Objective To observe the curative effect of paracetamol and indomethacin suppository in cancer- ous febrile. Methods 108 patients of lung cancer with fever were divided into.two groups,the treatment group of 54 cases and the control group of 54 cases, administered with paracetamol and indomethacin suppository respectively. Results After the two groups took medicine, the difference in defervesceing was significant, with statistics signifi- cance( P < 0.05). Conclusion Indomethacin suppository shows better function of defervesceing than paracetamol.

AIM The effects of GW501516, a peroxisome proliferator-activated receptor β (PPARβ) agonist, in long term diet induced obesity (DIO, high fat and maltose diet for 4 months) mice were evaluated, and the efficacy of GW501516 against insulin resistance and the involved mechanism was investigated. METHODSMice were divided into 3 groups: normal control, DIO model and DIO model+GW501516. GW501516 (10 mg·kg-1·d-1) was administered by ig once a day for 14 d. During the treatment, body weight and food intake were monitored every other day. The oral glucose tolerance test, and the serum biochemical parameters including the serum triglyceride, total cholesterol and high density lipoprotein cholesterol (HDL-C) levels were measured according to the specifications. To confirm the GW501516-mediated PPARβ activation, the mRNA levels of downstream genes related to glucose, lipid metabolism and energy expenditure was measured. RESULTS GW501516 treatment effectively improved the glucose intolerance, increased the area under the glucose curves[DIO model, (32.4±4.6) mmol·h·L-1 compared with DIO model+GW501516, (23.4±2.5) mmol·h·L-1, n=7-8, P<0.05], normalized the fasted blood glucose, and increased serum HDL-C level, besides, histological analysis revealed the decreased hepatic lipid accumulation and hypertrophy of hepatocyte in DIO mice. Moreover, RT-PCR results indicated that carnitine palmitoyltransferase 1b, uncoupling protein 2, uncoupling protein 3 and glucose transport protein 4 were all upregulated. CONCLUSIONGW501516 significantly ameliorates glucose intolerance, decreases fasted blood glucose and hepatic steatosis, which might be related to ① the enhancement of fatty acid oxidation and energy uncoupling in muscle, and ②the improvement of insulin-stimulated glucose transportation in skeletal muscle in the long term DIO mice.

Objective To study genotypes,antibiotic resistance and epidemiology of extendedspectrum β-lactamases (ESBL)-producing Shigella isolated in Tianjin,and to discuss the relationship between ESBL-producing Shigella and drug-resistance plasmid.Methods A total of 136 Shigella spp.were isolated from stool specimens of patients with diarrhea who presented mainly with bloody purulent stool from Tianjin Children's Hospital,Tianjin Medical University No.2 Hospital and Tianjin No.1 Central Hospital between May 2009 and September 2010.Suspicious ESBL-producing isolates were screened by K-B disc diffusion method. The conjugation experiment was performed in the confirmed ESBL-producing strains and antibiotic resistance was compared between clinical strains and transconjugants to confirm the plasmid-mediated resistance. The genotypes of these isolates were detected by polymerase chain reaction (PCR) using universal primers for TEM,SHV,CTX-M-1 group,CTX-M-2 group,CTX-M-9 group,respectively.Intergenic consensus PCR (ERIC-PCR) was employed to understand the molecular homology of the ESBL-producing isolates. The data were analyzed by x2 test.ResultsESBL were identified in 14.7％ (20/136) of Shigella isolates,but no AmpC enzyme were detected.Among all the Shigella isolates,16 strains were genotype CTX-M-14,4 were genotype CTX-M-15.The strains with CTX-M ESBL were resistant to multiple antibiotics,while 100％ sensitive to imipenem.The transconjugant test of 18 ESBL-producing isolates were positive,and these conjugations were only resistant to β-lactamases. Conclusions CTX-M type is the common genotype of ESBL-producing Shigella isolates in Tianjin. ESBL-producing is the main cause of multiple resistance to β-lactams.The transmission of CTX-M producing strains is mainly mediated by plasmids.

Objective To study whether post-operative radiotherapy is necessary for patients with early breast cancer after radical mastectomy. Methods In 1998, 270 early breast cancer patients with 0 -3 pathologically confirmed positive axillary lymph nodes after radical mastectomy were retrospectively ana-lyzed. There were 156 patients with negative lymph node and 114 with 1 -3 positive lymph nodes. The prog-nostic index (PI) was defined as the sum of scores of the tumor size, number of positive axillary lymph nodes, receptor status, surgical margin status, lymphatic thrombi status, pathological grading and age. The PI≥ 4 was considered as high-risk, and PI <4 as the low-risk. Numerical variables were compared using t test and categorical variables were compared using chi-square test. Kaplan-Meier method was used to calcu-late the survival rates, and the Log-rank test was used for the comparison of the survival curves between dif-ferent groups. Results Of the patients with lymph node negative and 1 - 3 positive, the survival rates were 75.0% and 63.2% (χ~2 = 4.40 ,P =0.036), respectively. The corresponding disease-free survival rate, lo-cal recurrence rate, distant metastasis rate were 71.2% and 9.6% (χ~2 = 3.90, P = 0.048), 7.7% and 16.7%(χ~2 =5.22,P=0.022),12.8% and 21.1%(χ~2=3.27,P=0.070), respectively. The mean dis-ease-free survival time of the two groups was 97.03 ± 2.53 months and 87.01 ± 3.80 months, respectively. In the high-risk group, the 10-year survival rates of patients with and without radiotherapy were 72% and 56% (χ~2 = 4.07, P = 0.044), the local recurrence rates were 5% and 24% (χ~2= 11.16, P = 0. 001), and the distant metastasis rates were 16% and 26% (χ~2= 2.18 ,P = 0. 140). In the low-risk group, the survival rate of patients with and without radiotherapy were 81% and 71% (χ~2 = 1.57 ,P = 0.210), the local recur-rence rates were both 11% (χ~2=0.01 ,P=0.975), and the distant metastasis rates were both 13% (χ~2 = 0.00,P = 1. 000). Conclusions Early breast cancer patients with 1 -3 positive axiilary lymph nodes should receive post-operative radiotherapy after radical mastectomy. The prognostic index may decrease the chance of unnecessary radiation by distinguishing the patients under low risk of recurrence from those under high risk.

Objective To understand the changing characteristics of drug concentration in the serum and cerebrospinal fluid(CSF) after intravenous (IV) drip of norvancomycin in patients after neurosurgery procedure.Methods Patients with surgical cavity/ventricular drainages after neurosurgery procedure in a hospital in 2014 were selected, and they were divided into 2 groups according to the administration modes (12 in each group), conventional administration group: 0.8 g norvancomycin IV drip for 60 minutes, repeated every 12 hours;continuous administration group, 0.8 g norvancomycin, IV drip for 60 minutes, followed by 0.4 g of IV drip for 11 hours, then 0.4 g for 12 hours, serum and CSF specimens were collected at different time points after administration, concentration of norvancomycin was determined.Results Serum norvancomycin concentration reached a peak of (55.52±26.04) and (59.22±41.88) mg/L in conventional administration group and continuous administration group respectively, 24-hour serum concentration were (8.21±6.04) and (9.11±5.09)mg/L respectively;CSF norvancomycin concentration reached a peak of (16.31±11.15) and (8.82±8.91)mg/L in conventional administration group and continuous administration group respectively, 24-hour CSF concentration were (6.12±2.34)and (5.71±4.72)mg/L respectively;CSF penetration rate of conventional administration group was calculated by ratio of area under curve (AUCCSF/AUCserum), at 0-12 and 12-24 h hour were 63.3% and 59.0% respectively;in continuous administration group were 25.4% and 47.4% respectively.According to 95% of the minimum inhibitory concentration (MIC90) 2 mg/L of target bacteria methicillin-resistant Staphylococcus aureus (MRSA), AUC0-24/MIC90 in conventional administration group and continuous administration group were 192 and 184 respectively.Conclusion For patients who receives early use of standard dose of norvancomycin after neurosurgery procedure, CSF drug concentration after convention and continuous administration of norvancomycin can both reach MIC90 against target bacteria.

Objective To analyze the total cost and clinical effectiveness of internal fixation and hemiar-throplasty in the treatment of femoral neck fracture for the elderly. Methods From October 2013 to May 2015,85 patients above 60-year old who were diagnosed as displaced femoral neck fracture and received operation in our hospital. All the patients were divided into internal fixation(IF)group and hemiarthroplasty(HA)group respec-tively. There were 40 cases in the IF group and 45 cases in the HA group. The total cost associated with fracture in a year was collected by medical record ,telephone interview and standard methods. At the last follow-up ,we ap-plied Harris scores to evaluate the clinical outcome for each group. Results All the patients completed the operation successfully. During 1 year follow-up the total cost in the IF group was less than that in the HA group including higher primary hospitalization cost and less post-discharge cost. The total cost was 44,556.1 Yuan in the IF group and 72,198.0 Yuan in the HA group respectively. The data showed that the total cost of HA was 1.6 times higher than that of IF. At the last follow-up the mean Harris scores was 71.1 ± 12.1 in the IF group and 74.3 ± 10.3 in the HA group while the EQ-5D index was 0.74 ± 0.15 and 0.76 ± 0.13 respectively which showed no significant differ-ence(P > 0.05). Conclusions Both internal fixation and hemiarthroplasty have effective treatment for elderly pa-tients with femoral neck fracture. Compared to hemiarthroplasty IF can provide similar clinical effectiveness with less total cost. Therefore IF may contribute to decrease the economic burden for elderly patients in China.

Objective Refractory constipation,when complicated with megacolon,is difficult to manage.This study aimed to compare the clinical outcomes of different preoperative nutritional therapies on refractory constipation patients complicated with megacolon.Methods Patients of refractory mixed constipation complicated with megacolon receiving surgical interventions between 2006 Jun and 2011 Jun were enrolled.Perioperafive nutrition support was evaluated in terms of postoperative recovery.Results 78 constipation patients received therapies of NPM,gastrointestinal decompression and total parenteral nutrition during the first 7-14 days.34 patients retained intestine patency and after 2 weeks of enteral nutrition therapy,they (enteral nutrition group) successfully received selective surgery.The other 44 patients (non-enteral nutrition group) received emergency surgery after correcting homeostasis.The surgical procedures included Jinling procedure (n =45),Jinling procedure plus ileostomy (n =6),total colectomy plus ileum-rectum side-to-side anastomosis (n =18) and total colectomy plus ileostomy (n =9).EN group patients had a significant low rate of pneumonia (0％ vs 11.4％),anastomotic leakage (0％ vs 11.4％),anastomotic bleeding (2.9％ vs 18.2％) and ostomy (0％ vs 34.1％),compared with N-EN group.At one month follow up,the nutrition status was significantly better in EN group than that in N-EN group.Condusions Refractory constipation complicated with megacolon required surgical intervention.Recovering the intestinal patency and receiving enteral nutritional support therapy preoperatively benefits patient's recovery.

Objective To analyze the clinical characteristics of urinary tract infection after kidney transplantation and to analyze the distribution of pathogenic virulence factors.Methods From January 2014 to June 2016,a total of 255 cases were subjected to DCD renal transplantation in our center,and 45 cases of urinary tract infection occurred after operation.Among them,urinary tract E.coli infection occurred in 32 cases.The virulence factors gene aer,hly,irp2 and iucD in the 32 strains of E.coli isolated from urine were tested using PCR and multiple PCR.Results Thirty-two cases (71.1％) of urinary tract infection after renal transplantation was caused by E.coli,and divided into 9 cases of nosocomial infection group,and 23 cases of community-acquired group.The positive rate for aer,hly,irp2 and iucD in Nosocomial infection group was 66.7％,33.3％,88.9％ and 77.8％,and that in community-acquired group was 30.4％,8.70％,39.1％ and 34.7％,respectively.There were statistically significant differences among four kinds of virulence factors between two groups (P＜0.05).The positive rate of virulence factors was significantly higher in nosocomial infection group than in community-acquired groups.The total resistance rate was 84.38％,and there was significarit difference in multi-drug resistance rate between two groups (P＜0.01).Conclusion E.coli is the main pathogenic bacteria of urinary tract infection after renal transplantation,especially nosocomial infections.The detection rate of virulence factor is high,and the multiple drug resistance is outstanding,so the attention should be paid clinically.

Objective To study the bystander effects and associated mechanisms through irradiated conditioned medium(1CM). Methods Natural kilhr(NK) cells were obtained from peripheral blood samples. ICM irradiated with different doses of 60Coγ-rays was used for culturing K562 cell strain. The degree of injury of K562cells by activated NK cells was observed, as well as the apoptosis frequency of K562 cell was investigated. Results Severe injury was induced in K562 cells cultured in ICM than the control (sham-irradiated) as shown by increased sensitivity to NK cells (P < 0.05). The apoptosis frequency of K562 cell was increased significantly compared with the control cells (P < 0.05). Conclusions The bystander effect induced by irradiation is existent. ICM can trigger the bystander effect on K562 cell strains.

Objective: To discuss whether T_2 breast cancer patients with 1-3 positive axillary lymph nodes after radical mastectomy need radiotherapy, and to determine the corresponding target region. Methods: We retrospectively analyzed 103 breast cancer patients treated in our hospital between 1997 and 1998. All pa-tients underwent radical mastectomy. Of these patients, 44 did not receive irradiation, 59 received irradiation to the internal mammary chain and supraclavicular area. All patients had no intumescent axillary lymph nodes or distant metastasis before radical mastectomy. T-test was used to analyze quantitative data, and ANOVA was used to analyze numerical data. Kaplan-Meier method and Log rank test were employed to calculate and compare the survival rate. Results: The 10-year survival rate was 56.8% in the non-irradiation group and 72.9% in the irradiation group (X~2=2.805, P=0.094). The 10-year disease free survival rate was 50.0% in the non-irradiation group and 64.4% in the irradiation group (X~2=4.063, P=0.044). The 10-year local recurrence rate was 27.3% in the non-irradiation and 10.2% in the irradiation group (X~2=5.112, P=0.035). The 10-year met-astatic rate was 43.2% in the non-irradiation group and 22.0% in the irradiation group (X~2=5.263, P=0.031).The 10-year chest wall recurrence rate in all patients was 7.8%. No patients had recurrence in the internal mammary chain area. Irradiation in the internal mammary chain area was useless and could not increase sur-vival rate and disease free survival rate. Irradiation in the internal mammary chain area was not helpful for re-ducing local recurrence rate or distant metastatic rate. Conclusion: Radiation therapy can reduce local recur-rence rate and metastatic rate in T_2 breast cancer patients with one to three positive axillary lymph nodes, and can increase survival rate and disease free survival rate. Recurrence in the internal mammary chain area is rare. Therefore, it is not necessary to irradiate the internal mammary chain area. We suggest that T_2 breast cancer patients with 1-3 positive axillary lymph nodes after radical mastectomy should have irradiation to the chest wall and supraclavicular area.