It is important that the oral hospital establish a guarantee system of medical graduation clinical practice quality. Having experienced clinical education for many years,the hospital has formed a system in order to achieve objective management and process management organic unification,which can gradually promote the clinical practice quality.

BACKGROUND: Numerous evidence has demonstrated that the magnesium aloy with excelent mechanical properties can degradein vivo, and can be used as vascular stent materials, bone fixation materials, porous materials for bone repair. But it is not reported in the biliary stent. OBJECTIVE:To observe the degradation procedures and evaluate the changes of mechanical characteristics of biliary stents made of magnesium aloy (AZ 31B) in human bilein vitro. METHODS:The baloon-expandable biliary stents were made of magnesium aloy with laser sculpture. Then, 15 stents treated with micro-arc oxidation on the surface served as experimental group and another 15 stents without micro-arc oxidation as control group. A dynamic numerical simulation system was establishedin vitro to simulate the internal environment of human biliary tract. Al of the biliary stents were placed into this system. Their shapes were observed, and their qualities and radical forces were measured every 20 days. At the same time, their surfaces were scanned by scanning electron microscope. RESULTS AND CONCLUSION:(1) The degradation speeds of the stents in the experimental group were obviously slower than those in the control group. The fracture of the connecting rods in control group and experimental group appeared 20 days and 40 days later, respectively. The peak time of degradation in the control group and experimental group were 30 days and 50 days, respectively. The stents were fuly biodegraded within 70 days in the control group while within 90 days in the experimental group. With time, the stent surface became more rough, and the density, area and depth of etch pits were al increased in the two groups. At the same stage, the degradation speed of the control group was more rapid than that in the experimental group. (2) The qualities and radical forces of the stents were gradualy reduced with time in both groups. However, the degradation speed of stents in the experimental group was much slower than that in the control group. In summary, the degradation speed of the biliary stents made of magnesium aloy treated with micro-arc oxidation is appropriate and can meet the clinical requirement for the degradation time of biliary stents. This novel material could potentialy be used for the preparation of biliary stents.

Objective:To investigate clinical features of distant metastases ( DM ) and analyze clinico-pathologic risk factors associated with DM from salivary gland carcinomas after being treated by surgery combined with 125 I internal brachytherapy. Methods: Between October 2001 and March 2010, 197 pa-tients with salivary gland carcinoma were treated by surgery combined with 125 I internal brachytherapy and had follow-up for 2 years or more. Univariate and multivariate analyses were performed to evaluate clini-copathologic risk factors that might influence the risk of distant metastases. Results:DM occurred in 28 of 197 patients (14. 2%). The commonest site of distant metastases overall was the lung 89. 3% (25/28), followed by bones 17. 9% (5/28) and liver (4/28). DM developed after an average interval of (44. 2 ± 45. 8) months from the time of initial diagnosis, and the mean interval was 64 months. The average time to death after the diagnosis of DM was only (9. 7 ± 13. 4) months, and the mean time was 12 months. The 3-year locoregional control rate and survival rate were 90. 8%, and 87. 8% respectively,and the 5-year ones 84. 0% and 81. 0%, respectively. Univariate analyses revealed that the risk of distant metasta-ses was significantly influenced by locoregional tumor failure (F=26. 997,P<0. 01) and histologic dif-ferentiation (F=1. 592,P<0. 01). Multivariate analysis of freedom from distant metastases revealed that locoregional control (F=29. 332,P<0. 01) significantly influenced this end point. Conclusion: Sali-vary gland carcinoma could achieve high local control rate after being treated by surgery combined with 125 I internal brachytherapy, and the average interval from diagnosis to DM was prolonged, DM was signifi-cantly influenced bylocoregional control.

Objective: To investigate clinical features of distant metastases from malignant salivary gland carcinomas after treated by 125I internal brachy therapy alone.Methods: Between 2002 and 2010, 43 patients with locally advanced unresectable or recurrent malignant salivary gland carcinomas were treated by 125I internal brachy therapy alone at Peking University School and Hospital of Stomatology.All of them had been follow-up at least 2 years.The primary sites of malignant salivary gland carcinomas were the parotid for 12 patients, infratemporal fossa for 9 patients, tongue for 7 patients, maxilla for 6 patients, parapharyngeal for 4 patients, floor of months for 3 patients, submandibular gland for 1 patient, and lip for 1 patient.The overall survival rate, local control rate, and distant metastases were retrospectively reviewed.Results: Distant metastases occurred in 23 of the 43 patients (53.5%).Distant metastases developed from 5 to 96 months, with an average interval of (27.0±23.7) months from the time of initial diagnosis, the mean interval was 21 months.The commonest site of distant metastases overall was the lung 69.6%(16/23).The most common pathological types of distant metastases were adenoid cystic carcinoma (14/23, 60.9%) and nonspecific adenocarcinoma (7/23, 30.4%).At the time of the last follow-up, 26 patients died, and 18 of them due to distant metastases (69.2%, 18/26).In the study, 27 patients got complete remission(CR), 12 got partial remission(PR) more than 50%, 2 less than 50%, and 2 patients were invalid.The effective rate (CR+ PR) was 90.7%.The 3 year loco-regional control rate and survival rate were 60.1%, 82.6%, respectively, and the 5 year's 53.4% and 56.0%.Conclusion: The 125I brachy therapy is a feasible and effective modality for the treatment of locally advanced unresectable or recurrent malignant salivary gland carcinomas.However, further studies are needed with larger numbers of patients and for a longer follow-up assessment.Distant metastasis was the main cause of treatment failure, and the lung was the most common site of distant metastases.

OBJECTIVE: To investigate the clinical application and efficacy of ¹²⁵Ⅰ radioactive seeds implantation in the treatment of recurrent salivary gland carcinoma after external radiotherapy. METHODS: From July 2004 to July 2016, 43 cases of recurrent salivary gland carcinoma of the neck after external radiotherapy or surgery combined with external radiotherapy were treated. According to the conventional segmentation radiotherapy for head and neck cancer (once a day, 1.8-2.0 Gy each time, 5 days per week), the cumulative radiation dose of the patients in this group was calculated. In the study, 26 patients received 50-60 Gy, 7 patients received less than 50 Gy, 4 patients received 60-70 Gy, and 6 patients received more than 80 Gy (range: 80-120 Gy). The interval between the last external irradiation and local recurrence was 4-204 months, and the median interval was 48 months. Among them, 25 cases were treated with ¹²⁵Ⅰ radioactive seeds implantation only and 18 cases were treated with ¹²⁵Ⅰ radioactive seeds implantation after operation. The prescription dose was 100-140 Gy. The control rate, survival rate and disease-free survival rate were recorded to evaluate the side effects. RESULTS: The median follow-up time was 27 months (ranging from 2.5 to 149.0 months). Among them, the median follow-up time of adenoid cystic carcinoma patients was 31 months (range: 2.5-112.0 months), and the median follow-up time of mucoepidermoid carcinoma patients was 18 months (range: 5-149 months). The local control rates for 1, 3 and 5 years were 66.5%, 48.8% and 42.7%, respectively. The 1-, 3- and 5- year survival rates were 88.0%, 56.7% and 45.8%, respectively. The disease-free survival rates of 1, 3 and 5 years were 58.3%, 45.4% and 38.1%, respectively. There was no statistically significant difference in local control rate, survival rate, and disease-free survival between the radioactive seeds implantation group and the radioactive seeds implantation group after surgical resection. There were 2 cases of acute radiation reaction Ⅰ/Ⅱ and 3 cases of reaction Ⅲ or above. In the late stage of radiotherapy, there were 8 cases with Ⅰ/Ⅱ grade reaction and 3 cases with Ⅲ grade or above reaction. The incidence of radiation reactions of Grade Ⅲ and above was 7%. CONCLUSION ¹²⁵Ⅰ radioactive seeds implantation provides an alternative method for the treatment of recurrent salivary gland carcinoma after external radiotherapy. The local control rate and survival rate are improved on the premise of low incidence of side effects.
Brachytherapy/adverse effects* ; Humans ; Iodine Radioisotopes/therapeutic use* ; Neoplasm Recurrence, Local/radiotherapy* ; Salivary Gland Neoplasms/radiotherapy* ; Salivary Glands

OBJECTIVETo explore the protection of high intensity microwave radiation on hypothalamo-pituitary-adrenal axis (HPAA) activity and hippocampal CA1 structure in rats and the protectiveeffect of Qindan Granule (QG) on radiation injured rats.

METHODSTotally 48 Wistar rats were randomlydivided into 8 groups, i.e., the normal control group, post-radiation day 1, 7, and 10 groups, 7 and 10days prevention groups, day 7 and 10 treatment groups, 6 in each group. Rats in prevention groups wererespectively administered with QG liquid (1 mL/100 g, 4. 75 g crude drugs) for 7 days and 10 days bygastrogavage and then microwave radiation. Then preventive effect for radiation injury was statisticallycalculated with the normal control group and the post-radiation day 1 group. Rats in treatment groupswere firstly irradiated, and then administered with QG liquid (1 mL/100 g, 4.75 g crude drugs). Finally preventive effect for radiation injury was statistically calculated with the normal control group, post-radiation day 7 and 10 groups. Contents of corticotrophin releasing hormone (CRH), beta endorphin (beta-EP), adrenocorticotropic hormone (ACTH), and heat shock protein 70 (HSP70) were detected. Morphological changes and structure of hippocampal CA1 region were observed under light microscope.

RESULTSCompared with the normal control group, contents of CRH and beta-EP significantly decreased in each radiation group. Serum contents of ACTH and beta-EP significantly increased in post-radiation day 1 and 7 groups (P < 0.05). Compared with radiation groups, beta-EP content in serum and pituitary significantly increased, and serum ACTH content significantly decreased in prevention groups (P < 0.05). Pituitary contents of CRH and beta-EP significantly increased in prevention groups. Serum contents of ACTH, beta-EP, and HSP70 were significantly lower in day 7 treatment group than post-radiation day 7 group (P < 0.05). Morphological results showed that pyramidal neurons in the hippocampal CA1 region arranged in disorder, with swollen cells, shrunken and condensed nucleus, dark dyeing cytoplasm, unclear structure. Vessels in partial regions were dilated with static blood; tissues were swollen and sparse. In prevention and treatment groups pathological damage of hippocampal CA1 region was obviously attenuated; neurons were arranged more regularly; swollen, pycnotic, or deleted neuron number were decreased; vascular dilatation and congestion was lessened.

CONCLUSIONQG could affect HPAA function and activity of high intensity microwave radiated rats, showing certain preventive and therapeutic effects of microwave radiated rats by adjusting synthesis and release of partial bioactive peptides and hormones in HPAA, improving pathological injury in hippocampal CA1 region.

Adrenocorticotropic Hormone ; blood ; Animals ; CA1 Region, Hippocampal ; drug effects ; pathology ; radiation effects ; Corticotropin-Releasing Hormone ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; HSP70 Heat-Shock Proteins ; blood ; Hypothalamo-Hypophyseal System ; drug effects ; radiation effects ; Microwaves ; adverse effects ; Pituitary-Adrenal System ; drug effects ; radiation effects ; Random Allocation ; Rats ; Rats, Wistar ; beta-Endorphin ; blood ; metabolism

AIM:To investigate the effect of reactive oxygen species(ROS)on the apoptosis of HepG2 cells induced by artesunate.METHODS:The effect of artesunate on the viability of HepG 2 cells was measured by MTT assay. The morphological changes of the apoptotic cells were observed by the method of Hoechst 33258 fluorescence staining.The apoptosis of HepG2 cells was analyzed by flow cytometry.DCFH-DA was used to detect the changes of ROS generation dur-ing the process of apoptosis.The protein levels of Bax ,Bcl-2,cleaved caspase-3 and cytochrome C(Cyt C)were deter-mined by Western blot.HepG2 cells were pretreated with apocynin and then Western blot was used to detect the expression of p47phox and p22phox,and ROS changes were analyzed by flow cytometry.RESULTS:Compare with control group,the cell viability was obviously inhibited after treatment with artesunate for 24 h(P<0.05).The nuclei were densely stained ,and the proportion of apoptotic cells was increased(P<0.05).ROS was increased significantly(P<0.05).The results of Western blot demonstrated that the expression level of Bax was increased ,Bcl-2 was decreased ,the ratio of Bax/Bcl-2 was increased ,and the protein levels of cleaved caspase-3 and Cyt C were increased.Pretreatment with apocynin reduced the expression of p47phox and p22phox and the generation of ROS in the artesunate treatment group.CONCLUSION:Artesu-nate induces the apoptosis of HepG 2 cells.The possible mechanism may be related to the increase in the generation of ROS.

Acute kidney injury (AKI) is one of the most common serious complications in Intensive Care Unit (ICU),and also an independent risk factor for death.It is associated with a substantial increase in morbidity and mortality.AKI occurs in about 13 million people per year,and the mortality of AKI was 13.1％.A meta analysis showed that the incidence of AK1 was 0.99％-11.6％ in China.Renal replacement therapy (RRT) has become one of the conventional treatments for AKI patients,however the timing of RRT initiation in patients with AKI has not yet been defined.In this article,based on the two recent large randomized controlled trials (RCT),the timing to start or terminate the treatment are reviewed.

Objective To design an automated detection protocol for morphological detection of sperm head based on deep learning and evaluate its efficiency,accuracy and reliability.Methods Fourteen pictures for each of 1 000 samples were analyzed by using the pre-trained YOLO target detection model and VGG16 classification model.At least 200 sperm were detected for each sample.Equal amount of samples were analyzed by manual microscope examination,and the efficiency,accuracy and correlation between the two methods were compared.Results The morphology of sperm heads which were manually classified but untrained was detected by pre-trained classification model,and the prediction accuracy reached to 95.5％.The detection time for clinical each sample was only 10 seconds,and its accuracy and efficiency were higher than those of manual microscope examination.The percentages of the sperms with normal morphology were significantly positively correlated(r=0.84,P＜0.01)in the detections of both the methods.Conclusion The detec-tion protocol proposed in this study can greatly improve work efficiency,and its reliability and accuracy exceed those of manual micro-scope examination.

OBJECTIVETo summarize the 23-year experience of laparoscopic biliary surgery in General Hospital of PLA and evaluate the application of laparoscopic surgery in the treatment of biliary diseases.

METHODSWe retrospectively analyzed the clinical data of 11 419 consecutive patients with biliary diseases undergoing laparoscopic surgery from April, 1992 and December, 2014. The disease spectrum was compared between patients treated before December 31, 2003 and those treated after the time point.

RESULTSThe 11419 patients receiving laparoscopic surgery accounted for 56.3% of the total patients undergoing biliary surgeries during the 23 years, including 4701 male and 6718 female patients with a mean age of 50.9∓13.2 years (6-93 years). Most (80.83%) of the patients received laparoscopic surgery for gallbladder stones, and 12.53% patients had the operation for gallbladder polyps. The laparoscopic operation rate was 84.81% in patients with gallbladder stones and 34.91% in patients with extrahepatic bile duct stones, but remained low in patients with biliary carcinoma. In laparoscopic operations, laparoscopic cholecystectomy was the most frequent (96.18%) followed by operations for extrahepatic bile duct stones, in which primary suture accounted for 1.38%, traditional T tube drainage for 0.90% and laparoscopic transcystic duct exploration for 0.72%. For malignant tumors, laparoscopic technique was used mainly for the purpose of exploration (0.34%). The application of laparoscopic technique in biliary surgery tended to increase after the year 2004, especially for benign gallbladder diseases and extrahepatic bile duct stones (P<0.05).

CONCLUSIONLaparoscopic technique in biliary surgery is gradually replacing the traditional open operation and becomes the gold standard for the treatment of benign biliary diseases.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; surgery ; Bile Ducts, Extrahepatic ; Child ; Cholecystectomy, Laparoscopic ; Drainage ; Female ; Gallbladder Diseases ; surgery ; Gallstones ; surgery ; Humans ; Laparoscopy ; trends ; Male ; Middle Aged ; Retrospective Studies ; Young Adult