The age of 18 is an important criterion in judicial trial, immigrant and competitive sports. Consequentially, the estimation of age 18 is a key issue in forensic practice and research. The extremitas sternalis claviculae, iliac crest, third molar, and the proximal limb of the limb bone were usually used as indictors of age 18. The results of the previous studies demonstrated that those indictors could be beneficial to the estimation of age 18. The X-ray, CT, ultrasound and MRI of different indictors were widely utilized for the estimation of age 18, particularly the thin-layer CT. But due to the non-radiation, MRI will be a trend for forensic age estimation in the future. Whilst in the previous studies, the descriptive analysis was applied for the estimation of age 18, but due to the low statistic efficiency, it is unsuitable for forensic age estimation, and the future studies should pay attention to the high efficiency statistical methods, for instance, the ROC curve or the data mining.

OBJECTIVE To study and improve the washing methods for the metal piping medical instruments. METHODS Some contaminated metal uteroventral scraping and drawing instruments were randomly divided into group A(by the ultrasonic vibration with proteinase washing method)and group B(by the traditional manual washing method). The effects of two washing methods were studied. RESULTS The qualified rate of experimental samples in the group A was higher than that in the group B(P

Objective To assess the classification and characteristics of headaches using the International Classification of Headache Disorders,3rd edition (beta version) criteria in a headache outpatient clinic.Methods In this prospective cross-sectional study,all consecutive patients presenting with headache to a headache outpatient clinic of Peking Union Medical College Hospital between April 1 st,2014 and February 28th,2015 were included.Results The average age of 593 patients was (42.I ± 15.6) years with female-male ratio 1.89∶ 1.Primary headaches were found in 483 (81.5％) patients,of which migraine and tension-type headache were found in 264 (44.5％) patients and 168 (28.3％) patients respectively.Chronic daily headache and new headache were found in 158 (26.6％) patients and 130 (21.9％) patients,while cough headache and thunderclap headache were found in 9 (1.5 ％) patients and 5 (0.8％) patients respectively.Patients with migraine were more likely complicated with medicationoveruse headache than patients with tension-type headache (x2 =4.21,P =0.032).Patients with tensiontype headache were more likely complicated with chronic daily headache than patients with migraine (x2 =18.92,P =0.000).Conclusions In this headache outpatient clinic,most patients were primary headaches.Chronic daily headache and new headache were common,while cough headache and thunderclap headache were uncommon.These headache syndromes should be paid attention to identify the possible underlying malignant etiologies.

Objective To systematically analyze and assess the overall value of transrectal shear wave elastograpy in diagnosis of prostate cancer (PCa) using Meta-analysis.Methods Relevant Chinese and foreign papers diagnosing PCa with transrectal shear wave elastograpy published before December 2016 were searched.The references were evaluated and screened according to the criteria of diagnostic research.The selected references were analyzed by Meta-Disc 1.4 and Stata 12.0 statistical software.Results Eight articles were included in the present Meta-analysis.Five of these literatures were about transrectal shear wave elastograpy in diagnosis of PCa,the summarized sensitivity (SEN) and summarized specificity (SPE) in diagnosis of PCa were 0.80 (95％CI [0.75,0.84]) and 0.75 (95％CI [0.71,0.79]),respectively;the positive likelihood ratios (PLR) and negative likelihood ratios (NLR) were 3.60 (95 ％ CI [2.57,5.05]) and 0.17 (95 ％ CI[0.08,0.37]),respectively;the area under SROC curves was 0.895.Five of these literatures were about transrectal shear wave elastograpy supplemental prostatic biopsy in diagnosis of PCa,the summarized SEN and SPE were 0.86 (95％ CI [0.83,0.88]) and 0.84 (95％CI [0.82,0.85]) respectively;the PLR and NLR were 5.81 (95％CI [3.07,10.99]) and 0.14 (95％CI [0.04,0.49]) respectively;the area under SROC curves were 0.924.Conclusion Transrectal shear wave elastograpy has better clinical value in detection of PCa and can be used to supplemental prostatic biopsy.

OBJECTIVEThis study aims to synthesize MTO1 (a kind of oligodeoxynucleotides) and N-isopropylacrylamide-modified polyethylenimines (PEN) complexes (MT01/PEN) as well as to investigate the effect of the complexes on the expression of osteoprotegerin (OPG) and the receptor activator of nuclear factor κB ligand (RANKL) in the human osteoblast-like cell line MG63.

METHODSMG63 cells were transfected by MT01/PEN complexes formed with three different mass ratios (1:2, 1:4, 1:6) of MT01 to PEN. MT01 and MT01-s were used as positive control. Enzyme-linked immunosorbent assay and real-time polymerase chain reaction were performed to estimate the amount of OPG and RANKL released into the culture media and in MG63 at 24, 48, 72 h.

RESULTSMG63 responded to the MT01/PEN complexes by significantly upregulating the OPG on the protein and mRNA levels (P < 0.05). The protein and mRNA levels of RANKL were lower in most of the groups with complexes, and the OPG/RANKL ratio were higher (P < 0.05). MG63 were affected by the MT01/PEN complexes with different mass ratios, particularly when the ratio was 1:6.

CONCLUSIONMT01 can enhance the promotion of ossification by establishing the delivery system with PEN.

Acrylamides ; Cell Line ; Enzyme-Linked Immunosorbent Assay ; Humans ; Oligodeoxyribonucleotides ; Osteoblasts ; Osteoprotegerin ; Polyethyleneimine ; RANK Ligand ; RNA, Messenger ; Real-Time Polymerase Chain Reaction

Objective To summarize the clinical and radiological features of DYT6 dystonia with mutations based on the data of our patient cohort as well as the report by others.Methods Clinical data of the 11 patients with DYT6 dystonia in Peking Union Medical College Hospital from June 2009 to May 2012 were retrospectively reviewed and analyzed.Clinical data included gender,onset age,initiative symptom of onset,the sites of involvemet,family history,etc.All patients were examined for brain MRI scan,6 patients were examined for DTI.Results Of the eleven gene-confirmed DYT6 dystonia patients,7 were male and 4 were female,with an onset-age ranged from 5 years to 36 years,the mean age of onset was 19.4years.Eight patients had a family history.There were 10 patients with early onset dystonia and only 1 patient with late onset dystonia.The most common site of onset was the neck (7/11),and the next was the right arm,1-5 body areas were affected at the time of neurological assessment,the average amount was 2.8,and the most frequently affected anatomical site was the neck (10/11),next came lower face,jaw and tongue.Among all the patients,6 patients presented with segmental dystonia,4 patients presented with focal dystonia,only 1 patient presented with generalized dystonia.All the patients with thanatos-associated protein domain-containing apoptosis-associated protein (THAP) domain affected had a family history,but the patients with the same mutant gene varied with clinical manifestation.Only 1 patients with non-THAP domain affected had a family history,but in most families,there were adult asymptomatic mutant gene carriers.Mutations within the THAP domain were associated with an earlier age of onset than non-THAP domain (17.3 and 21.8 years old).Routine MRI of all patients were normal and DTI of 6 patients showed that fractional anisotropy values in the bilateral sensorimotor area in DYT6 dystonia were reduced.A detailed description of a patient with TOR1A and THAP1 gene mutations was given.Conclusions Early onset dystonia is the main manifestation in patients with DYT6 dystonia in China.The most common site of onset is the neck,and the next is the right arm.The most frequently affected anatomical site is the neck,next come lower face,jaw and tongue.Laryngeal dystonia is absent.The patients with same mutant gene show high heterogeneity in the clinical manifestations,mutations within the THAP domain of THAP1 tend to manifest at an earlier age and higher penetration than mutations localized to non-THAP domain.Reduction of fractional anisotropy values indicates that the axonal integrity and coherence in the region of sensorimotor area is damaged in DYT6 dystonia.

Objective To assess the preferential expressions of peripheral blood T cell receptor beta chain variable region (TRBV) subfamilies in patients with psoriasis vulgaris(PV), and to estimate their role in the pathogenesis of psoriasis. Methods Thirty-three upstream primers were designed to target the human functional TRBV genes, downstream primers to target the common T cell receptor beta constant (TRBC) gene,with T cell receptor alpha constant (TRAC) gene as the internal reference. Total RNA was extracted from the peripheral blood T cells of 10 health human controls and 10 patients with PV, and transcribed into cDNA.Then, TRBV genes were amplified by real-time fluorescence quantitative PCR (RFQ-PCR) and the fluorescence intensity of each samples was detected. The expression levels of TRBV genes in the control group were used to calculate the cut-off values (mean expression levels of TRBV subfamilies in the 10 normal controls + 3 standard deviations). When the expression level of a TRBV subfamily from patients with PV was equal to or higher than the cut-off value, it was considered as the preferentially expressed TRBV subfamily. Results The threshold cycle (Ct) value varied from 21 to 24 for TRAC gene. The difference in the Ct value between TRBV subfamily genes and TRAC gene in patients with PV was 2.98 for TRBV2 gene, 3.24 for TRBV5-7 gene, 2.52 for TRBV6-6/6-9 gene, 2.04 for TRBV 12 gene, 3.56 for TRBV 24 gene, and 4.12 for TRBV 29 gene, and the expression levels of these subfamily genes were significantly higher than those in the normal controls (all P ＜ 0.05). According to the above standard, TRBV6-6/6-9, TRBV12 and TRBV29 were considered to be preferentially expressed subfamilies. Conclusions There is a preferential expression of TRBV gene subfamilies in peripheral blood of patients with psoriasis vulgaris, which may play a vital role in the abnormal T cell-mediated immune responses in psoriasis.

TEA转录因子4（TEAD4）是Hippo信号通路中转录共激活子YAP/TAZ下游最重要的转录因子TEAD家族的成员之 一。近年来，TEAD4的促癌作用被逐渐发现，其可与YAP形成转录复合体或不依赖于YAP独立调控下游相关靶基因的表达， 在 胃肠道肿瘤、肝癌、肺癌、乳腺癌等多种人类实体肿瘤中发挥促癌作用，导致肿瘤的发生和进展，并且是多种肿瘤不良预后的标 志。此外，靶向TEAD4及以阻断YAP-TEAD4结合为靶点的药物在多种肿瘤的体外实验及动物模型中取得显著的治疗效果， 提 示TEAD4可能是肿瘤治疗的一个理想靶点。本文就目前TEAD4在肿瘤发生、发展及治疗中的研究现状作一总结及展望，以期 为TEAD4的后续研究及以其为靶点的肿瘤治疗提供新思路。

Objective To compare the clinical efficacy of different surgical methods in the treatment of cholecystolithiasis combined with choledocholithiasis,and its effect on immune function. Methods From December 2009 to February 2017,93 patients with cholecystolithiasis combined with choledocholithiasis in Rongjun Hospital and the First Hospital of Jiaxing,were divided into the observation group and the control group according to random number table method. The observation group(47 cases) was given laparoscope combined surgery,and the control group(46 cases) was given conventional laparotomy surgery. The immune function,pain condition,complete stone clearance rate and analgesics use rate of the two groups were compared. Results After treatment,the CD +4 / CD +8 , CD +4 ,CD +8 ,CD +3 in the observation group were (1. 39 ± 0. 36),(40. 12 ± 8. 70)％ ,(22. 62 ± 2. 22)％ ,(56. 77 ± 3. 47)％ ,respectively,which were significantly lower than those in the control group[(1. 70 ± 0. 40),(46. 00 ± 9. 00)％ ,(25. 00 ± 2. 11)％ ,(60. 00 ± 4. 40)％ ],and the differences were statistically significant (t = 3. 93,3. 20, 5. 30,3. 93,all P < 0. 05). The use rate of analgesics in the observation group (4. 26％ ) was significantly lower than that in the control group (21. 74％ ) (χ2 = 6. 32,P < 0. 05). The complete stone clearance rate of the observation group(95. 74％ ) was significantly higher than that of the control group (80. 43％ ) (χ2 = 5. 22,P < 0. 05). After treatment for 3d,7d,14d,the VAS scores of the observation group were (3. 60 ± 1. 20)points,(2. 57 ± 1. 60)points, (0. 60 ± 0. 06) points, respectively, which were significantly lower than those of the control group [(5. 20 ± 2. 22)points,(4. 12 ±2. 30)points,(2. 77 ±1. 30)points],and the differences were statistically significant (t = 4. 31, 3. 77,11. 31,all P < 0. 05). Conclusion For the patients with cholecystolithiasis combined with choledocholithiasis, laparoscope combined surgery has better clinical efficacy,it can significantly improve the patients' immune function and reduce pain.

Artificial anus is the important surgical treatment for low colorectal cancer. However, fecal incontinence caused by artificial anus has significant influence on quality of life of patients. A series of novel therapy devices have been invented to solve the problem. According to the different applying methods, these devices can be divided into artificial sphincter and occluder. Artificial sphincter is implanted surgically and more automatic but its complicated design increased risk of complications such as infection and gastrointestinal symptoms. By comparison, occluder is less automatic and needs daily cleaning or replacement, but more comfortable, concealed and safer. For most of occluder are disposable or replaced frequently, advanced devices will greatly increase the economic burden on patients. With the progress of science and technology, artificial anal devices will become more intelligent, automatic and miniaturization.
Anal Canal ; surgery ; Fecal Incontinence ; Humans ; Prostheses and Implants ; Prosthesis Implantation ; Quality of Life