The multi drug resistance(MDR) of tumor cells has become a difficult problem in the chemotherapy of tumor, meanwhile, the mechanism of MDR are various:relevant drugs with reversal effects have been discovered. This review will provide the most impossible mechanisms of MDR and some prospecting reversal drugs.

Female ; Humans ; Male ; Occupational Diseases ; epidemiology ; Proportional Hazards Models ; Time Factors ; Trinitrotoluene ; poisoning

Objective: To study the epidemiological of social anxiety disorder in pupils of Zhanjiang urban districts. Methods:2409 pupils from 5 elementary schools in Zhanjiang city completed the SASC. Those with a total score higher than 2 standard deviation away from the mean were interviewed. SADC was diagnosed according to the standard of CCMD-3.Results:The overall prevalence rate of SADC was 2.74 in Zhanjiang urban districts, prevalence rate for boys was 2.6, while 2.9 for girls. No sex difference was found (?~2=0.11,P=0.744). There was no significant difference among different grades (?~2=5.47,P=0.361).Conclusions:SADC exists in pupils of Zhanjiang city, we should pay more attention to this disorder for children's mental health.

Objective To investigate the concentration of S-100 protein presenting in cerebrospinal fluid (CSF) and blood serum in patients with Guillain-Barr? syndrome (GBS), and discuss the value of assessment in measuring S-100 protein level to Schwann′s cell insult. Methods S-100 beta protein was measured dynamically by ELISA in CSF and blood serum from 50 patients with GBS and 22 referencesThe patients were divided into two categories by disease severity: the severe group and the mild groupMeanwhile, CSF cytology was also detected. Results (1) The level of CSF S-100 beta protein in both severe and mild groups were higher than that of the control group (P0.05)(2) The percentage of CSF monocyte in severe group was higher than that of the mild and the control groups(P0.05)(3) There was a dynamic change of CSF S-100 beta protein level in GBS patients correlated with the percentage of CSF monocyte and the severity of disease. Conclusions CSF and blood serum S-100 beta protein level in patients with GBS may be related to the severity of the disease.

Objective To explore the experience in scalp operation of craniopagus and repairing of scalp and dura defect after separating Methods Analysis the cause and management of the complication after skin expander implantation Discuss the characteristic of repairing skull soft tissue defect by expanded scalp flap and fiber capsule Results Dural and scalp defect could be repaired satisfactory with expanded scalp at one stage Conclusion It's necessary and important for successful separation in D type craniopagus with preoperation care, an elabarate operative management, careful postoperative observation and timely treatment for complication

In order to explore the value of assessment in measuring S-100 beta protein (S-100B protein) and neuron-specific enolase (NSE) present in cerebrospinal fluid (CSF) from patients with brain insult in central nervous system infections, S-100B protein and NSE in CSF were measured dynamically by ELISA in 42 patients with Herpes Simplex Encephalitis (USE), 19 patients with purulent meningitis, 17 patients with cryptococcus meningitis and 22 unrelated control patients. It was found that the levels of CSF S-100B protein in all the three groups were higher than that of the control group (P0. 05). There were dynamic changes of CSF S-100B protein and NSE concentrations in all three groups correlating with the severity of disease. It is suggested that elevated concentrations of S-100B protein and NSE in CSF related to the damage of glia and neurons could be used as CSF markers of brain insult in patients with central nervous system infections.

Objective To evaluate the efficacy and safety of low energy intracardiac cardioversion in persistent atrial fibrillation. Methods Low energy intracardiac cardioversion was performed by delivering R wave synchronized biphasic shocks in 7 patients(4 men, 3 women) with persistent atrial fibrillation. Prior to the procedure, all patients underwent transesophageal echocardiographic examinations to rule out the presence of intracardiac thrombus and received subcutaneous injection of low molecular weight heparin for 3 5 days. Two custom made 6 Fr catheters(Rhythm Technologies of Getz, USA) were used for de fibrillation shock delivery. One catheter was positioned in the lower right atrium so that the majority of the catheter electrodes had firm contact with the right atrial free wall. The second catheter was placed randomly either in coronary sinus through right internal jugular vein or in the left pulmonary artery through femoral vein. In addition, a standard diagnostic 6 F quadropolar catheter was placed at the right ventricular apex for ventricular synchronization and postshock ventricular pacing. Shocks were delivered by Implant Support Device(Model 4510, Teleceronics). After conversion, all patients were treated with intravenous amiodarone in the first 24 hours followed by oral administration. Results In all 7 patients cardioversion of atrial fibrillation to sinus rhythm was successfully obtained. A mean of 2?1 shocks per patient has been delivered with a total amount of 13 shocks. The average delivered energy was 7.8?2.2 Joules. No complication occurred. At a mean follow up of 18?9 months, 4 of the 7 patients treated successfully showed sinus rhythm there after. Atrial fibrillation recurred in 3 patients at the second, fifth day and eighth month after cardioversion. Conclusions Low energy intracardiac cardioversion is effective and safe, and can be easily performed in patients without geneal anesthesia. It offers a new option for restoring sinus rhythm in patients with persistent atrial fibrillation.

Objective To investigate the clinical effect of acellular allogenic dermis combined with split-thickness autogenous skin graft for coverage of wound in extremity joint. Methods After contraction scar, giant pigmented nevus and capillary hemangioma being removed, acellular allogenic dermis with split-thickness autogenous skin graft was used to repair 25 cases of wounds of elbow, ankle, knee and wrist joints. The area of wounds was from 7cm?11cm to 12cm?19cm. Out of 25 wounds, there were 4 in wrist, 8 in elbow, 7 in ankle and 6 in knee joints. The survival rate of graft skin and improvement degree of joint function were observed. Results All grafts survived and had the smooth surface without obvious pigmentation and wound contraction. The function of joint was significantly improved after operation. Conclusion Tissue-engineered dermis with autogenous epithelium is an ideal graft for coverage of various wounds in extremity joint.

Objective To discuss the value of preoperative digital design of struetund bone graft for acetabular wall defects. Methods The . dieom data from spiral CT scans were imported into Mimics 10.0 to build the 3D solid model of the pelvis of an old female patient with left acetabular wall defects. The 3D solid model of the defect area was built by Mirror and 3D mask editing. A simulated bone graft was conducted on the 3D model by segmentation and trimming according to the data measured on the reconstructed model. Results The reconstructed 3D model of the patient's pelvis could be presented in different colors, transparenees, or combinations of interested tissues. The acetabular wall defects could be visualized very clearly at different angles. The geometric data of the bone graft could be measured to ensure the bone graft would fit the defects accurately. Conclusion Preoperative digital design based on 3D com-puterized reconstruction of acetabular wall defects may provide a valuable aid to clinical treatment, because it is a simple, rapid, and accurate method of increasing the fitness of bone graft and the defects,

Objective To evaluate the modified Physical and Operative Severity Score for the Enumera-tion of Mortality and Morbidity (POSSUM) in predicting the postoperative morbidity in patients with fractures of the pelvis and acetabulum. Methods The clinical data of 94 patients with pelvic and acetabular fractures were retrospectively analyzed. Their postoperative prognosis during hospital stay was evaluated with the POSSUM scoring system modified according to the features of orthopedics and pelvic and acetabular fractures. The peritoneum in-fection in the severity index of operation was replaced by operative approach, the several operations at one time by operative duration, and the cancer by the associated injury. The size and type of operation were made into 4 grades with corresponding orthopedic scores. The scores were compared between the complication group and the non-complication group. The receiver operator characteristic (ROC) curve was drawn to describe the coincidence degree, define the cut points, and evaluate its predicting capability. Results The mean preoperative physi-ological score (PS) and operative severity score (OS) in the complication group (38 cases) were significantly higher than those in the noncomptication (56 cases) (17.26 ± 2.84 vs 16.04 ± 2.77; 19.50 ± 5. 14 vs 13.00 ±3.81 ) ( P ＜ 0.05) . In the modified POSSUM, the area under ROC curve was 0. 856, the cut point 43%, sen-sitivity 73.68%, specificity 80. 36%, and coincidence degree 77.66%. Conclusions Since the modified POSSUM scoring system has a high capability of predicting postoperative morbidity for fractures of the pelvis and acetabulum, it can be helpful for surgeons to lower operative risks and ensure safety in operation. When the score is higher than the cut point, the risk is too great for an operation. Therefore, the fracture should be treated non-operatively or mini-invasively until the score is lower than the cut point.