[ ABSTRACT] AIM:To investigate the effect of sodium valproate ( VPA) on bleomycin-induced pulmonary fibro-sis ( PF) and its mechanism.METHODS: SD rats ( n =42 ) were randomly divided into model group and treatment group.Bleomycin at dose of 5 mg/kg was intratracheally injected to establish a rat PF model.The rats in treatment group were given normal saline (NS, 0.5 mL/d), VPA (300 mg· kg-1· d-1) or dexamethasone (DEX, 0.6 mg· kg-1· d-1 ) via intraperitoneal injection from the 14th day to the 28th day after modeling.The rats in model group were sacrificed on 0 d, 14 day and 28 d after modeling .The rats in treatment group were killed at 14th day after treatment.The effects of VPA on PF were evaluated by HE and Masson staining.The hydroxyproline ( HYP) content in the rat lung tissues was de-tected, and the expression ofα-smooth muscle actin (α-SMA) and E-cadherin was determined by Western blotting.RE-SULTS:HE staining showed that the alveolar structure and interstitial morphology in VPA group were better than those in NS group and DEX group.The level of collagen in VPA group was significantly lower than that in DEX group and NS group by determining the HYP content and Masson staining.VPA reduced the expression ofα-SMA, a mesenchymal marker pro-tein of PF, while increased the expression of epithelial marker protein E-cadherin.CONCLUSION:VPA reduces collagen content and distribution, and up-regulates the expression of the epithelial marker protein E-cadherin, while down-regulates mesenchymal marker proteinα-SMA, thereby preventing the rat lung tissues from bleomycin-induced PF.

Objective To investigate the diagnostic value of electrophysiological examination for tarsal tunnel syndrome (TTS).Methods Motor nerve conduction velocity (MCV),sensory nerve conduction velocity (SCV),F wave and electromyographic measurements were carried out with 26 clinically suspected TTS patients.Results Of the 26,22 patients were unilaterally affected and 4 were bilaterally affected,so 30 tarsal tunnels in total were affected.All received electrophysiological examination.Of the 30 affected tarsal tunnels,abnormal MCV was detected in 28 of the posterior tibial nerves (93.3％),while abnormal SCV was detected in 27 medial plantar nerves (90％) and 24 lateral plantar nerves (80％).Needle electromyography of 156 targeted foot muscles detected abnormal spontaneous potentials in 90 of them (57.7％),giant potential in 12 muscles (7.7％) and decreased recruitment in 76 (48.7％).Conclusions The distal posterior tibial nerve is impaired in TTS,presenting axonal damage in an electrophysiological examination.Such examinations should have an important role in the diagnosis and differential diagnosis of TTS.

Objective To explore the methods of training for therapists. Methods The students participated in 2014 Beijing Clinical Shortage of Manpower Training Programs (Therapist) by Beijing Quality Control and Improvement Center of Medical Rehabilitation accepted theoretical and operating training and tests. They were interviewed for the situation of training program. Results 39 students had completed the training with the average age of (28.41±6.05) years. The average scores of theory test was (76.23±5.70), and it was (87.18±8.00) of operation. The score of theory test was more than that before the training (P<0.01). From interview, a total of 59 recommendations were obtained, which focused on the quality of training of training provider and the support from sending institutes. Conclusion Beijing Clinical Shortage of Manpower Training Programs (Therapist) has improved the academic and operative level of therapists.

Objective To evaluate the effect of training for therapists based on Kirkpatrick's Four-level Model. Methods Totally 39 ther-apists who completed 2014 Beijing Clinical Shortage of Manpower Training Programs (Therapist) were investigated with Kirkpatrick's Four-level Model, named reaction, learning, behavior and results. Results For reaction level, the total satisfaction was high, but different with the degree of education, especially in the items of Participate in Training, Type of Cases, Organizing on Practice Training, Organizing Case Discussions and Get A Lot of Benefits from the Training (F>4.59, P<0.05). For learning level, the test scores were significantly differ-ent before and after the training (t>9.53, P<0.001). For behavior level, the self-reports of the therapists, and the reports from their depart-ment directors and colleagues all agreed that their ability improved after training (t>4.44, P<0.001). For results level, eleven therapists passed the rehabilitation therapist test, two therapists participated in some researches, and one published an article. Conclusion The thera-pists satisfied in the training, that may improve the ability of therapists to contribute to their organization.

Objective To evaluate the accuracy of electromyography (EMG) in localizing the compressed nerve root in lumbar intervertebral disc protrusion (LIDP) pre-operatively.Methods Data were collected on 198 cases of LIDP.Of those,152 cases had positive EMG findings and were treated surgically to relieve compression of the nerve roots caused by LIDP.The intra-operative findings were compared with the pre-operative EMG findings.Results The sensitivity of EMG in detecting radiculopathy was 76.8％ (152/198).Among those 152 EMG positive cases,140 were confirmed in the subsequent operation (92.1％),24 clinically suspected cases of single L5 or S1 compression had indicated of both L5 and S1 damage by EMG and subsequently confirmed on surgical exploration.Conclusions Almost all preoperative EMG findings were confirmed in the subsequent operations (92.1％).Moreover,the indication of combined double nerve root damage by EMG was valuable for guiding the surgical procedure.

Objective To investigate the effect of clinical pathway on inpatients for rehabilitation. Methods The hospital expense, the ex-pense for medicine and length of stay in hospital were compared in patients with cerebral hemorrhage, cerebral infarction, spinal cord injury and spastic cerebral palsy before (January 1st, 2012 to April 30th, 2013) and after (May 1st, 2013 to December 31st, 2015) clinical pathway implementation, 50 inpatients for each disease, totally 200 patients. Results The length of stay in hospital reduced after of clinical pathway implementation, in all the diseases (t>5.226, P<0.001), with the decrease of hospital expense for cerebral infarction (t=3.327, P<0.001). There was no significant increase in any expense in the disease (t<1.777, P>0.05). Conclusion The implementation of rehabilitation clinical pathway can reduce the length of stay in hospital for the patients rehabilitation in hospital, without increasing their cost.

Objective:To explore the clinical and electrophysiological characteristics of flail arm syndrome (FAS).Methods:Clinical and electrophysiological data were collected on 13 FAS patients and 31 persons with upper limb onset amyotropic lateral sclerosis (UL-ALS), including the amplitude of compound muscle action potential (CMAP) related to median nerve, ulnar nerve, and axillary nerve motor conduction. A split-hand index (SI) was calculated by dividing the CMAP amplitude of abductor pollicis brevis by that of the abductor digiti minimi. Clinical features, the CMAP amplitudes and SIs were compared between the FAS and UL-ALS patients.Results:Compared with UL-ALS patients, the age at onset among the FAS patients was older (averaging 60.9 years). The development to the second stage was longer (24±6 months). The upper limb reflexes of 15% of the FAS patients had disappeared and those of 77% were weakened, while the lower limb reflexes of 54% of the FAS patients were active and 38% were weakened, significantly different from the UL-ALS patients. However, there were no significant differences in the CMAP amplitudes of the median and ulnar nerves, nor in SI between the FAS and UL-ALS patients. The SIs of the FAS patients with upper motor neuron signs were significantly lower than those of FAS patients without such signs. Among the FAS patients, the average CMAP amplitude of the ulnar nerve was the highest, followed by those of the median and axillary nerves. Among the UL-ALS patients, however, the average CMAP amplitude of the ulnar nerve was not significantly different from that of the axillary nerve.Conclusions:FAS patients with upper motor neuron signs are more likely to have slip hand. The CMAP amplitude of their axillary nerve tends to be lower than that of their median and ulnar nerves. FAS seems to be a special type of ALS.

Objective To investigate the inhibitory effects of CIK on the proliferation of Lewis lung carcinoma cell line and the growth of transplanted Lewis lung carcinoma in C57BL/6N mice in vivo.Methods CIK cells were induced by culturing PBMC with regular method.The proliferation of Lewis lung carcinoma cells was measured by MTT assay.Uhramicrostrueture of Lewis lung carcinoma cells was observed under a transmission electron microscope.Flowcytometric analysis was used to detect cell apoptosis.Ultrastructural observation expressions of FasL were individually determined by MTT and immunocytochemistry(ICC) analysis.Results Electron microscopic observations sbowed that CIK cells could induce the hepatoma cells to apoptosis.Flow cytometric analysis demonstrated that apoptosis cells of Lewis lung carcinoma were increased in CIK group compared with those in the control group.FasL expression on CIK increased.Cytotoxieity was blocked after addition of anti-FasmAb.Conclusion CIK has inhibitory effect on Lewis lung carcinoma cells both in vitro and in vivo.CIK cells can induce the apoptosis of Lewis lung carcinoraa cells.and Fas/FasL pathway plays an important role in apoptosis of Lewis lung carcinoma cells by CIK.

Objective To report the clinical features, myopathological changes, and gene mutations in five Chinese patients with mitochondrial diseases caused by POLG gene mutations. Methods Clinical materials of five unrelated patients who were referred to Department of Neurology, Peking University First Hospital from April 2012 to January 2018, carrying POLG gene mutations, were retrospectively analyzed. Muscle/nerve biopsies and targeted second-generation gene sequencing were performed on the patients. Results Among the five patients, three were male and two were female. Two cases were dominant inheritance and three were sporadic or recessive inheritance. The ages of onset were from 15 to 40 years with disease course of one to 26 years. One of them showed atypical SANDO (sensory ataxic neuropathy, dysarthria, and ophthalmoparesis) syndrome accompanied by cardiac preexcitation syndrome. There were two cases with autosomal dominant and one case with recessive progressive external ophthalmoplegia plus syndrome. One case presented with cognitive delay and sensory neuropathy. The pathological changes of mitochondrial myopathy were observed in all four patients with muscle involvement. Sural nerve biopsy in the patient with cognitive delay and sensory ataxia revealed chronic axonal pathological changes. POLG gene mutations were found in all five patients by targeted next generation sequencing, including single heterozygous mutations in two dominant inherited patients (c. 914 G＞A and c. 2864A＞G, respectively), and compound heterozygous POLG gene mutations in the other three sporadic/recessive inherited patients (c. 2591 A＞G/c. 1790 G＞A, c. 924G＞T/c. 3002delG and c. 1613A＞T/c. 1612 G＞T, respectively). There were six novel mutations not reported before, i.e., c.914G＞A(p.S305N), c.924G＞T(p.Q308H), c.1613A＞T(p.E538V), c.1612G＞T(p.E538*), c.1790 G＞A(p.R597Q) and c.3002delG. Conclusions POLG gene mutations can lead to different clinical spectrums. Progressive external ophthalmoplegia, limb weakness and axonal sensory neuropathy are common presentations in this group of patients with POLG gene related mitochondrial neuromuscular diseases. Novel mutations found in this study expand the mutational spectrum of POLG gene.

Objective: To analyze the prognostic factors and the value of radiotherapy (RT) for the early stage (T_1-2N₁M₀) triple-negative breast cancer (TNBC) patients after modified radical mastectomy, and provide a basis for the selection of the clinical treatment strategy. Methods: The retrospective analysis was performed in 87 TNBC patients at T_1-2N₁M₀ stage. All patients were admitted to the Second Affiliated Hospital of Dalian Medical University from Jan 2006 to Oct 2011. Fifty-three cases received postoperative RT (RT group), and the other 34 cases without RT (non-RT group). Factors enrolled in Kaplan-Meier analysis were postoperative RT, age, menstruation, histological grade, vascular tumor thrombus, T staging, the number of positive lymph node and metastasis rate, surgery procedure, Ki-67 index. The endpoints were local regional recurrence rate (LRR), distant metastasis rate (DM), recurrence free survival (RFS), and overall survival (OS) rate for 5 years. Results: The significant difference was found in the 5-year LRR (9.4% vs. 15.2%) and RFS (81.3% vs. 66.7%) between RT group and non-RT group (χ²=8.073, 12.789, P<0.05). No significant difference in the DM and OS was observed between the two groups (P>0.05). The univariate analysis showed that RT, lymph node metastasis, age, and Ki-67 index were the risk factors for 5-year LRR (P<0.05), while vascular thrombus and lymph node metastasis rate were risk factors for 5-year DM (P<0.05), RT, vascular tumor thrombus, lymph node metastasis rate, and Ki-67 index 5-year RFS (P<0.05). The multivariate analysis showed that RT and lymph node metastasis were the independent risk factors for 5-year LRR (HR=0.279, 5.277, P<0.05), vascular thrombus was an independent risk factor 5-year DM (HR=2.313, P<0.05), while RT, vascular tumor thrombus and lymph node metastasis rate were the independent risk factors for 5 years RFS (HR=0.378, 2.350, 5.084, P<0.05). Conclusions Postoperative RT might improve the local control rate of TNBC patients at T_1-2N₁M₀ stage, while the effect on DM and OS in 5 years was little. Postoperative RT, lymph node metastasis rate, vascular tumor thrombus, Ki-67 index and age are related to patient′s prognosis of early stage TNBC.