[Abstract] Objective: To investigate the expression and clinical significance of PD-1/PD-L1 in gastric cancer (GC) tissues. Methods: Paraffin embedded tumor tissues and clinical data of 82 GC patients who had undergone operation at the Fourth Hospital of Hebei Medical University from January 2007 to December 2007 were collected, and their survival status was followed. The protein expressions of PD-1 and PD-L1 in tumor tissues were detected by immunohistochemistry. Kaplan-Meier analysis and Log-Rank test were adopted to analyze the survival of GC patients, and the ROC curve was plotted. Results: The positive rate of PD-L1 protein expression was 42.68% while the positive rate of PD-1 expression was 13.41% in GC tissues. The positive rate of PD-1 and PD-L1 expression in GC tissues of patients without pre-operative distant metastasis was significantly lower than those patients with pre-operative metastasis (PD1： 3.28% vs 42.86%; PD-L1： 13.11% vs 90.48%; all P<0.01). The positive rate of PD-L1 expression in tumor stroma of patients without pre-operative distant metastasis was significantly lower than those with metastasis (PD-L1: 13.11% v s 47.62%, P<0.01). The resection range of stomach, PD-L1 over-expression and the presence of pre-operative distant metastasis were the adverse factors affecting the prognosis of patients with GC (P<0.05). Conclusion: PD-1 and PD-L1 expressions in GC tissues were closely related to the presence of pre-operative distant metastasis and the depth of tumor infiltration. The postoperative survival of patients who were PD-L1 positive was shorter than the negative ones.

Objective: To investigate the relationship between the mutations in precore/core (preC/C) region of hepatitis B virus (HBV) gene and the postoperative survival in patients with hepatocellular carcinoma. Methods: A total of 81 cases in HBV associated hepatocellular carcinoma (HBV-HCC) patients with cancer tissue genomic DNA were extracted. The preC/C region of HBV was amplified and sequenced, and survival-associated HBV mutations were identified according to the NCBI database. The relationships between the mutations in the preC/C region and HCC survival was analyzed with the Kaplan-Meier method and the Cox proportional hazards model. Eleven mutational sites were identified as statistically significant independent predictors of HBV-HCC postoperative survival. Results: The portal vein thrombosis, tumor TNM classification and size were identified as statistically significant independent predictors of survival in HBV-HCC patients. In the research, we found that seven mutational sites in preC/C region of HBV were associated with independent risk factors for postoperative survival in patients of HBV-HCC. The following five mutational sites were identified as statistically significant independent predictors of HBV-HCC survival: 1915, 2134, 2176, 2221, 2260. The mutational site of 1979 and 2245 were identified for the association with survival at a borderline significance level. Conclusions The portal vein thrombosis, tumor TNM classification, size and seven mutational sites in the PreC/C region were identified as independent predictors of postoperative survival in HCC patients.

Objective To investigate the diagnosis and treatment of mammographic calcifications found by mammary molybdenum target inspection.Methods 150 women who were found out with breast calcifications by mammary molybdenum target inspection and had been treated with surgical excision biopsy were selected.Their clinical data were retrospectively analyzed.Results In 150 cases of mammographic calcifications,102 cases were benign lesions by pathologic diagnosis,and 48 cases were malignant.Compared the morphological characteristics of the benign and malignant breast calcifications,the nature of the lesion was associated with lesion size (x2 =5.55),the density of calcification (x2 =7.591) and the distribution of calcifications (x2 =11.859).Conclusion Mammographic calcifications found by mammary molybdenum target inspection has a certain clinical value for diagnosis and treatment of breast cancer,so such patients should be encouraged to do biopsy to diagnose or exclude breast cancer.

Objective To investigate the therapeutic effect of L-carnitine combined with erythropoietin (EPO) and iron on renal anemia in rats. Methods The renal anemia rat model was established using adenine. All rats were randomly divided into three groups: control group (group A), EPO combined with iron group (group B), and L-carnitine combined with EPO and iron treatment group (group C). The levels of red blood cells (RBC), hemoglobin (Hgb), hematocrit (Hct), C-reactive protein (CRP), Fe in peripheral blood (Fe), serum ferritin (SF) and transferrin saturation (TS) were measured. Pathological changes in the kidney, liver and small intestine tissues were examined using HE staining. Results Compared with the group A, the levels of RBC, Hgb, Hct, Fe, SF, and TS were significantly increased, however, the level of CRP significantly decreased in the groups B and C (P＜ 0. 05). In the group C, the levels of RBC, Hgb, and CRP was higher than the group B (P＜ 0. 05). Furthermore, the pathological changes in the kidney, liver and small intestine tissues were improved in the groups B and C. Conclusions L-carnitine combined with EPO and iron has a therapeutic effect on renal anemia in rats, thus, it deserves further studies and application.

Objective To explore the effect of forgiveness intervention on improving the happiness index and self-esteem of the elderly.Methods Totally 103 cases who had been offended and did not relieved were enrolled in this research.Two groups were assigned using digital random method.There were 49 cases in the experimental group and 50 cases in the control group that were counted in final statistics according to the inclusion and exclusion criteria.The experimental group received 8-week forgiveness therapy,control group re-ceived no special intervention.Results The scores of well-being,forgiving self,forgiving others and self-es-teem respectively were 3.06±0.97,3.23±0.62,3.01±0.63 and 2.71±0.35 respectively.Forgiving others was positively related with well-being and self-esteem(r=0.296,0.273,P<0.01),and there was no correlation between forgiving self and well-being(r=0.113,P>0.05). Forgiving others(t=5.309,P<0.01),self-esteem (t=2.732,P=0.008),well-being(t=2.732,P=0.008)in experimental group were improved after the inter-vention,but no difference was found in forgiving self(t=1.413,P=0.165). And there were significant differ-ence in both main effect and interaction effect in forgiving others(Fmain=39.05,Pmain<0.01; Finter=34.96, Pinter<0.01),self-esteem(Fmain=26.41,Pmain<0.01; Finter=35.83,Pinter<0.01),well-being(Fmain=20.96,Pmain<0.01;Finter=18.06,Pinter<0.01)at the pre-test,post-test and 1 month after intervention in experimen-tal group. In the control group,there was no significance in main effect(Fmain=1.98,Pmain=0.152),but the interaction effect was significantly different(Finter=10.98,Pinter<0.01).Conclusion Forgiveness interven-tion can improve forgiveness for elderly people.This intervention method has a positive effect on improving the overall happiness index and self-esteem of elderly people who have been subjected to other offenses,unfair treatment or interpersonal conflicts.

ObjectiveTo report the methods and clinical efficacy of bridging severed thumbs and fingers with foot joint compound flaps.Methods Ten patients with completely amputated thumbs and fingers with extensive defects in the proximal phalanx had bridged and repaired by using composite-free flap with joints from foot. Three of 4 cases of thumb amputation were repaired by using composite flaps of the second metatarsophalangeal and proximal interphalangeal joints in foot,and the other was used composite flap of the second metatarsophalangeal joints in foot.Donor sites underwent the second metatarsals distal osteotomy associated with free skin graft. And 6 cases with absent fingers by using composite-free flaps of the proximal interphalangeal joint to repair. The donor site in foot underwent metatarsophalangeal and toe joints osteotomy.ResultsAll flaps and replanted thumbs and fingers survived. Hand wounds recovered by primary repair.Donor site in foot all healed by primary repair except for 1 case,which healed after several dressing changes.All 10 cases were followed-up from 6 to 28 months,averaged of 9 months.The metacarpophalangeal joint of 4 replanted thumbs extension between -10° and 0°,and flexion between 20° and 50°.The function of fullfield digital mammography recovered well in 3 replanted thumbs, as well as the function of thumb-middle in the other. Three of them could completely 2-5 fingers tapping,one case could complete middle finger tapping,four cases could complete radial abduction.The proximal interphalangeal joints of 6 replanted fingers extension between -10° and 0°,and flexion between 30° and 90°,averaged of 50°.Sensory recovery of 1 case reached S4,two cases reached S3+,five cases reached S3,and 2 cases of S2.All replanted bones and joints healed after transplantations(bone healing time was 6 to 16 weeks), with no occurrence of re-fracture nor nonunion. Walking function was not significantly affected. According to the evaluation criteria of replanted severed fingers by Chinese Medical Association,one was excellent,eight were good,and 1 was poor.The excellent and good rate was 90％. Conclusion Repairing amputated thumbs and fingers with foot joint compound flaps could not only maximize the recovery of replanted fingers shape,but also get some function,which to meet everyday needs of patients.

Objective To explore the treatment method with combined dorsal flap based on the second toe and tibial flap for repairing the finger distal degloving injury.Methods From March 2008 to September 2011,our department chose treatment with combined use of free dorsal flap based on the second toe and contralateral second toe tibial flap for repairing finger distal degloving injury.The 11 fingers in 11 cases were treated and followed up after surgery.Results The flaps in 11 cases all survived; The donor site with skin grafting successfully healed; The follow-up was 4-15 months,averaged of 6 months.There was not obvious atrophy for the toe dorsal flaps in the finger back side and toe tibial flaps in the palm side.The finger pulp was full,the nails grew well and the appearance of the fingers was good.There was satisfactory sensory function restoration for finger pulp,two cases for S4,five cases for S3,three cases for S2 and 1 case for S1.The protective sensation was restored in the finger back for all the cases; the finger function was restored to normal; the foot donor site was healing well without scarring.Walking was completely normal.Conclusion It is an ideal treatment with combined use of free dorsal flap based on the second toe and contralateral second toe tibial flap for repairing finger distal.

Objective To evaluate the clinical effects of free dorsalis pedis flap on the repair of two skin and soft tissue defects in hand. Methods From February 2003 to February 2009, free dorsalis pedis flap was used to repair two skin and soft tissue defects in 11 patients. Six cases were males and 5 females.Two was used the hand skin and soft tissue defects in 4 cases; back of the hand skin and soft tissue defect with the middle finger proximal palmar skin and soft tissue defect in 1 case, the hand ripped through injury to the back of the hand of the hand ripped through skin and soft tissue defects in 3 cases, were cut flap:proximal flap 3 cm× 3 cm-8 cm × 7 cm, distal flap 4 cm × 2 cm-6 cm × 5 cm. Foot for the area will adopt the lower abdominal full-thickness skin grafting. Results Uniform flap survival period of the wound healing class, foot skin graft donor sites were successfully survived. Ten patients were followed up from 6 to 19 months, with an average follow-up of 9 months. Follow-up flap fine texture, appearance of natural, nonbloated, feeling to restore S2-S3, hand function recovered satisfactorily, for the district of foot healed well without ulceration and ulcer formation,had no effect on walking function. Conclusion The dorsalis pedis flap for hand two series of skin and soft tissue defects, with design flexibility, excellent texture flaps, etc., is to repair the hand skin and soft tissue defects of the two better way.

Objective To determine the surgical approaches and evaluate the clinical efficacy of skin defects of the emergency thumb, finger reconstruction.Methods Emergency in 11 cases complicated skin defect of the thumb and the hand, fingers missing injured patients by using the method of combined of toenail flap of biped dorsalis pedis flap or the second toe.The implantation of thumbnail flap of dorsalis pedis flap combined with the second toenail flap was applied on 5 cases.3 cases had received the implantation of thumbnail flap of dorsalis pedis flap combined with the second toe and 3 cases with combined repair of the second toe of biped dorsal flap.Of all the cases, reconstruction of 3 fingers in 1 case, reconstruction of 2 fingers in 10 cases,5 cases with reconstruction by means of implantation of toenail flap of same pediele splitting flap or the second toe, 6 cases with repair of toenail flap of dorsalis pedis flap or second toe.Results Except for 1 necrosis occurred in 1 finger in 1 case of 3 fingers reconstruction, the rest of tissue flaps and fingers all survived.The primary healing was achieved postoperatively.The patients were followed up for 5-24 months.The functions such as grabbing, grasping, nipping were basically restored after the repair.The appearance of hand was also restored to a certain degree.Sensory recovery S2-S4 of reconstruction finger and flap was achieved.Healing was satisfying in the donor area, no obvious cicatricial contracture was seen, while the walk function was not affected.Conclusion The application of combined implantation of toenail flap of biped dorsalis pedis flap or the second toe in the repair of overall hand skin degloving injury could restore the function and appearance of the injured hands to a certain degree.It is proved to be an effective treatment method.

Objective To evaluate the repair of perforated fingers using complex tissue transplantation of articulated second toe.Methods From July 2001 to January 2008, complex tissue grafts of articulated second-toe with blood supply were used to repair 14 cases of perforated finger defects, 11 males and 3 females.Their average age wag 25.4 years old.Using the proximal interphalangeal joint of the second toe, total joint transplantation was conducted in 5 cases and half joint transplantation in 3 cases.Using the metatarsophalangeal joint of the second toe, total joint transplantation was performed in 2 cases and half joint transplantation in 4 cases.Results Primary healing of the grafted complex tissues was achieved in 13 cases, though partial necrosis of skin flap was observed in 1 patient with a defect at the metacarpophalangeal joint of the little finger, whose wound healed after change of dressings.In the other cases, followed up for 6 to 15(average, 11)months, the grafts had satisfying appearance and fine healing of joints.No nonunion, bone deformity or degeneration of joints was present.Finger functions were favorably recovered, and finger to finger activity was achieved.According to the criteria for hand functions by Chinese Medical Association, 4 cases were excellent, 6 fine, and 4 fair.Conclusion Repair of perforated fingers using composite tissue grafts of the second toe is a one-off repair of defects of bone, joint, tendon, skin and other tissues, providing fine rehabilitation for each subtle defect and maximizing functional recovery of injured fingers.