Objective To identify whether the branches of cervical nerve roots joined into the accessory nerve trunk or not.Methods In 10 adult cadavers (7 males and 3 females, including 20 laterals of brachial plexus nerves), we observe source of cervical plexus branches to the accessory nerve anatomically.In 10 clinical cases of males with brachial plexus nerve injures, in the supraclavicular approach of brachial plexus exploration, the part of the supraclavicular cutaneous nerve for histological specimen were cut off;in the posterior approach, electrical stimulation of the trunk and branches of cervical plexus were performed to observed istaltrapezius muscle contraction.After accessory nerve transfer, the residual terminal accessory nerve and branch of cervical plexus were taked for histological specimens;and observed and judged of each nerve sample by acetylcholinesterase (AchE) immunohistochemical staining.Results In 10 of 20 lateral cases, cervical plexus communicating branches were derived from the fourth cervical nerve root.The intraoperative electrical stimulation of the accessory nerve trunk, 10 cases of distal trapezius muscle were significantly shrink;electrical stimulation of the cervical plexus branch, 2 cases after stimulation of the mild distal trapezius contraction, the remaining 8 cases without trapezius muscle contraction.10 cases of supraclavicular nerve staining for AchE were negative, 10 cases of accessory nerve terminal branches of AchE staining were mixed,10 cases of branch AchE cervical plexus to the accessory nerve staining were negative.Conclusion The branches of the fourth cervical nerve root constantly joins into the accessory nerve, participating in the trapezius muscle inner vation, the fibers of the branches are sensorial fibers.

AIM: To study the effect of thyroid hormone on the expressional change of myosin heavy chain(MHC) gene in cardiomyocyte induced by angiotensinⅡ(AngⅡ) and its potential mechanism. METHODS: Cardiac myocyte was cultured according to the method of Simpson. 10 -8 mol/L T_3 and 10 -7 mol/L AngⅡ were added to the culture medium,respectively or synchronously. After 48 h,the expression of ? and ?-MHC mRNA in myocytes were detected by RT-PCR. The protein kinase C activation were detected by PepTag non-radioactive PKC assay. The incorporation of -Leucine and -thymine to test the protein and DNA synthesis in myocytes were also performed. RESULTS: AngⅡalone increased the incorporation of -Leucine of myocytes while it had no effect on the incorporation of -thy mine. The expression of ?-MHC mRNA was increased and the expression of ?-MHC mRNA was decreased significantly at the condition of AngⅡ. The enhanced PKC activation was induced by AngⅡalso. When AngⅡand T_3 were added to the culture medium synchronously,though the incorporation of -leucine and -thymine were not changed compared with AngⅡ treated alone. The ?-MHC mRNA expression was increased and the ?-MHC mRNA expression was decreased significantly. The PKC activation of the myocytes also was decreased. CONCLUSIONS: T_3 inhibited the expressional change of myosin heavy chain gene in cardiac myocytes induced by AngⅡ. The effect of T_3 on the change of PKC activation in cardiac myocytes may be one of its mechanisms.

Objective To compare the efficacy and safety of modified FOLFOX4 program with docetaxel-oxaliplatin-5-fluorouracil (DOF) program as neoadjuvant chemotherapy in stage Ⅲ gastric cancer patients.Methods In 86 cases of stage Ⅲ gastric cancer patients,42 received modified FOLFOX4 chemotherapy,44 cases were treated by DOF program.After two cycles of chemotherapy,the treatment effect and adverse reactions were evaluated.Results The total effectiveness in modified FOLFOX4 group and DOF group was 60％ (25/42) and 68％ (30/44) respectively (P ＞ 0.05).Tumor control rate was 83％ (35/42) and 89％ (39/44) respectively (P ＞ 0.05).The incidence of nausea,vomiting and leukopenia was higher in DOF group than modified FOLFOX4 group (P ＜ 0.05).The D2 lymph node dissection rate between modified FOLFOX4 group and DOF group was 80％ (20/25) and 87％ (26/30) respectively (P ＞ 0.05),the R0 resection rate was 72％ (18/25) and 83％ (25/30) respectively (P ＞ 0.05).In 43 R0 resection patients using FOLFOX4 the median survival time was 38.7 months,1-,3-year survival rate was 90％,and 60％ ; while that in DOF group the median survival time was 39.6 months,1-,3-year survival rate was 95％,and 75％.Multivariate analysis showed that postoperative TNM stage only was an independent risk factor for prognosis.Conclusions TNM stage was the independent risk factor for prognosis of gastric carcinoma patients after radical gastrectomy.

Objective To analyze the efficacy of chemoradiotherapy in the treatment of esophageal carcinoma and its influencing factors,and to provide an optimal combination mode of chemoradiotherapy for treating esophageal carcinoma. Methods A retrospective analysis was performed on clinical data from 232 patients with esophageal carcinoma who were admitted to our hospital from January 2006 to December 2012 and received radical chemoradiotherapy. All patients received three?dimensional conformal radiotherapy or intensity?modulated radiotherapy as well as platinum?based chemotherapy. The overall survival ( OS ) and local control ( LC) rates were calculated using the Kaplan?Meier method and analyzed using the Logrank test. Univariate and multivariate prognostic analyses were made by the log?rank test and the Cox proportional hazard model,respectively. Results In all patients,the 1?,3?,and 5?year LC rates were 66?1%,42?2%, and 38?5%,respectively;the median LC time was 24?4 months;the 1?,3?,and 5?year OS rates were 73?3%, 37?2%,and 19?5%,respectively;the median OS time was 21 months. The univariate analysis revealed that T stage,N stage,clinical stage,irradiation range,and no less than 3 cycles of chemotherapy were influencing factors for OS ( P=0?000,0?000,0?000,0?030,0?001) and LC ( P=0?112,0?031,0?009,0?074,0?218) . The multivariate analysis revealed that N stage,clinical stage,and no less than 3 cycles of chemotherapy were independent prognostic factors for OS ( P=0?006,0?000,0?001) . Conclusions The LC and long?term OS rates in patients with early?stage esophageal carcinoma can be substantially improved by radical chemoradiotherapy. The irradiation range and no less than 3 cycles of chemotherapy improve the long?term survival in patients.

AIM To study the anti atherogenesis action of sodium ferulate and its mechanisms. METHODS Atherosclerotic rabbit models were duplicated by feeding high lipid forage and ECV304 were cultured with the hyperlipidemic serum. The atherosclerotic plaque area was measured. Scanning electron microscope, spectrophotometer and immunocytochemical methods were used to detected the microstructures of endothelial cell, the content of NO in suspension and the expressions of TGF? 1, bFGF on the cell surfaces. RESULTS Sodium ferulate could decrease the plaque area, lessen the damnification of endothelial cell induced by HLS, enhance the expression of TGF? 1 and the release of NO from ECs, and reduce the expressions of bFGF in ECs, significantly. CONCLUSION Sodium ferulate can decrease the atherosclerotic plaque area induced by hypercholesterol, which may be relate to the expression change of cytokines.

Antimicrobial resistance of Neisseria gonorrhoeae has become a big challenge in the control and prevention of sexually transmitted diseases. Recently, a ceftriaxone-resistant Neisseria gonorrhoeae strain FC428 has spread across the world including China, which has worsened the antimicrobial resistance problem. This strain is highly resistant to ceftriaxone due to a novel mosaic penA gene. In order to better understand the characteristics of FC428 and control its further spread, this review summarizes its origin, spread, main molecular characteristics, resistance mechanisms, detection methods, and strategies for clinical treatment and antimicrobial resistance surveillance.

Objective:To explore the efficacy of neurolysis or nerve grafting in the treatment of the conducting neuroma of Narakas II obstetric brachial plexus palsy (OBPP), and provide the reference basis for choosing an optimal method.Methods:From January, 2009 to December, 2014, 32 patients undergoing surgical treatment due to Narakas II OBPP were included in this study. Neurolysis was performed in 15 patients, and the procedure of nerve grafting was performed in 17 patients. The general information included gender, age, birth weight, injury cause, etc. were recorded and compared to each other between 2 groups. A followed-up study had been conducting after surgery, the functional rating systems of Gilbert and Raimondi were used for quantitative comparison between preoperative function and postoperative function of shoulder joint, elbow joint and hand. In addition, the differences of the measurement data were compared with the single factor analysis of variance and paired t-test by using SPSS 22.0 statistical software. When P<0.05, it was considered statistically significant. Results:There was no statistically significant difference in the baseline information between 2 groups ( P>0.05). The average time of follow-up was 58.44 (48-96) months. And the fourth year' average score of shoulder joint, elbow joint, hand of the neurolysis group improved from preoperative (1.07±0.85) , (2.07±0.77) and (3.47±0.62) score to (3.00±0.73), (4.13±0.62) and (4.53±0.72) score ( P<0.05), and the nerve grafting group rose from an average of (0.76±0.73), (1.71±0.46) and (3.71±0.67) score to (3.24±0.55), (4.29±0.46) and (4.65±0.48) score ( P<0.05). But the different score between 2 groups was no statistically significant ( P>0.05), respectively. In addition, the proportion of the patients who needed the secondary operation about functional reconstruction in the neurolysis group and the nerve grafting group was 73.33% and 35.29% respectively, besides the proportion of the shoulder joint and elbow joint in the surgical sites accounted for 82.35%, 17.65% respectively. Conclusion:Nerve grafting is a better choice for the treatment of conducting neuroma of Narakas II OBPP at present.

Objective:To explore the diagnosis and treatment of the multi-segment injury of brachial plexus and provide reference for diagnosis and treatment in clinical practice.Methods:From October, 2012 to January, 2015, 24 patients (21 males and 3 females, aged 7-46, average at 25.06±13.01 years) who suffered multi segments injury of brachial plexus were treated by surgical operations. Time from injury to surgery was 7 days to 7 months, with (2.43±2.15) months in average. The general data, injuries and surgical procedures of the patients were recorded. Muscle strength grading was used to evaluate and analyse the curative effect.Results:Twenty-four cases were followed-up for 3.1-7.2 years, with 4.3 years in average. Of the patients, 58.3% of the injuries were caused by mechanical traction. Combined injuries were counted for 83.3%, of which 62.5% combined with ipsilateral limb fractures, 20.8% (5/24) involved in the root of brachial plexus, 79.2% (19/24) with upper part of the clavicle, 91.6% (22/24) with lower part of the clavicle, 16.7% (4/24) with branches of the brachial plexus and 91.7% (22/24) with injuries of 2 segments, 8.3% (2/24) with injuries of 3 segments. At the last followed-up, 55.0% of the patients achieved better than M 3 in total muscle strength. The excellent and good rate was 70.8% in neurolysis group and 42.9% in multiple segment injury group. Conclusion:The mechanism of multi segments injury of brachial plexus is special, and the actual injury is difficult to be located. For patients with multi segments injury, surgical operation should be carried out as early as possible, and the correct surgical procedure can only be determined after the exploration of all sections of the brachial plexus.

[Abstract] Objective: To investigate the effects of exosome originated from bone marrow mesenchymal stem cell (BMSCs) on proliferation, migration and invasion of prostate cancer PC-3 cell and its mechanism. Methods: qPCR was used to detect the expression level of miR-21-5p in prostate cancer cell lines. The morphology of exosomes isolated from BMSCs was observed with an electron microscope. Western blotting was used to detect the expressions of exosome surface markers and the epithelial-mesenchymal transition (EMT)-related proteins (E-cadherin, N-cadherin and Vimentin). Dual luciferase reporter gene experiment was used to detect the targeted regulation relationship between miR-21-5p and PH domain leucine-rich repeat protein phosphatase 2 (PHLPP2). PC-3 cells were co-cultured with 10 μl BMSCs exosomes suspension (Exo group), transfected with sh-PHLPP2 or antagomiR, then CCK-8 and Transwell experiments were used to detect changesinproliferation,migrationandinvasionofPC-3cell.Results: miR-21-5p was highly expressed in prostate cancer PC-3 cell line. The exosomes in the supernatant of BMSCs culture fluid were successfully isolated, and the typical vesicle-like structures of exosomes were observed under transmission electron microscope. Exosomes expressed specific proteins such as CD9, CD63 and CD81. In the Exo group, the proliferation, invasion, migration, as well as the expressions of N-cadherin, Vimentin and miR-21-5p in PC-3 cells were significantly higher than those in the control group (all P<0.05). PHLPP2 is a target gene of miR-21-5p. Compared with the control group, the expression of PHLPP2 in PC-3 cells of Exo group and sh-PHLPP2 group was significantly reduced (0.66±0.09, 0.42±0.05 vs 1.09±0.08, all P<0.01); cell viability, invasion and migration were significantly improved (all P<0.01); and E-cadherin expression level was significantly reduced while N-cadherin and Vimentin expressions were significantly increased (both P<0.05). Conclusion: miR-21-5p is highly expressed in prostate cancer PC-3 cell line. BMSC exosome miR-21-5p can increase the proliferation, migration and invasion ability of PC-3 cells through targeted down-regulation of PHLPP2.

Objective:To analyze the local recurrence patterns after concurrent chemoradiotherapy (CCRT) for thoracic esophageal squamous cell carcinoma (ESCC) through image fusion, and to explore the risk factors of local recurrence and its relationships with dosimetric indices.Methods:A retrospective analysis was conducted for 209 thoracic ESCC patients who received radical CCRT in Fourth Hospital of Hebei Medical University during 2016-2019. For the patients diagnosed as the local recurrence of esophageal lesions, their CT images were fused with the original planning CT images using image registration software to identify the recurrence sites. Through 1∶1 propensity score matching (PSM) of the clinal data of patients with local recurrence (the recurrence group, nbefore = 81, nafter = 62) and those without local recurrence (the recurrence-free group, nbefore = 128, nafter=62), the dose and volume parameters of the treatment plans for the two groups were compared. Univariate and multivariate analyses were conducted using the Kaplan-Meier method and the Cox regression model to analyze the factors affecting the overall survival (OS), progression-free survival (PFS), and recurrence-free survival (RFS). Results:All patients had 1-, 3-, and 5-year OS rates of 80.9%, 42.6%, and 33.0%, respectively, 1-, 3-, and 5-year PFS rates of 67.9%, 34.0%, and 27.9%, respectively, and 1-, 3-, and 5-year RFS rates of 71.3%, 39.2%, and 30.5%, respectively. T stage, N stage, and radiation dose were independent prognostic factors for the OS, PFS, and RFS ( HR = 1.42-1.87, P < 0.05) of the patients, respectively. Among 68 patients with local recurrence, 62 cases (91.2%) suffered recurrence within the gross tumor volume (GTV). The dose and volume parameters of patients with local recurrence, such as GTV- D95%, clinical target volume (CTV)- D95%, GTV- D50%, CTV- D50%, and planning target volume (PTV)- D50%, GTV- V60, CTV- V60, and PTV- V60, were significantly lower than those of patients free from the local recurrence ( t=1.90-2.15, P < 0.05). Conclusions:Local recurrence of patients with thoracic ESCC after radical CCRT occurs mainly within the GTV. Increasing radiation doses may contribute to their survival benefits. The D50% for each target volume in the radiotherapy plan may be related to local recurrence, and it is necessary to conduct further research.