Objective:To investigate the influence of curcumin on the level of nitric oxide in kidney and the renal protective effect in diabetic rats.Methods:Diabetic models were induced by a single intraperitoneal injection of streptozoticin(STZ)into male Wistar rats at a dose of 60mg/kg body weight and was randomly divided into two groups:untreated diabetes group(group DM,n=10) and diabetes group treated with curcumin 200mg?kg -1 ?d -1 (group Cur,n=10).A normal contral group(group N,n=10)was also designed,After treated for eight weeks,the level of NO in kidney,renal structure and function were evaluated.Results:The levels of urinary albumin excretion rate (UAER),albumin-creatinine ratio(Alb/Cr),kidney weight(KW),profile of kidney hypertrophy(KW/BW),mean glomerular area (MGA) and mean glomerular volume(MGV)were all significantly increased in dialetic rats as compared with normal rats (all P

Objective To learn the professional ability of rural doctors in our country ,to provide scientific reference for educa-tional reform of junior-college clinical medicine .Methods A self-made questionnaire was performed in 1 245 rural doctors from 86 rural grassroots health institutions in 7 provinces(municipalities) of our country .Results The rural doctors were familiar with working environment ,coordinated and communicated well with colleagues ,basic competence at work .But their clinical diagnosis-treatment technology and operational capability of medical equipments were not strong .The doctor-patient relationship was not so good .Conclusion Not the proper use of medical equipment and treatment technology of weak seriously affected the quality of serv-ice .Not ideal doctor-patient relationship influenced the service effect .It was suggested that college of clinical medical professional education should enhance the cultivation of students′clinical diagnosis technology ,basic operational skills and communication skills between doctors and patients .

Objective To assess the level of soluble Fas (sFas) and soluble Fas ligand (sFasL) in the sera of patients with systemic lupus erythematosus (SLE),rheumatoid arthritis (RA),multiple sclerosis (MS)and insulin dependent diabetes mellitus (IDDM).Method The level of sFas and sFasL was determined by a sandwich enzyme linked immunosorbent assay.Anti ssDNA (single stranded DNA) was detected by indirect enzyme linked immunosorbent assay.Results The level of sFas in patients with SLE,RA,IDDM and MS was significantly higher than that in healthy individuals.It was interesting that among these autoimmune diseases,the level of sFas in the sera of patients with SLE was dramatically higher than that of the other diseases.The high level of sFasL accompanied by sFas was found in the sera of SLE and RA patients.In the sera of patients with SLE,the anti ssDNA antibody always accompanied by high concentration of sFas and,by contrast,no anti ssDNA antibody was found in all the patients in whose sera no sFas was found.In patients with IDDM,the sFasL level of the serum was significantly lower than that of the serum of healthy donors.Conclusion Serum sFas level of patients with SLE,RA,MS and IDDM is higher than that of healthy individuals.These results indicate that the sFas level can be used as a marker of disease progress and relaxing after treatment with the medicine.It is also demonstrated that there is relationship between the level of anti ssDNA antibody and sFas.The level and significance of serum sFas and sFasL in these autoimmune disease patients are under investigation.

Objective To understand the work tasks of rural doctors in our country and to provide bases for the reforms of clini‐cal medical education of junior colleges .Methods A self‐made questionnaire was performed in 1 245 rural doctors from 86 rural grassroots health institutions in 7 provinces/municipalies of our country .Results The academic levels of rural doctors were low (65 .54% )and the rates of their medical certification holding were low in western district(7 .79% ) .The work load including basic medical care and basic public health services they committed were approximately matching .The top 5 items of basic medical care were ,in proper sequence ,diagnoses and treatments of common diseases ,common symptoms ,chronic disease management ,communi‐ty rehabilitation ,community first aid .The top 5 items of basic public health services were establishment of residents′health files , maternal and child health ,health care of the aged ,immunization ,health education .Conclusion The technological levels of diagnosis and treatment and theoretical knowledge of rural doctors should be further improved .The clinical medical education of junior medi‐cal colleges must strengthen the training and cultivation of the students′abilities of basic public health services ,besides consolida‐ting the training of the abilities of practical diagnosis and treatment .

Objective To study the effect of recombinant human endostatin (rhES)on the radiosensitivity of esophageal squamous cells KYSE-150 and its preliminary mechanism.Methods Cells were divided into four groups:control group without treatment,rhES group treated with recombinant human endostatin,radiation alone group exposed with X-rays,and combination group exposed with X-rays plus endostatin.Colony formation assay was used to measure cell survival fraction.A single-hit multi-target model was used to fit cell survival curve and calculate the sensitive enhancement ratio (SER).Influence of rhES combined with X-ray radiation on cell cycle and apoptosis was measured by flow cytometry.Expressions of Cyclin B1,Cyclin D1,Bcl-2 and Bax mRNAs were determined by RT-PCR.Protein expressions of HIF-1α,VEGF,and VEGFR were determined by Western blot.Results D0,Dq and SF2 value of KYSE-150 cells decreased along with the concentration of rhES.At D0dose,the SER for 100 and 200 μg/ml rhES was 1.14 and 1.27,respectively.Compared with the radiation alone group,the apoptosis rate and bax expression increased,while the expressions of VEGF and HIF-1α decreased in the combination group (t =7.97,3.02,117.55,7.22,P ＜ 0.05).Conclusions rhES has radiosensitive effect on esophageal carcinoma cells KYSE-150 in vitro by inhibiting the expressions of HIF-1α and VEGF,regulating bax expression,and inducing apoptosis.

Objective To prospectively study the dynamic variation of vascular endothelial growth factor (VEGF),the short-term efficiency and the tolerability of the esophageal cancer patients treated by radiotherapy combined with thalidomide.Methods The serum samples of 86 esophageal cancer patients were collected before,during and after the radiotherapy.The VEGF levels were assayed by enzyme-linked immunosorbent assay (ELISA).3 patients interrupted the treatment because of intolerance radiotherapy.Based on the changes of VEGF level,32 esophageal cancer cases whose VEGF levels increased or remained were assigned to the group to which thalidomide was given during the whole course of radiotherapy.The rest 51 patients whose VEGF level decreased received radiotherapy without thalidomide during the whole course.In addition,30 healthy cases were included in control group.Then the efficiency and safety of the introduction of thalidomide in radiotherapy were investigated. Results The VEGF levels of 86 esophageal cancer cases were significantly higher than the 30 healthy control cases ( t =5.07,P ＜ 0.01 ),which were also correlated with the primary tumor size ( t =4.55,P ＜ 0.01 ),lymph node metastasis ( t =7.50,P ＜0.01 ),histological type( F =3.40,P ＜ 0.01 ) and clinical stage ( t =2.52,P ＜ 0.0 l ).However,it was irrelevant to the lesion site,distant metastasis,X-ray pathologic type,gender or age ( P ＞ 0.05).For the thalidomide involved group, the VEGF level after radiotherapy was significantly lower than during radiotherapy (t =2.37,P ＜0.05 ) with an effective rate of 71.88％.For the rest 51 cases without using thalidomide,the effective rate was 78.43％ yet there was no significant difference between the VEGF levels during and after radiotherapy ( t =0.18,P ＞ 0.05 ).62.50％ patients reported symptoms of dizzy and burnout after using thalidomide,while this incidence was 15.69％ for the rest patients (x2 =19.28,P =0.000).For the groups with or without thalidomide combination,the sleepiness incidences were 18.75％and 1.96％,respectively (x2 =5.168,P =0.023 ); the Ⅲ - Ⅳ grade esophagitis incidences were 12.50％ and 11.76％,respectively (x2 =0.061,P =0.806) ; the Ⅱ - Ⅳ grade leukocyte decrease incidences were 6.25％ and 9.80％,respectively (x2 =0.026,P =0.872) ; the Ⅲ - Ⅳ grade platelet descend incidences were 3.13％ and 5.88％,respectively (x2 =0.002,P =0.965 ) ; the Ⅲ - Ⅳ grade nausea and vomiting incidences were 9.38％ and 27.45％,respectively (x2 =2.913,P =0.088 ). No anaphylaxis was observed. Conclusions Thalidomide can decrease the VEGF expression level of esophageal cancer patients.Patients treated with thalidomide show good tolerance and compliance.

Objective To investigate the changes and clinical value of serum vascular endothelial growth factor (VEGF) level before,during and after radiotherapy in patients with esophageal carcinoma.Methods The sera of 67 esophageal carcinoma patients and 30 healthy control cases were collected.The VEGF level in serum samples were measured with enzyme-linked immunosorbent assay (ELISA) method.The relations among VEGF level changes,clinical stages and radiotherapy effect were analyzed.Results The VEGF levels of patients with esophagus cancer before,during and after radiotherapy were significantly higher than those in control group ( F =11.65,P ＜ 0.01 ).The VEGF level after radiotherapy was significant lower than that before radiotherapy ( F =10.72,P ＜ 0.01 ).The average VEGF level of patients with T3 and T4 was significantly higher than that of control group ( F =14.10,P ＜ 0.01 ).The average VEGF level of patients with N1 and N2 was significantly higher than that of control group( F =8.64,P ＜0.01).In 62 patients,the serum VEGF level increased in 21 cases but decreased in 41 cases after radiotherapy.With difference in radiotherapy efficiency of 61.90％ and 90.24％,respectively(x2 =6.08,P＜ 0.05).The average VEGF level during and after radiotherapy for 50 cases of CR + PR were significantly lower than that before radiotherapy( F =7.98,P ＜ 0.01 ).Conclusions Monitoring the serum VEGF level of patients with esophagus cancer can help evaluate the radiosensitivity,which has a significance in predicting the prognosis of radiotherapy.

Objective To observe the clinical efficacy of ulinastatin(UT) conjoined to high flow continuous blood purification( CBP) in the critical patients with multiple organ dysfunction syndrome(MODS). To evaluate the therapeutic potential of UT and CBP in systemic inflammatory response syndrome (SIRS) , severe sepsis( SS) , acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Method A total of 122 cases of emergency and critical patients with a score of more than 15 counted up from APACHE H (acute physiology and chronic health evaluation 11 ) were randomly divided into Ulinastatin treatment group (UT group, n = 35) .continuous blood pu-rification(CBP group, n = 31),UT plus CBP (combine group, n = 30) and routine treatment group (control group, n =26). Routine treatment was given to patients of all groups, and patients of UT group had Ulinastatin 0.4 MIU given intravenously every 8 hours for 7 days in addition. Patients of CBP group were managed with continuous blood purification round the clock for 7 days and those of combine group were treated with UT plus CBP for 7 days.The efficacy of the treatment in four groups was assessed,and serum high sensivity reactive protein(hs-CRP) and IL-6 levels were measured on admission and comparison was made between values of biomarkers taken before and 1 d,3 d,and 7 d after treatment in four groups. The changes in WBCs,arterial gas analysis and the oxygena-tion index PaO2/FiO2 were checked, and at the same time, the APACHE II values and the incidence of MODS were compared within four groups. Results (1)One, three and seven days after treatment the plasma hs-CRP and IL-6 levels in UT and CBP groups were reduced significantly more than those in control group ( P < 0. 05), and in combine groups those were more dramatically lowered ( P < 0.05, P < 0.01). Before treatment there was no significance diffience in those values between groups, and there was on diffience in those values between 3 rd day and 7 th day after treatment ( P > 0.05). (2) The 1 st,3 rd and 7 th day after treatment the arterial gas PaO2/FiO2 index in UT and CBP groups was improved more than that in control group ( P < 0.05) , and it in combine group was most significant improved (P < 0.05,P < 0.01). The ALT and creatinine were lower than those in control group ( P < 0.05), and there were no significant differences in ALT and creatinine between groups before treatment (P > 0.05). (3) The 1 st,3 rd and 7th day afer treatment,the APACHE II values in UT and CBP groups were decreased more than those in control group ( P < 0. 05) , and therefore, the incidence of MODS was lower ( P < 0.05). Conclusions Ulinastatin could significantly inhibit the production of inflammatory cytokines and CBP could effectively eliminate inflammatory factors from blood, and the combination of these two approaches produce a more effective therapeutic potential for preventing MODS development.

Objective To optimize the registration template of kilovohage cone-beam CT (CBCT) guided radiotherapy in whole breast irradiation(WBI)after lumpectomy of breast cancer.Methods From April 2006 to July 2009,twelve patients undergoing WBI with intensity-modulated radiotherapy (IMRT)were recruited in this study.All patients were performed with both conventional planning CT and CBCT integrated on Varian 23 EX.Six distinguishable referenee points(the diameter 1 mm)around the lumpectomy cavity and the surrounding gland on the planning CT image were marked.The images were manually registered offline based on the breast surface,surgical clips,breast gland,contiguous rib,ipsilaterai lung and its external contours,respectively.The same six reference points were then marked on the CBCT image.The performance of the five registration templates was compared using the concept of registration error,while the registration time was taken into account.The registration error was calculated based on the six reference points'translations between the planning CT image and CBCT image,and analyzed with SPSS 13.0 software using one-way ANOVA.Results The values of the registration error for the breast surface,surgical clips,breast gland, contiguous rib,ipsilateral lung and its external contours were(0.60±0.20),(0.43±0.15),(0.49±0.19),(0.69±0.36)and(0.94±0.49)cm,respectively,and the registration time were(3.8±1.1),(3.0±0.9),(4.7±1.7),(4.3±1.3)and(4.5±1.3)min,respectively.There was no statistical difforence between the breast surface,surgical clips and breast gland registration template(t=0.48-1.36,P>0.05),the same result trend to contiguous rib compared with ipsilateral lung(t=2.00,P=0.055),however,there was significant difference between surgical clips and the last two registration methods(t=2.08-4.08,P<0.05).Conclusion In this initial study with a modest number of patients,surgical clips show a best registration template from the standpoint of accuracy and efficiency,whereas contiguous rib and ipsilateral lung are not an ideal method.

Objective To evaluate the treatment outcomes and toxicities of intensity-modulated radiation therapy (IMRT) combined with chemotherapy for children and adolescents with nasopharyngeal carcinoma.Methods Forty-three nasopharyngeal carcinoma patients less than 19 years old were recruited between April 2010 and April 2016.All patients were treated with IMRT (total dose 61.2-76 Gy) combined with cisplatin based chemotherapy.The Kaplan-Meier test was used to calculate overall survival (OS) and progression-free survival (PFS).The patient's clinical characteristics,side effects and longterm effects of treatment were retrospectively analyzed.Results Among 43 patients,there were 29 (67.4％) male and 14 (32.6％) female,and the median age was 14 years old (range,6-18 years).According to AJCC 7thstaging system,2 patients were in stage Ⅱ,26 in stage Ⅲ,7 in stage ⅣA and 8 in stage Ⅳ B.All patients were confirmed as non-keratinizing carcinoma.The positive rates of EB virus VCAIgA was 53.8％ (7/13),and Rta-IgG was 60.0％ (6/10) before treatment.The median radiation dose was 70 Gy (range,61.2-76 Gy) to the primary tumor.Thirty-three (76.7％) patients received neoadjuvant chemotherapy,with 20 (46.5％) and 36 (83.7％) patients treated by concurrent and adjuvant chemotherapy,respectively.With a median follow-up of 24 months (range,3-76 months),the 5-year OS and PFS ratios were 75.3％ and 64.7％,respectively.There were 5 patients (11.6％) occurred to bone metastasis within 2 years after treatment.Hypothyroidism was reported in 47.4％ (9/19) patients after IMRT.Conclusions Nasopharyngeal carcinoma in childhood and adolescence is mostly locally advanced diseases with poor differentiation.IMRT combined with chemotherapy produce a well treatment outcome with good tolerance in children and adolescents patients.The most common treatment failure bone metastasis.Radiation-induced hypothyroidism is common.