Background and purpose: Brain metastases are common occurrences in patients with non-small cell lung cancer (NSCLC). Gefitinib is a specific inhibitor of epidermal growth factor receptor-associated tyrosine kinase, which has been commonly used in the treatment for advanced NSCLC. The aim of this study was to evaluate the antitumor efficacy of gefitinib in NSCLC patients with brain metastases. Methods: Fifty NSCLC patients with brain metastases were reviewed retrospectively. All of them were treated with gefitinib, given orally at a daily dose of 250 mg. These patients discontinued administration of gefitinib when disease progression, death or intolerable side effects appeared. X~2 test was applied in response analysis. Survival analysis was compared with Kaplan-Meier method and Log-rank test respectively. The multivariate analysis was perfonned with Cox's proportion risk model. Statistical significance was defined as P<0.05. Results: In terms of intracranial lesions, partial response (PR) was observed in 5 patients (10%), stable disease (SD) in 37 patients (74%) and progressive disease (PD) in 8 patients (16%), objective response rate (ORR) and disease control rate (DCR) were 10% and 84%, respectively. As for systemic disease, PR was observed in 5 patients (10%), SD in 30 patients (60%) and PD in 15 patients (30%), overall ORR and DCR were 10% and 70%, respectively. Overall DCR was related to the patients' PS score and the number of brain metastases (P=0.004, P=0.022), but there was no statistical difference in overall DCR among different subtypes of age, gender, smoking history, histology, the onset of brain metastases, chemotherapy, brain radiotherapy and side effects (P>0.05). The median time to disease progression (MTTP) was 7.0 months, which was related to the patients' PS score and smoking history (P=0.000, P=0.045). The median survival time (MST) was 10.8 months, and 1-and 2-year survival rates were 44% and 6% respectively. The univariate analysis showed that the survival time was related to the patients' PS score. smoking history and the number of brain metastases (P=0.011, P=0.028, P=0.044). The multivariate analysis indicated that both the patients' PS score and smoking history were two independent prognostic factors (P=0.005, P=0.006) and the relationship of the survival time and the number of brain metastases was near to statistical significance (P=0.075). Conclusion: The patients with non-smoking history and favorable performance status(PS 0-1) may have better survival benefit and those with single brain metastasis have a trend to survive longer. Gefitinib may be effective on brain metastases in NSCLC patients and appears to be a possible new treatment option.

Acute appendicitis is the most common general surgical problem encountered during pregnancy, which may be associated with serious maternal and /or fetal complications such as appendiceal perforation or premature delivery.Clinical presentation and imaging remains vital in the diagnosis of appendicitis.As a general rule,the clinical suspicion of acute appendicitis during pregnancy is an indication for an urgent surgical intervention.Appendectomy is the preferred treatment.Laparoscopic appendicectomy(LA)can also be performed safely and effectively in pregnant patients without bringing additional maternal complications.

Purpose: To evaluate the efficacy, safety and survival of low molecular weight heparin ( LMWH) plus chemotherapy in patients with advanced non-small cell lung cancer. Methods: 46 patients with NSCLC were randomized into chemotherapy plus LMWH. (study group) and chemotherapy only( control group). Both groups received two cycles of MVP regimen (MMC 6 mg/m2, YDS 3 mg/m2 x 2, DDP 90 mg/m2). Patients in the study group were treated with LMWH 5000u twice daily from the third day before chemtherapy up to 7 days. Results: The response rate was 56. 5% (13/23) for the study group and 39. l%(9/23) for the control group. Median survival time( MST) and 1-year survival rate were 12, 1 months(95%CI:8.52~14.64) and 52.2% for the study group compare 8.4 months(95%CI:6.15 ~ 10. 85) and 34. 8% for the control group. There were significant differences for MST( 12. 1 vs 8. 4) and 1 year survival rate(52. 2% vs 34. 8%) in the study group as compared to the control group. No difference in response rate and toxicities were found between the two groups. Conclusions: Chemotherapy( MVP regimen) plus LMWH is effective and safe. Prolonged survival was observed in patients who received MVP regimen plus LMWH.

BACKGROUND: The most common surgical methods for the treatment of medial interventricular osteoarthritis of the knee are high tibial osteotomy and monocondylar replacement, and systematic evaluation of the difference in efficacy between the two is still lacking. OBJECTIVE: To compare the clinical efficacy of high tibial osteotomy and monocondylar replacement in the treatment of medial interventricular osteoarthritis of the knee. METHODS: PubMed, The Cochrane library, EMBASE, ScienceDirect, CNKI, Wanfang, and VIP were searched by computer. Literature was collected on observational cohort studies or randomized controlled trials comparing high tibial osteotomy/monocondylar replacement in the treatment of medial interventricular osteoarthritis of the knee, with a retrieval period from 2000 to 2019. Two people independently read and screened literature, extracted data and evaluated the quality of the study. RevMan 5.3 software was used for data analysis. RESULTS AND CONCLUSION: (1) A total of 13 studies were included, with 711 patients. (2) Meta-analysis results showed that the knee range of motion of high tibial osteotomy group (MD=-5.47, 95%CI: -9.53 to -1.41, P=0.008) was significantly better than that of monocondylar replacement group. Lysholm knee score (MD=0.84, 95%CI: 0.29 to 1.39, P=0.003) in the monocondylar replacement group at the last follow-up was significantly better than that of the high tibial osteotomy group. (3) There were no significant differences between the two groups in the incidence of postoperative complications, revision rate of total knee replacement, postoperative infection rate, degeneration rate of patellofemoral articular cartilage, degeneration rate of lateral compartment, excellent and good rate, and tibiofemoral angle after surgery (P > 0.05). (4) It is concluded that in the treatment of medial interventricular osteoarthritis of the knee according to the indications of operation, high tibial osteotomy can obtain similar complications, postoperative revision rate of total knee arthroplasty, postoperative infection, degeneration rate of patellofemoral articular cartilage, degeneration rate of the lateral compartment, excellent and good rate, postoperative tibial angle as monocondylar replacement, but the postoperative motion range of high tibial osteotomy is better than that of monocondylar replacement, while monocondylar replacement enables better knee function.

Objective To analyze the treatment and prognosis of lung cancer patients with brain metastases.Methods The clinical data of 352 lung cancer patients with brain metastases were retrospectively reviewed.According to the treatment modalities,patients were divided into palliative therapy group(n=28),simple whole brain radiotherapy(WBRT)or chemotherapy group(n=49)and comprehensive treatment group(n=275).Comprehensive treatment group was subdivided into WBRT plus chemotherapy group(n=192),stereotactic radiosurgery(?knife)plus chemotherapy/WBRT group(n=72,n=16 for?knife plus chemotherapy and n=56 for?knife plus WBRT and chemotherapy)and neurosurgical resection plus chemotherapy/WBRT group(n=11).In comprehensive treatment group,111 patients received chemotherapy≤3 cycles,and the other 164≥4 cycles.Survival curves of each group were drawn respectively,and both survival time and survival rates were compared among groups.Results The median survival time of palliative therapy group,simple WBRT or chemotherapy group,WBRT plus chemotherapy group,?knife plus chemotherapy/WBRT group and neurosurgical resection plus chemotherapy/WBRT group was 1.7,3.2,9.0,11.6 and 17.1 months,respectively.It was revealed by survival analysis that WBRT plus chemotherapy group was better than simple WBRT or chemotherapy group (P=0.0000),?knife plus chemotherapy/WBRT group was better than simple WBRT or chemotherapy group(P=0.0000),and neurosurgical resection plus chemotherapy/WBRT group was better than simple WBRT or chemotherapy group and WBRT plus chemotherapy group(P=0.0001,P=0.0229).There was no significant difference in survival rates between neurosurgical resection plus chemotherapy/WBRT group and?knife plus chemotherapy/WBRT group(P=0.2543),and there was no significant difference in survival rates between those with?knife plus chemotherapy and those with?knife plus WBRT and chemotherapy(P=0.3804).In comprehensive treatment group,the survival rates of those with chemotherapy≥4 cycles was significantly higher than that of those with chemotherapy≤3 cycles(P=0.0000). Conclusion Both WBRT plus chemotherapy and?knife plus chemotherapy and WBRT are effective modalities for the treatment of lung cancer patients with brain metastases,and the latter has the tendency to gain more survival benefit.There is no significant difference in the survival time between patients receiving?knife with WBRT and those without.It is proper for the patients to have no less than 4 cycles of chemotherapy.

Objective:Performance appraisal of large-scale medical equipment has a significant impact on hospital management. Process equipment performance evaluation of digital is an important part of digital medical&hospital. How to fully utilize the large number of advanced medical equipment resources, how to monitor and manage equipment are focuses that hospital administrators pay much attention to. Methods: The effective performance appraisal of large-scale medical equipment can promote the resource allocation optimization, accurate and scientific management, reasonable and benign application, and then allows large-scale medical equipment fully and effectively applied to clinical practice. Results: Collecting basic data is the basis for performance appraisal of large-scale medical equipment; its instant validity, accuracy, and scientific can enhance the operability and the scientific accuracy of the performance appraisal for large-scale medical equipment. Conclusion:The acquisition of basic data has few specialized research in previous studies, the rules set up for basic data acquisition of large-scale medical equipment in this paper can improve the timeless, accuracy and normalization of the basic data using in the performance appraisal of large-scale medical equipment.

Background and purpose:Brain is one of the most common sites for distant metastasis in patients with non-small cell lung cancer,and the prognosis of patients with brain metastasis is usually dismal.The purpose of this retrospective study is to document the relationship between the prognosis of lung cancer patients with brain metastasis and the expressions of p53,nm23 and VEGF in resected lung cancer tissues.Methods:Ninety-two patients who were definitively treated with surgery for non-small cell lung cancer but lately developed brain metastasis between 1997 and 2005 were identified in our institution.Their clinical data were retrieved and retrospectively reviewed.All pathological specimens of their resected lung cancer were examined for the expressions of p53,nm23 and VEGF by immunohistochemical staining.The association between the treatment outcome and the expression of the above mentioned biomarkers were analyzed.Results:The median survival time(MST) of patients with p53(+) versus p53(-) was 11.0 versus 11.9 month,respectively.The 1,2,and 3-year overall survival rates were 45.71%,22.86%,and 18.29% respectively for p53(+) patients,and 49.55%,16.12%,and 8.89% respectively for p53(-) patients(P=0.5179);The MST of patients with nm23(+) versus nm23(-) was 13.0 versus 10.1 month,respectively.The 1,2,and 3-year overall survival rates were 54.20%,21.51%,and 16.45% respectively for nm23(+) patients,and 32.0%,12.0%,and 4.0% respectively for nm23(-) patients(P=0.1075);The MST of patients with VEGF(+) versus VEGF(-) was 10.5 versus 12.2 months,respectively.The 1,2,and 3 year overall survival rates were 42.20%,0,and 0 respectively for VEGF(+) patients,and 50.0%,25.41%,and 16.57% respectively for VEGF(-) patients(P=0.0231).Conclusions:VEGF was a significant adverse prognostic factor for patients with non-small cell lung cancer who developed brain metastasis.Lung cancer patients whose tumor tissue demonstrated positive VEGF expression had reduced overall survival rates at 1,2,and 3 years after surgery.The expression of p53 and nm23 are not significantly associated to the prognosis of this group of patients.

Objective The experiment aims at probing the best condition of the isolation and purification of rat islets. Methods The islets were isolated from rat pancreas by hepatopancreatic duct perfusing with collagenase and purified with Ficoll 400 discontinuous density gradient centrifugation.Then the purified islets were subjected to histological staining,electron microscopy and radioimmunoassay for identification of specificity and viability. Results The histological staining revealed that the viability and the purity of the purified islets were above 95% and 85% respectively.Electron microscopy showed that the purified islets were morphologically intact with clear membrane and plenty of secreting granules.Radioimmunoassay demonstrated the secreted insulin concerntration between low-glucose groups and high-glucose groups varied significantly,which verified the good function of the islets.Conclusion Hepatopancreatic duct perfusing with collagenase is a good method for digestion.There are many factors that influence the quantity and quality of the acquired islets,such as the completed expansion of pancreas,the concentration and viability of collagenase and the digested time,etc.

ObjectiveThe purpose of this study was to evaluate the effect of prostaglandin E1 (PGE1) on blocking the development of acute respiratory distress syndrome (ARDS) induced by acid aspiration. MethodsTwenty new Zealand rabbits were used. Dilute HCl was instilled into right bronchus of the rabbits. The rabbits were then divided randomly into two groups: injury group and treatment group. In injury group ( n = 10) rabbits received no treatment except mechanical ventilation. In treatment group ( n = 10) immediately after acid instillation the rabbits received an intravenous bolus of PGE1 followed by a continuous infusion. Blood gas, airway pressure and dynamic and static compliance were measured before and after acid instillation. Blood samples were taken from artery for determination of 6-k-PGF1α, TXB2, NO2-/NO3- and ET-1. The animals were killed and the wet/dry lung weight (W/D) ratio and total protein of bronchoalveolar lavage fluid(BALF) of right lung were measured. Microscopic examination of the lung was done. ResultsIn treatment group PaO2 was significantly higher than that in injury group after acid instillation. Plasma 6-k-PGF1α and NO2-/NO3- levels were significantly higher in treatment group while plasma TXB2 and ET-1 levels were significantly lower. W/D ratio and TP of BALF of right lung were significantly lower in treatment group. The inflammatory changes were diffuse in injury group while in treatment group they were localized and less severe. Conclusions PGE1 can lessen severity of ARDS induced by acid aspiration. It may protect pulmonary vascular endothelial cells through maintaining the balance between PGI2 and TXA2 and that between NO and ET-1 .

Objective　To study the value of intraoperative cholangiography(IOCG) in cholecystectomy for gallbladder stone. Methods　The IOCG data of 694 cases in the Affiliated Hospital, Yanan University Medical School were retrospectively analysed. Results　Among 694 cases with IOCG, 65 had positve findings. Bile duct stone occurred in 44 patients, residnal stone in cyst duct in 7, bile duct injury in 2, and Mirizzi syndrom in 3. Among the 44 cases with bile duct stone, the age of 4.3% cases was 22～50 years old, 10.3% older than 50 years. The incidence of bile duct stone occurring after 50 years old increased with age. The accurate rate of IOCG was 98% in this series. Conclusions　IOCG can not only find residual stone, but also find bile duct abnormality and bile duct injury in time, if correct imagic technique is applied.