Objective To evaluate the value of fractionated stereotatic radiation therapy (FSRT)(X knife) as a boost for recurrent or residual nasopharyngeal carcinoma (NPC) at the primary focus. Methods From Sept.20, 1995 to Dec.30,1998, 50 such patients were treated by FSRT with 6 MV photons. The total FSRT dose was 24～30?Gy prescribed at 1～4 centers on the 60%～90% isodose curves normalized to isocenter by multifractions of fraction size 6～8?Gy, 12,15?Gy, with interfraction duration of 4～6 days. Results CR 38/50 (76%), PR 9/50 (18%) and in evaluated 3/50 (6%). Total survivals(Kaplan meier):1 yr 83.6%, 2 yr 65.0% and 3 yr 59.6% . Conclusion Fractionated stereotatic radiotherapy (FSRT) is strongly indicated for recurrent or residual NPC at the primary focus.

This paper reports the post-operative care of 41 patients with Chiari malformation associated with syringomyelia. The nursing points included postoperative vital signs monitoring,management of the body posture and incision,observation of complications. Among these patients,21 of them had cerebrospinal fluid leakage,3 of them had cranial nerve palsy,a patient suffered from acute respiratory arrest caused by brainstem edema. Patients recovered and discharged after active appropriate treatment and care.

Objective To investigate the cerebral protective effect of anti-intercellular adhesion molecule-1 (anti-ICAM-1) antibody (1A29) in rats with global cerebral ischemia/reperfusion (I/R) injury. Methods Forty healthy SD rats weighing 180-200 g were randomly divided into 4 groups ( n = 10 each) : group Ⅰ received isotype-matched control antibody 1 mg/kg iv (control group); group Ⅰ ,Ⅲ ,Ⅳ received 1A29 1 mg/kg iv before cerebral ischemia (group Ⅱ), at the onset of reperfusion (group Ⅲ) and at 4 h of reperfusion (group Ⅳ) respectively. The global cerebral I/R was produced by 30 min four-vessel occlusion followed by 24 h reperfusion. All animals were killed at 24 h of reperfusion. Their brains were removed for microscopic examination and measurement of W/D weight ratio, infarct size and neurological deficits (0 = no deficit,4 = unable to crawl with mental depression) .Results The PMN leukocyte and monocyte infiltration, water content of the brain and infarct size were significantly decreased in group Ⅱ ,Ⅲ and Ⅳ as compared with control group. The neurological deficit scores were significantly lower in group Ⅱ ,Ⅲ, Ⅳ(1.6-1.8) than in control group (2.5).Conclusion 1A29 antibody administered either before ischemia or during the 4 h of reperfusion can protect the brain against global cerebral I/R injury.

Objective To investigate the correlation between clinical presentations and the findings of video fluoroscopic swallowing study (VFSS)in patients with post-stroke dysphagia. Methods A total of 56 consecutive patients with post-stroke dysphagia admitted to Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from June 2012 to May 2014 were enrolled. Four different kinds of food were selectively used to complete clinical assessment of swallowing function and VFSS respectively. The SPSS 20. 0 statistical software was used to perform univariate and multivariate Logistic regression analyses for all observed indexes of the 2 methods. Results there were significant correlations in the point correspondence relation among the clinical manifestations and VFSS in food residue in the mouth and abnormal closure of lips in the oral phase (95%CI 1. 430-101. 468;P=0. 022);poor soft palate elevation and food residue in the mouth (95%CI 1. 476-102. 033;P=0. 020);graded swallowing and piecemeal deglutition with delayed oral transit (95% CI 2. 616 -182. 897;P = 0. 004);tongue movement disorders,poor soft palate elevation and tongue dyskinesia with poor bolus formation (95%CI 1. 468-50. 795,1. 220-13. 825;P=0. 017,0. 023);food leak from the corner of mouth,dysphagia,bolus falling to the epiglottis from the base of tongue or trachea (95%CI 1. 146-125. 459,1. 657-174. 400;P=0.038,0. 017). The weakened pharyngeal reflex with weak laryngeal elevation in the pharyngeal phase (95%CI 1. 150-92. 815;P =0. 037);dysphagia and delayed swallowing with prolonged triggering of swallowing reflex (95%CI 2. 123-37. 770,1. 233-114. 176;P=0. 003,0. 032);graded swallowing,hard swallowing, choking sensation,and poor laryngeal elevation with prolonged pharyngeal transit (95%CI 1. 619-223. 316,1. 061-31. 445,2. 834 -132. 707;P =0. 019,0. 042,and 0. 003);dysphagia and the opening of cricopharyngeal muscle insufficiency (95%CI 1. 037 -24. 115;P =0. 045);weak laryngeal elevation,foreign body sensation in the throat,and choking after swallowing with food retention or residual in vallecula or pyriform sinus (95%CI 1. 046 -13. 685,1. 116 -87. 741;P =0. 043, 0.040);and coughing during swallowing and eating choking or aspiration (95%CI 0. 010-0. 921,0. 037-0. 826;P=0. 042,0. 028). Conclusion Some clinical manifestations are closely correlated with the swallowing dysfunction revealed by VFSS. With the help of this law,it may more simply and safely determine the degree and type of dysphagia in patients,and provide guidance for patients with dysphagia after stroke who can not accept VFSS in the rehabilitation treatment.

OBJECTIVE To investigate drugresistance and clinical distribution characteristics of Staphylococcus strains isolated from inpatients.METHODS The meticillin-resistance and drug-resistance of the Staphylococcus strains isolated from the clinical specimens of the inpatients in our hospital between 2003 and 2005 were tested.RESULTS Totally 768 Staphylococcus strains were mainly isolated from sputum,blood,pus and wound secretion.The main clinical wards were from pediatrics,ICU,tumor chemotherapy departments.The age of these inpatients were mainly over 60 years old(48.7%) and less than 13 years old(33.2%).Two hundred and ninetyStaphylococcus aureus strains(37.8%)and 478 coagulase-negative Staphylococcus strains(62.2%)were included.The isolated rates of meticillin-resistant S.aureus and meticillin-resistant coagulasenegative Staphylococcus were 74.8% and 89.1%,respectively.CONCLUSIONS Infections of Staphylococcus are increased year by year among inpatients.There are high rates of meticillin-resistant strains.It is very important to monitor infections of Staphylococcus,to control the source of infections,to interrupt their spread and to protect impressionable inpatients,in order to prevent infections of Staphylococcus actively.

Objective To investigate the ischemic preconditioning time for inducing rat brain ischemia tolerance.Methods Procerebrum ischemic preconditioning injury was caused by occlusion of two-side common carotid artery for 10 minutes or 20 minutes,and subsequent cerebral ischemic injury was caused by occlusion of middle cerebral artery for 2 hours after 72 hours of reperfusion.The percentage of brain infarct size was calculated for the investigation of the proper ischemic preconditioning time for rat brain ischemia tolerance.Results Ischemic preconditionaing for 10 minutes and 20 minutes can reduce the percentage of brain infarct size significantly.The difference of the percentage of brain infarct size between 10-minute preconditioning group and 20-minute preconditioning group is insignificant,but the mean percentage of brain infarct size in 10-minute preconditioning group is less than that in 20-minute preconditioning group.Conclusion Ten minutes are the suitable time of ischemic preconditioning for rat brain ischemia tolerance.

Objective To investigate the clinical efficacy of dexmedetomidine combined with ropivacaine for ilioinguinal and iliohypogastric nerve block in elderly patients undergoing inguinal her-nia surgery.Methods Sixty elderly patients undergoing inguinal hernia surgery were randomly divided into dexmedetomidine group (group D)and control group (group C),30 patients in each group.All patients received ilioinguinal and iliohypogastric nerve block by the same anesthesiologist. 0.375% ropivacaine and dexmedetomidine 1 μg/kg 20 ml were used in ilioinguinal and iliohypogastric nerve block in group D,while 0.375% ropivacaine 20 ml were used in ilioinguinal and iliohypogastric nerve block in group C.Sensory block onset time and blockade duration were recorded.Side effects were recorded in both groups.Results Sensory block onset time in group D was significantly shorter than that in group C (10.6±4.3 min vs 14.4±5.1 min,P <0.05).Sensory block durations in group D was significantly longer than that in group C (832.7±136.6 min vs 669.8±140.1 min,P <0.05). There were two bradycardia cases in group D.No adverse reactions or anaesthesia complications oc-curred in all patients following postoperative follow-up.Conclusion Dexmedetomidine combined with ropivacaine can be used in ilioinguinal and iliohypogastric nerve block safely,and dexmedetomidine shortens the onset time and prolonged the duration of sensory block.

Objective To investigate the earlier diagnostic methods and operative procedures of gastric remnant cancer. Methods Clinicopathologic data of 19 cases of gastric remnant cancer were retrospectively analysed,and the diagnostic value of the gastroscopy and barium meal was compared.Influencing the prognosis of gastric remnant cancer treated by different operations according to the situation seen during operation were observed. Results The diagnostic rate of gastroscopy and barium meal was 78.9% and 47.4%, respectively.All the 5 cases who underwent radical remnant gastrectomy sarvived≥3 years postoperatively.Two of the 3 cases who underwent palliative remnant gastrectomy survived 2 years and 1 alived 1.5 years postoperatively. In 6 cases of gastrojejunostomy, 4 cases died within half year, 2 cases died 12.5 and 14 months postoperatively. Conclusions The diagnostic value of gastroscopy takes advantage over barium meal examination. The patients who treated by radical remnant gastrectomy have better prognosis.

Objective To explore the possibility of anterior open reduction and internal fixation to treat the lower cervical irreducible dislocation. Methods 15 cases of lower cervical irreducible dislocation were treated by the anterior open reduction and internal fixation, 11 cases were male and 4 cases were female, 10 cases were unilateral facet locked and 5 eases were bilateral facet locked which were confirmed by the MRI and CT scan. All the cases were failed to the skull traction before operation and received anterior open reduction and plate fixation, and interver-tebral fusion. All the cases were followed up, the recovery of neurological function and the fusion rate were evaluated. Results 15 cases were completely reduction and none of them got a worse neurological function. Conclusion The treatment effect of anterior open reduction and fixation for the lower cervical irreducible dislocation were good.

ObjectiveTo investigate the mechanisms and the effects of magnesium Valproate on the expressions of the kinin B1 and B2 receptors in the hippocampus of the juvenile rats submitted to pilocarpine model of epilepsy.Methods 35 healthy Wistar juvenile rats were randomly divided into six groups,that is the model groups:Ⅰ group,Ⅱ group,Ⅲ group,and intraperitoneal injection of saline water control groups:Ⅰ a group,Ⅱ a group,Ⅲ a group,after succession of 15 rats to kindle to establish the model of epilepsy by pilocarpine.To collect hippocampus tissue after the rats were to put to death,and to compared the expression levels of kinin B1 and B2 receptor mRNA by RT-PCR and western blot in the hippocampus of rats.ResultsBy treated with magnesium valproate,kinin B1 receptor mRNA (0.38 ± 0.051 ) and protein expressions(0.58 ± 0.057 ) decreased and kinin B2 receptor mRNA (0.48 ±0.056 ) and protein expressions(0.48 ± 0.044 ) increased in Ⅰ group,compared with that (0.76 ±0.068,0.89 ± 0.034;0.28 ± 0.034,0.32 ± 0.039 ) of Ⅰ a group(P ＜ 0.05 ).Compared with control group,there were more significant upregulation of kinin B1 receptor mRNA and protein expressions (P＜0.05) in the Ⅰ and the Ⅱ groups and there were no alteration in Ⅲ group.The expressional levels of B2 receptor mRNA and protein were upregulated in the Ⅰ,Ⅱ and Ⅲ groups.ConclusionThe kinin B1 and B2 receptor may play a role in the onset and maintenance of epilepsy.The magnesium valproate increased the expressional levels of kinin B2 receptor,and decreased the expressional levels of kinin B1 receptor.