To observe the efficacy and safety of apatinib in the treatment of advanced bone and soft tissue sarcoma, and to analyze the possible related factors affecting the progression-free survival (PFS) of patients. Methods: Twenty-one patients with ad-vanced bone and soft tissue sarcoma admitted to the Department of Orthopaedics, Yunnan Cancer Hospital from June 2017 to Sep-tember 2018, were treated with apatinib tablets. The main efficacy index was progression free survival (PFS), and the secondary effica-cy index was overall survival (OS). Clinical efficacy was evaluated according to response evaluation criteria in solid tumors (RECIST) 1.1, and overall response rate (ORR), disease control rate (DCR), and safety were olserved according to the National Cancer Institute (NCI) 4.0 standard. Results: All of the 21 patients were followed up. At the last follow-up time point, March 31st, 2019, there were no CR, 2 patients (9.5%) with PR, 7 patients with SD (33.3%), and 12 patients with PD (57.1%). The ORR was 9.5%, the DCR was 42.8%, the medi-an PFS was 8 months, and the median OS was 14 months. The patient's gender, age, ECOG score, tissue source, surgery, or chemother-apy had no statistically significant effect on PFS (P>0.05). Only the history of radiotherapy before taking apatinib was a factor for pa-tients with PFS. The effect was statistically significant (P<0.05), and patients with a history of radiotherapy had a lower PFS than pa-tients without a history of radiotherapy. The adverse reactions of gradeⅢand above had hand-foot syndrome (14.3%), pneumotho-rax (14.3%) and anemia (4.8%). Conclusions: Apatinib has a certain effect for advanced bone and soft tissue sarcoma. The adverse re-actions are generally predictable, controllable and reversible. Apatinib can be a choice for patients with advanced bone and soft tissue sarcoma with good treatment adherence and no other treatment options.

Objective To explore the treatment methods and prognosis of early infection and delayed infection after intramedullary nail fixation.Methods Data of 22 cases of postoperative infections after intramedullary nail from January 2013 to August 2017 were retrospectively analyzed.There were 18 males and 4 females aged from 20 to 72 years old,with an average age of 46.8 years.14 cases were tibias and 8 cases were femurs.In the early infection group,6 cases showed swelling,heat and pain in the affected area with drainage and pus.In the late infection group,12 cases showed sinus formation and 4 cases showed no sinus tract.According to whether the infection occurred within six weeks,it was divided into early infection and delayed infection groups.Of 6 patients in early infection group,there was 1 case of septic shock which underwent removal of intramedullary nails,debridement and antibiotic bone cement stick implantation.5 cases were retained intramedullary nail and underwent local debridement treatment.Late infection occurred in 16 patients.One patient with tibia infection was given partial dressing to heal the fracture.Then the intramedullary nail was removed and intramedullary debridement was performed.Two patients with poor general condition,the intramedullary nails were removed and debridement was performed.Calcium sulphate cement was implanted and fixed with external fixation.The remaining 13 cases were treated with debridement and antibiotic cement stick implantation.We compared the differences between early and late infections of internal fixation,infection control,fracture healing,and secondary fracture fixation.Results Of the 6 patients with early infection,1 patient with septic shock removed intramedullary nails to control infection.After infection controlled,the fracture was treated with intramedullary nailing.Of the 5 patients with retained intramedullary nails,2 patients' infection were controlled and 3 were uncontrolled.After removal of the intramedullary nails the infection was control.The success rate of retaining intramedullary nails was 33.3％ (2/6).Late infection occurred in 16 cases and infection was all controlled.The fractures healed in 22 patients.The fracture healing time of 6 patients with early infection was 2-6 months,with an average of 3.67±2.08 months.The fracture healing time of 16 patients with late infection was 2-4 months (average 3.2±0.79) months.Conclusion Patients with early bone infections after femoral and tibial intramedullary nail surgery may attempt debridement therapy with retained intramedullary nails,but the failure rate is high.If the intramedullary nail fails to remain,follow the treatment of patients with delayed bone infection.For patients with delayed bone infection,because the fracture has not yet healed,thorough debridement is used after the removal of internal fixation,then calcium sulfate or antibiotic bone cement stick should be implanted and fixed with external fixation.For the second phase,we may choose plate,intramedullary nail or external fixation to fix the fractures according to the soft tissue condition.All of the fixation methods could provide good fracture healing.

A 50?year?old woman presented with intermittent dull pain in the forehead and mild dizziness occasionally after her forehead was subjected to a mild bump accidentally 20 days prior to the presentation, and was diagnosed with angioneurotic headache in a local hospital. After the treatment with oral sibelium tablets, the condition wasn′t relieved obviously. Computed tomography (CT) scan showed multiple localized bone destruction and low?density area in the frontal and bilateral parietal bones with adjacent soft tissue swelling. Magnetic resonance imaging(MRI)revealed equal T1 signals and slightly long T2 signals for multiple nodules in the frontal and bilateral parietal bones, high signals on diffusion?weighted imaging (DWI), obvious enhancement on contrast?enhanced MRI, and linear enhancement in adjacent meninges. Whole?body bone scintigraphy showed multiple increased radionuclide uptake in the skull. Laboratory examination demonstrated that specific antibodies to Treponema pallidum (Tp) were positive, and the serum rapid plasma reagin(RPR)titer was 1∶128. Cerebrospinal fluid(CSF)examination showed normal CSF pressure, nucleated cell counts(8 × 106/L)and glucose level(4.0 mmol/L), slightly high chloride flux(129.1 mmol/L), high protein level(0.9 g/L), high CSF?RPR titer of 1∶16 and presence of specific antibodies to Tp. Histopathological examination revealed hyperemia of adjacent tissues in the cranial osteolytic area, hyperplasia of interstitial fibrous tissue, endothelial cell swelling, and infiltration of inflammatory cells mainly containing plasma cells. The treatment regimen for neurosyphilis was given, and headache was relieved after 1 week of treatment, basically disappeared after 2 weeks, and completely disappeared after 4 weeks, and no similar headache occurred thereafter. Finally, the patient was diagnosed with acquired syphilitic skull osteomyelitis complicated by syphilitic meningitis.

ObjectiveTo evaluate temporary balloon occlusion of the abdominal aorta in high-order position sacral tumor surgical operation as a useful adjuvant technique.MethodsReviewed 79 cases of patients from 2005 to 2015 treated in our department and the diagnosis of high-order position sacral tumor. Temporary balloon occlusion of abdominal aorta was used in 50 patients(male 29,female 21)during the sacral tumors surgical operations. The other 29 patients(male 18,female 11)with sacral tumors who received the non-temporary balloon occlusion therapy were used as control group. The statistical differences of the whole surgery time,the blood loss during the surgery,the happening of the postoperative deep vein thrombosis,the time of the postoperative extubation were analyzed. ResultsThe differences were statistically significant(P<0.001)in the whole surgery time of balloon occlusion group(146.36±29.38)min vs non-balloon occlusion group(206.03±125.93)min,the blood loss of balloon occlusion group(1610.70±491.14)ml vs non-balloon occlusion group(2658.62±562.213)mL, and the time of the postoperative extubation of balloon occlusion group(6.60±2.76)d vs non-balloon occlusion group(12.52±2.86)d. However,there was not significant difference of the happening of the postoperative deep vein thrombosis between balloon occlusion group and non- balloon occlusion group. ConclusionTemporary balloon occlusion of abdominal aorta is effective and reliable. It significantly reduced the time of operations,the loss of blood,mean days in hospital,effusion of post-operation and recurrence rate. It makes the operation of sacral tumors much more safer than before and is a technique worthy of popularizing.

Objective To screen the splicing isoforms of estrogen receptor βin the Beagle hypothalamic -pituitary -gonadal axis.Methods For ERβmRNA CDS sequence of eight exons, primers were designed confined to the CDS sequences of two sequential exons.Beagle hypothalamus, pituitary, ovary and uterus tissue cDNA were used as template, and corresponding sequences were amplified by PCR.PCR products were sequenced and aligned in the NCBI web site.The correct gene was then analyzed with DNAMAN comparative analysis software and handwork checking up, thus got the ERβsplicing isoforms of Beagle. Results Four beagle ER beta splicing isomers were obtained:exon 4 complete skipping ER βisomer (300 bp missing), two kind of Beagle ERβisoforms with partial exon 4 and partial exon 5 complicated missing (isoformⅠ334 bp missing and isoformⅡ265 bp missing), and exon 7 complete missing ERβsplicing isoforms (181 bp missing).Exon 4 complete skipping and exon 7 complete missing isomers had been obtained full length coding sequence, and the other two splicing isomers were partial coding sequence.Conclusion This project gained four ERβsplicing isomers of Beagle, and that will lay an important foundation for further study of their roles in the Beagle reproductive regulation mechanism.

Objective To evaluate the effects of ulinastatin preconditioning on protamine-induced pulmonary injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Sixty NYHA class Ⅱ or Ⅲ and ASA physical status Ⅱ or Ⅲ patients of sexes,aged 21-59 yr,scheduled for elective cardiac valve replacement under CPB,were randomly divided into 3 groups (n =20 each):group control one protamine given via central vein (group C1) ; group control two protamine given via ascending aorta (group C2) ;group ulinastatin preconditioning (group U).Heparin was neutralized with protamine after termination of CPB.Ulinastatin 20 000 U/kg was infused via the central vein at a rate of 500-1000 U· kg-1 · min-1 starting from the time point after tracheal intubation until 10 min before cross-clamping of superior vena cava and inferior vena cava in group U.At 10 min after termination of CPB,protamine 4 mg/kg was infused over 8 min via the right internal jugular vein in groups C1 and U,or via the aortic root in group C2.Blood samples were obtained from the left atrium and right atrium at 5 min before neutralization of heparin with protamine (T1) and 15 min after neutralization of heparin with protamine (T2) for determination of polymorphonuclear leukocyte (PMN) and platelet (Plt) counts,and plasma concentrations of thromboxane B2 (TXB2) and 6-keto-prostaglandin F1α (6-keto-PGF1α).Blood samples were obtained from the left atrium at T1 and T2 for determination of the levels of TNF-α,IL-1,IL-8,CD11b/CD18,C3a,C5a,and malondialdehyde (MDA) and superoxide dismutase (SOD) activity and for blood gas analysis.Alveolar-arterial oxygen gradiant (A-aDO2),respiratory index (RI) and oxygenation index (OI) were calculated.Pulmonary arterial pressure (PAP) was recorded.Results Plt and PMN counts in the blood obtained from the left atrium were significantly lower,and plasma TXB2 concentrations in the blood obtained from the left atrium were higher at T2 in group C1,and the plasma 6-keto-PGF1α concentrations and SOD activity in the blood obtained from the left atrium were higher at T2 in groups C2 and U than those in the blood obtained from the right atrium (P ＜0.05).Compared with group C1,Plt and PMN counts and plasma 6-keto-PGF1α concentrations were significantly increased,the levels of plasma TXB2,TXB2/6-keto-PGF1α,TNF-α,IL-1,IL-8,C3a,C5a and MDA were decreased,CD11b/CD18 expression was down-regulated,PAP,A-aDO2 and RI were decreased,and OI was increased at T2 in C2 and U groups (P ＜ 0.05).There were no significant differences in the parameters mentioned above between groups C2 and U (P ＞ 0.05).Conclusion Ulinastatin preconditioning can inhibit protamine-induced pulmonary injury in patients undergoing cardiac valve replacement under CPB,and the effect is similar to that of protamine administered via the aorta.

Objective To study the expression of MCP-1 in the diabetes mellitus skin defect healing, then discuss its effect. Methods The diabetes mellitus models were established, and the expression of MCP-1 was detected by immunohistochemical staining and Elisa. Results The immunohistochemistry stain showed that the expression of MCP-1 in DM group was higher than that in control group at all time. And the serum value of MCP-1 in DM group had statistical significance ( <0.05) at 3 days or 1 week, but that in 2 weeks and 4 weeks was no statistical significance ( <0.05) . Conclusion The MCP-1 might play a role in the healing of diabetes mellitus skin defect through mediate abnormal inflammatory response.

Objective To investigate the current status of health education among nursing undergraduates,to analyze the existing problems and to bring up corresponding strategies for improving the health education ability for nursing undergraduates.Methods Totally 381 nursing undergraduates were recruited and investigated with a self-designed questionnaire.Aspects of students' cognition of health education,influencing factors of health education and the implementation of health education in clinic were investigated.Data were processed using SPSS 12.0 and percentages were calculated.Resuits 98.75％ students understood the importance of heath education in nursing work.However,systemic training courses of health education for nursing undergraduates were insufficient in both colleges and hospitals.Meanwhile,clinical teachers' ability of health education was limited.Only 15.59％students provided health education for patients independently.Conclusions Nursing colleges and practicing hospitals should strengthen health education consciousness of nursing undergraduates,enhance faculty construction and should set up related courses to train the health education skills.

In recent years,medical colleges have generally accepted the higher education assessment(evaluation).How to put the good practices and experience we obtained during the educational assessment into the daily teaching management and achieve normalization of teaching evaluation is of great significance to continuously improving the teaching quality.It is the primary condition to establish the evaluation index system for evaluating clinical teaching quality by regular teaching assessment. In this paper,the author constructed a clinical teaching quality evaluation index system through systematic research and exploration.

Objective To evaluate the effects of ulinastatin postconditioning and combination of ulinastatin preconditioning and postconditioning on myocardial apoptosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Eighty NYHA class Ⅱ or Ⅲ patients of both sexes,aged 21-59,scheduled for cardiac valve replacement with CPB,were randomly divided into 4 groups ( n =20 each):normal saline control group ( group C ),ulinastatin preconditioning group ( group U1 ),ulinastatin postconditioning group (group U2 ) and ulinastatin preconditioning plus postconditioning group(group U3 ).In group U1,uinastatin 20 000U/kg was infused via central vein at 500-1000 U·kg-1 ·min-1 from after tracheal intubation until 10 min before ascending aortic cross-clamping.In group U2,ulinastatin 10 000 U/kg was perfused via aortic root at 4000-5000 U· kg-1 · min-1 at 5-7 min before aortic unclamping.In group U3,ulinastatin preconditioning and postconditioning were performed as described in groups U1 and U2.In group C same volume normal saline was infused instead of ulinastatin.Blood samples were taken from radial artery at 10 min before ascending aortic cross-clamping,40 min after ascending aortic cross-clamping,45 min after aortic unclamping and the end of operation for determination of plasma concentrations of TNF-α and soluble tumor necrosis factor receptor 1 (sTNF-R1).Myocardial tissues were obtained from right atrial appendage at 45 min after aortic unclamping for determination the expression of TNF-d,Bcl-2,Bax and caspase-3 and apoptosis.The Bcl-2/Bax ratio and apoptotic index were calculated.Results Plasma concentrations of TNF-α and sTNF-R1 and the expression of TNF-α,Bax,caspase-3 and apoptotic index were lower,the expression of Bcl-2 and Bcl-2/Bax ratio were higher in groups U1,U2 and U3 thah group C and in group U3 than groups U1,U2 ( P ＜ 0.05 ).Conclusion Ulinastatin postconditioning can inhibit myocardial apoptosis in patients undergoing cardiac valve replacement with CPB,and efficacy of combination of ulinastatin preconditioning and postconditioning is stronger than that of ulinastatin postconditioning.The mechanism is involved in balancing the expression of Bax and Bcl-2 and down-regulating the expression of TNF-α and its receptor.