Objective:To study the significance of induction chemotherapy and subsequent comprehensive therapy for overall survival rate (OS) and larynx dysfunction-free survival rate (LDFS) in patients with advanced hypopharyngeal carcinoma.Methods:Patients who met the inclusion criteria with the diagnoses of advanced hypopharyngeal carcinoma between 2011 and 2017 received 2 or 3 cycles of TPF regimen induction chemotherapy. Patients who attained complete response (CR) received radical chemotherapy. Patients who attained partial response (PR) and the reduction of tumor volume was more than 70% were defined as large PR and received concurrent chemoradiotherapy. When the tumor volume reduction of PR patients was less than 70%, they were defined as small PR. (CR+large PR) group was defined as effective group. Patients who did not reach CR and large PR were defined as uneffective group and underwent radical surgery and received adjuvant radiotherapy as appropriate after the surgery. The end points of the study were OS, progression-free survival (PFS) and LDFS. Chi-square (χ 2) test was used for correlation analysis. Survival analysis was performed by the Kaplan-Meier method with a Log-rank test. Cox proportional hazards model was used for univariate and multivariate survival analysis. Results:A total of 260 patients were enrolled in the study. The follow-up period ranged from 5 to 83 months, with an average of 24.7 months. The 3-year and 5-year OS rate was 46.0% and 32.6%, respectively. The 3-year and 5-year PFS rate was 41.0% and 26.6%, respectively. The 3-year and 5-year LDFS rate was 37.9% and 24.8%, respectively. Poor outcome of induction chemotherapy, advanced N stage, strong positive Ki-67 immunohistochemistry (all P<0.001) were negative prognostic factors. The advanced clinical stage was positively related to the poor outcome of induction chemotherapy ( P=0.015). There was no significant difference in OS and PFS between the large PR group and the small PR group (all P>0.005). Conclusion:TPF regimen induction chemotherapy and subsequent comprehensive therapy for patients with advanced hypopharyngeal carcinoma may improve the quality of life of patients, with high OS rate and LDFS rate.

The clinical practice teaching reform of pediatrics based on TBL combined with medical simulation teaching model was carried out. TBL teaching plan writing under the model of medical simulation teaching was researched. The principles, requirements, contents and procedures of compiling teaching plans were formed. Emphasis should be placed on medical simulation teaching, team cooperation, humanistic quality education and humanistic skills training. The purposes of the reform were to achieve standardized operation skills, improve clinical ability, ensure medical safety, and improve the quality of medical purposes, but still the reform need further improvement in the teaching practice.

Objective To evaluate the mid-to-long term therapeutic effect of endoscopic pneumatic dilation for achalasia of cardia (AC).Methods Endoscopic pneumatic dilation was used in 45 AC patients, with follow-up of 2-12 years. Eckardt score and Stooler grading were used before and after the operation for evaluation of curative effect of dilation. Results The operation success rate was 97. 8%( 44/45) and the effective remission rate was 93. 2%( 41/44 ). No massive hemorrhage, perforation or other serious complications occurred.The longest follow-up time was up to 144 months.Ten cases were followed up for over 60 months. Patients′symptoms relieved significantly (P＜0. 01). Eckardt scores in 24 months and 60 months after operation significantly decreased compared with those before the operation ( P＜0. 01). But Eckardt score in 60 months was higher than that in 24 months ( P＜0. 01). The length of the disease history was positively related to post-operative scores, and negatively related to efficacy ( P＜0. 01). Conclusion Endoscopic balloon dilation is a satisfactory therapy to AC with good efficacy and safety.

Objective To explore the clinical effect of three doses of mifepristone on patients with dysfunc-tional uterine bleeding.Methods 150 patients with dysfunctional uterine bleeding were chosen,and they were randomly divided into 3 groups,including low dose group (50 patients),middle dose group (50 patients)and high dose group (50 patients).All patients adopted routine treatment.On the basis of this,the low dose group received 6.25mg/d mifepristone,the middle dose group received 12.5mg/d mifepristone,the high dose group received 18.25mg/d mifepristone,continued 6 months.The influence of follicle stimulating hormone (FSH),luteinizing hor-mone (LH),estradiol (E),progesterone (P),volume of uterine and endometrail thickness of patients were observed. Results After treatment,the FSH,LH,E and P levels in the three groups were significantly decreased compared with before treatment (FSH:t=4.406,5.329,3.610,LH:t=4.563,6.134,4.455,P=0.000,0.000,0.000;P=0.000, 0.000,0.000;E:t=7.173,6.815,7.018,P=0.000,0.000,0.000;E:t=2.367,6.315,4.351,P=0.020,0.000, 0.000),and the difference were statistically significant (all P<0.05).Before and after treatment,FSH,LH,P levels among the three groups had no obvious differences (P>0.05 ).Compared with the low dose group,E levels in the middle dose group and high dose group significantly decreased(t=3.850,2.085,P=0.000,0.004).Before and after treatment,the uterine volume among the three groups had no significant difference (P>0.05 ).After treatment,the functional uterine bleeding symptoms were significantly relieved in the three groups,the effective rate was 100%.The recurrence rate of the low dose group was 32%,which was significantly higher than 8%and 10%of the middle dose group and high dose group.The amenorrhea rate of the middle dose group and high dose group(6% and 2%)was significantly lower than that of the low dose group (46%).Conclusion The treatment of 12.5mg/d mifepristone is effectively adapted to patients with dysfunctional uterine bleeding.

Objective To explore the effect of continued nursing on postpartum breastfeeding within 6 months. Methods Two hundred and twenty parturient women were randomly divided into the observation group and the control group using random digits table. The control group received breastfeeding knowledge education and nursing skills instruction. The observation group was given continued nursing and breastfeeding guidance . The two groups were compared in terms of breastfeeding rates at 1 , 2 , 3 , 4 , 5 , 6 months . Result The breastfeeding rates of the observation group were significantly higher than those of the control group at each time point ( all P < 0 . 05 ) . Conclusion According to reasons why the parturient women don′t breastfeed , they are given continued nursing and detailed solutions after discharge , to make them confident in breast feeding and improving breastfeeding rate within six months after delivery .

Objective To explore the clinical manifestation of a patient with hypoparathyroidsmsensorineural deafness-renal dysplasia (HDR) syndrome and to sequence the related GATA3 gene of the patient.Methods A 22 year old person with HDR syndrome was reported in regard to clinical manifestation,laboratory examination,and genetic mutation.Some related literatures were reviewed.Results The patient showed tetany,deafness,and positive Chvosteks' and Trousseau' s signs.The initial laboratory studies showed that serum concentration of calcium was lowed and the iPTH level were lower than normal.Binaural pure tone audiometry showed Binaural sensorineural deafness.Colour doppler ultrasound revealed that his right kidney was not observed and the level of creatinine was increased,indicating renal insufficiency.GATA3 mutations on DNA sequence analysis indicated that the 6 exon IVS6-1G-A (G/A heterozygosis splicing),showed the mutation of G to A is in the upstream of the first base in the six exon.After treating with calcium carbonate and vitamin D,the symptoms and signs were improved.Conclusion HDR syndrome is a rare endocrine disease,that should receive more attention in order to avoid missing diagnosis;The IVS6-1G-A as a novel mutation of GATA3 gene,has not been reported so far.

Objective To investigate the prevalence of hyperglycemia in patients with primary aldosteronism.Methods Thirty two patients diagnosed as primary aldosteronism(PA) in our hospital from 2010 to 2013 (PA group),and 40 patients as essential hypertension (EH group).Two groups were measured and compared,including blood pressure,plasma aldosterone,urine aldosterone,and plasma potassium.Oral glucose tolerance test (OGTT) was performed and homeostasis model assessment-insulin resistance index(HO-MA-IR) were calculated.Results The prevalence of hyperglycemia was 43.75％ in PA group,including 25％ patients of glucose intolerance and 18.75％ patients of diabetes mellitus,which was significantly higher than those of EH group (25％,12.5％,and 12.5％,respectively).PA group's fasting and 2-hour postprandial insulin levels and insulin resistance index were higher than that of EH group.Conclusions The present study indicated that patients with PA had a significantly high prevalence of glucose metabolism disturbance and insulin resistance.Screening test should be performed and avoid missed diagnosis.

Objective To discuss the antigenic change caused by the mutation of amino acid on the epitopes of the hemagglutinin of measles virus.Methods The B cell linear epitopes in the hemagglutinin were predicted with bioinformatics software.Peptide pairs,which located on the same region but originated from measles vaccine and wild-type virus respectively,were designed and synthesized.After detecting the immunogenicity of peptides with indirect ELISA assay,sera against each peptide was prepared.Antigenic specificity between the two peptides within each peptide pair were tested by using cross ELISA assay,and then antigen ratios were calculated.Results All the synthesized peptides could bind with immune sera against measles virus,of which the peptide pair CW23/CW22 designed on the epitope region (273-282 aa) possessed the highest binding ability,while the peptide pair CW150/CW151 designed on the non-epitope region (418-427 aa) showed the lowest binding ability.The difference in antigenic specificity between the two peptides from different sources was significant.The antigenic ratio was up to 16 between CW23 (vaccine-originated) and CW22 (wild-type originated),and 2.877 ± 0.583 between CW123 (vaccine-originated) and CW124 (wild-type originated) (236-246 aa).On the non-epitope regions,the antigenic ratios was only 1.631 ± 0.481 between peptide pair CW125 and CW126(356-364 aa),but reached to 10.367± 1.617 between CW150 and CW151.Conclusion Although there were several conservative epitopes,specific amino acid mutation on the predicted epitope or non-epitope regions might cause the antigenic change of wild-type measles virus.

Objective To explore the application value of 3.0T magnetic resonance perfusion weighted imaging(PWI)in the rat late brain glioma model.Methods C6 glioma cells were injected stereotactically into the right caudate nucleus of 32 Wistar rats.In 3 weeks after inoculation,the conventional MRI and PWI were performed.The relative cerebral blood volume(rCBV)values were recorded and compared with the pathological results.Results The tumor formation in 30 inoculated rats were confirmed by the sub-sequent pathological examination,with the tumor formation rate of 100%.PWI showed that rCBV values of the brain glioma region and the contralateral mirror image brain tissue were 262.61±72.82 and 189.39±57.21,the difference between them was statisti-cally significant(P<0.05).Conclusion The rat late brain glioma model is suitable for the study on the blood volume of brain tumor tissues.

Objective To summarize the key points of nursing care to pregnant women with acute cholecystitis and gallstones. Methods The clinical data of twenty three pregnant women with acute cholecystitis and gallstones during August 2007 to January 2012 were reviewed and analyzed retrospectively,including 19 cases for conservative treatment,3 cases for surgical treatment,1 case for abortion.Results All patients were cured and discharged with hospital stay for 7 to 21 days,averaged(12.7±4.7)days. Conclusion For pregnant women with acute cholecystitis and gallstones,efforts should be focused on dynamic monitoring of vital signs and fetal conditions,psychological care and diet care in order to ensure the safety of the mathers and infants.