Objective Based on the published articles,this paper aims to study the pattern and probability of lymph nodes metastasis in nasopharyngeal carcinoma (NPC) and establish a radiotherapy standard for selecting and delineation of clinical target volume of neck lymphatics for NPC patients with N0 or N1.Methods Clinical trials about NPC by MRI as the main or only diagnostic imaging way were collected and extracted from database,such as WanFang,CBM,PubMed,Cochrane Library.Statistical analyses were performed using Stata software,version 12.0.Results Twenty-one clinical trials from 963 original articles were included in this analysis.The most commonly involved regions included retropharyngeal (67％) and level Ⅱ lymph nodes (71％).The overall probability of levels Ⅲ,Ⅳ and Ⅴnodal involvement were 37％,14％ and 21％,respectively.Low-risk node groups included levels ⅠA,ⅠB,Ⅵ nodes,and the rates of lymph node metastasis were 0,2％,2％ and 1％,respectively.Nodal metastases followed an orderly pattern of top-down,and the probability of skip metastasis between levels varied between 0.5％ ～7.9％.Conclusion Lymph node metastasis in NPC follows a predictable and orderly pattern.The rarity of metastasis in certain nodal groups andskip metastasis suggest that reduced treatment volume is feasible in conformal radiotherapy for NPC patients with No or N1.

Chills ; prevention & control ; Cold Temperature ; Female ; Humans ; Occupational Exposure ; prevention & control ; Occupational Health Services ; Water

OBJECTIVETo investigate the clinical efficacy of cannulated screw fixation with percutaneous Poking reduction for the treatment of Sanders II, III calcaneal fracture.

METHODSFrom January 2012 to January 2014, 19 patients with Sanders II, III calcaneal fracture were treated with cannulated screw fixation with percutaneous Poking reduction. There were 14 males and 5 females, ranging in age from 19 to 58 years old, with an average age of (38.3 +/- 4.1) years old. The changes of Bohler angle and Gissane angle were measured and compared preoperatively and postoperatively to observe the recovery of the articular surface. The Maryland Foot Score was used to evaluate operation outcomes.

RESULTSAll the patients were followed up, and the duration ranged from 12 to 28 months with a mean of (22.3 +/- 5.3) months. The Bohler angle and Gissane angle were improved significantly after operation compared with those before operation (P < 0.05). The Maryland score was 83.2 +/- 8.4.

CONCLUSIONTreatment of calcaneal fractures with screw fixation with percutaneous Poking reduction has several advantages such as satisfactory outcome,less damage, fewer complications, quicker recovery, and shorter hospital stay,and it is one of the effective treatments for Sanders II and III calcaneal fractures.

Adult ; Bone Screws ; Calcaneus ; injuries ; surgery ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Objective To study the physical and chemical properties of silibinin; To lay foundation for optimal formulation design.Methods The high performance liquid chromatography method was used to detect the equilibrium solubility of silibininin in various solutions. The partition coefficients of silibinnin in the n-octalution-water and n-octalution-buffer solution systems were determined by shaking flask method. The destructive tests were carried out on silibinin.Results The equilibrium solubility of silibininin at 25℃ was 1.352 mg/L in water and the largest in acetonitrile, and increased in basic buffer solutions and after adding surfactants, of which sodium dodecyl benzene sulfonate was the strongest in solubilizing ability. The apparent oil-water partition coefficient of silibinnin was 61.39. Silibinnin was unstable in the acidic, basic, oxidizing and reducing solutions.Conclusion The experiment results can provide references for designing new preparations of silibinin.

The teaching quality,clinical case teaching,innovations consciousness of teacher are three important items in how to develop students' creation thinking during the course of otolaryngology.

Objective Helicobacter pylori（ ）， To investigate the infection status of HP and analyze the correlation between HP Methods infection and serum bilirubin in railway drivers. A total of 2 731 railway drivers in Zhengzhou locomotive depot were - selected as study subjects using judgment sampling method. Carbon 13 urea breath test was used to evaluate the HP infection ， status. The metabolic indexes of HP positive group and HP negative group were compared and the relationship between HP Results （ ） ， infection and serum bilirubin was analyzed. The HP infection rate was 42.3% 1 156/2 731 . The older the age the ， （ ）， （ P ） longer the work years and the higher the body mass index BMI the higher the HP infection rate all <0.01 . The infection （P ） rate of HP in married people was higher than that in unmarried people <0.01 . The HP infection rate of smokers was higher - （P ） - ， than that of non smokers <0.01 . Compared with the HP negative group fasting blood glucose and serum levels of total ， （ - ）， （ ） - cholesterol low density lipoprotein cholesterol LDL C triglyceride and homocysteine Hcy were increased in the HP （ P ） （ - ）， ， positive group all <0.05 . The serum levels of high density lipoprotein cholesterol HDL C total bilirubin direct bilirubin （ ） - （ P ） DBIL and indirect bilirubin were lower than those in HP negative group all <0.05 . Logistic regression analysis showed that （ P ） HP infection was associated with low serum total bilirubin and low DBIL all <0.01 after adjusting for the confounding effects ， ， ， ， ， ， ， - ， - ， of age work years marital status smoking history fasting blood glucose total cholesterol triacylglycerol LDL C HDL C Conclusion ， ， ， and Hcy. The age work length BMI smoking and marital status are the influencing factors of HP infection in railway drivers. HP infection is associated with low levels of total bilirubin and DBIL.

Animals ; Animals, Newborn ; Cells, Cultured ; Fibroblasts ; cytology ; metabolism ; Myocardium ; cytology ; Pravastatin ; pharmacology ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; genetics ; metabolism

Objective To investigate the expression of integrin β3 and osteopontin(OPN) in eutopic and ectopic endometrium of adenomyosis. Methods From January 2007 to July 2008, the endometrium specimens were collected from 43 patients with adenomyosis undergoing hysterectomy in Peking University First Hospital. Eutopic endometrium were 11 in proliferative phase and 32 in secretory phase (18 cases in mid-secretory phase) were collected. Ectopic endometriums were also collected. In the mean time, it was chosen 41 cases with pure subserous uterine myoma or cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ treated by hysterectomy as controls including 12 endometrium in proliferative phase and 29 endometrium in secretory phase (19 cases in mid-secretory phase). The expression of Integrin β3 subunit and OPN in the endometrium were assessed by immunohistochemical staining and quantitative real-time polymerase chain reaction. Results (1)Immunohistochemical staining showed that positive staining of integrin β3 and OPN were present predominantly in eutopic and ectopic endometrial glandular epithelium. There was significant different protein expression of integrin β3 and OPN, which were 1.6±0.8 and 1.7±0.7 in eutopic endometrium,1.7±0.7 and 1.8±0.9 in ectopic endometrium,2.1±0.9 and 2.0±0.9 in control endometrium (P<0.05). The protein expression of integrin β3 and OPN in eutopic endometrium of adenomyosis in the proliferative phase(0.8±0.4 and 0.7±0.3) were remarkably lower than those of the secretory phase(1.8±0.8 and 1.9±0.8,P<0.01). The protein expression of integrin β3 and OPN in the endometrium of controls in the proliferative phase(1.0±0.4 and 1.0±0.4) were significantly lower than those of the secretory phase(2.5±0.7 and 2.5±0.7)(P=0.000). In the mid-secretory phase, the protein expression of integrin β3(2.0±0.9) and OPN (2.1±0.8)in eutopic endometrium of adenomyosis were significantly lower than that of control endometrium(2.7±0.5 and 2.7±0.7)(P<0.01). (2)The mRNA expression level of integrin β and OPN in eutopic and ectopic endometrium were assessed by quantitative real-time PCR(result was shown by median index). It was observed that integrin β3 mRNA and OPN mRNA were significantly lower in the eutopic endometrium of adenomyosis (4.69 and 4.23), when compared with ectopic endometrium(7.96 and 14.84)and controls (13.47 and 17.40) (P<0.05). Eutopic endometrium had higher mRNA expression of integrin β and OPN mRNA in the secretory phase (5.54 and 11.40) than that in the proliferative phase(2.69 and 3.30) (P<0.01).The mRNA expression level of integrin β and OPN of control endometrium in the proliferative phase (3.12 and 4.75)were significantly lower than that in the secretory phase(19.94 and 21.00, P=0.000). The mRNA expression of integrin β and OPN were 10.10 and 14.34 in the mid-secretory phase, which were significantly lower than 21.50 and 24.18 in control endometrium(P<0.05). Conclusions High expression of integrin β3 and OPN in ectopic endometrium of adenomyosis may cause endometriotic lesions; abnormal expression of integrin β3 and OPN in the endometrium of adenomyosis during the implantation window may contribute to infertility in some patients.

Objective To investigate the effect and mechanism of high concentration glucose on cholesterol absorption of human colon cancer epithelial Caco-2 cells.Methods The experimental study was used.(1) CCK-8 detected cell proliferation:the proliferation rate changes of Caco-2 cells were detected by CCK-8 when different concentrations (12.5,100.0,300.0,700.0,1 000.0,1 388.0 mmol/L) of glucose solution effects on Caco-2 cells in order to ensure the half hindering concentration of glucose concentration on Caco-2 cells.(2)Cholesterol absorption of Caco-2 cells was detected:Caco-2 cells were divided into the cholesterol group,cholesterol plus ezetimibe (cholesterol inhibitor) group and blank control group.Cholesterol group:100 μmol/L cholesterol solution and different concentrations (5.0,25.0,50.0 mmol/L) of glucose solution were added.Cholesterol plus ezetimibe group:100 μmol/L ezetimibe,100 μmol/L cholesterol solution and different concentrations (5.0,25.0,50.0 mmol/L) of glucose solution were added.Blank control group:DMEM culture medium and corresponding concentrations of DMSO were added.The cholesterol absorption amounts of Caco-2 cells were measured.(3) The relative expressions of ATP binding cassette G8 (ABCG8),ATP binding cassette G5 (ABCG5),Nickman-Pick CI Like 1 (NPC1L1) and scavenger receptor class B type Ⅰ (SR-B Ⅰ) were examined by Western blot in the different groups.Caco cells were divided into the glucose group,glucose plus ezetimibe group and control group.The different concentrations (5.0,25.0,50.0 mmol/L) of glucose solution were added into the glucose group,different concentrations (5.0,25.0,50.0 mmol/L) of glucose solution and 100 μmol/L ezetimibe were added into the glucose plus ezetimibe group,and 100 μmol/L ezetimibe were added into the control group.The relative expressions of ABCG8,ABCG5,NPC1L1 and SR-B Ⅰ were detected by Western blot.Measurement data were presented as (x) ±s,repeated measure variance analysis was used to perform variation trend test,and t test was utilized to conduct comparisons among groups.Results (1) CCK-8 results showed:proliferation rates of Caco-2 cells with the glucose solution concentration of 12.5,100.0,300.0,700.0,1 000.0 and 1 388.0 mmol/L were 1.380 ±0.043,1.238 ±0.072,0.736 ±0.035,0.336 ±0.021,0.316 ±0.020 and 0.288 ±0.010,respectively,with a statistically significant difference in the proliferation rates (F =11.019,P ＜ 0.05).The half hindering concentration of glucose solution on Caco-2 cells was 283.54 mmol/L.(2)Cholesterol absorption of Caco-2 cells:① the cholesterol absorption amounts of Caco-2 cells with the glucose solution concentration of 5.0,25.0 and 50.0 mmol/L were 0.282 ± 0.042,0.380 ± 0.063,0.390 ± 0.060 in the cholesterol group and 0.042 ± 0.012,0.197 ± 0.015,0.277 ± 0.029 in the cholesterol plus ezetimibe group,respectively,showing a statistically significant difference between the 2 groups (F =55.566,P ＜ 0.05).②There was a statistically significant difference in cholesterol absorption amounts of Caco-2 cells with different glucose solution concentration in the cholesterol group (F =79.117,P ＜ 0.05).The cholesterol absorption amounts of Caco-2 cells with the glucose solution concentrations of 5.0 mmol/L was lower than that with the glucose solution concentrations of 25.0 mmol/L and 50.0 mmol/L,respectively (t =11.207,11.532,P ＜0.05).There was no statistically significant difference in the cholesterol absorption amounts of Caco-2 cells between the glucose solution concentrations of 25.0 mmol/L and 50.0 mmol/L (t =12.389,P ＞ 0.05).③There were statistically significant differences in cholesterol absorption amounts of Caco-2 cells with the glucose concentration of 5.0 mmol/L and 25.0 mmol/L between cholesterol group and cholesterol plus ezetimibe group (t =10.908,10.644,P ＜ 0.05).(3) The results of Western blot showed:① the relative expression of NPC1L1 protein in Caco-2 cells with the glucose solution concentrations of 5.0,25.0 and 50.0 mmol/L were respectively 0.277 ±0.019,0.558 ±0.015,0.576 ±0.003 in the glucose group and 0.057 ±0.002,0.054 ±0.005,0.077 ±0.005 in the glucose plus ezetimibe group,showing a statistically significant difference (F =482.207,P ＜0.05).② The relative expression of NPC1L1 protein of Caco-2 cells with the different concentration of glucose solution in the glucose group were compared,with a statistically significant difference (F =8.112,P ＜ 0.05).There was a statistically significant difference in the relative expression of NPC1L1 protein in Caco-2 cells with the different concentration of glucose solution in the glucose plus ezetimibe group (F =11.708,P ＜ 0.05).③ The relative expression of NPC1L1 protein in Caco-2 cells with the glucose solution concentrations of 5.0,25.0 and 50.0 mmol/L in the glucose group was statistically different from that in the glucose plus ezetimibe group (t =8.112,11.708,13.920,P ＜ 0.05).Conclusion High concentration glucose solution could promote the reabsorption of cholesterol through increasing NPC1L1 protein expression in Caco-2 cells,and increase the risk of suffering from cholelithiasis in diabetes patients.

Objective To investigate the dynamic changes of the contents of brain water and Ca,Fe,Cu,Zn,Mg and microvascular damage in hippocampal tissue of radiation-injured rat brain.Methods The rats were randomly divided into control group,protective group (with intraperitoneal injection of 10％ MgSO4,400 mg/kg body weight + a single dose of 20 Gy electron beam irradiation in whole brain) and irradiation alone group (with intraperitoneal injection of normal saline,400 mg/kg body weight + a single dose of 20 Gy electron beam irradiation to the entire brain) with 18 rats assigned to each group and 3 rats sampled at each time point.Radiation-induced brain injury (RBI) was modeled by irradiating the rat' s whole brain with 5 MeV electrons.A dry-wet weight method was used to detect brain water content (BWC),and the level of microvascular damage was detected with HE staining of brain tissue slices,and the contents of Ca,Fe,Cu,Zn,Mg in hippocampus were detected with inductively coupled plasma atomic emission spectroscopy at different time points after radiation.Results BWC in the irradiated rats at 7,14 and 30 d post-irradiation was higher than that of control group (t =3.21,-2.11,2.82,P ＜0.05),andBWC in the protective group was less than that in the irradiated group (t =2.84,4.33,1.90,P ＜ 0.05).Microvascular thrombosis was induced in the radiated brain but this thrombosis was reduced by MgSO4.Thecontents of Ca and Fe in the brain tissue after 1,3,7 d of irradiation was higher than that of control group(t =11.41,6.81,14.03,17.17,6.89,9.12 and 5.43,5.66,3.60,P ＜ 0.05),and the content of Cain the protective group at various time post-irradiation was less than that in the irradiated group (t =5.35,5.28,11.02,14.26,5.68,9.10,P ＜0.05).The content of Cu (1,7,14,60 d post-irradiation) andZn (1,7,14,30,60 d post-irradiation) of the irradiated group was less than that of the control group(t =4.24,3.76,4.76,3.86 and 5.25,4.78,26.53,6.67,11.37,P ＜ 0.05),and the content of Cuin the protective group at different time points post-irradiation was less than that of the irradiated alonegroup (t =4.23,3.57,4.01,4.73,3.78,3.44,P ＜0.05),the content of Zn in the protective group(14 d post-irradiation) was higher than that of the irradiated group (t =6.21,P ＜ 0.05).The content ofMg in the irradiated group (7 d post-irradiation) was less than that of the control group (t =5.85,P ＜0.05).Conclusions The contents of Ca,Fe,Cu and Zn were imbalanced in the radiation-injured ratbrain,and the supplement of MgSO4could recover the balance of Ca,Fe,Cu and Zn content and alleviateradiation-induced brain injury.