Objective To verify the traditional serrated pathway by comparing microsatellite instability(MSI) status among traditional serrated adenoma, traditional adenoma, serrated colorectal cancer and non-serrated coloreetal cancer. Methods Seventy-five paraffin-embedded tissue samples, including 15 with serrated adeneearcinoma (Sca), 20 with non-serrated adenocareinoma (N-Sca), 20 with traditional serrated adenoma(TSA) and 20 with villous adenoma(AD) were collected from the pathology department of our hospital. Genomic DNA was extracted from these samples and then amplified with fluorescently-labeled primer specific for BAT25 and BAT26. The MSI status was detected with DNA automatic sequencer. Results Six of 18 samples with TSA harbored MSI-H and twelve MSI-L/MSS; 18 samples with conventional adenoma were exclusively of MSS; 3 of 13 samples of serrated carcinoma harbored MSI-H and ten MSI-L/MSS; 18 of 19 N-Sca samples harbored MSI-L/MSS and only one MSI-H. With Chi-square test, the MSI frequency in AD group and N-Sca group was significantly lower than that in TSA group and Sca group ( P < 0. 05 ) ; but with no statistical difference between the TSA group and Sca groups ( P > 0. 05 ). Conclusion MSI-H frequency in AD group and N-Sca group was obviously lower than that of TSA group and Sca group. It is concluded that there might be a new traditional serrated neoplasia pathway which is different from the conventional adenoma-carcinoma carcinogenesis pathway, but we still need prospective follow-up studies to verify its existence.

[Objective]To study the correlation between the severity of bone marrow edema(BME) and the collapse of osteonecrosis of the femoral head(ONFH),to explore the relationship between the severity and the score of Harris,so as to offer the direction for understanding and judging the prognosis of ONFH clinically.[Method]Fifty-eight cases of ONFH patients(94 hips) without collapse,according to the X-Ray and the MRI examination,made a follow-up visit for 16～28 months,an average of 18 months,and made a retrospective study of the correlation between the severity of BME and the collapse,the Harris of ONFH.[Result]The correlation between the BME degree and the collapse of ONFH:the collapse rate was 4.5% in degreeⅠ,11.8% in degreeⅡ 66.7% indegreeⅢ,90% in degree Ⅳ.The correlation between the BME degree and the Harris:93.0?5.41 in degree Ⅰ,84.1?5.42 in degree Ⅱ,76.4?4.22 in degreeⅢ,66.3+7.46 in degree Ⅳ.[Conclusion](1)BME is the secondary sign of ONFH;(2)The tendency of collapse could be predicted through the BME;(3)There is a negative correlation between the BME degree and the Harris,namely the larger scope of BME is,the lower the score of Harris is.

BACKGROUND: What kind of traumatic changes could be observed in remote lumbar spinal cord after high-speed steel ball induced sciatic nerve injury?OBJECTIVE: To study the ultra structural changes of lumbar spinal cord motor neurons after the sciatic nerve injury due to high-speed steel ball.DESIGN: Retrospective randomized controlled study with experimental animals as subjects.SETTING: The field operation research institute of a military medical university college.MATERIALS: This study was carried out at the Ballistic Laboratory of Research Institute for Surgery from May 2001 to December 2002. Sixty-five SPF flap-eared rabbits of either gender weighing from 2.5 to 3.0 kg were provided by the Experimental Animal Center of Daping Hospital Affiliated to the Third Military Medical Univeristy of Chinese PLA. All the rabbits were divided randomly into normal control group( n = 5), firearms injury group (n = 30) and cutting injury group( n = 30) . The two latter groups were subdivided into one-day, three-day, one-week, two-week, 4-week and twelve-week groups with 5 rabbits in each group.METHODS: The rabbits in the firearms injury group were injured at the midpoint of lateral posterior body surface projection of the right sciatic nerve with 0. 38 g steel ball containing 0.65 g detonators. The right sciatic nerve was cut at the same injury level in the cutting injury group.MAIN OUTCOME MEASURES: The following pathologic changes of the lumbar spinal cord were observed with optical and electronic microscope at posttraumatic day 1, day 3 and week 1, week 2, week 4 and week 12 respectively.RESULTS: Micro-hemorrhage, neuron swelling and vacuoles were observed in the firearms injury group and the number of motor neurons decreased significantly, but these changes were unobservable in the cutting injury group.CONCLUSION: Compared with the cutting group, the injury to the spinal cord was severer in the firearms group and the survival neurons were less.

Objective To investigate the effect of the prescription of Yiqiyangyin Huoxuehuayu on the mice model with viral dilated cardiomyopathy by examining the levels of serum ?-IFN.Methods Replicated the animal models of early viral dilated cardiomyopathy by injecting the CVB3m virus to the peritoneal cavity of the Balb/c mice.Two hundred and ten Balb/c mice were divided into 4 groups at random:blank group,model group,high and low dose traditional Chinese medicine group.The blank group has 30 mice.The other three group has 60 mice each.The mice of high dose traditional Chinese medicine group and low dose traditional Chinese medicine group were treated with the prescription of Yiqiyangyin Huoxuehuayu.The change of pathomorphology in the cardiac muscle tissue,the rate of death,the weight change and the cardiac weight index were observed after 4 weeks of the treatment.At the same time,ELISA method was used to exam the levels of serum ?-IFN.Results The prescription of Yiqiyangyin Huoxuehuayu can induce the expression of serum ?-IFN in the mice with viral dilated cardiomyopathy.The mean level of serum ?-IFN of the high dose traditional Chinese medicine group and low dose traditional Chinese medicine group were significantly higher than that of the model group.Conclusions The prescription of Yiqiyangyin Huoxuehuayu can inhibit the viral replication and regulate the immunologic function.

Objective To investigate the effects ofTongbicapsule on the knee joint function and the synovial fluid levels of matrix metalloproteinase (MMP)-3,-9 in patients with knee osteoarthritis.Methods A total of 76 patients with knee osteoarthritis were randomly divided into a control group and an observation group according to the random number table, 38 in each group. Patients in the control group were treated with glucosamine hydrochloride capsules, while patients in the observation group were givenTongbicapsule on the basis of the control group. Both groups were treated for 12 weeks. The Western Ontario and McMaster Universities Osteoarthritis Index was used to measure the knee joint function, and enzyme-linked immunosorbent assay was used to determine the synovial fluid levels of MMP-3 and MMP-9.Results The knee joint function in the observation group was significantly improved than that in the control group (94.74%vs. 78.95%;χ2=4.146, P<0.05). The synovial fluid levels of MMP-3 (67.58 ± 22.35 ng/mlvs.93.51 ± 27.84 ng/ml;t=4.477,P<0.01) and MMP-9 (36.24 ± 10.56 ng/mlvs.51.87 ± 12.35 ng/ml;t=5.930,P<0.01) in the observation group patients were significant lower than those in the control group after treatment.ConclusionsTongbicapsule was effective in treating knee joint function in patients with knee osteoarthritis, and its mechanism may be related to its reducing the synovial fluid levels of MMP-3 and MMP-9.

BACKGROUND:Under physiological conditions, nerve roots can move along with the movement of limbs and spine. However, the mechanisms of nerve root stretch injury under physiological conditions and the neurological dysfunction after injury are unclear.
OBJECTIVE:To review the reason of nerve root stretch injury, and to analyze the mechanism of nerve function from biomechanics, pathology and neurophysiology.
METHODS:A computer-based online search of PubMed database was undertaken by the first author to identify the articles related to the research of nerve root injury and nerve stretch injury between 1990 and 2012, with the key words of“nerve root, nerve, stretch injury”. A total of 391 articles were screened out. The articles on the anatomy and biomechanics research of nerve root were included, as wel as the pathology and neurophysiology research after nerve root stretch injury. Final y, 44 articles were included for review.
RESULTS AND CONCLUSION:Nerve root can be stretched along with limbs and spine movement. However, diseases or trauma may cause pathological nerve root stretch, and thus leading neurological dysfunction. The nerve root is often influenced stretch because of its anatomical and tissue structure. Mechanical injury mechanism of stretch composes of peripheral (peripheral nerve conduction stress) and central mechanism (displacement of spinal cord content). Pathological studies found that the local fibrosis is caused by the extracted serum protein that difficult to remove after injury, and this is because of the shortage of lymphatic system in nerve roots. Fibrosis can cause nerve root ischemia, affect the nerve function, and change the biomechanical properties of nerve root. Nerve root injury can cause primary and secondary injury of internal axons, and this is the main reason for neurological dysfunction after injury.

Objective To investigate the cut-off point value of 1-hour plasma glucose of oral glucose tolerance test in the diagnosis of the T2DM and IGR.Methods Three hundred and fifty-four subjects (6.0mmol/L≤ FPG ＜ 7.0mmol/L) were participated in the OGTT.To get the cut-off point value of 1-hour plasma glucose in the diagnosis of the T2DM and IGR by applying the receiver operator characteristic curve,and compare it with the WHO diagnostic criteria.Results (1)The cut-off point value of screening T2DM by ROC curve was 12.90mmol / L,whose specificity was 77.1％ and sensitivity was 90％.Meanwhile the cut-off point value of screening IGR was 10.83mmol / L,whose specificity was 73.2％,and the sensitivity was 73.5％.(2)Among the 136 patients with type 2 diabetes mellitus that diagnosed by WHO criteria,115 patients could be diagnosed by 1hPG that more than FPG which could diagnose 81 patients.And the difference was statistically significant (P ＜ 0.05).Meanwhile,It was more than 106 patients that diagnosed by 2hPG,but there was no statistically significant.According to the diagnostic criteria of 2hPG ≥11.1mmol/L,there were 106 cases of T2DM.Among these patients,95 cases and 51 cases could be diagnosed respectively by 1 hPG and FPG,and there was statistically significant (P ＜ 0.01).(3)Application of the cut-off point of 1 hPG,NGT,IFG,CGI and DM re-grouped.FPG,2hPG increased gradually in order to NGT,IGR,DM.(4) No matter the blood glucose levels,1hPG and 2hPG had good correlation,(P =0.000).A significant correlation could be found between FPG and 2hPG only in hyperglycemia.The correlations between 1 hPG and FPG disappeared only in a normal level of blood glucose.Conclusion The cutoff point value of 1hPG is 12.90mmol/L which has advantage to diagnosis of type 2 diabetes mellitus.It is a useful complement to the WHO Diagnostic criteria.

Objective To explore the clinical efficacy,adverse effect and prognosis of infliximab in treatment of the patients with juvenile idiopathic arthritis (JIA).Methods Thirty-two cases of infliximab-treated JIA patients and 30 cases of JIA control patients were investigated in this prospective study,and their tender joint count (TJC),swollen joint count (SJC),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),visual analog scale for general health (GH),disease activity score (DAS) 28,as well as adverse reactions of treatment and follow-up outcomes were analyzed.The infliximab-treated patients were intravenously infused with infliximab at the low dose of ＜ 5 mg/(kg · time) or the high dose of ≥ 5 mg/(kg · time) in 0,2nd,6th,14th,22nd,30th week.The JIA control patients were treated with conventional therapy.Results The treatment of infliximab ameliorated the TJC,SJC,ESR,CH,CRP and DAS28 of JIA patients.In the dynamical analysis of these clinical indexes of the infliximab-treated JIA patients,the index of SJC was found to fall firstly in the 2nd week,the indexes of TJC,ESR,CH and DAS28 were found to decline secondly at 6th week,the indexes of TJC,SJC,ESR,CRP and DAS28 continued dropping till 22nd week,and only the index of GH progressively declined to 30th week.The high-dose infliximab-treated group had lower levels of ESR,GH and CRP than the low-dose infliximab-treated group (t =2.14,3.04,2.33,P =0.04,0.01,0.04).But there were no statistical difference in TJC,SJC,DAS28 and the incidence of recent adverse reactions between the high and low infliximab dose groups.In the infliximab treated group,2 cases of patients (6.25％) failed in the therapy of infliximab;9 cases of patients (28.13％) continued therapy with infliximab to 46th-62nd week; 7 cases of patients (21.88％) stopped therapy with infliximab in the 30th week had good improvement of joint symptoms and inflammatory indexes; 14 cases of patients (43.75％) relapsed and retreated by infliximab after cease the first course of treatment; 1 case of patient died of severe chickenpox infection after therapy with infliximab was ceased.Conclusions Infliximab can alleviate the joint symptoms,inflammatory indexes and DAS28 of JIA patients,and is an effective and safe therapy for JIA patients in the short-term study.

Objective To explore the long-term dialysis therapies suitable for Chinese patients by comparison of the long-term clinical effect of daily ambulatory peritoneal dialysis ( DAPD ) and hemodialysis (HD) on patients with end-stage renal failure.Methods Forty-six outpatients and inpatients with end-stage renal failure were enrolled from our hospital and divided into group A (24 patients) and group B (22 patients) randomly.Participants in group A received HD treatmant,including conventional HD,hemodiafiltration (HDF),hemoperfusion (HP),etc.For three times in total 12 - 15 h each week;patients in group B received DAPD with a daily dialysate dose of 6 - 8 L and a replacement in every 3 - 4 h for each bag of peritoneal dialysate,as well as a break overnight.The subsequent long-term monitoring was performed,and the following variables were compared for the patients in these two groups:sufficiency of dialysis (i.e.Kt/V),nutritional status [ including SGA and sALB ),complication control ( including Hb,CO2CP,K+,Ca2+,P-,iPTH and blood pressure (MAP) ],infection incidence,employment rate and annual medical expense.The evaluation on daily activities of living was also performed using Barthel Index (BI) and the presence of depressive dsymptoms was assessed by HAMD.Results Patients in both group A and group B could survive under long-term dialysis,and there was no statistically significant difference in sufficiency of dialysis (Kt/V),nutritional status (SGA and sALB ),complication control ( Hb,CO2 CP,K +,Ca2 +,P -,and MAP) and infection incidence ( P ＞ 0.05 ).One year after dialysis,the urine volume [ (274 ± 102) ml vs.( 205 ± 86 ) ml,P =0.017 ],BI ( 82 ± 13 vs.73 ± 11,P =0.044) and employment rate (40.9％ vs.12.5％,P=0.044) of the patients in group B were higher than those of the patients in group A,but the ultra-filtration volume [ ( 1162 ± 124 ) ml vs.( 1542±136 ) ml,P ＜ 0.001 ],iPTH [ (77.5 ± 12.7 ) ng/L vs.( 104.4±11.3 ) ng/L,P ＜ 0.001 ],HAMD ( 8 ± 3 vs.18 ± 4,P ＜ 0.001 ) and annual medical expense [ (7.67±1.48 ) ng/L vs.( 11.35 ± 2.52 ) ng/L thousand yuan,P ＜ 0.001 ] were lower than those of the patients in group A.Five years after dialysis,B1 ( 80 ± 13vs.71 ± 14,P =0.029 ) and employment rate ( 36.4％ vs.8.3％,P =0.032 ) in group B were greater than those in group A,while iPTH [ (83.8 ± 13.4) ng/L vs.( 123.8 ± 12.4) ng/L,P ＜ 0.001 ],HAMD ( 8±2 vs.19 ± 2,P ＜ 0.001 ),and annual medical expense [ ( 10.32±1.64 ) thousand yuan vs.( 13.47 ±2.38 ) thousand yuan,P ＜ 0.001 ] were lower than those in group A,and there was no statistically significant difference in survival rate (70.8％ vs.86.4％,P=0.289) and dialysis duration [ ( 56.82 ± 6.13 ) mouths vs.(57.35 ± 6.30) months,P =0.774 ] between the two groups ( P ＞ 0.05 ).Conclusion The comparison between the patients treated by long-term DAPD and those treated by conventional HD shows that DAPD has a satisfactory clinical effect in the aspects of sufficiency of dialysis,maintainence of nutritional status,control of complications,regulation of blood pressure and decrease of infection incidence,and it is also superior in reducing depressive symptoms,ensuring better quality of life and mitigating economic burden of patients.

The paper elucidated the necessity of programmed operation in competence education of medical postgraduate students.This paper introduced the specific methods of programmed operation mode,exactly as selection of the best,scientific combination,coordination and arrangement,allocation of responsibility to individual,exact procedures,succession and development.The seven years practice experience in their colleges testified that these operational methods aroused the enthusiasm of postgraduate students' participation in campus activities and trained postgraduate student cadres.Meanwhile,these methods activated the campus culture and atmosphere and enhanced the comprehensive competence of postgraduates wholly.