Objective To evaluate positive p-mTOR expression and its significance in gastric cancer.Methods Original studies published for the correlation between p-mTOR and clinicopathological parameters as well as prognostic significance were enrolled from Cohrane Library,Pubmed,EMbase database and CBM,CNKI.Analyses were performed by software REVMAN 5.0.Age,gender,TNM stage,lymph node metastasis,type were analyzed using pooled odds ratio (OR) with 95％ confidence interval (CI),and OS were analyzed using pooled hazard ratio (HR) with 95％ CI.Results Seven studies including 2 477 gastric cancer patients were enrolled in the meta analysis.p-mTOR expression was positive in 1 089 of the cases.p-mTOR positive expression was correlated with age,OR =0.74,95％ CI:0.62-0.89,dcpth of invasion OR =0.76,95％ CI:0.60-0.97,lymph node metastasis,OR =1.95,95％ CI:1.59-2.39,TNM stage,OR =0.57,95％ CI:0.38-0.84,type,OR =0.64,95％ CI:0.50-0.83,and OS,HR =1.86,95％ CI:1.60-2.16.Gastric cancer patients with p-mTOR positive expression tend to be younger,had a higher risk of lymphatic invasion,later TNM stage and poor prognosis.Its positive expression had no relation with the gender.Conclusion p-mTOR positive expression is a significant predictor for advanced TNM stage,more lymph node metastasis,intestinal type and poorer OS.

Objective To investigate the expression of Golgi protein?73(GP73) and Ki?67 antigen in gallbladder carcinoma ,and to analyze their correlations with proliferation ,invasion ,and prognosis of gallbladder carcinoma. Methods Streptavid?in?peroxidase (SP) immunohistochemistry was used to detect the expression of GP73 and Ki?67 in surgically resected specimens of 58 gallbladder carcinomas ,15 gallbladder adenomas and 15 gallbladder polyps samples . Results The positive rates of GP73 and Ki?67 protein in gallbladder carcinomas were 72.4% and67.24%,respectively ,which wer significantly higher than those in gallbladder adenomas(GP73:40.0%,Ki?67:26.7%,P<0.05)and in gallbladder polyps(GP73:13.3%,Ki?67:25.0%,P<0.05).The expression of GP73 was positively correlated with tumor differentiation ,Nevin staging and lymph node metastasis(P < 0.05), and the expression of GP73 was positively correlated with tumor differentiation ,Nevin staging(P < 0.05). GP73 expression was positively correlated with Ki?67 expression in gallbladder carcinoma (r = 0.473 ,P = 0.000). Patients with negative expression of GP73 and Ki?67 had longer survival time than those with positive expression of GP73 and Ki?67. Conclusion The expression of GP73 and Ki?67 was associated with proliferation ,invasion of gallbladder carcinoma. The combined detection of GP73 and Ki?67 is conducive to judging the progress and prognosis of the gallbladder carcinoma .

OBJECTIVE:To observe the efficacy of urapidil hydrochloride in control of blood pressure at the perioperative stage of hemorrhagic apoplexy.METHODS:All80patients with hypertensive cerebral hemorrhage were managed with seda?tive,dehydration,hemostasis,and cerebral nerve nourishment,then when the blood pressure still remained high,or the blood pressure was hard to control after the intubation,urapidi hydrochloride was administered by intravenous infusion at the dose of250mg added with250ml of5%glucose infusion,the infusion drip was set at constant speed,with2mg/min as its starting speed,while at the same time the blood pressure and heart rate were monitored and infusion speed was adjusted every10to15min,after the target blood pressure21.2/13.2kPa was obtained,the infusion speed was kept at0.1～0.4mg/min.The blood pressure and heart rate were observed separately before the administration of urapidil hydrochloride and2,5,10,15,20and30min after the administration as well as after the operation.RESULTS:5min after the administration,blood pres?sure decreased remarkably but not to the extent to cause low blood pressure,and the heart rate increased slightly at the same time,generally not over10beats each minute.CONCLUSION:Urapidil hydrochloride decreases blood pressure steadily and safely at a manageable dosage.It can be used to control blood pressure during hemostasis and clearance of hematoma,which reduces the possibility of rehemorrhagia caused by high blood pressure during and after the operation.

OBJECTIVE To explore the pro-apoptotic mechanism of juglone in SiHa cells and to in?vestigate its associated signal transduction pathways. METHODS SiHa cells were treated with juglone 20μmol·L-1 for 24,48 and 72 h. Cellular morphology was detected by inverted microscopy.The cell viability was detected by methyl thiazolyl tetrazolium (MTT) assay. After 24 h treatment with juglone 20μmol·L-1,the cell apoptosis was detected by flow cytometry while the expressions of apopto?sis-related protein BCL-2,BAX and cleave-caspase-3,PI3K/AKt pathway-related protein PTEN,AKT and pAKT were detected by Western blotting. RESULTS After treatment with juglone for 24, 48 and 72 h,the growth of SiHa cells was significantly inhibited. Compared with cell control group,cells in juglone treated gruop were sparse,slipped off the wall,became round and the cell proliferation inhibitory rate was 43.3%,63.0%and 73.1%(P<0.05,P<0.01),respectively. Twenty-four hours post treatment, the early apoptosis rate of juglone treated gruop cells was increased by(6.47±1.79)%(P<0.01)compared with cell control group. Western blotting results showed that the expression of BCL-2 decreased by 53.0%while the expression of BAX and caspase-3 increased by 85.5%and 183.3%,respectively. The expression of PTEN was increased by 75.0% but the pAKt was decreased by 45.8%(P<0.01). CONCLUSION Juglone can upregulate the expression of PTEN, thus inhibiting PI3K/AKt pathway and promoting apoptosis of SiHa cells.

Objective: To investigate the mediating effect of insomnia among mobile phone addiction, aggressive behaviors and self-perceived identity among university students. Methods: A total of 740 university students were sampled from five universities in Binjiang District, Hangzhou City using a cluster random sampling method. The mobile phone addiction, aggressive behaviors and self-perceived identity were assessed using the Mobile Phone Addiction Index Scale, the Athens Insomnia Scale, the Chinese college students' version of the Buss-Perry Aggression Questionnaire, and the Self-Perceived Identity Scale, and the mediating effect of insomnia among mobile phone addiction, aggressive behaviors and self-perceived identity was examined using Process macro program and Bootstrap method. Results: A total of 740 questionnaires were allocated, and 700 valid questionnaires were recovered, with an effective recovery rate of 94.59%. The respondents included 221 men (31.57%) and 479 women (68.43%), and there were 607 respondents with a specialty of medicine (86.71%). There were 331 participants detected with mobile phone addiction (47.29%), 90 with aggressive behaviors (12.86%) and 289 with low-level self-perceived identity (41.29%), and the prevalence rates of mild, moderate, severe and extremely severe insomnia were 28.00%, 26.14%, 26.43% and 19.43% among respondents, respectively. Mobile phone addiction had a direct predictive effect on aggressive behaviors (β=0.301, P<0.001) and self-perceived identity (β=-0.129, P<0.001), and presented an indirect predictive effect on aggressive behaviors (effect of mobile phone addiction on insomnia: β=0.083, P<0.001; effect of insomnia on aggressive behaviors: β=0.999, P<0.001; effect of insomnia on self-perceived identity: β=-0.698, P<0.001). The contributions of mediating effects caused by insomnia were 21.61% and 31.02% to total effects. Conclusions Insomnia presents partial mediating effects among mobile phone addiction, aggressive behaviors and self-perceived identity among university students. Mobile phone addiction may directly affect aggressive behaviors and self-perceived identity, and indirectly affect aggressive behaviors and self-perceived identity via insomnia.

Objective:To evaluate Masquelet technique plus flap transfer in repair of tibial infected defects complicated with extensive soft tissue defects in the lower leg.Methods:A retrospective analysis was performed in the 23 patients who had been treated by Masquelet technique plus flap transfer at Institute of Orthopedics and Trauma, 920 Hospital for tibial infected defects complicated with extensive soft tissue defects in the lower leg from March 2016 to June 2019. They were 15 males and 8 females, aged from 18 to 59 years (average, 38.4 years). The duration of disease ranged from 6 to 312 months (average, 23.6 months). All patients underwent surgery by 2 stages:1) debridement, locking compression plate fixation, formation of induced membrane by antibiotic-loaded bone cement, and repair of soft tissue defects with lower leg flaps; 2) removal of bone cement and fixation 6 to 8 weeks after infection control, fixation of broken ends after rinse, followed by grafting of cancellous bone particles in the induced membrane. The area of wound soft tissue defects after debridement ranged from 4.0 cm × 3.5 cm to 18.0 cm × 6.0 cm, and the length of bone defects from 6 to 12 cm (average, 8.4 cm). Locally grafted were pedicled fasciocutaneous flap in 4 cases, sural nerve nutrition skin flap in 9 cases (including 4 anterograde and 5 retrograde ones), saphenous nerve nutrition vascular flap in 7 cases (including 2 anterograde and 5 retrograde ones), retrograde superficial peroneal nerve nutrient vessel flap in one and free flap in 2 cases. The curative efficacy was evaluated according to the Paley fracture healing scores.Results:All the 23 patients were followed up for 9 to 46 months (average, 15.6 months). Flaps healed by the first stage in 18 cases and after skin grafting in 3 cases; skin flap transfer was conducted again in 2 cases. Infection was controlled in 21 cases but recurred in 2 cases at 9 and 14 months respectively after secondary surgery. The time for bone reunion ranged from 4 to 11 months (average, 6.2 months). According to the Paley criteria for fracture healing, 21 cases were excellent, one was good and one poor.Conclusion:In the treatment of tibial infected defects complicated with extensive soft tissue defects, Masquelet technique plus transfer of a variety of lower leg flaps can result in reliable outcomes because it controls infection, promotes formation of complete induced membrane and accelerates the process of bone reconstruction along with repair of soft tissue defects.

BACKGROUND:Increasing reports have focused on the application of tranexamic acid to reduce bleeding during total knee arthroplasty, but its usage method remains controversial.
OBJECTIVE:To explore the impact of topical articular application of tranexamic acid and intravenous application of tranexamic acid on blood loss during primary unilateral total knee arthroplasty.
METHODS:According to randomized control ed principle, 90 patients who received unilateral total knee arthroplasty in the Tengzhou Central People’s Hospital from October 2013 to December 2014 were enrol ed in this study, and randomly assigned to intravenous injection group and topical injection group (n=45). Patients in the intravenous injection group were given tranexamic acid by intravenous injection (10 mg/kg, maximum 1.2 g) during the induction of anaesthesia. Patients in the topical injection group were given intraarticularly tranexamic acid (2 g dissolved in 50 mL physiological saline) before articular capsule suture and after prosthesis fixation. Drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, and the number of blood transfusion population were compared between the two groups. Simultaneously, clinical symptoms of pulmonary embolism and deep vein thrombosis in the lower limb were observed. If necessary, lower extremity vascular Doppler ultrasound was conducted.
RESULTS AND CONCLUSION:No significant differences in drainage amount after replacement, hemoglobin and hematocrit on the next day after replacement, the number of blood transfusion population, and the proportion of blood transfusion were detected between the two groups (P>0.05). No deep vein thrombosis was found in the lower limbs at 14 days after replacement in both groups. These findings confirm that compared with intravenous systemic application, periarticular topical application of tranexamic acid during total knee replacement could obtain identical effects on reducing blood loss and blood transfusion after surgery, and could avoid relevant complications of intravenous application of tranexamic acid.

BACKGROUND: Reducing perioperative blood loss in total hip arthroplasty is a hot topic for joint surgeons. Both intravenous infusion and intra-articular injection of tranexamic acid significantly reduce perioperative blood loss, blood transfusion volume, and need for blood transfusion in patients undergoing total hip arthroplasty. However, differences between the intravenous and intra-articular methods are not clear.OBJECTIVE: To evaluate the effects of these two tranexamic acid administration methods on perioperative blood loss in patients undergoing total hip arthroplasty.METHODS: We are conducting a prospective, single-center, open-label, randomized, controlled clinical trial at the Tengzhou Central People's Hospital, China. Ninety patients undergoing unilateral total hip arthroplasty have been randomized into three groups. In the intravenous infusion group (n=30), 15 mg/kg tranexamic acid diluted in 100 mL physiological saline was infused intravenously at the beginning of surgery and 20 mL of physiological saline was injected intra-articularly after deep fascia suturing. In the intra-articular injection group (n=30), 100 mL of physiological saline was infused intravenously at the beginning of surgery and a mixture of 1.5 g tranexamic acid and 20 mL physiological saline was injected intra-articularly after deep fascia suturing. In the control group (n=30), 100 mL of physiological saline was infused intravenously at the beginning of surgery and 20 mL of physiological saline was injected intra-articularly after deep fascia suturing. The primary outcome is hidden blood loss at 1 and 3 days postoperatively. The secondary outcomes are visible blood loss, need for blood transfusion, and mean blood transfusion volume intraoperatively and on days 1 and 3 postoperatively. Other outcomes are the incidence of adverse reactions and complications within 3 months of surgery. The study protocol has been approved by the Ethics Committee of Tengzhou Central People's Hospital of China, approval number 2015-026. All protocols will be performed in accordance with the Ethical Principles for Medical Research Involving Human Subjects in the Declaration of Helsinki. Written informed consent was provided by each patient and their family members after they indicated that they fully understood the treatment plan.DISCUSSION: This trial was designed in April 2015. Cases were collected in July 2015. Data analysis will be finished in December 2017. This study is designed to investigate the effects of intravenous infusion versus intra-articular injection of tranexamic acid on perioperative blood loss in patients undergoing total hip arthroplasty to determine the more effective mode of administration.

Objective To analyze the short- and long-term effect of chemoradiotherapy combined with rhAd-p53 on locally advanced cervical cancer (LACC). Methods A total of 51 patients with stage ⅡA-ⅣA LACC were divided into experimental group (chemoradiotherapy+rhAd-p53 gene therapy, RCT-p53) and control group (chemoradiotherapy, RCT). Short-term effect, long-term effect and early side-effect were evaluated. Results ORR of RCT-p53 group and RCT group were 91.7% and 62.9%, respectively (P=0.037); CR rates were 66.7% and 40.7%, respectively. There was no significant difference of early side-effects between two groups, in terms of hematologic toxicity, digestive toxicity, hepatotoxicity or renal toxicity. Five-year PFS of RCT-p53 group and RCT group were 79.8% and 51.3%, respectively (P=0.028); 5-year OS were 81.6% and 60.3%, respectively (P=0.061). Conclusion rhAd-p53 treatment has better short-term effect and long-term effect than concurrent chemoradiotherapy, without increasing early side effects.

Objective To observe the clinical outcomes of the superior gluteal neurocutaneous flap for sacrococcygeal pressure sores. Methods Twelve cases with sacrococcygeal pressure sores were covered by the superior gluteal neurocutaneous flap from May 2005 to Nov. 2009. The sore size ranged from 15 cm ×30 cm to 5 cm × 8 cm, while the flap size ranged from 17 cm × 32 cm to 10 cm× 12 cm. Results All 12 flaps survived totally with the pressure sores healed. The longest follow-up time was four years, the short follow-up time was half a year, the average time was 2.5 years. The superior gluteal neurocutaneous flap was good blood circulation, pressure sores not recur. Conclusion The superior gluteal neurocutaneous flap is a good treatment for sacrococcygeal pressure sores for its reliable blood supply and simple harvesting.