubMed,Embase,ScienceDirect,Wilcy,Scopus and Ovid. Inclusion criteria were that trials reported mortality in HD patients according to the traditional WHO/NIH BMI classification,and BMI levels were acceptable within 2 kg/m2.The quality of the trials was evaluated using the assessing risk of bias in studies included in Cochrane reviews.The mortality rate in HD patients was the primary endpoint of the study.ResultsWith no significant heterogeneity ( I2 =0％,P =0.45 ),a fixed-effects model was used for analysis.Four studies with a total of 81 423 patients met final inclusion criteria.Compared to individuals with non-elevated BMI levels,the elevated group (BMI ≥25 kg/m2) was associated with lower all-cause mortality ( OR 0.67,95％ CI 0.65-0.68 ). In a risk-adjusted sensitivity analysis,elevated BMI levels remained protective against mortality( adjusted HR 0.94,95％ CI 0.92-0.96 ).ConclusionsHigh BMI levels are associated with lower all-cause mortality rate in HD patients.More stable hemodynamic status,cytokine and neurohormonal alternations,and nutritional status maybe contribute to the protective effects of BMI on the mortality of HD patients.There is a need for more prospective studies to elucidate underlying mechanisms.

Objective To observe the mitochondrial damage associated with protein-energy wasting of skeletal muscle in diabetic kidney disease (DKD) model of Goto-Kakizaki(GK) rats and evaluate the effects of low-protein diet supplemented with α-keto acids on muscle wasting.Methods Forty-five male 24-week-age GK rats were randomly divided into three groups,normal protein diet group (NPD),low-protein diet group (LPD) and LPD +or-keto group (Keto).Fifteen gender and age matched Wistar rats were served as control group (CTL).The living condition of GK rats was observed and the weight was measured once a week.Urine albumin,serum glucose,creatinine and urea nitrogen were measured at 24,32,40,48 week age.Soleus muscle was observed to calculate the muscle size and the percentage of Ⅰ and Ⅱ type muscle fiber with software after SDH and NADH staining at 48-week-age.Tissue ultrastructure was observed under the transmission electron microscopy.The activity of citrate synthase was detected by spectrophotometer.Expression of mitochondrial DNA was examined by Q-PCR.Results Compared with the CTL group,NPD,LPD and Keto groups had lower body weight,higher urine albumin,higher serum creatinine and urea nitrogen (P ＜ 0.05).The crosssectional area of muscle fibers was larger in CTL group.Compared with CTL group,the muscle fiber was partly broken,the mitochondrial morphology was obviously changed,the percentage of type Ⅱmuscle fiber was increased significantly (P ＜ 0.05),and the activity of citrate synthase and the number of mitochondrial DNA were decreased significantly in NPD,LPD and Keto groups (P ＜ 0.05).In Keto group,muscle wasting was improved compared with NPD and LPD group (P ＜ 0.05),the crosssectional area of soleus muscle increased and the percentage of type Ⅱ muscle fiber decreased,levels of urine albumin,semm creatinine and urea nitrogen decreased (P ＜ 0.05).Under transmission electron microscopy,the muscle fiber of keto group was intact and mitochondiral morphology was close to that of CTL group.The activity of citrate synthase and number of mitochondiral DNA were higher as compared to CTL group (P ＜ 0.05).There were no significant differences between NPD and LPD group.Conclusions In DKD condition,protein degradation in the skeletal muscle is accelerated,mitochondrion is swelling,the number of mitochondrial DNA is decreased and mitochondrial function is impaired.Low-protein diet supplemented with α-keto acids can improve mitochondrial damage and muscle wasting induced by DKD.

BACKGROUND:Al oying is a convenient and effective method to alter the microstructure and control the corrosion behavior of magnesium al oy.
OBJECTIVE:To explore the in vitro and in vivo degradation of Mg-Nd-Zn-Zr al oy as a degradable medical biomaterial.
METHODS:(1) In vitro static immersion test:The immersion tests were carried out at (37.0±0.5) thermostatic bath. Six Mg-Nd-Zn-Zr al oy samples and six pure magnesium samples were immersed in the 250 mL simulated body fluid and vibrated without agitation during immersion. After 3, 7 and 30 days static immersion, the samples were taken out from the simulated body fluid. Then the in vitro corrosion properties were evaluated using scanning electron microscope and energy dispersive spectrometer analysis. (2) In vivo animal experiment:After bone tunnel was established in the left femur of adult New Zealand rabbits, the Mg-Nd-Zn-Zr al oy rods were embedded in the Mg-Nd-Zn-Zr al oy group, titanium al oy rods were embedded in the titanium al oy group, and only bone tunnel was established in the sham-operated group. At 1, 2, 4, 8 weeks after implantation, an X-ray of the implanted region was taken to determine the location and the degradation behavior℃in a of Mg-Nd-Zn-Zr al oy. At 4, 8 weeks after implantation, the corrosion product and its element composition were observed using scanning electron microscope with an energy dispersive spectroscopy system.

Objective To observe the clinical effects of radiotherapy and/or chemotherapy in the treatment of nasal and Waldeyer ring natural killer (NK)/T cell lymphoma and to analyze the prognostic factors.Methods Between January 20,2000 and December 21,2010,109 patients with nasal NK/T cell lymphoma and 21 patients with Waldeyer ring NK/T cell lymphoma were admitted to our hospital; the diagnosis was confirmed by immunohistochemistry.According to the Ann Arbor staging system,116 patients were classified as stage Ⅰ E,and 14 as stage Ⅱ E.Thirty patients received radiotherapy alone;2 patients received chemotherapy alone; 98 patients received radiochemotherapy.Results The follow-up rate was 100％.Seventy-eight patients were followed up for at least 5 years.The complete remission (CR) rate was 89.2％ in all patients.The CR rates of stage Ⅰ E patients and stage Ⅱ E patients were 88.8％ and 92.9％,respectively (x2 =0.02,P =0.837).The CR rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 86％ and 96％,respectively (x2 =1.44,P =0.230).The five-year overall survival (OS) rate and disease-free survival (DFS) rate of all patients were 58.0％ and 57.2％,respectively.The five-year OS rates of stage Ⅰ E patients and stage Ⅱ E patients were 60.6％ and 36.3％,respectively (x2 =0.25,P =0.615) ;the five-year DFS rates of stage Ⅰ E patients and stage Ⅱ E patients were 59.7％ and 36.3％,respectively (x2 =0.21,P =0.648).The five-year OS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 70.0％ and 48.4％,respectively (x2 =0.01,P =0.933) ; the five-year DFS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 65.6％ and 48.4％,respectively (x2 =0.09,P =0.764).The grade 3-4 toxicity rates of radiotherapy alone and radiochemotherapy were 6.7％ and 54.1％,respectively (x2 =41.38,P=0.002).The radiation dose to the primary lesion and Eastern Cooperative Oncology Group (ECOG) score were correlated with OS (x2 =3.1 8,P =0.005 ; x2 =2.97,P =0.008).Conclusions The clinical effect of radiochemotherapy is similar to that of radiotherapy alone in the patients with stage ⅠE and ⅡE nasal and Waldeyer ring NK/T cell lymphoma,but radiochemotherapy has higher toxicity than radiotherapy alone.The radiation dose to the primary lesion and ECOG score are the influential factors for OS.

To improve the quality of postgraduate students,school of medicine of Shanghai Jiao Tong University have offered medical molecular genetics course to postgraduates and obtained good teaching efficiency. More than ten professors gave lectures on the academic foreland,leading students to find and solve academic problems and training practical and innovative ability of students. Accord-ing to the questionnaires of evaluation of the course and suggestions from postgraduates in the recent two years,some recommendations for the further teaching reform were proposed,such as using multi-plex teaching models,strengthening communication for teaching information with the students,em-ploying comprehensive evaluation methods and strengthening coordination and management of the course.

Objective To investigate the effects of S100B on the expressions of dopamine receptors and the synthesis,metabolism of neurotransmitters dopamine,5-hydroxytryptamine which are related to the abnormal motor coordination of Parkinson's disease (PD).Methods The hS100B transgenic mice were established.The mice were divided into S100B transgenic group (TG,n =14),S100B knockout group (KG,n =14) and the non-transgenic control group (CG,n =14).The motor coordination ability of mice was measured by the Rota-rod test.The expressions of dopamine D1 receptor (D1DR),dopamine D2 receptor (D2DR),tyrosine hydroxylase (TH) and phosphorylated TH at Ser19,Ser31,Ser40 in brain tissue were detected by reverse transcription polymerase chain reaction and Western blotting.The levels of Tyr,levodopa,dopamine,homovanillic acid,Trp,5-hydroxytryptamine and 5-hydroxyindoleacetic acid in mesencephalon were measured by high performance liquid chromatography with fluorescence detection.Results Compared with CG,the motor coordination ability of mice (s) showed progressive decline in TG (3 months:4.60±0.30vs4.25±0.21,q =5.194;6 months:4.52±0.31 vs4.07±0.22,q =6.139;9 months:4.43 ± 0.25 vs 3.60 ± 0.18,q =13.484;all P ＜ 0.05),the expressions of D2DR mRNA and protein decreased (1.34 ± 0.13 vs 0.48 ± 0.07,q =21.578;1.05 ± 0.15 vs 0.69 ± 0.10,q =8.063,both P＜0.05) and phosphorylated TH at Serl9 and Ser40 increased (0.95 ±0.10 vs 1.14-0.13,q =4.972;0.94 ± 0.12 vs 1.17 ± 0.14,q=5.382,both P＜ 0.05),the levels of levodopa,dopamine and homovanillic acid were elevated (87.04 ± 11.77 vs 115.28 ± 16.80,q =4.764;56.66 ± 9.87 vs 72.96 ± 11.02,q=3.923;26.58 ± 8.11 vs 38.65 ± 6.67,q=3.981,all P＜ 0.05),the leve1 of 5-hydroxytryptamine was reduced (925.50 ± 74.26 vs 637.87 ± 56.76,q =11.084,P ＜ 0.05),the ratios of homovanillic acid/dopamine and 5-hydroxyindoleacetic acid/5-hydroxytryptamine increased (0.45 ± 0.05 vs 0.54±0.08,q =3.325;0.94±0.07 vs 1.42±0.12,q =12.367,both P＜0.05) in the brain of TG at the age of 9 months old.There was no significant difference of detection indexes between KG and CG.Conclusions S100B plays an important role in the development of PD and the brain-specific S100B transgenic mice can be used to investigate the function of S100B gene on the development of PD.

Objective To investigate the influence of low-dose ketamine and dexmedetomidine on cardiovascular response during. sedative amnesia fiberoptic nasotracheal intubation. Methods Ninety ASA Ⅰ or Ⅱ patients scheduled to recerve general anesthesia were evenly random-ized to dexmedetomidine and ketamine (group DK),dexmedetomidine and propofol (group DP)and dexmedetomidine and remifentanil (group DR).Ten minutes before intubation,the patients in group DK received intravenously dexmedetomidine 1.0 μg/kg plus ketamine 0.5 mg·kg-1 ·h-1 ;those in group DP received intravenously dexmedetomidine 1.0 μg/kg plus propofol 2.0 mg · kg-1 · h-1 ;those in group DR received intravenously dexmedetomidine 1.0 μg/kg plus remifentanil 5.0μg·kg-1 ·h-1 .Nasotracheal intubation was performed with fiberoptic bronchoscopy after dexemeto-midine injection and complete topical anesthesia.HR,MAP,SpO 2 and Ramsay sedation score were re-corded before anesthesia (T0 ,baseline),before intubation (T1 ),immediately intubated (T2 )and five minutes after intubation (T3 ).Side effects such as restlessness,bucking,respiratory depression and cardiovascular event during intubation and awareness of intubation were also recorded.Results All pa-tients in three groups were performed successfully.HR and MAP were significantly decreased in groups DP and DR at T1 (P <0.05),SpO 2 was significantly decreased in group DP at T1 (P <0.05);MAP in group DR were higher than those in group DP,HR in groups DP and DR were significantly increased than those in group DK at T3 (P < 0.05 );Ramsay score were significantly decreased in groups DP and DR at T2 ,significantly lower in group DR at T3 than those in groups DK and DP (P<0.05).The incidences of bradycardia and respriatory depression were significantly higher in group DP than those in group DK,and bucking,restlessness,tachycardia incidence rate in group DR were significantly higher than those in groups DK and DP (P <0.05).Conclusion Dexmedetomidine com-bined with low dose ketamine together with topical anesthesia is an ideal method for sedative amnesia fiberoptic nasotracheal intubation with slighter cardiovascular response and less side effects.

Objective To study skeletal muscle atrophy and the change of autophagy in skeletal muscle of patients with chronic kidney disease.Methods Mean muscle cross sectional area,mRNA and protein expression of autophagy markers Bcl-2-adenovirus E1B interacting protein 3 (LC3B),Bcl-2-adenovirus E1B interacting protein 3 (Bnip3),Beclin-1 were measured in rectus abdominis biopsies obtained from 22 consecutive patients with stage 5 CKD scheduled for peritoneal dialysis from 4 hospitals in Shanghai.Control biopsies were obtained from another 8 healthy subjects during elective surgery for adenomyosis and 6 subjects during elective surgery for abdominal wall hernias.Rectus abdominis muscles were obtained at the beginning of surgery.HE staining was performed and mean cross sectional area (CSA) was calculated.Electron microscopy was used to confirm the changes of autophagy.mRNA levels of LC3B,Beclin-1,Bnip3 were evaluated by RT-PCR and protein levels of those parameters were evaluated by Western blotting.Results Compared with control group,mean CSA of muscle fibers was decreased and the transcript levels of LC3B,Beclin-1,Bnip3 were up-regulated in CKD group.Similarly,protein levels of LC3BⅠ,LC3B Ⅱ,Beclin-1 and Bnip3 were increased in CKD group.Additionally,activation of autophagy was confirmed by the appearance of autophagosomes by electron microscopy.Conclusion Chronic kidney disease may cause skeletal muscle atrophy and lead to activation of autophagy,which may contribute to muscle atrophy.