At present, lung cancer has entered a new era of immunotherapy. However, a single immunotherapy is unable to satisfy the requirements of the immune microenvironment. More and more different combined immunotherapy schemes have become effective methods to overcome immune resistance. As a promising target in the novel immunotherapy, cancer-testis antigen (CTA) is a highly specific tumor antigen to produce a powerful anti-tumor immune response that is almost only expressed in malignant tumors. This article reviews the research progress of CTA's expression, function and immunotherapy application in lung cancer.

The article is to discuss the effect of the trained SPs acted by retired nurses in the test of internal medicine inquiry in OSCE for the graduates. The results were evaluated by those samples drawn from medical students who took part in OSCE and the professors. The evaluation of the SPs was objective and accurate, and they acted well. There are remarkable advantages in retired nurses simulating standardized patients, and it deserves extensive application in clinical medical education in our country.

BACKGROUND: There have been reports about the cochlea injury after high-velocity projectile wounding. The effect on ultrastructure of cochlea after blast was still unclear.OBJECTIVE: To investigate ultrastructural changes of cochlea and cochlear nerve after maxillofacial blast wound.DESIGN:A randomized controlled observational trail with dogs as subjects.SETTING: Otolaryngeal Department and Maxillofacial Surgery Laboratory of the Third Military Medical University of Chinese PLA.MATERIALS: The study was conducted from August 1995 through July 1997. The animal model in maxillofacial blast wound was established in Animal Center of Xinqiao Hospital of the Third Military Medical University of Chinese PLA. Specimens were treated in Maxillofacial Laboratory and observed in Electron Microscope Laboratory. Totally 15 dogs of either sex (weighting 9. 5 - 13.5 kg, mean 11.3 kg ) were randomly divided into three groups with 5 in each group. Two groups served as trauma groups 1 and 2 and the other group as control.METHODS: The maxillary and mandibular regions of 10 dogs in trauma groups were wounded by model 8 cardboard-shelled detonators to establish animal model of maxillofacial blast wound. At the 1st and 6th hour after trauma the wounds were examined and specimens of cochlea and cochlear nerve were dissected out for electron microscopic observation to study the ultrastructural changes. The specimens in the control group were treated the same way as those in the trauma groups except for blast injury.RESULTS: After wounded, the cochlea and cochlear nerve in the early period manifested cilia disorder, edema of the nerve and mitochondrial degeneration. At the 6th hour after trauma there were extensive degeneration in cochlea and cochlear nerve, cilia fallen off hair cells and dissolution of the structures in nerve sheath.CONCLUSION: The ultrastructural changes of cochlea and cochlear nerve are severed as a result of maxillofacial blast wound, but in early period the injury is reversible. So it is very important that early cure should be emphasized in treatment.

Objective To evaluate the relation of circadian blood pressure rhythm with vascular status in elderly patients with isolated systolic hypertension.MethodsAnkle-brachial index (ABI),brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) were measured in 74 elderly patients with non-dipper hypertension (non-dipper group)、78 elderly patients with dipper hypertension ( dipper group),and 72 healthy controls ( control group).Results In comparison with the dipper group,baPWV and IMT of the non-dipper group were significantly increased [ baPWV (1801.61± 314.27) vs (1658.67±274.80) (cm/s)],P＜0.01; IMT:(0.96 ±0.22) vs (0.87 +0.19) (mm),(P＜0.05),while ABI of the non-dipper group was decreased (1.03 ±0.17 vs1.12 ±0.18,P＜0.01).Identification rate was significantly different among 3 groups when baPWV ＞1400 cm/s (x2 =12.57,P ＜0.01) or ABI ＜0.9 ( x2 =9.74,P ＜0.01).The detection of carotid plaques was also significantly different ( x2 =16.49,P ＜ 0.01).Conclusions These findings suggest that vascular damage could be found in elderly patients with isolated systolic hypertension,especially in those with non-dipper hypertension.ABI,baPWV and IMT measurement may be helpful for the assessment of vascular status.

Purpose To clarify the morphological parameter and describe the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks through precisely anatomical explore of human cadaveric ankles,so as to provide anatomical evidences for the reconstruction of lateral ankle ligaments.Methods Nineteen ankle specimens were dissected to isolate the lateral ankle ligaments and measure the morphological parameters such as length,width,thickness and the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks.Results The average length of anterior talofibular ligaments (ATFL) was 23.1 ± 2.98 mm,among which 8 were single-banded(42.1％)and 11 were double-banded(57.9％).The average distance from the fibular origination of ATFL to the anterior tubercle of fibula(AA)was 17.1 ± 3.00 mm,to the fibular obscure tubercle(AO)was 5.1 ± 1.69 mm,to the tip of the fibula(AT)was 14.1 ± 2.86 mm.The distances from the talus insertion of ATFL to the superior and inferior talus articular surface were 11.4 ± 2.25 mm and 18.4 ± 2.30 mm respectively,to the anterior lateral talus chondral surface was 4.8 ± 1.42 mm.The average length of calcaneofibular ligament(CFL)was 31.4 ± 3.55 mm.The average distance of the fibular origination from ATFL to CFL was 6.4 ± 2.55 mm.The average angle between ATFL and CFL was 116.6 ± 12.69°.The distance from the calcaneus insertion of CFL to the peroneal tubercle(CP)was 15.4 ± 2.86 mm,to the posterior superior border of calcaneus(CC)was 13.9 ± 2.46 mm,to the subtalar joint surface was 15.2 ± 3.21 mm.The coefficient variation assessing the anatomical reliability of different bony landmarks were as follows:ATFL fibular origination AA(17.54％) ＜AT(20.28％) ＜ AO(33.14％),CFL calcaneus insertion CC(17.70％)＜CP(18.57％)＜CS(21.1％).Conclusion Certain variations exist in the morphological parameters and the distances from the insertion of the lateral ankle ligaments to the adjacent bony landmarks.It provides anatomical evidence for lateral ankle ligament reconstruction in treating chronic ankle instability.

Objective To compare T2* value in healthy and diseased achilles tendons (AT) using 3D-ultra-short echo time (UTE),and to analyze the correlation between T2* value and clinical scores.Methods Fifteen patients (patients group) and ten volunteers (control group) were included and underwent an MR scan with UTE sequence.The T2* value of four ROI in AT were calculated.Independent sample t-test was used to compare the differences of T2* value between two groups.The correlation of T2* values with the American Orthopaedic Foot and ankle society ankle hindfoot scale (AOFAS) and achilles tendon total rupture score (ATRS) were analyzed.Results The T2* value of four ROI were statistically significantly higher in patients group than those of control group.There were negative correlation between T2* and AOFAS or ATRS scores (r=-0.92,-0.90,both P＜0.01).Conclusion The T2* value of pathologic AT increases.The quantitative MRI UTE-T2* can evaluate AT from the biochemical structure and correlates with clinical outcomes,which is helpful to diagnose AT in the early stage.

Objective To quantitatively analyze the histological and MR images of repaired tissue (RT) following microfracture for knee joint osteochondritis dissecans (OCD) in rabbit models at different time points,make comparisons with the RT performances of joint debribement,explore the efficiency of the microfracture treatment for OCD.Methods Twenty-seven New Zealand rabbits were randomly assigned into 3 groups (sacrificed at the end of 3,5 and 7 weeks post-operation respectively),with 9 in each group.For each rabbit,one knee joint was made into an OCD model.In each group,6 were for microfracture treatment,and the other 3 were for joint debridement as control.MR scan,which mainly included sequences of 3D double echo steady state sequence (3D-DESS) and T2-mapping,was taken at 3,5 and 7 weeks postoperation.The thickness index and T2 value index of RT were calculated and T2-mapping of repaired region was drafted.Then the operation sites were removed to make histological sections of HE and Masson staining.The modified O' Driscoll score system was employed to make semi-quantitative evaluation for the histological performance of RT.Comparisons were made with respect to MR and histological findings between two treatments at each time point using unpaired Student t test.Effects of two treatments were evaluated longitudinally by comparing the results of three time points using one-way ANOVA.Results The post-operation thickness indexes of two groups increased gradually (F =33.940,28.841,P ＜ 0.05),T2 value indexes decreased (F =80.183,206.206,P ＜ 0.05),and O'driscoll scores increased gradually (F =29.867,17.167,P ＜ 0.05).At each time point,the thickness index of microfracture was higher than that of debridement group(3-week:0.743 ±0.048 vs 0.624 ±0.013,t =4.077 ;5-week:0.813 ±0.031 vs 0.734 ±0.015,t =4.107 ; 7-week: 0.972 ± 0.064 vs 0.777 ± 0.039,t =4.782 ; P ＜ 0.05),and the defects of microfracture in 7-week group were almost fully recovered while the defects of the debridement in 7-week group were not.The T2 value index of microfracture group was lower than that of debridement group at 3-week point(1.338 ±0.043 vs 1.510 ± 0.009,t =6.583,P ＜ 0.05),but it was higher than that of debridement group at 5-week and 7-week points (5-week: 1.284 ± 0.097 vs 1.116 ± 0.068,t =2.663 ; 7-week: 0.916 ± 0.036 vs 0.843 ± 0.016,t =3.283 ; P ＜ 0.05).The O'Driscoll score of microfracture group was higher than that of joint debridement at every time point(3-week:7.167 ±0.753 vs 4.667 ±0.577,t =5.000;5-week: 9.833 ± 1.169 vs 7.667 ± 0.577,t =2.960 ; 7-week: 11.167 ± 0.753 vs 8.333 ± 1.155,t =4.520 ; P ＜ 0.05).For microfracture group,the RT was mainly repaired by fibrocartilage and got matured gradually with more production of well-distributed collagen fibrils ; while for joint debridement group,the RT was mainly repaired by fibrous and scar tissue.Conclusions The post-operation repairing thickness and tissue composition of microfracture for OCD are superior to that of joint debridement.MR 3D-DESS and T2-mapping can show the thickness and tissue composition of the RT after OCD treatments,provide effective evaluation of repairing conditions,and they are of great importance on the OCD post-op follow-up.

Objective To explore the effect of pain management by pain resource nurse (PRN) attending pain nursing group, and to know the patient′s satisfaction. Methods Advanced practice nurse as the lead of the group. The selection of PRN members in the group was made on merit which all have definite responsibility and like pain nursing, established pain management quality control system in group and training,standardized pain management processes and the regulations, educated knowledge and skills of pain management for PRN. Results Patient satisfaction with pain management increased significantly from 82.0%(496/605) to 97.1%(572/589)(P<0.05). Moderate and serious pain rate of patients decreased significantly from 60.0%to 20.0%(P<0.01). The qualified rate of pain assessment increased from 84.9%(514/605) to 95.1%(560/589)(P<0.05). Conclusions The establishment of pain nursing group can not only improve pain management quality and patients satisfaction, but also improve of PRN′s professional behaviors and development of clinical pain nursing .

Objective To evaluate periphery artery and renal injury in elderly patients with dipper and non-dipper isolated systolic hypertension(ISH). Methods Totally 187 elderly cases were divided into 51 patients with non-dipper hypertension,70 patients with dipper hypertension aged (72.4±5.6) years and 66 cases with normal blood pressure as control according to results of dynamic blood pressure recorder. Ankle-brachial index (ABI),brachial ankle artery pulse wave velocity (baPWV),retinol-binding protein (RBP) and Cystatin C were assessed. ABI and baPWV were determined by a non-invasive automatic waveform analyzer. Results The baPWV value in nondipper group was higher than dipper group [(1869.3±285.6)cm/s vs.(1703.1±235.2)cm/s,q=4.73,P＜0.01],while the value of ABI in non-dipper group was lower than dipper group (1.0 ±0.2vs.1.1±0.2,q=4.74,P＜0.01).The level of Cystatin C was elevated in non-dipper group versus dipper group [(1.4±0.5) mg/L vs. (1.0±0.5)mg/L,q=6.92,P＜0.01]. There were no differences in RBP concentration among the three groups (F=2.39,P＞0.05).At baPWV＞ 1400cm/s,the level of Cystatin C was increased in 47 cases with non-dipper hypertension as compared with 64 cases with dipper hypertension [(1.4±0.5)mg/L vs.(1.1±0.5)mg/L,q=5.59,P＜0.01].Conclusions The elderly patients with non-dipper hypertension may be more easily suffered from periphery artery and renal injury in comparison with dipper hypertension.

Objective To compare the clinical results of anterior cruciate ligament(ACL)reconstruction using anterior tibial muscle tendons allograft and hamstring tendons autograft.Methods According to the graft used for ACL reconstruction,60 patients with chronic ruptures of ACL were divided into group A(30 patients,using anterior tibial muscle tendons allograft)and group B(30 patients,using semitendinosus and gracilis tendons autograft).The average follow-up periods after surgery were 29.4 and 31.6 months respectively.Lysholm,Tegner,IKDC clinical rating scales and KT2000 were used for evaluation pre-and post-operation.The muscle strength of the extension,flexion,internal rotation and external rotation of knees was evaluated by the isokinetic tester.Results There were statistically significant differences in Lysholm,Tegner,IKDC clinical rating scales and KT2000 results between pre-and postoperation(P<0.01).However,there were no statistically significant differences between group A and group B after operation(P>0.05).The Isokinetic muscle strength tester showed that the knee muscle strength of the internal rotation and flexion were decreased post-operative in group B,rather than group A,which showed no significant differences between pre-and post.operation(P<0.05).Conclusion For ACL reconstruction under arthroscopy,anterior tibial muscle tendons allograft was a favorable substitute for autograft materials for its convenience,satisfactory clinical effect and less complications.