Objective:To investigate the effectiveness of postoperative radiotherapy using shrinking field for patients with extremity soft tissue sarcoma (STS), mainly focusing on the local control rate and adverse events.Methods:Clinical data of 49 extremity STS patients who received postoperative intensity-modulated radiotherapy in the First Hospital of Tsinghua University from October 2017 to March 2021 were retrospectively analyzed. Target volumes were contoured on CT and MRI fusion images. The tumor bed was defined as GTV tb, with 3 cm expansion in the longitudinal direction and 1.5 cm expansion in the radial direction to construct CTV (the target volume should be properly repaired according to the anatomical barrier, and the edema area around the tumor should be included). GTV tb and CTV were expanded in all directions by 0.5 cm to construct PTV1 and PTV2 respectively, at a dose of 95%PTV1 63-66 Gy, 95%PTV2 50-56 Gy,1.8-2.0 Gy/f. The dose of surgical volume should be given at 70 Gy for patients who had a microscopic positive margin. Results:The median follow-up time was 32.1 months (7.9-45.6 months). The 3-year local failure-free survival (LFFS), overall survival (OS)and distant metastasis-free survival (DMFS) were 91.7%,77.6% and 71.5%, respectively. Univariate analysis showed that patients with a microscopic positive margin were more likely to develop local recurrence ( P<0.05). The incidence of grade 2 or above wound complications, joint stiffness, fracture, edema and skin fibrosis were 2%, 4.1%, 2%, 8.2% and 26.5%, respectively. Conclusion:Postoperative radiotherapy with shrinking field provides excellent local control rate and low incidence of late adverse events in patients with extremity STS.

China has a heavy burden of hepatocellular carcinoma, which is a serious threat to people′s life and health. However, the available drugs for advanced hepatocellular carcinoma in the past are limited and the efficacy is not satisfactory. In recent years, immunotherapy has a significant effects in some tumors. The authors introduce the efficacy of restart immunotherapy on an advanced hepatocellular carcinoma patient undergoing interruption of treatment due to corona virus disease 2019, in order to provide references for the diagnosis and treatment of this kind of patients.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

BACKGROUND:Studies have shown that pulsed electromagnetism has a good effect in promoting peripheral nerve regeneration after cerebral infarction and spinal cord injury, and improving memory function in patients with neurological disorders. OBJECTIVE: To investigate the impact of pulsed magnetic field on brain function and endogenous neural stem cell factor in the brain tissue of rats with brain injury. METHODS: Totally 320 adult male Sprague-Dawley rats were randomly divided into model group, pulsed magnetic field 0.1 mT group, pulsed magnetic field 0.3 mT group and pulsed magnetic field 0.5 mT group (n=80 per group). After brain injury models were established using lateral hydraulic strike method, rats in the latter three groups were exposed to pulsed magnetic fields 0.1, 0.3, 0.5 mT, respectively. After electromagnetic radiation 1, 3, 7, 14 days, the motor function of rats was evaluated by beam-walking test and water maze test. Rats were intraperitoneally injected 5-deoxy-uridine (BrdU) at 1 day prior to different radiation time points, and BrdU and nestin expressions in the cerebral cortex were measured by immunohistochemical method. RESULTS AND CONCLUSION: (1) The time of water maze test and the beam-walking test at 1, 3 and 7 days after irradiation was ranked as follows: pulse magnetic field 0.5 mT < pulse magnetic field 0.3 mT < pulse magnetic field 0.1 mT < model group, and there were significant differences between groups (P < 0.05). (2) The expressions of BrdU and nestin at 1, 3 and 7 days after irradiation were highest in the pulse magnetic field 0.5 mT group, successively followed by pulse magnetic field 0.3 mT group, pulse magnetic field 0.1 mT group and model group (P < 0.05). In summary, the pulse magnetic field exhibits remarkable protective effects on the brain function of rats with craniocerebral injury in an intensity-dependent manner. The possible mechanism is related to the activation of neural stem cells and the proliferation of neural stem cells in the brain tissue of rats with craniocerebral injury.

Objective To investigate the diagnostic value of serum brain natriuretic peptide(BNP)in chron-ic cor pulmonale of different period.Methods According to the inclusion criteria,we recruited 216 cases from heart and respiratory medicine(including outpatients and inpatients)of Qingyuan People 's Hosptial from April 2013 to December 2014.All the cases were divided into healthy control group(group A,n =48),cor pulmonale heart function compensatory period group(group B,n =43),cor pulmonale right heart failure group(group C,n =45),the simple left heart failure group(D group,n =40)and the whole heart failure group(group E,n =40).The serum BNP value,pul-monary function,echocardiography were detected.We compared the differences amomg them with correlation analysis, and drew the ROC curves to obtain the best cutoff point.Results The BNP value was higher in group C(495.44 ± 219.90)ng/L than group B[(182.44 ±69.71)ng/L,P <0.001],while the value was higher in group D(882.57 ± 288.56)ng/L and E(891.78 ±256.45)ng/L than group C(P <0.001).In cor pulmonale groups,BNP was positive-ly correlated with RV,RVOT,and PASP,negatively correlated with FEV1 ,and not correlated with LVEF %.In group D and E,BNP was negatively correlated with LVEF %.The best cutoff point of BNP was 285.3ng/L between cor pul-monale heart function compensatory period group(group B)and cor pulmonale right heart failure group(group C). The best cutoff point of BNP was 764.2ng/L between cor pulmonale right heart failure group(group C)and the whole heart failure group(group E).Conclusion There is certain correlation between serum BNP level and the progress of chronic cor pulmonale.Dynamic monitoring of serum BNP level in the judgement of treating cor pulmonale is of certain reference significance.

Objective To explore the correlation between social support and the self-efficacy among community patients with chronic obstructive pulmonary diseases ( COPD ) .Methods From October 2008 to March 2009 ,320 community patients with COPD were recruited from a community health service center by using a convenience sampling.The research data were taken by questionnaires and scale .The Spearman’s correlation analysis was done to analyze the correlation of social support and the self-efficacy.Results The total score of social support of the patients with COPD was ( 37 .64 ±5 .96 ) , which was lower than the national norm (40.80 ±7.64), and the total score of self-efficacy was (74.24 ±9.50).The number of patients with medium-level self-efficacy was 286 (89.4%).The overall social support was positively correlated with self-efficacy (r=0.553,P<0.01), and it was also positively correlated with the various dimensions of self-efficacy (r=0.190-0.515,P <0.05).Conclusions Social support and the self-efficacy are closely related.It is important to promote patients ’ self-efficacy and mobilize the social and family support by various approaches .

Objective To explore the relationship between self-efficacy and self-management behaviors of patients with chronic obstructive pulmonary disease (COPD).Methods A total of 350 COPD patients form 5 residents' committees in shanghai were recruited by using a convenient sampling method and were scored using Chinese Self-efficacy Scale (CSES)and the self-management behaviors scale.Spearman's correlation analysis was performed to detect the relation of self-efficacy with self-management behaviors.Results Three hundred and twenty adults were included in this investigation,and their average FEV1/FVC was (57.86 ± 7.06)％,average score of self-efficacy was 74.2 ± 9.5.In self-management behaviors,time spent on physical exercise was (16.2 ± 33.9) minutes per week,and endurance exercises accounted for (109.0±49.0) minutes per week.The score of cognitive symptom management practice was 0.9 ± 1.0 and communication with physicians was 0.7 ± 0.8.Total score of self-efficacy was positively correlated with self-management behavior in each dimension (r values were 0.522,0.407,0.330 and 0.044,respectively ; all P ＜ 0.01).Conclusions Self-efficacy and self-management behaviors of COPD patients need to be improved,and self-efficacy may be related to self-management behaviors.

Objective To investigate the self-efficacy levels and its influencing factors of community-based patients with chronic obstructive pulmonary diseases (COPD).Methods From October 2008 to March 2009,320 community COPD patients were recruited from a Shanghai community.They undertook questionnaires,scale survey and pulmonary function testing so as to investigate the influencing factors of self-efficacy.Results The total scale of self-efficacy was 74.24 ± 9.50 and the level of selfefficacy in 286 cases( 89.4％ )was intermediate.The knowledge of COPD,social supports,forced expiratory volume at 1 second (FEV1)/forced vital capacity (FVC) and self-management level were entered into regression equation and could explain 57.1％ of the total variance of independent variables.Conclusions The knowledge of COPD,social supports,FEV1/FVC and self-management level are the major influencing factors of self-efficacy in the COPD patients.We should improve the knowledge of disease and strengthen the psychological care and social supports so as to improve their quality of life.

BACKGROUND: Oxygen-derived free radicals are produced during non-enzymatic glycosylation of diabetic protein and accompanied with decrease in nitrogen monoxide (NO) synthesis so as to cause the calcium increase in cell,evacuation of pykno-granule and apoptosis induced by activating endoenzyme.OBJECTIVE: To observe the effects of non-enzymatic glycosylation inhibitor-aminoguanidine on apoptosis of cardiac myocyte and cardiac function in diabetic rats.DESIGN: Completely randomized grouping design and controlled study.SETTING: Pharmacological Department of Jinzhou Medical College.MATERIALS: The experiment was completed at the Central Laboratory of Jinzhou Medical College between September 2002 and March 2003. Totally 54 male SD rats with 2-month old were selected.METHODS: Totally 36 rats were selected to establish diabetic model 60 mg/kg of streptozotocin were injected into the caudal vein. If blood glucose of rats was more than 16.7 mmol/L, the establishment of diabetic model was successful. Model rats were divided into diabetes group and aminoguanidine (AG) group with 18 in each group. Rats in each group were also divided into two 12-week groups with 8 and 12 respectively. Another 18 rats were determined as the control group at 2 time points: 12 weeks (n=8) and 24 weeks (n=10). Rats in each group were fed for 12 and 24in other two groups. Calculation of mass index was [heart (mg)/body mass (g)]. Myocardial tissue of left ventricle was taken out and observed with transmission electron microscope and then stained with in situ end-labeling (ISEL) method. Number of positive nucleus was counted with 10 × 10 ocular lens check system and with 10 fields ISEL method; meanwhile, their average was obtained.MAIN OUTCOME MEASURES: Whether there was apoptosis of cardiac cell and the effect on AG in changes of cardiac structure and function of diabetic rats or not.RESULTS: Eight rats were lost during the experiment because of death mass: That of rats in the 12-week and 24-week diabetic group was higher decrease and increase rate of pressure in left ventricle: That of rats in the 12-week and 24-week diabetic group was lower than that in the control in left ventricle: That in 24-week diabetes group was obviously lower than diabetic group was obviously more than that in AG group (P ＜ 0.01), and that in 24-week diabetes group was obviously more than that in 12-week Apoptosis could be observed in myocardial cell in diabetic group.CONCLUSION: Apoptosis of myocardial cell plays an important role in the development of heart failure in diabetic rats. AG can reduce the apoptosis of myocardial cell and decrease the myocardial pathomorphological abnormality.

Currently, the model of the research evaluation system of traditional Chinese medicine (TCM) is set up through imitating that of western medicine. The application of quantitative research to TCM does promote the advance of modernization of TCM, which explore the part of TCM that can be measured in quantitative method. However, TCM has a background of profound philosophy and culture. The priority of TCM can not be expressed through quantitative research alone. On the contrary, qualitative research is more suitable to most research area of TCM. In TCM clinical research, the priority of TCM should be fully explored. It is very significant to set up the effectiveness evaluation system of TCM, especially by applying qualitative research to the diagnosis and the evaluation of treatment results and combining quantitative research.