AIM: To study the relationship between nitric oxide (NO) and gastric mucosal injury induced by reserpine in rats. METHODS: Sixteen healthy male Wistar rats were randomly divided into control group and experimental group (n=8). NO contents and malondialdehyde(MDA) contents in plasma, gastric mucosa of the rats were respectively determined with Cadmium-reduct plus Greiss and TBA; nitric oxide synthase in gastric walls of the rats were observed using NADPH-diaphorase histochemistry and quantitatively measured with image analyzer.RESULTS: The NO contents in both plasma and gastric mucosa of experimental group were significantly lower than that in control group (P

Objective To observe the clinical efficacy and adverse reactions between pemetrexed plus cisplatin and paclitaxel plus cisplatin in the treatment of advanced non-small cell lung cancer (NSCLC).Methods Forty-two cases with non-small cell lung cancer in our hospital from June 2013 to June 2015 were selected.Patients were randomly divided into observation group and control group with 21 cases in each group.The observation group was treated with pemetrexed plus cisplatin and the control group was treated with paclitaxel plus cisplatin.The clinical efficacy and adverse reactions were observed after two courses (21 days of a course) and the statistical analysis was performed.Results In the observation group and control group,response rate and clinical benefit rate were33.33％ (7/21),28.57％ (6/21) and76.19％ (16/21),71.43％ (15/21) respectively.No statistical significance were seen between the two groups (P＞0.05).The rate of hair loss (23.81％) (5/21) and the total number of adverse reactions (18.37％) (27/147) in the observation group were significantly lower than the rate of hair loss (47.62％) (10/21) and the total number of adverse reactions (25.17％) (37/147) in the control group (P＜0.05) No statistical significance was found in the incidence rate of leukopenia,neutropenia,erythropenia,thrombocytopenia,nausea and vomiting and phlebitis between the two groups (P ＞0.05) Conclusion Pemetrexed plus cisplatin is as effective as paclitaxel plus cisplatin in the treatment of advanced NSCLC with less adverse reactions and is much safer than paclitaxel plus cisplatin.Pemetrexed plus cisplatin is more valuable in the clinical treatment of advanced NSCLC.

Objective To compare the efficacy of different analgesia regimens in elderly patients with femoral neck fracture undergoing posture changing during epidural anesthesia. Methods Ninety patients (35 males,55 females,aged 65-90 years,48-78 kg)with femoral neck fracture who would be treated with artificial femoral head replacement were randomly divided into 3 groups (n = 30 each):femoral nerve block group (group FNB),fascia iliaca compartment block group (group FIC)and intravenous group (group IV).Femoral nerve block or fascia iliaca compart-ment block was performed 30 min before epidural anesthesia (EA)in FNB group or FIC group re-spectively.Fentanyl 0.5 μg/kg was injected intravenously 3 min before EA.In the three groups,addi-tional 0.25 μg/kg fentanyl was administrated intravenously to keep the VAS scores <4 before posi-tioning.EA was performed between L1-2 in a position of troubled leg upper,and patients returned to supine position after epidural catheterization.The VAS scores at T0 (after entering the operation room),T1 (in supine posture before EA),T2 (before posture changing),T3 (while supine from lateral posture after EA),T4 (3 min after T3 ),the time for achieving EA,the fentanyl consumption, the cases of cardiovascular events and hypoxemia was recorded.Results Compared with group IV, VAS scores at T1 ,T2 ,the fentanyl consumption,time for achieving EA,and incidence of cardiovas-cular events and hypoxemia in group FNB and group FIC decreased significantly (P <0.05 or 0.01). There was no significant difference between group FNB and group FIC.Conclusion Preemptive anal-gesia regimens through both femoral nerve block and fascia iliaca compartment block during epidural anesthesia can reduce the fentanyl consumption,as well as decrease the incidence of cardiovascular e-vents and hypoxemia.

AIM: To observe the effects of Egr-1 gene knockout on the expression of inflammatory-related factors in pancreatic tissue in a mouse acute pancreatitis model.METHODS: The experimental pancreatitis was induced by high-dose of cearulein in wildtype mice and Egr-1 knockout mice.The pancreatitis indexes,such as serum amylase,pancreata edema,and myeloperoxidase(MPO) levels in pancreata and lungs were recorded.The mRNA levels of tissue factor(TF),plasminogen activator inhibitor(PAI-1),monocyte chemoattractant protein(MCP-1),Gro-1,IL-6 and ICAM-1 were measured by quantitative PCR.RESULTS: Contrary to wildtype mice,typical pancreatitis was not induced by high-dose cearulein in the Egr-1 knockout mice,not only markedly reduced edema in pancreata and lungs,but decreased MPO levels in lungs as well were found.Furthermore,the mRNA of TF,PAI,MCAP,ICAM-1 and IL-6 in pancreata were significantly decreased in Egr-1 knockout mice.CONCLUSION: The severity of pancreatitis and lung damage is ameliorated in Egr-1 knockout mice stimulated by high-dosage of cearulein,which was probably mediated by decreasing expression of inflammatory-related factors in pancreata,such as TF,PAI,MCP-1,ICAM-1 and IL-6.

Objective To investigate the diagnosis and differential diagnosis value of multisequences magnetic resonance imaging (MRI) in autoimmune pancreatitis (AIP).Methods The MRI data of twelve AIP patients were retrospectively analyzed.The sequences of MRI included T1 weighted imaging,T2-weighted imaging,magnetic resonance cholangiopancreatography (MRCP),diffusionweighted imaging (DWI) and dynamic enhancement images.The location and involving extent of lesions,signal,patterns of dynamic enhancement,changes of pancreatic and biliary duct,pseudo-capsule sign and other accompanying signs were observed.Twelve pancreatic cancer patients and twelve other patients with normal pancreas were set as controls.The imaging signs of AIP group and pancreatic cancer group were compared with Fisher's exact test.On the sequence of DWI,the apparent diffusion coefficient (ADC) values of pancreatic interested region of the three groups were tested and compared with least significant difference t test.At each period of enhanced MRI,the intensity ratios of pancreatic interested region to the left paraspinal muscle at the same level of the three groups were measured and compared with Pillai's Trace test.Results Among 12 patients with AIP,seven were diffused lesion,four were localized lesion,and one was multiple lesions.Among 12 pancreatic cancer patients,one was diffused lesion,and eleven were localized lesion.The difference of these two groups was statisfically significant (Fisher's exact test,P＜0.01).Among 12 AIP patients,on the T1-weighted image,intensity decreased in nine lesions,two cases without obvious intensity decreasing,and one case unevenly increased.On the T2 weighted image,intensity slightly increased in nine lesions,equal in one case,and slightly lowered in two cases.The ADC value of the lesions of AIP group ((1.011 ± 0.118) × 10 3 s/mm2) was lower than that of normal pancreas group ((1.489 ± 0.072) × 10 3 s/mm2) and pancreatic cancer group ((1.274 ± 0.120) × 10 3 s/mm2),and the differences were statistically significant (t=-11.793,-4.300; both P＜0.01).Among 12 AIP patients,the pancreatic duct of the lesions was irregular segmental sclerosis and stenosis in four patients.Pseudo-capsule sign around the lesions of pancreas was seen in seven patients.Among 12 pancreatic cancer patients,the pancreatic duct of the lesions was stenotic in two patients while the pseudo-capsule sign wasn't found.The differences of these two groups were statistically significant (Fisher's exact test,both P＜0.01).Dynamic enhanced MRI showed that enhancement patterns of the lesions of both AIP and pancreatic cancer presented progressive enhancement.However,during the balanced period,the signal intensity ratio of AIP group (3.34±1.40) was significantly higher than that of pancreatic cancer group (2.38 ± 0.18),and the difference was statistically significant (F =60.703,P ＜ 0.01).Conclusion Combination of a variety of sequences of MRI can help to fully reflect the pathological and biological characteristics of AIP and increase the accuracy of diagnosis.

BACKGROUND: Naloxone has a significant arousal effect on many types of comas. It is usually believed that this is because its inhibition on endogenous opioid peptides. But depth of coma is not necessarily positively correlated to endorphin (EP).OBJECTIVE: Based on existing findings on direct stimulating effect of naloxone on cerebral cortex, further studies need to be done to explore whether it is dose-dependent or not.DESIGN: Single-factor design based on cells.SETTING: Neurology department in a university hospital and the neurology department in a hospital of a military medical university of Chinese PLA.MATERIALS: This study was completed in the Laboratory Center of Tongji Medical College, Huazhong University of Science and Technology. Thirty healthy new born Wistar rats, regardless of their gender, aging 8 - 12 days and weighing 150 -250 g, were selected.METHODS: The experiment was performed at room temperature. The perfusion slot were placed on the microscope stage, and cells with smooth surfaces, triangle or pyramidal shapes, strong refraction and more than one neurites were selected for patch clamp experiment. Patch clamp whole-cell recording technique was used to measure the pyramidal cells of the frontal lobe immediately after separated from the Wistar rats, and to investigate the fluctuations of their membrane potential of cerebral cortex neurons and the frequencies of their spontaneous electric activities after administration of naloxone at different doses.MAIN OUTCOME MEASURES: The neural excitatory reaction rate, depolarization amplitude and increasing rate of spontaneous electric activities after administration of different doses of naloxone were selected as main outcome measurements.RESULTS: The excitatory reaction rates of cerebral cortex neurons immediately after separation to doses of naloxone(100, 50, 10, 1, 0. 1 μmol/L)were 83%, 67%, 86%, 71% and 33%; while the depolarization amplitude of them were 9. 8, 9.6, 8.4, 5.2 and 1. 3 mV respectively; and the corresponding spontaneous electric activity were increased by 587% , 375% ,291%, 125% and 69%.CONCLUSION: Naloxone can induce excitatory reactions in cerebral cortex neurons directly, and the reactions have proved to be dose-dependent.

Objective To investigate the consensus and controversies on delineation of radiotherapy target volume for patients with non-small cell lung cancer(NSCLC). Methods Study questionnaires were designed by radiation oncologists in Peking University School of Oncology. The forms were sent through email to radiation oncologists in 10 radiation departments in China and 2 departments in US in November,2007. The brief introduction and PET/CT digital data of one patient with NSCLC were sent to radiation oncologists in 10 departments in Beijing. On Jan. 12,2008,the case discussion was held by more than 300 radiation oncologists from Beijing,Tianjin, Hebei, Liaoning Province and Inner Mongolia Autonomous Region. Results All receivers of the questionnaire responded . The set up error was 5-7 mm . For patients with locally advanced NSCLC treated with radiotherapy concurrently with near full dose chemotherapy,ll out ot 12 responding departments defined planning target volume(PTV) of primary tumor as gross tumor volume(GTV) plus 6-8 nun plus set-up error and respiratory movements ,and only one defined PTV as GTV plus set-up error and respiratory movements. For PTV of the mediastinal lymph nodes in the same patient,9 out of 12 responding departments defined PTV as GTV plus 6-8 mm plus set-up error and respiratory movements,and 3( of China) out of 12 defined PTV as GTV plus set-up error and respiratory movements. Stereotactic body .radiotherapy with high fraction dose was used in 11 out of 12 responding departments with fraction dose varying from 6 to 20 Gy,including 6 of which defined PTV of primary tumor as GTV plus 6-8 mm plus respiratory movements and set-up error, and 5 defined PTV of early stage lung cancer as GTV plus respiratory movements and set-up error. The consensus on delineation of primary tumor of the case discussion was that the appropriate window width and window level were 1600 Houasfield Units(HU) and -600 HU for lung window,and 400 HU and 20 HU for mediastinal window. The controversies was focused on whether the CTV for metastatic lymph nodes should be restricted as GTV plus 6-8 mm or enlarged to enclose all the involved lymph node region. Conclusions PIT of primary tumor and mediastinal metastatic lymph nodes should be GTV plus 6-8 mm plus respiratory movements plus set-up error. The basic controversies of target delineation are focused on the fraction dose and PIT range for early stage NSCLC, and on the possibility of defining the PIT as GTV plus respiratory movements and set-up error when treated with concurrent radiotherapy and full dose chemotherapy for locally advanced NSCLC.

Objective To explore the clinical effects of sequential flap of thigh perforator for closure of the anterolateral thigh free flap donor site.Methods From March,2014 to May,2015,8 consecutive patients underwent elective anterolateral thigh free flap reconstruction for limb soft tissue defect.To design a sequential flap of thigh perforator to achieve primary closure of the anterolateral thigh free flap donor site.The area of anterolateral thigh free flap ranged from 9.0 cm×6.0 cm to 20.0 cm×1 1.0 cm,respectively.The area of thigh perforator flap ranged from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm.Results All flaps healed uneventfully.Distal skin flap necrosis appeared in 1 flap which was healed after local transposition flap.All the patients were followed up for 1 to 6 months,with mean time of 4 months.The color,texture and appearance of flaps were satisfactory.Conclusion Sequential flap of thigh perforator,with reliable blood supply and constant position,represents an ideal model to close the anterolateral thigh free flap donor site of small defect.

Objective To retrospectively analyze the safety of anti-radiation injury drug of Andorin using real-world big data.Methods A total of 87 053 hospitalized cancer patients receiving radiotherapy from 2015 to 2017 were analyzed.Ten medical institutions with the largest number of patients treated with Andorin capsules were screened.Patients with 5 types of cancer including lung cancer,cervical cancer,nasopharyngeal carcinoma,breast cancer and colorectal cancer with/without use of Andorin capsule were subject to propensity score matching (PSM).The safety of Andorin capsule as an adjuvant drug in the radiotherapy for cancer patients was evaluated by the results of blood biochemical detection and liver and kidney function test.Results In the relevant indexes of liver function,the AST and TBIL levels in the lung cancer patients with use of Andorin capsule were significantly lower than those in their counterparts without use of Andorin capsule (22.1 U/L vs.24.7 U/L,P =0.04 and 9.8 mmol/L vs.11.4 μmol/L,P =0.01),but all the results were within the normal range.In patients with cervical cancer,the ALT level in patients treated with Andorin capsule was considerably higher than that in those without use of Andorin capsule (24.7 U/L vs.21.1 U/L,P=0.01) and both the results were within the normal range.In terms of the renal function-related indexes,CRE and UREA were similar between patients with and without use of Andorin capsule in 5 types of tumors (P=0.09-0.86).In patients with cervical and colorectal cancer,the LDH in patients with Andorin capsule was significantly lower compared with that in those without use of Andorin capsule (P=0.04,0.00),but both the resuhs were within the normal range.Regarding the nutrition-related indexes,the TB level in breast cancer patients with use of Andorin capsule was significantly higher than that in those without use of Andorin capsule (69.4 g/L vs.67.1 g/L,P=0.030),but both the results were within the normal range.Conclusion As the first anti-radiation traditional Chinese medicine in China,Andorin capsule is utilized as an adjuvant drug for radiotherapy,which yields no significant liver and kidney toxicity and possesses high safety.

Objective To evaluate the effect of electroacupuncture (EA) preconditioning on inositol-requiring kinase 1 (IRE1)-X-box binding protein 1 (XBP1) signaling pathway in endoplasmic reticulum in the cortex in a rat model of cerebral ischemia-reperfusion (I/R).Methods One hundred and eight pathogen-free healthy male Sprague-Dawley rats,aged 8-12 weeks,weighing 200-250 g,were assigned into 3 groups (n =36 each) using a random number table:sham operation group (group S),group I/R and EA preconditioning group (group EA).Focal cerebral I/R was induced by occlusion of right middle cerebral arteries for 2 h followed by reperfusion in rats anesthetized with chloral hydrate.In group EA,Baihui acupoints were stimulated with an electric stimulator for 30 min once a day for 5 consecutive days starting from 5 days before ischemia,and the model was established at 24 h after the last preconditioning.Rats were sacrificed after neurological deficit was scored at 6,12 and 24 h of reperfusion,brains were removed,and the ischemic area in cerebral cortex was isolated for examination of the cell ultrastructure (with an electronic microscope) and for determination of the expression of IRE1 and XBP1 (by Western blot).Results Compared with group S,the neurological deficit scores were significantly increased,and the expression of IRE1 and XBP1 in the ischemic area was up-regulated at each time point in I/R and EA groups (P＜0.01).Compared with group I/R,the neurological deficit scores were significantly decreased,and the expression of IRE1 and XBP1 was up-regulated at each time point in group EA (P＜0.05).The cell damage in the ischemic area in cerebral cortex was significantly attenuated in group EA when compared with group I/R.Conclusion The mechanism by which EA preconditioning attenuates cerebral I/R injury is related to activating IRE1-XBP 1 signaling pathway and relieving endoplasmic reticulum stress in rats.