Objective:To investigate the effects of paricalcitol on bone metabolism and transforming growth factor-β(TGF-β)/bone morphogenetic protein-7(BMP-7)/Smad signaling pathway in rats with renal osteodystrophy(ROD).Methods:Total 90 rat were randomly divided into 6 groups:control group,model group,paricalcitol low-dose(0.2 μg/kg)group,paricalcitol medium-dose group(0.4 μg/kg)group,paricalcitol high-dose(0.8 μg/kg)group,calcitriol(10 μg/kg)group,with 15 rats in each group.Rats in control group were fed with ordinary feed,and rats in other groups were fed with feed containing adenine to induce the establishment of ROD model.After grouping and drug treatment,the blood urea nitrogen(BUN)and blood creatinine(Scr)levels,blood calcium and blood phosphorus levels,femoral bone mineral density(BMD),maximum load,elasticity modulus and yield load,serum inflammatory fac-tors IL-6 and IL-17 levels of each group were measured;and the expression of TGF-β/BMP-7/Smad pathway protein in bone tissue was detected with Western blot.Another 45 rats were randomly divided into 3 groups:paricalcitol(0.8 μg/kg)group,TGF-β inhibition(LY2157299,150 mg/kg)group,paricalcitol(0.8 μg/kg)+TGF-β inhibition(LY2157299,150 mg/kg)group,with 15 rats in each group.ROD model was established with the same method.After drug treatment,the renal function indexes and femoral biomechanical indexes were measured.Results:Compared with control group,the blood calcium level,BMD,elastic modulus,maximum load,yield load,bone tissue TGF-β/BMP-7/Smad pathway proteins TGF-β and BMP-7 expressions,p-Smad3/Smad3 were significantly re-duced in the model group(P<0.05),the BUN and Scr levels,blood phosphorus level,and serum IL-6 and IL-17 levels were signifi-cantly increased(P<0.05).Compared with the model group,the blood calcium level,BMD,elastic modulus,maximum load,yield load,bone tissue TGF-β/BMP-7/Smad pathway protein TGF-β and BMP-7 expression,p-Smad3/Smad3 were significantly increased in the paricalcitol low,medium and high dose groups and calcitriol group(P<0.05),the BUN and Scr levels,blood phosphorus level,and serum IL-6 and IL-17 levels were significantly reduced,and paricalcitol groups showed a dose-dependent relationship(P<0.05),there was no significant difference in the indexes of rats in high-dose paricalcitol group and calcitriol group(P>0.05).Compared with paricalcitol+TGF-β inhibition group,the renal function indexes BUN,SCR and blood phosphorus level in paricalcitol group were de-creased(P<0.05),while the blood calcium level,BMD,elastic modulus,maximum load and yield load were increased(P<0.05).In TGF-β inhibition group,the renal function indexes BUN,SCR and blood phosphorus levels were increased(P<0.05),while the blood calcium level,BMD,elastic modulus,maximum load and yield load were decreased(P<0.05).Conclusion:Paricalcitol can activate the TGF-β/BMP-7/Smad signaling pathway,inhibit inflammation,improve renal function and abnormal bone metabolism in ROD rats,reduce blood phosphorus level,increase blood calcium level and bone density,repair bone biomechanics,and improve the symptoms of osteodystrophy.

Objective:To evaluate the feasibility of the "task-based" teaching mode in dose measurement of tumor radiotherapy to develop the independent practical ability of students.Methods:Twenty-one undergraduate students majoring in radiotherapy dosimetry were randomly divided into experimental group ( n=11) and control group ( n=10). The "task-based" teaching mode based on independent learning, thinking and designing was used in the experimental group, while the traditional teaching mode based on the guidance of teachers was applied in the control group. Then the practical examination of students was carried out through the case of measuring the absorbed dose of accelerator electron beam. The practical ability of the two groups of students was scored and compared by the objective and comprehensive scoring criteria. Results:The scores of each practical step and total score in the experimental group were higher than those in the control group ( P<0.05). The average total scores of the two groups were (90.18±1.97) and (83.70±3.68), respectively. Conclusion:The "task-based" practice teaching mode can improve students' ability of completing radiotherapy dose measurement independently.

[Abstract] Objective: To observe the effect of allogeneic platelets transfusion on the invasion and metastasis of human lung cancer A549 cells, and to preliminarily explore its mechanism of action. Methods: Eighty-nine patients with advanced lung cancer, who had received platelet transfusion in the Chemotherapy Department of Fourth Hospital of Hebei Medical University between January 2017 and December 2018, were enrolled in this study. The study cells were randomized into Ctrl group (A549 cells co-incubated with culture medium), Before group, and After group (A549 cells co-incubated with plasma Before and After platelet transfusion, respectively). The migration and invasion of A549 cells co-cultured with plasma before and after platelet transfection were detected by Scratch and Transwell experiments. The expression of MMPs, TIMPs and epithelial-mesenchymal transition (EMT) related proteins E-cadherin, N-cadherin and Vimentin, as well as vascular endothelial growth factor (VEGF) and its receptor 2 (VEGFR2) were detected by Western blotting (WB) method. Results: The scratch healing ability of A549 cells in After group was significantly higher than that of Ctrl group and Before group [(73.67±2.60)% vs (58.33±2.33)%, (35.33±2.03) %; P<0.01, vs Ctrl group; P<0.05, vs Before group], and there was also a significant difference between Before group and Ctrl group (P<0.05). The results of cell migration experiment showed that the number of transmembrane cells in After group was significantly higher than that in Ctrl group and Before group [(69.67±7.84) vs (18±2.08) and (39.33±2.03), all P<0.01]. The cell invasion experiment showed that the number of transmembrane cells in After group was significantly higher than that in Ctrl group and Before group [(59.34±3.46) vs (18.34±1.56) and (37.58±2.79), all P<0.01]. When A549 cells were co-incubated with plasma before and after platelet transfusion for 48 h, it was found that the expressions of MMP9 and MMP2 were increased (P<0.05), while their inhibitors TIMP1 and TIMP2 were decreased (P<0.01); the expressions of EMT-related proteins N-cadherin and Vimentin were increased (P<0.05), but E-cadherin was decreased (P<0.01); the expressions of angiogenesis related proteins VEGF and VEGFR2 were increased (P<0.05). Conclusion: Alloplatelets transfusion can promote the invasion and metastasis of lung cancer A549 cells, which may be realized by regulation of the expressions of EMT, metallomatrix protease and vascular growth factor-related proteins.

Objective:To explore the effects of pedicled anterolateral thigh flaps in repairing skin and soft tissue defects in perineal region caused by necrotizing fasciitis.Methods:From March 2014 to December 2018, 6 patients with skin and soft tissue defects in perineal region caused by necrotizing fasciitis were admitted to Department of Burns of Hanzhong Central Hospital (hereinafter referred to as our hospital). Two female patients had labia major defects and 4 male patients had scrotum defects, with age of 43-68 years. The areas of skin and soft tissue defects after debridement were 4%-8% total body surface area. The wounds in non-joint and non-functional area were repaired with free split-thickness skin grafts from medial femoral region, and the residual wounds areas in perineal region after repair were 10 cm×4 cm-22 cm×10 cm, which were repaired with pedicled anterolateral thigh flaps, with area of 12 cm×5 cm-24 cm×12 cm. The secondary wounds in the donor sites were sutured directly or repaired with free split-thickness skin grafts from medial thigh on the same or opposite side of the wounds. The bacterial culture result of wound exudate, drug sensitivity test result, and blood bacterial culture result on admission were recorded. The postoperative flap survival was observed. The length of hospital stay, debridement times, and antibiotics use time were recorded. The flap swelling condition was observed to evaluate whether flap thinning operation was necessary, the sensory recovery of the flap and hip joint activity were evaluated, and the scrotum function of male patients was evaluated by urologist in our hospital during follow-up.Results:The bacterial culture results of wound exudate in 5 patients on admission showed Escherichia coli with 4 of them having the same bacteria and the other one having methicillin-resistant Staphylococcus aureus detected in their blood samples. All the flaps survived in 6 patients after the operation, with total length of hospital stay of (22±5) d, debridement of 3-5 times, and antibiotics use time of (13±3) d. During follow-up of 3 to 6 months after the operation, the flaps were slightly bloated in 2 patients, and the flap thinning operation was performed 6 months after wound repair. The sensory function recovered to normal in 2 flaps of patients with anterolateral femoral cutaneous nerve, and the superficial sensory function in the other flaps of patients recovered in different degrees.The hip joint activity was close to normal in all the patients, and the scrotum function was normal in 4 male patients. Conclusions:The pedicled anterolateral thigh flap showed good effects in repairing skin and soft tissue defects on perineal region caused by necrotizing fasciitis, with good appearance and function after operation, and the method is simple, safe, and easy to apply.

Objective: To investigate the clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps. Methods: From August 2014 to December 2016, 12 patients (8 males and 4 females, aged 35-72 years) with skin and soft tissue defects of extremities associated with tendon and bone exposure were treated in Hanzhong Central Hospital. The sizes of the primary wounds after debridement were 10 cm×8 cm-22 cm×14 cm, and the wounds were repaired with 12 cm×10 cm-24 cm×16 cm free anterolateral femoral perforator flaps. The anterolateral femoral donor sites, which were 8.0 cm×4.0 cm-14.0 cm×7.5 cm in the secondary wounds after skin extensional suture, were repaired with perforating branch flaps of medial vastus muscle in the size of 9.0 cm×5.0 cm-15.0 cm×8.5 cm. The medial femoral donor sites were sutured directly. Results: All the perforating branch flaps of medial vastus muscle and free anterolateral femoral perforator flaps survived in 12 patients. Following up for 6 to 12 months, the medial femoral perforator flaps had good local shape and texture. The flaps of 8 patients without cutaneous nerve transection were sensitive. The sensation of the flaps of the other 4 patients gradually recovered, and the functions of the ipsilateral knee joints were normal. Conclusions The medial femoral perforator flap has a stable anatomy and abundant blood supply, which can be used to repair the secondary wound in the donor site of the free anterolateral femoral perforator flap conveniently. It is safe and easy to be popularized. Moreover, it has a good shape and function after operation.

Objective: To observe the clinical application effect of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flap. Methods: From March 2014 to March 2017, 6 patients with large area of skin and soft tissue defects of extremities were hospitalized in our unit, including 5 males and 1 female, aged 27-65 years, 1 case of electric injury, 2 cases of coal burn, 3 cases of traffic injury, 2 cases involving upper limb, and 4 cases involving lower limb. After debridement, the wound area ranged from 26 cm×8 cm to 36 cm×15 cm, and the bone exposure area ranged from 24 cm×7 cm to 35 cm×14 cm. The blood circulation enhancement technique was used when the wound with bone exposure was repaired with super large free anterolateral thigh flap. The area of flaps ranged from 28 cm×10 cm to 38 cm×16 cm. The donor site of flap and the primary wound without bone exposure were repaired with medial thigh split-thickness skin graft of the donor leg of flap. The blood circulation enhancement technique mode during operation and the survival of flaps after operation were recorded, and the recovery of donor and recipient areas and the occurrence of complications were followed up. Results: Three patients were treated with simple vascular supercharging technique during flap transplantation, and the other 3 patients were treated with vascular supercharging and turbocharging technique during flap transplantation. All the flaps survived well in 6 patients without vascular crisis. Follow-up for 3 to 12 months after surgery showed that the blood flow of the flaps was good and the depth and superficial sensation recovered to varying degrees. Except for 1 case of upper limb flap, the other flaps had no obvious swelling and needed no second thinning. There were only depressed scars in the donor sites, and no obvious scar hyperplasia in the area without bone exposure repaired by the skin grafts. No short-term or long-term complications were found. Conclusions The application of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flaps provides reliable blood supply for the flaps and results in good effect after operation, which is worth popularizing.

Objective To observe the effect of acupuncture and auricular application in the treatment of puerperal hypogalactia.Methods 300 patients with puerperal hypogalactia,according to the principle of random, balanced,together,were divided into 3 groups:Chinese herbal medicine group and acupuncture combined with auricular group and massage group,each group in 1 00cases.Collected patients'informed consent,and obtained the hospital ethics committee approval.The clinical curative effect was observed.Results After 3 days,in the Chinese herbal medicine group 34 cases recovered,24 cases were markedly effective,efficient in 1 5 cases,27 cases were invalid.In the massage group 7 cases recovered,1 3 cases had marked effect,1 5 cases were effective,ineffective in 65 cases.In the acupuncture combined with auricular group 73 cases cured,1 3 cases were markedly effective,effective in 9 cases, 5 cases were ineffective.The total effective rate between the acupuncture combined with auricular group and Chinese herbal medicine group had significant difference(χ2 =9.600,P <0.01 ).The total effective rate between the acupuncture combined with auricular group and the massage group had significant difference (χ2 =1 3.400,P <0.01 ).The total effective rate between Chinese herbal medicine group and massage group had significant difference (χ2 =6.400,P <0.01 ).Conclusion Acupuncture and auricular application has obvious curative effect for patients with postpartum hypogalactia.

Objective: To observe the effects of axial vascular network flap of scalp or anterolateral thigh perforator flap with fascia lata on repairing defects after radical resection of scalp carcinoma in patients. Methods: From February 2006 to December 2015, twenty-one patients with scalp carcinoma were admitted to our hospital, and the carcinoma invaded external lamina or full-thickness of skull and dura mater. After perfect preoperative examination, carcinoma and scalp tissue in 3 to 5 cm from the edge of carcinoma, external lamina or full-thickness of skull and invaded dura mater were resected and sentinel lymph nodes around carcinoma were cleaned in 3 to 4 days after admission. The postoperative defects with size reached from 11 cm×8 cm to 22 cm×18 cm. The flap transplantation was performed at the same time when quick frozen pathological examination results of resected scalp carcinoma margin tissue, skull, dura mater margin and basal tissue, and sentinel lymph nodes showed completely negative. Defects in 3 elderly patients were repaired by single or multiple axial scalp vascular network flaps, with the resected flaps size ranged from 12 cm×7 cm to 19 cm×14 cm. Defects in the other 18 patients were repaired by anterolateral thigh perforator flaps with fascia lata, with the resected flaps size ranged from 13 cm×10 cm to 23 cm×19 cm and the resected fascia lata size ranged from 8 cm×7 cm to 10 cm×10 cm. The head donor site of flap was repaired by medium thickness skin of head and back; the thigh donor site of flap was repaired by medium thickness skin of thigh on the same side. All patients gave up postoperative radiotherapy, chemotherapy, and other follow-up treatments. Results: After operation, the flap and skin in all patients survived completely, with no vascular crisis or other condition. During the follow-up for 6 months to 9 years, all patients showed good appearance except for baldness in operation area of head, with no obvious malformation in head donor site of flap and skin, no swollen external hernia in the brain tissue, and no local recurrence or distant metastasis of carcinoma. The appearance of thigh donor site of flap and skin was good, with normal muscle strength and movement of lower limbs. Conclusions Patients with scalp carcinoma were performed with radical resection of carcinoma, and axial vascular network flap of scalp or anterolateral thigh perforator flap with fascia lata were applied to repair the postoperative defects, with good appearance of head operation area and no local recurrence or distant metastasis of carcinoma.

Objective To investigate the feasibility and clinical effect of immediate ureterovesical reimplantation after ureteral rupture during laparoscopic hysterectomy. Methods From August 2010 to December 2015, 5 cases of ureteral rupture during the operation of laparoscopic hysterectomy were treated with immediate ureterovesical reimplantation under laparoscopy. Results All operations were successfully performed without transversion to open surgery. No patients with urinary leakage occurred. The mean follow-up were 21 months (range 3-60 months) . No cases with ureteral stricture were observed. Slight urine reflux was found in two patients, of whom obvious hydronephrosis and renal damage were not found. Conclusion Immediate ureterovesical reimplantation under laparoscopy is a feasible, safe and minimal invasive method for treatment of ureteral ruputure during laparoscopic hysterectomy.

Objective To compare the medical selection standards of flying cadets in the nervous and mental system between Air Force of PLA(PLAAF) and the US Air Force(USAF), and to offer suggestions on revising PLAAF medical standards for flying cadets .Methods All our candidates who had participated in the final medical selection of flying cadets were subjected to neurological examinations , and determined as qualified or not according to USAF Medical Standards Directory.Results 123 people were disqualified during the neurological examination , accounting for 1.1% of the total. According to USAF Medical Standards Directory , 13 of them were disqualified , 24 of them were qualified , and 86 of them needed a second examination .There was marked difference between disqualification rates of PLAAF and USAF .Conclusion There are some differences in medical selection standards for flying cadets in the nervous and mental system between PLAAF and USAF, and we could revise PLAAF standards using USAF standards for reference .