Objective To study the clinical outcome of thoracolumbar fractures treated by ante rior route decompression,bone-graft-fusion and internal fixation.Methods 51cases of thoracolumbar fractures from Jun1994to Mar 2002were treated by anterior route decompression,bone-graft-fusion and internal fixation,of w hich32cases by Kaneda system and 19cases by Z-Plate system.Their clinical data were analyzed.Results The patients were followed up from five months to eight years(average of 3.5years).45cases had a good anatomic reduction and maintain thoracic-lu mbar lordosis.48cases gained one to three Frankel grades of neurologic r e-covery as a consequence of operation.Conclusion Kaneda internal fixation has the characteristics of low cost,neurological decompression and reliable fixation;and Z-Plate systems has the advantages of simple manipul ation,intrinsic stability,less complications and good biocompatibility.

Objective To evaluate the feasibility of contrast material on image quality of coronary CT angiography (CCTA)by using double injection technology and iterative reconstruction.Methods 120 patients with suspected coronary heart disease who underwent CCTA were randomly divided into two groups.Then,60 patients with 30 kg/m2>BMI≥25 kg/m2 were averagely divided into A1 and B1 groups,and other 60 ones with BMI<25 kg/m2 were also averagely divided into A2 and B2 groups.The patients in group A were scanned with 120 kV tube output and iolromide 350 mg I/mL,and the images were reconstructed using filtered back projection (FBP).Meanwhile,the patients in group B were scanned with 80 kV or 100 kV tube output and 245 mg I/mL or 280 mg I/mL of contrast media (BMI≥25 kg/m2 )using double injection technology,and the images were reconstructed using adaptive iterative dose reduction 3D (AIDR 3D).The effective radiation dose (ED)of each patient was also calculated.CT attenuation of the main proximal vessels (ascending or descending aorta,pulmonary artery,RCA,LM,LAD and LCX)and the obj ective image quality (SD,CNR and SNR)were measured,and the subj ective evaluation was also assessed by an experienced radiologist.Results There was significant differences in mean image quality scores,SD,SNR and CNR of ascending aorta between group A1 and B1(P<0.05),but no difference in the SI of values (P>0.05).There was no significant difference in mean image quality scores between group A2 and B2 (P>0.05), however,there were significant differences in the SI,SD of values and SNR,CNR of ascending aorta (P<0.05).The values of BMI were negatively related to the values of CT in ascending aorta between two subgroups (r=-0.66 and -0.441,P<0.05).The values of weight were not related to the values of CT in ascending aorta (P>0.05).There was significant difference in effective dose between subgroups (P<0.05).Conclusion The method with a combination of iterative reconstruction and a contrast material of 245 mg I/mL using double inj ection technology can improve the contrast enhancement without impairing image quality.

AIM: To construct human GPI-B7-1 fusion protein and investigate the therapeutic potentials in the treatment of tumors. METHODS: The chimeric GPI anchored-B7-1 gene was obtained by overlap PCR and inserted into expressing vector pcDNA3.1, named pc3.1/GPI-B7-1. pc3.1/GPI-B7-1was transfected into CHO cells by lipofectamine ~2 000 reagent. The CHO cells, expressing GPI-B7-1 on membranes, were obtained after selecting by G418. That was confirmed by flow cytometry, SDS-PAGE and Western blot. RESULTS: Recombinant vector pc3.1/GPI-B7-1 was successfully constructed and sequence result indicated that it was identical with reference sequence. The protein on transfected CHO cell membrane selected by G418 was confirmed to be GPI-anchored protein by flow cytometry, and GPI-B7-1 approximately 60 kD was conformed by SDS-PAGE and Western blot. CONCLUSION: A large amount of GPI-B7-1 fusion protein was obtained and will be further studied in the treatment of tumors.2? [

Objective · To evaluate the efficacy and prognostic factors of ifosfamide-cisplatin-etoposide (ICE) chemotherapy as salvage regimen for patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL).Methods · A retrospective analysis was performed on 84 relapsed/refractory DLBCL patients who were treated with ICE salvage regimen at Ruijin Hospital (Shanghai Jiao Tong University School of Medicine,China) from July 2004 to June 2016.Overall survival (OS) was analyzed by Kaplan-Meier method and multivariate Cox proportional hazards models.Results· Of the 84 patients who were treated with ICE regimen,37 (44.0％) patients had responses,including 26 (31.0％) achieving complete remission.The median number of cycles per patient was 3 (range 1-6 cycles).The 1-year and 2-year OS rates were 49.5％ and 30.0％,respectively.The median OS time was 12.2 months.On univariate analysis,patients with early progression/recurrence (P=0.041) and a high-intermediate/high risk according to the international prognostic index (IPI) (P=0.024) and NCCN-IPI (P=0.002) had poorer outcomes.While improved outcome was found in patients in complete remission after chemotherapy (P=0.000).The multivariate analysis revealed that the intermediate-high/high risk according to NCCN-IPI was an independent risk factor,and remission after chemotherapy was an independent prognostic factor for prolonging survival.Conclusion· The ICE regimen can be used as an effective salvage therapy for patients with relapsed/refractory DLBCL.

Studies have shown that the clinical manifestation of patients with neuropsychiatric disorders might be related to the abnormal connectivity of brain functions. Psychogenic non-epileptic seizures (PNES) are different from the conventional epileptic seizures due to the lack of the expected electroencephalographically epileptic changes in central nervous system, but are related to the presence of significant psychological factors. Diagnosis of PNES remains challenging. We found in the present work that the connectivity between the frontal and parieto-occipital in PNES was weaker than that of the controls by using network analysis based on electroencephalogram (EEG) signals. In addition, PNES were recognized by using the network properties as linear discriminant nalysis (LDA) input and classification accuracy was 85%. This study may provide a feasible tool for clinical diagnosis of PNES.
Brain ; physiopathology ; Electroencephalography ; Epilepsy ; Humans ; Seizures ; diagnosis

Objective To establish rat models of polycystic ovary syndrome(PCOS) induced by different methods,to assess the serum levels of several related hormones,to examine the morphological changes in the ovaries,and to discuss their significance.Methods Letrozol,sodium prasterone sulfate,or sodium prasterone sulfate combined with human chorionic gonadotropin were used to establish rat models of PCOS.Radioimmunoassay was used to measure the serum levels of hteinizing hormone(LH),follicle-stimulating hormone(FSH),estrogen(E_2),progesterone(P),testosterone(T),prolactin(PRL),and insulin(INS).HE staining was used to examine the morphological changes of the ovaries.Results Comparing with the normal group A,the serum FSH was increased and the serum progesterone was reduced in the group B,with a statistically significant difference(P<0.05).The serum testosterone was significantly higher in the group B than in the group A(P<0.01).The levels of serum sex hormones and insulin were not significantly different in the group D and C(P>0.05).In comparison with the group C,the levels of serum testosterone and LH/FSH ratio was significantly increased in the group E.(P<0.05).Comparing with the group D,the serum levels of progesterone and testosterone were significantly increased in the group E(P<0.05).The ovaries in the rats of groups A and C showed almost a normal histyology,with mature follicles and dominant follicles.Polycystic changes were observed only in the ovaries of groups B,D and E.Conclusion At the aspect of affecting the level of sex hormones in serum and changing the ovarian morphology.adopting letrozol tablets or sodium prasterone sulfate combined with HCG to induce rat PCO model is more close to clinic manifestations and meets the criteria of PCO animals.In the rat PCOS models induced with letrozol or with sodium prasterone sulfate combined with HCG,either the serum levels of sex hormones and ovarian histology are quite similar to those of human clinical appearance,and may well meet the modeling requirements for future experimental studies of polycystic ovary syndrome.

Since the 2019 novel coronavirus (2019-nCoV or officially named by the World Health Organization as COVID-19) outbreak in Wuhan, Hubei Province, China in 2019, there have been a few reports of its imaging findings. Here, we report two confirmed cases of 2019-nCoV pneumonia with chest computed tomography findings of multiple regions of patchy consolidation and ground-glass opacities in both lungs. These findings were characteristically located along the bronchial bundle or subpleural lungs.
China ; Coronavirus ; Lung ; Pneumonia ; Thorax ; World Health Organization

Objective To investigate the induction and regulatory mechanism of placental trophoblast cell autophagy in women with preeclampsia (PE).Methods Twenty gravidas with severe PE who underwent cesarean section in the Department of Obstetrics and Gynecology of Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University from August 2016 to November 2016 were enrolled in PE group.An equal number of normotensive gravidas without proteinuria who also underwent cesarean section during the same period were randomly selected as control group.Placental tissue samples were collected from all gravidas.Ultrastructure of placental trophoblast cells and changes in autophagosome formation were observed by transmission electron microscope.Expressions ofmicrotubule associated protein 1 light chain 3B (MAP1LC3B,or LC3B) and Beclin 1 in placental tissue samples were detected by quantitative real-time polymerase chain reaction (PCR) and Western blot.Activities of protein kinase B (PKB,also known as Akt)/mammalian target of rapamycin (mTOR) pathway in placental tissue samples were detected by Western blot.Two independent samples t-test or Mann-Whitney U test was used for statistical analysis.Results Sparse and disordered villi and many typical autophagosomes were observed in placental trophoblast cells from patients with severe PE.Significantly enhanced expression of LC3B at mRNA and protein levels and increased ratio of LC3-Ⅱ/LC3-Ⅰ were observed in the PE group as compared with the control group [3.37 (2.37-6.11) vs 0.62 (0.25-4.15),1.40±0.17 vs 1.00±0.13,1.57±0.25 vs 1.00±0.31,Zor t=--4.440,3.274 and 3.113,all P＜0.05].No significant difference in the expression ofBeclin 1 at mRNA or protein level in placental tissues was found between the two groups (both P＞0.05).Furthermore,Akt and mTOR phosphorylation in the PE group was significantly suppressed as compared with that in the control group (1.00±0.29 vs 0.64±0.21,1.00±0.32 vs 0.60±0.22,t=--3.672 and-2.895,both P＜0.05).However,the two groups showed no significant difference in the expression of Akt or mTOR protein (both P＞0.05).Conclusions Suppressed activity of Akt/mTOR pathway and enhanced induction of trophoblast cell autophagy are detected in placental tissues of patients with severe PE,indicating that excessive trophoblast cell autophagy,induced by decreased activity of Akt/mTOR pathway,may be the pathogenesis for PE.

Background: Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations. Methods: Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients. Conclusion The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.

Pathophysiology is a comprehensive subject, which is very important to cultivate the clinical comprehensive thinking of medical students. Pathophysiology involves a wide range of subjects and contents, and is one of the major and difficult courses in basic medicine. Based on many years of research and practice, we have developed main-line-problem-based learning (ML-PBL). ML-PBL is a diversified teaching mode, including the main line teaching method, clinical case discussion method, and the main line synopsis explaining method. The analysis of application results shows that ML-PBL teaching improves the student performance. Furthermore, ML-PBL is more conducive to cultivating the comprehensive clinical thinking ability, improving the independent learning ability, and fully mobilizing the learning initiative.