Objective To study the effect and molecular mechanism of vitamin D(VitD)on Tfh cells of MRL/lpr lupus mice.Methods C57/B6 mice and MRL/lpr lupus mice were transfected with siRNA to construct VDR knockout mouse models.Splenic Tfh cells of C57/B6 mice and MRL/lpr lupus mice were divided into control group,lupus group and VDRsiRNA lupus group(treated with vitamin D 0,1 and 10 nmol·L-1,respectively)by siRNA transfection.The percentage of Tfh cells was detected by flow cytometry.MRL/lpr lupus mice Peyer node Tfh cells were randomly divided into 7 groups,blank control group,vitamin D dose groups of 1 and 10 nmol·L-1,paricalcitol group(VitD 10 nmol·L-1+PA),VDRsiRNA control group,VDRsiRNA group(VitD 10 nmol·L-1),CaN inhibitor group(VitD 10 nmol·L-1+CsA),and incubated for 72 h.The concentration of calcium ions in Tfh of each group was detected.The expressions of AT1R,NFAT,CaN and P-CaN in Tfh cells were determined by Western blotting.Results The percentage of Tfh cells decreased significantly with the increase of vitamin D dose.Vitamin D CaN reduce the intracellular calcium concentration of Tfh,up-regulate the expression of AT1 protein in Tfh cells,and down-regulate the expression of CAN,P-CaN and NFAT protein in a dose-dependent manner,and the effect is more obvious when combined with PA.Conclusion Vitamin D may regulate the activation of follicular T helper cells in MRL/lpr mice via the Ca-CaN-NFAT pathway.

Objective To study the effect and molecular mechanism of vitamin D(VitD)on Tfh cells of MRL/lpr lupus mice.Methods C57/B6 mice and MRL/lpr lupus mice were transfected with siRNA to construct VDR knockout mouse models.Splenic Tfh cells of C57/B6 mice and MRL/lpr lupus mice were divided into control group,lupus group and VDRsiRNA lupus group(treated with vitamin D 0,1 and 10 nmol·L-1,respectively)by siRNA transfection.The percentage of Tfh cells was detected by flow cytometry.MRL/lpr lupus mice Peyer node Tfh cells were randomly divided into 7 groups,blank control group,vitamin D dose groups of 1 and 10 nmol·L-1,paricalcitol group(VitD 10 nmol·L-1+PA),VDRsiRNA control group,VDRsiRNA group(VitD 10 nmol·L-1),CaN inhibitor group(VitD 10 nmol·L-1+CsA),and incubated for 72 h.The concentration of calcium ions in Tfh of each group was detected.The expressions of AT1R,NFAT,CaN and P-CaN in Tfh cells were determined by Western blotting.Results The percentage of Tfh cells decreased significantly with the increase of vitamin D dose.Vitamin D CaN reduce the intracellular calcium concentration of Tfh,up-regulate the expression of AT1 protein in Tfh cells,and down-regulate the expression of CAN,P-CaN and NFAT protein in a dose-dependent manner,and the effect is more obvious when combined with PA.Conclusion Vitamin D may regulate the activation of follicular T helper cells in MRL/lpr mice via the Ca-CaN-NFAT pathway.

Objective To explore the safety and feasibility of laparoscopic hepatectomy combined with radiofrequency ablation for primary liver cancer difficult to manage.Methods A retrospective study was conducted to analyze the clinical data of 16 patients who underwent laparoscopic hepatectomy combined with radiofrequency ablation in the Zhejiang Provincial People's Hospital from Apr 2015 to Dec 2017.Results 2 more tumors were found by intraoperative laparoscopic ultrasound.All patients underwent laparoscopic hepatectomy combined with radiofrequency ablation successfully.There were 2 laparoscopic left hepatectomy combined with radiofrequency ablation,2 laparoscopic right hepatectomy combined with radiofrequency ablation,6 laparoscopic left lateral lobectomy combined with radiofrequency ablation,4 laparoscopic right postrior lobectomy combined with radiofrequency ablation and 2 irregular laparoscopic hepatectomy combined with radiofrequency ablation.The intraoperative blood loss ranged from 100-800 ml.The average operative time was (283 ± 112) min.The length of postoperative hospital stay ranged from 5 to 12 days.The tumor-free survival rate after operation is 100％ (16/16) on 6 to 38 months follow up.Conclusion It is safe and feasible to carry out laparoscopic hepatectomy combined with radiofrequency ablation in difficult to manage primary liver cancer.

Objective:To observe the effect of 3 Hz and 10 Hz repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function and activities of daily living in patients with ischemic stroke. Methods:From June, 2016 to September, 2017, 60 inpatients with ischemic stroke were randomly divided into sham rTMS group (n = 19), 3 Hz-rTMS group (n = 21) and 10 Hz-rTMS group (n = 20). All the patients received routine training and their own rTMS for two weeks. Their rest motor threshold (RMT) was measured, and they were assessed with modified Ashworth Scale (MAS), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment, and at six weeks follow-up. Results:There were 48 patients completing the trial, while five in 3 Hz-rTMS group, five in 10 Hz-rTMS group and two in the sham rTMS group dropped. The RMT increased in 3 Hz and 10 Hz rTMS groups (t > 2.390, P < 0.05) after treatment, but there was no significantly difference among the three groups (F = 0.164, P > 0.05). The MAS scores of elbow and wrist decreased gradually over time in 3 Hz and 10 Hz rTMS groups (P < 0.05), and the MAS scores of elbow was less in 3 Hz and 10 Hz rTMS groups than in the sham rTMS group at follow-up (P < 0.05). The interaction of time and group was significant on the FMA-UE scores (F = 14.243, P < 0.001), and the FMA-UE scores improved more in 3 Hz and 10 Hz rTMS groups than in the sham rTMS group at different stages (P < 0.01). The interaction of time and group was not significant in MBI score (F = 1.481, P > 0.05), and there was no significant difference among the three groups at any time (F < 2.925, P > 0.05). Conclusion:Both 3 Hz and 10 Hz rTMS can promote the recovery of upper limb motor function in ischemic stroke patients safely and effectively, and 10 Hz rTMS is recommended as less time is needed.

Objective To investigate the related factors of gastroparesis syndrome after radical distal gastrectomy and the curative effect of different treatment regimens.Methods Univariate analysis and unconditional multivariate Logistic regression analysis werc used to analyze the influencing factors in 41 patients with postsurgical gastroparesis syndrome (PGS) and 719 patients without PGS.Results There were significant differences in surgical methods,gastrointestinal reconstruction,pyloric obstruction,abdominal infection,postoperative hyperglycemia,postoperative low protein,postoperative anemia,postoperative nutrition,operation time and bleeding volume between PGS patients and non-PGS patients (P ＜ 0.05).Multivariate Logistic regression analysis showed that patients with Billroth-Ⅱ gastrointestinal reconstruction,abdominal infection,postoperative hyperglycemia,postoperative anemia,postoperative low protein,prolonged operation,and bleeding were risk factors for PGS (OR ＞ 1,P ＜ 0.05).Laparoscopic surgery was the protective factor of gastroparesis (OR ＜ 1,P ＜ 0.05).The recovery time of combined drug therapy was significantly better than that of single drug (P ＜ 0.05).The length of hospital stay and hospitalization expense in PGS group were significantly higher than non-PGS group.Conclusion Avoidance of the above risk factors in perioperative period can prevent the occurrence of gastroparesis.Combined treatment can accelerate the recovery of gastroparesis.

Objective To investigate the related factors of gastroparesis syndrome after radical distal gastrectomy and the curative effect of different treatment regimens.Methods Univariate analysis and unconditional multivariate Logistic regression analysis werc used to analyze the influencing factors in 41 patients with postsurgical gastroparesis syndrome (PGS) and 719 patients without PGS.Results There were significant differences in surgical methods,gastrointestinal reconstruction,pyloric obstruction,abdominal infection,postoperative hyperglycemia,postoperative low protein,postoperative anemia,postoperative nutrition,operation time and bleeding volume between PGS patients and non-PGS patients (P ＜ 0.05).Multivariate Logistic regression analysis showed that patients with Billroth-Ⅱ gastrointestinal reconstruction,abdominal infection,postoperative hyperglycemia,postoperative anemia,postoperative low protein,prolonged operation,and bleeding were risk factors for PGS (OR ＞ 1,P ＜ 0.05).Laparoscopic surgery was the protective factor of gastroparesis (OR ＜ 1,P ＜ 0.05).The recovery time of combined drug therapy was significantly better than that of single drug (P ＜ 0.05).The length of hospital stay and hospitalization expense in PGS group were significantly higher than non-PGS group.Conclusion Avoidance of the above risk factors in perioperative period can prevent the occurrence of gastroparesis.Combined treatment can accelerate the recovery of gastroparesis.

OBJECTIVE:To explore an effective method to formulate management-related strategies for off-lable use of drugs by the evidence-based medicine. METHODS:The process of guideline formulation included seven procedures,i.g. establishment ofguideliesformulation workgroup;investigation and selection of the status quo on off-label drug use;identification of the clinical problems;retrieval and evaluation and comprehensing of evidence;applification of GRADE in evidence quality grading;formation of the recommendations consensus;peer review and result publication. And eventually guidelines were formed based on the steps. This study took off-label use of rheumatoid immunoprotective subjects as a case to explore. RESULTS & CONCLUSIONS:Based on the evidence evaluation system and above 7 steps,the methods and process of guideline formulation on off-label use of rheuma-toid immunoprotective subjects that integrated administration,law,clinical medicine,pharmacy subjects were made .The process of guideline formulation fully reflects multidisciplinary characteristics of the workgroup,the advanced nature of the process,the comprehensiveness of evidence ,the rigor of evidence quality grading,and the normalization of consensus. It provides reference in methodology for establishing a comprehensive evidence-based evaluation and management system of off-label use of drugs for all clinical specialist disease. Therefore,this scientific research results may promote the standardization and legalization of the off-label use of drugs management in China.

In order to help improving mental attention and sensory integration ability of mental retarded children, this paper proposes an interactive eyes-brain-hands coordination training system. This system realizes the principle of seeing, thinking and moving of hands by an interactive operation between the computer software custom icons and a touch control panel, so it can improve cognitive function and activity of daily living. The results show this training platform has a high degree of application and acceptance, and provides a portable training method for mental retarded children.

OBJECTIVETo investigate the correlation between enhanced computed tomography (CT) findings and pathological results of rare parotid gland tumors, and improve diagnosis accuracy.

METHODSThe enhanced CT manifestations of 22 cases with pathologically documented rare parotid gland tumors, which included 6 cases of basal cell tumor, 5 cases of myoepithelioma, 4 cases of vascular invasion, 3 cases of lymphatic cyst, 3 cases of lipoma, and 1 case of chondrosarcoma, were retrospectively analyzed. The location, size, shape, density, and relationship with surrounding structure were evaluated on CT images.

RESULTSThe enhanced CT showed that basal cell tumors occurred in the superficial lobe of the parotid gland, with clear boundary, within the cystic lesion. The lesions were moderate to obviously enhanced, which may be accompanied by enlarged lymph nodes. Myoepithelial tumors were located in the superficial lobe of the parotid gland, with a small cystic prone and microcalcification within a few cases. The lesions were moderate to obviously enhanced. Hemangiomas of soft tissue mass prominent in the parotid gland surface were mild to significantly enhanced. Larger lesions may occupy the entire parotid gland, with uneven density and visible vein stone. The CT density values of the lymphatic cyst were usually higher. Chondrosarcoma mainly manifested cystic mass at the calcification edge. Lipoma with fat density mass exhibited clear boundary without enhancement. Fiber separation could be observed in the lesion.

CONCLUSIONCT can reflect the pathological features of rare parotid gland tumors by demonstrating their corresponding imaging features. Enhanced CT is the most effective means of imaging to identify the nature of rare tumor of the parotid gland lesions.

Objective??To?investigate?the?correlation?between?enhanced?computed?tomography?(CT)?findings?and?patholo-gical?results?of?rare?parotid?gland?tumors,?and?improve?diagnosis?accuracy. Methods??The?enhanced?CT?manifestations?of?22?cases?with?pathologically?documented?rare?parotid?gland?tumors,?which?included?6?cases?of?basal?cell?tumor,?5?cases?of?myoepithelioma,?4?cases?of?vascular?invasion,?3?cases?of?lymphatic?cyst,?3?cases?of?lipoma,?and?1?case?of?chondrosarcoma,?were?retrospectively?analyzed.?The?location,?size,?shape,?density,?and?relationship?with?surrounding?structure?were?evaluated?on?CT?images.?Results??The?enhanced?CT?showed?that?basal?cell?tumors?occurred?in?the?superficial?lobe?of?the?parotid?gland,?with?clear?boundary,?within?the?cystic?lesion.?The?lesions?were?moderate?to?obviously?enhanced,?which?may?be?accompanied?by?enlarged?lymph?nodes.?Myoepithelial?tumors?were?located?in?the?superficial?lobe?of?the?parotid?gland,?with?a?small?cystic?prone?and?microcalcification?within?a?few?cases.?The?lesions?were?moderate?to?obviously?enhanced.?Hemangiomas?of?soft?tissue?mass?prominent?in?the?parotid?gland?surface?were?mild?to?significantly?enhanced.?Larger?lesions?may?occupy?the?entire?parotid?gland,?with?uneven?density?and?visible?vein?stone.?The?CT?density?values?of??the??lymphatic?cyst?were?usually?higher.?Chondrosarcoma?mainly?manifested?cystic?mass?at?the?calcification?edge.?Lipoma?with?fat?density?mass?exhibited?clear?boun-dary?without?enhancement.?Fiber?separation?could?be?observed?in?the?lesion.?Conclusion??CT?can?reflect?the?pathological?features?of?rare?parotid?gland?tumors?by?demonstrating?their?corresponding?imaging?features.?Enhanced?CT?is?the?most?effec-tive?means?of?imaging?to?identify?the?nature?of?rare?tumor?of?the?parotid?gland?lesions.