Objective To investigate the adverse reactions by stereotactic body radiation therapy(SBRT)for advanced hepatocellular carcinoma and summarize nursing experience.Methods Forty-one patients with advanced hepatocellular carcinoma from the radiation department of Sun Yat-sen University Cancer Center from July 2010 to May 2012 were enrolled in this retrospective study.The adverse reactions were closely observed and the patients were given pertinent nursing.Results The effectiveness rate was 56.2%.During the therapy,36 patients developed nausea/vomiting of grade 1-2,taking up 87.8%,18 had grade 1-3 elevation of liver enzymes,taking up 43.9%,16 had grade 1-2 decrease of white blood cells,taking up 39.0%,8 had grade 1 anemia,taking up 19.5%and 21 had grade 1-2 decrease of blood platelet,taking up 51.2%.The adverse reactions were contained satisfactorily through careful observations and pertinent nursing.Conclusions The toxic reactions by SBRT are nausea,vomiting,enzymes elevation and decrease of whole blood cell.Therefore,nurses need to observe these toxic reactions carefully and give pertinent care to the patients so as to prevent the complications,especially radiation-induced liver injury.

Objective To study the characteristics of the wounded injured from of a strong and spiraling up wind of tornado blowing in Yancheng on 23 June 2006.Methods The clinical data of 144 inpatients within 36 h after tornado disaster were collected and analyzed,including gender,age,time of visiting hospital,causes of injury,injury site,injury severity score,et al.Microsoft Excel for data input and SPSS 20.0 for statistical analysis were used.Results The majority of the patients with injury was over 60 years old (57.6％).The two peak periods for accepting patients were during the 6 h ～8 h (n =55) and the 21 h ～ 22 h (n =27) after tornado disaster.The patients during the first peak period had the higher injury severity score than that during the second peak period [(18.21 ± 7.13) vs.(14.65 ±4.86),P ＜ 0.05)].The most common causes of injuries for survivors were being hit by flying/falling object blown by the wind of tornado.The common kinds of injuries were soft-tissue (24.48％),chest (20.30％),head (17.61％),lower limb/pelvis (13.73％),upper limb (8.06％),spine (7.76％).And 41.0％,17.4％ and 13.9％ of patients were admitted to department of orthopedic,department of chest surgery and department of neurosurgery,respectively.Conclusions The destructive force of tornado was very strong leading to a large number of casualties.Therefore,medical aid agencies should have to develop a appropriate treatment process to improve their emergency response capabilities and rescue capacity.

Objective To explore the key points of graded nursing care to rectal cancer patients with radioactive proctitis induced by preoperative neoadjuvant chemoradiotherapy.Methods The clinical data of 162 rectal cancer patients undergoing neoadjuvant chemoradiotherapy were analyzed retrospectively. The experience of grading nursing care for patients with radioactive proctitis induced by neoadjuvant chemoradiotherapy was summarized.Results Of 162 patients,radioactive proctitis occurred in 110 patients(67.9%).Among the 110 patients with proctitis,62(38.3%)were grade I radioactive proctitis,29(17.9%)gradeⅡand 19(11.7%)gradeⅢ.The graded nursing was done to the patients with radioactive proctitis and achieved good effect.Conclusions Radioactive proctitis has a high incidence in rectal cancer patients with preoperative neoadjuvant chemoradiotherapy and graded nursing care can reduce the distress of patients with radioactive proctitis effectively and promote wound healing,thus to improve their quality of life.

BACKGROUND: Common complication of traditional joint replacement is hip joint dislocation and large head joint implant can effectively solve this problem. OBJECTIVE: To investigate the preliminary efficacy of large head metal-on-metal implants for patients undergoing total hip arthroplasty. DESIGN, TIME AND SETTING: Prospective cohort study. The patients were selected from Department of Joint Surgery, Xinjiang Hospital of Traditional Chinese Medicine between February 2007 and January 2008. PARTICIPANTS: A total of 65 patients (71 hips) undergoing large head metal-on-metal implantation in Xinjiang Hospital of Traditional Chinese Medicine were selected, including 21 females and 44 males with an average age of 54.6 years (ranging 19 to 77 years). Of them, there were 28 cases of necrosis of the femoral head, 24 of hip osteoarthritis, 9 of femoral neck fracture and 4 of acetabular dysplasia. METHODS: According to age, sex, cause of disease and preoperative joint function, the patients were divided into traditional prosthesis (n=30, 33 hips, metal-on-polyethylene implant) and large head M-O-M group (n=35, 38 hips, ASR/XL prosthesis, DePuy, Motech, Warsaw, IN, USA). MAIN OUTCOME MEASURES: The pre and postoperative Harris scores for the hip, range of motion, periprosthetic radiolucency, leg-length inequality and complications were recorded and compared. RESULTS: All patients were followed-up. The traditional group was followed up for 20 months (ranging 13-28 months), and the large head M-O-M group was followed up for 17 months (ranging 10-26 months). The mean Harris score was 89 points (ranging 59-98) in traditional group, and 94 points (ranging 71-100) in large head M-O-M group (P=0.014). The range of motion of hip was improved, and the large head M-O-M group (34?) was superior to traditional group (26?, P=0.004) at 6 months after surgery; the range of motion was improved 27? in traditional group and 37? in large head M-O-M group (P=0.009) over 1 year of follow up. The leg-length inequality was 4 mm (2-11 mm) in large head M-O-M group and 7 mm (5-16 mm) in traditional group (P=0.005). Both groups exhibited periprosthetic radiolucency (≤1 mm, 2 cases in traditional group and 3 cases in large head M-O-M group). One patient in the traditional group suffered dislocation. CONCLUSION: The large head M-on-M implants in total hip arthroplasty has excellent short-term effects on patients compared with traditional prosthesis. They offer the more stability and better restoration of hip articulation function and biomechanical reconstruction.

AIM: To study the differentiation of rat bone mesenchymal stem cells (MSCs) into cardiomyocytes in vitro. METHODS: MSCs were isolated and purified from the bone marrow of rats by density gradient centrifugation and adhering to the plastic culture. The third passage MSCs were treated by 5-azacytidine (5-aza). The induced cells were evaluated by immunocytochemistry staining and RT-PCR analysis. RESULTS: After being induced by 5-aza, some MSCs became bigger and longer. The connection of the cells were formed on day 14.The direction of the cells arraying was similar gradually. The induced cells were stained positively for desmin, ?-actin and troponin I. RT-PCR showed that these cells expressed ? myosin heavy chain. CONCLUSION: 5-aza can induce MSCs to differentiate into cardiomyocytes in vitro.

Objective To explore the effect of whole renal perfusion imaging removal of arterial phase data on perfusion parameters of renal clear cell carcinoma using Revolution CT.Methods Perfusion imaging with Revolution CT was retrospectively analyzed in 10 patients with pathologically proven clear cell renal cell carcinoma.The z-direction coverage model was used in perfusion imaging,and the images were analyzed with CT Perfusion 4D software.All images were analyzed twice.All 23 phases data was included in group A and only 16 phases except arterial data (9-15 phases) were selected in group B.The abdominal aorta on the level of right hilus was chosen to be the input artery,and the perfusion parameter maps were obtained,including blood flow (BF),blood volume (BV),mean transit time (MTT),permeability of surface (PS).Every perfusion parameters of lesions and contralateral normal cortex,lesions and normal cortex in both groups were compared.Results The BF and PS of lesions were lower than those of normal cortex in both groups (both P＜0.05).There was no statistical difference in BV and MTT between lesions and normal cortex in both groups (all P＞0.05).There was no statistical difference in all perfusion parameters of renal clear cell carcinoma between group A and group B (all P＞0.05).The difference of BF in normal cortex between the two groups was statistically significant (P 0.009),and the difference of the PS,BV,MTT had no statistically significant (all P＞0.05).Conclusion When the duration time of renal CTP is 600 s,there is no difference between including and excluding arterial phase in all perfusion parameters of renal clear cell carcinoma.

Objective To explore the feasibility of one-stop examination with Revolution CT for axial perfusion of normal pancreas.Methods Thirteen patients who received axial perfusion scan by one-stop examination with Revolution CT were analyzed as perfusion group.Two radiologists measured pancreatic CT perfusion (CTP) parameters independently and selected optimal phase for CTA and three phases of enhanced images.The effect dose (ED) was calculated.Eighteen patients who underwent abdominal enhanced CT and CTA with spiral scan were included as control group.Patients in both groups had no pancreatic disorders.The interobserver variation of CTP parameters was estimated.Two independent radiologists separated the superior pancreaticoduodenal artery (SPDA) image into 5 points according to image quality,and the consistency was assessed.The subjective points of SPDA image quality of two groups was compared.CT value,images noise,CNR and SNR of SPDA on CTA images and those of pancreas on three phases enhanced scan images between two groups were compared.Results ICC values of all CTP parameters were higher than 0.75.The ED of perfusion protocol was (24.52±-0.01)mSv.The subjective image scores of SPDA on CTA images in both groups were both 5,the consistency was good (Kappa=0.629,0.769).The CT value,CNR,and SNR of SPDA on CTA images of CTP group were higher than those of control group (all P＜0.05).The CT value,CNR,and SNR of pancreas of CTP group were higher than those of control group in venous phase and balanced phase (all P＜0.05).Conclusion The pancreatic CT one-stop examination can be performed by Revolution CT scanner with maximum detector width with acceptable radiation dose,from which pancreatic CT perfusion data,enhanced images with high quality and better CTA images can be extracted.

Objective Cervical heterotopic heart transplantation model was established in different inbred strains of mice with modified cuff technique. Inbred male Balb/c mice and C57BL/6 mice were selected as donors and recipients, respectively. Mice were randomly assigned into four groups: control group (the donor hearts were perfused through coronary artery with 200 μl, 0℃～4℃ St. Thomas Ⅱ solution during 2 to 3 min, then they were immersed in it for 15 min), CsA group ( the donor hearts were perfused with the same method as for the control's and intraperitoneal injection of CsA 5 mg· g-1 · d -1 was given after surgery ), H2-B1 transfection group (the donor hearts were perfused through coronary artery with 200 μl, 0℃ -4℃ St. Thomas Ⅱ solution contained with 30 μg H2-Bl plasmid vectors during 2 to 3 min, then they were immersed in it for 15 min ), and H2-B1 + CsA group ( the donor hearts were perfused with St. Thomas Ⅱ solution contained H2-Bl gene plasmid and intraperitoneal injection of CsA was given after surgery as mentioned above. ). At 1,3 and 7 days after transplantation, three allografts were harvested at each time points in all of the groups, respectively, for pathological examination and analysis of CD40 expression with immunohistochemistry assays. The expression of Th1/Th2 cytokines were also determined with flow cytometry. The survival time of rest allografts were observed. Results Histological features for rejection were observed more apparent in the grafts of control group than those in other groups, especially those in H2-Bl + CsA group. The expression of CD40 in H2-Bl + CsA group and CsA group was lower significantly than that of the control group ( P ＜0.01 ), so was the expression of CD40 in the H2-Bl group as compare with that of the control group (P ＜0.05). No significant difference between H2-Bl group and CsA group (P ＞0.05 ) at 7 days was observed. The expression of IL-2, TNF-α (Th1 cytokines) in control group was much higher than that in other groups, and the expression of IL-4 ( Th2 cytokine) in control group was much lower ( P ＜0.05 ). The level of IL-4 in CsA group increased significantly at 3 days ( P ＜ 0.05 ), with a peak level at 7 days after transplantation (P＜0.01). The survival time of grafts was significantly prolonged in CsA group (P＜0.01), H2-Bl group (P＜0.05) and H2-Bl+CsA group(P＜0.01). Conclusion Treating the donor hearts with H2-Bl plasmid vectors at the time of transplantation may suppress rejection in the heart allografts and prolong the survival time through some presumed mechanisms such as preventing upregulation of CD40 expression, relucing the production of IL-2 and TNF-α, increasing the production of IL-4, and as a result, inducing immune tolerance, as well as improving the function of transplanted heart grafts.

Objective To investigate the effects of Blastocyst MHC gene transfection to coronary on the survival time of mouse heart grafts and the mechanism. Methods Inbred male Balb/c mice and C57BL/6 mice were selected as donors and recipients respectively, to construct mouse cervical heart transplantation models. In the control group, the donor hearts were perfused using the 0～4 ℃ St. ThomasⅡ solution; in the cyclosporine A (CsA) group, the donor hearts were perfused as same as the control's and received intraperitoneal injection of CsA (5 rng·g-1·d-1) after surgery; in the transfection group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid; in the combined treatment group, the donor hearts were perfused using St. Thomas Ⅱ solution with Blastocyst MHC gene plasmid and received intraperitoneal injection of CsA (5 mg·g-1·d-1) after surgery. The survival time of transplanted heart allografts were observed, and their histopathological changes and the degrees of coronary intimal hyperplasia were estimated.Blastocyst MHC gene mRNA expression levels were detected by real-time fluorescence quantitative RT-PCR. Flow cytometry was applied in assessment of the levels of CD4+ CD25+ regulatory T cells (Treg) and CD3+ CD8+ T cells. Results The survival time in the CsA group, transfection group and combined treatment group was significantly longer than in the control group (P＜0.05) and that in the combined treatment group was the longest, up to (20. 50 ± 5. 61) days. On the postoperative day 1 and 3, Blastocyst MHC gene mRNA expression level in the transfection group was significantly higher than that in the control group (P＜0.05). On the postoperative day 7, the degrees of rejection and coronary intimal hyperplasia in the combined treatment group were the lightest. On the postoperative day 7 the number of Tregs in the CsA group and the combined treatment group was significantly increased as compared with that in the control group (P＜0.05), but that of CD3 + CD8+ T cells in the CsA group and the combined treatment group was less than that in the control group (P＜0.05). Conclusion Blastocyst MHC gene transfection in mouse transplanted cardiac allograft can extend its survival time through upregulation of Treg and downregulation of CD3 + CD8 + T cells in the mice. The combination of Blastocyst MHC gene and CsA may exert the synergic effects.

Objective To investigate the protective effects of esmolol on peritoneal macrophages in rats with sepsis.Methods Rat peritoneal macrophages were deprived of serum and divided into four groups,namely normal group,LPS stimulated group,esmolol group and LPS plus esmolol group.Quantitative real-time PCR and Western blot were performed to assay the expressions and protein levels of TNF-α,β1-AR and p65.The activation of NF-κB was determined by electrophoretic mobility shift assay.Results The expression of TNF-α mRNA and protein level was significantly increased in LPS-treated group than those in normal group (P ＜ 0.01),and those in LPS plus esmolol group was significantly lower than those in LPS stimulated group (P ＜ 0.01).The expression of β1-AR mRNA and protein level were significantly higher in LPS-treated group than those in normal group (P ＜ 0.01),The expression of β1-AR mRNA and protein level in the esmolol group was lower than those in normal group (P ＜ 0.01),and those in LPS plus esmolol group was lower than those in LPS stimulated group (P ＜ 0.01).Besides,compared with the normal group,the expression of p65 mRNA in the LPS stimulated group was noticeably higher (P ＜ 0.01).The expression of P65 mRNA in LPS plus esmolol group was significantly lower than that in LPS-treated group (P ＜ 0.01).The NF-κB/DNA binding force in the LPS stimulated group was significantly higher than that in normal group (P ＜0.01).Compared with the LPS stimulated group,the NF-κB/DNA binding force in the LPS plus esmolol group was significantly lower (P ＜ 0.01).Conclusions The expression of TNF-α mRNA induced by LPS was decreased by esmolol in rat peritoneal macrophages which might be achieved via inhibiting NF-κB pathway by the modulation role of β1 adrenergic receptor.