Hemispatial neglect often occurs after brain injury, especially the higher incidence after stroke. The studies on cognition, attention, and perception have greater significance. However, the related domestic studies at present are rare. Being themed by line bisection, this article reviews the influencing factors and relevant mechanisms, brain location, and extensional study in the assessment of hemispatial neglect.

Students(64)of two years in our department were divided into two groups in experimental teaching of forensic toxicology analysis:in one group,the methods of LBL was performed,while the methods of PBL was performed in the other group. By comparing effects between these two methods,we analyzed the function methods of PBL to improve students'experimental skills and capacity of analyzing and solving problems. It was concluded that the PBL methods was more suitable for the experiment teaching of forensic toxicology analysis than the LBL methods.

The phytase was extracted from solid state leavening of Trichoderma Viride LH374.The crude product was purified by(NH_4)_2SO_4 precipitation,gel filtration and ion exchange chromatography.The purified phyatse was 13.3 times of the raw products,and the extraction ration was 27.1%.The study on the enzymology of phyatse showed that the optimal temperature and pH were 55℃ and 6.0,respectively.The Km value of the phytase was 0.15mmol/L.

Objective:To analyze clinical and pathological features of Reed nevi (pigmented spindle cell nevi) .Methods:The clinical and pathological data were collected from 26 patients with Reed nevi, who visited Department of Dermatology of Xijing Hospital from January 2015 to June 2019, and analyzed retrospectively.Results:Among the 26 patients, 15 were males, and 11 were females. Their average age of onset was 17.35 years, and median age of onset was 13.85 years. Reed nevi occurred predominantly on the lower limbs (12 cases) , followed by the face (6 cases) , upper limbs (5 cases) and trunk (3 cases) . All the skin lesions were black in color, and 7 cases presented with maculae, 19 with flat papules, 22 with quasi-circular skin lesions, and 4 with irregular skin lesions. The diameter of skin lesions ranged from 2 to 10 mm, and 23 cases had skin lesions with a diameter of ≤ 5 mm. As histopathological examination showed, pathological subtypes included junctional nevus (15 cases) and compound nevus (11 cases) ; melanocytes were spindle-shaped with obvious cytochromes in 26 cases; nevus cell nests merged with the surrounding epidermis in 4 cases, and obvious fissures were formed between nevus cell nests and the surrounding epidermis in 22 cases; no obvious cell atypia or mitotic figure was observed in any of the 26 cases, and Kamino bodies were observed in 6 cases. All the skin lesions were resected by surgery, and no recurrence was observed during the follow-up of 1 - 5 years.Conclusion:Reed nevi can manifest as irregular lesions, pagetoid distribution of spindle cells of various sizes can be observed histopathologically, and they need to be differentiated from melanoma.

Objective To compare the safe zone and safe angles between males and females for screw placement on the medial iliosciatic plate for acetabular posterior column using 3D reconstruction technique.Methods Normal pelvic CT scans of 52 adults (27 males and 25 females;aged from 18 to 74 years,averaging 47.2 years) were obtained to create pelvic 3D models.After the acetabulum was thickened by 5 mm,the width (d) of the safe zone for placement of the medial iliosciatic plate was measured.After the vertical distance (w) between the vertex of the obturator canal and the greater sciatic notch was measured,the ratio (r) of d/w was calculated.The recombined innominatum model was cut through the center of the acetabulum with a plane perpendicular to the quadrilateral plate and the greater sciatic notch.The cross-section was marked as M.In males,4 points at distances of 1.0 cm,1.5 cm,2.0 cm and 2.5 cm anterior to the greater sciatic notch were marked.At the 4 points,the angulations (∠ a,∠b,∠ c and ∠ d) between the quadrilateral plate and the tangent line of the outer edge of the thickened acetabulum model were measured on the cross-section M.In females,3 points at distances of 1.0 cm,1.5 cm and 2.0 cm anterior to the greater sciatic notch were marked before ∠a,∠b,and ∠c were measured.The differences in the above parameters were compared between males and females.Results The width (d) of the safe zone for placement of the medial iliosciatic plate was 28.56 ±2.44 mm in males and 24.36 ±2.47 mm in females;the ratio (r) was 0.61 ± 0.07 in males and 0.54 ± 0.05 in females.The safe angulations for screw placement in males,∠ a,∠b,∠cand ∠d,were 88.04°±3.18°,77.81°±3.85°,68.01°±4.11°and56.81°±4.81° while those in females,∠a,∠b and ∠c,were 91.29°±4.52°,76.23°±3.82° and 62.79°±3.51°,respectively.There were statistically significant differences between males and females in values of d,r,∠ a and ∠ c (P ＜ 0.05).Conclusions In fixation of acetabular posterior column fractures using medial iliosciatic plate,the differences between males and females should be taken into account.Besides,specific safe angles should be chosen according to the position of the plate.

Objective To compare the efficacy and safety of percutaneous nephrolithotomy ( PCNL) in modified supine Valdivia and traditional prone positions for the treatment of renal stones.Methods Clinical data of 80 consecutive patients with renal calculi who accepted PCNL from December 2012 to September 2014 were retrospectively reviewed.They were divided into modified supine Valdivia group ( n=44) and prone position group (n=36) according to the position during surgery.There was no significant difference between the 2 groups in age, sex, ASA class, stone location and size (P>0.05).Total operative time, ratio of multi-access, blood loss, perioperative complications and stone-free rate were compared between the 2 groups.Results All punctures were performed successfully.No case was converted to open surgery.No severe complications such as colon injury, pleura or peritoneum perforation, or death occurred intra-and post-operatively.In prone position, 1 patient was found to develop high intra-trachea pressure because of large stone burden and prolonged operative time (130 min).This procedure was stopped and the patient received the second session of PCNL 1 week later.The mean total operative time was significantly shorter in the modified supine than in the prone position ( 67.7 ±24.5 min versus 91.5 ±29.8 min, P<0.05).There were no significant differences in ratio of multi-access (14% versus 22%), mean blood loss (1.3 ±0.2 g/L versus 1.4 ±0.7 g/L), incidence of complications (18% versus 19%), and stone clearance rate ( 80% versus 86%) between the 2 groups ( P >0.05 ) .Conclusion PCNL in modified supine Valdivia is as safe and effective as that of prone position for the treatment of renal stones, but the former is more time-saving than the latter.

Objective The aim of this study was to analyze the effect of gender and age on shoulder and hip range of motion (ROM) and to determine the differences of ROM of normal side shoulder and hip joints between the data we collected and the published standards (Guideline of Examination for Body Impairment in Clinical Forensic Medicine SF/ZJD0103003-2011) in China. Methods We collected cases with unilateral injury of shoulder or hip from clinical forensic medicine. The differences of ROM of normal side joint between the data we collected and the published standards were studied. Descriptive statistics was calculated between male and female subjects in ifve age groups including 0~25, 26~40, 41~50, 51~60 and >60 years, and the ROM changes with age were also studied. Results The data collected in this study was signiifcantly different from the published standard. With age growth, the ROM of shoulder and hip were decreased and a significant difference between genders in partial activity direction of shoulder and hip was found in the individuals who were over 50 years. Conclusion Gender and age appear to be inlfuential factors to determine the normal ROM of the shoulder and hip joint, and there is signiifcantly difference of ROM of normal side shoulder and hip joints between the data we collected and the published standards (Guideline of Examination for Body Impairment in Clinical Forensic Medicine SF/ZJD0103003-2011).

Objective To investigate the differential expression levels and significance of regulatory T cell (Treg) and T helper 17 (Th17) related immunologic factors in peripheral blood of arsenic-exposed rats.Methods Thirty-two Wistar rats were numbered by weight,randomly divided into four groups [control,low (1.25 ml/kg),medium (2.50 ml/kg),and high (5.00 ml/kg)],8 rats per group.Rats in control group were given oral gavage of deionized water,and low,medium and high arsenic exposed groups were given oral gavage doses of 2.00 g/L sodium arsenite (NaAsO2) according to their body weight for 6 days every week.After 4 months,the urine and peripheral blood samples of rats were collected,urinary arsenic (uAs) was detected by inductively coupled plasma-mass spectrometry (ICP-MS),the results were shown in [median (minimum and maximum)],uAs was corrected by urinary creatinine (uCr),the unit was μg/g Cr;enzyme-linked immune-sorbent assay (ELISA) was applied to detect the levels of Treg,Th17,T lymphocytes activation related immunologic factors [interleukin-10 (IL-10),transforming growth factor beta1 (TGF-31),IL-17,IL-6,IL-2],the results were shown in (x) ± s.Results The uAs of the rats was compared between control,low,medium,and high arsenic exposed groups [7.50 (3.16-9.81),72.34 (62.34-106.63),209.15 (154.41-232.20),369.73 (289.50-516.55) μg/g Cr],the differences were statistically significant (F =337.55,P ＜ 0.05).IL-10 [(85.03 ± 7.11),(93.96 ± 8.14),(97.48 ± 6.23),(93.47 ± 4.41) ng/L],TGF-β1 [(72.88 ± 2.96),(81.45 ± 8.15),(86.08 ± 7.55),(90.29 ± 5.35) ng/L],IL-17 [(18.15 ± 3.66),(25.54 ± 5.59),(31.48 ± 5.74),(37.25 ± 7.36) ng/L],IL-6 [(83.68 ± 8.48),(85.14 ± 7.11),(89.78 ± 5.36),(93.48 ± 5.77) ng/L],and IL-2 [(80.65 ± 6.90),(73.86 ± 8.00),(69.93 ± 7.77),(62.06 ± 9.82) ng/L] of the rats were compared between control,low,medium,and high arsenic exposed groups,the differences were statistically significant (F =5.094,11.054,16.249,3.474,5.119,all P ＜ 0.05).There were positive correlations between uAs and TGF-β1,IL-17 concentration (r =0.723,0.605,all P ＜ 0.01),while IL-2 showed a negative correlation (r =-0.484,P ＜ 0.05).Concltsion Arsenic exposure could affect the secretion of Treg and Th17 related immunologic factors,so as to the imbalance of anti-inflammatory and pro-inflammatory,which may play a role in the formation and development of arsenic-related immune injury.

Objective To investigate the clinical significance and distribution of different rotational displacements on the sagittal plane in unstable pelvic fractures radiologically.Methods We retrospectively reviewed 82 patients with unilateral pelvic fracture who had been treated at our department from June 2005 to June 2015.They were 48 men and 34 women,with an average age of 43 ± 18 years.By Tile classification,there were 48 cases of type B and 34 cases of type C.Their rotational displacements on the sagittal plane of the pelvic ring were determined on the anteroposterior X-ray films of the pelvis by measuring the changed distances from the top of iliac crest to the lowest point of ischial tuberosity and to the pubic tubercle.The data were recorded for analysis of different displacements and their clinical significance.Results Of all the 82 patients,based on the preoperative radiographic evidence,36 (43.9％) showed sagittal plane rotational displacement.Of them,28 (77.8％) showed supination displacement and 8 (22.2％) pronation displacement.The preoperative CT three-dimensional reconstruction confirmed the findings from the X-ray films.Twenty-one of the 48 cases of Tile type B (43.8％) and 15 of the 34 cases of Tile type C (44.1％) showed sagittal plane rotational displacement.The success rate of closed reduction was,respectively,66.7％ (24/36) in the 36 cases with sagittal plane rotational displacement,62.5％ (5/8) in those with pronation displacement and 67.9％ (19/28) in those with supination displacement,all significantly lower than the total success rate of closed reduction in this cohort(84.1％).Conclusions The sagittal plane rotational (pronation and supination) displacement of pelvic fracture can be determined by measuring special points and lines on the anteroposterior radiographs of the pelvis.The supination displacement on the sagittal plane is more common.The unstable pelvic fracture with sagittal plane rotational displacement is more difficult to reduce.

Objective To summarize the clinical features,diagnosis,treatment and prognosis of hepatolithiasis complicating cholangiocarcinoma. Methods From June 1958 to March 2011,709 cases of hepatolithiasis were admitted to Department of General Surgery,Peking University Third Hospital.The cases concomitant with cholangiocarcinoma were reviewed. Results 20 of 709 (2.8％ ) hepatolithiasis cases developed cholangiocarcinoma.17 cases (85％,17/20) were followed-up for 2 years (0 - 15 years).The hepatolithiasis course before the malignant diagnosis was 15 ± 1 1 years (3 -38 years).14 cases had frequent episodes of cholangitis,15 cases had liver cirrhosis.Preoperative diagnosis was established by CT,MRCP,B-ultrasound and tumor markers in 55％ (11/20) cases.4 cases underwent radical resection,7 received palliative resection,9 cases received conservative treatment.In radical resection,one lost to follow-up,one survived one year,two for 5 years.In palliative resection,2 lost to follow-up,two survived one year,one survived 3 years, one for 5 years. None in conservative group survived more than one year.Conclusions Cholangiocarcinoma developed from hepatolithiasis with a long history,frequent cholangitis,liver cirrhosis,especially in cases with imige showing thickness of bile duct or mass and rising tumor markers (CA19-9,CA125,CEA).The cases undergoing radical resection may have a favorable prognosis.