Objective To investigate the possible roles of serum bilirubin and uric acid in the course of carotid artery intima thicken/plaque formation. Methods Patients with ischemic cerebral vascular disease were divided into the control group, intima thicken group and plaque formation group according to the carotid artery intimamedia thickness (IMT) examination by B-mode ultrasound. The serum bilirubin and uric acid were detected by Automatic Chemistry Analyzer. Results The serum level of uric acid of (391.22 ± 27.52) μmol/L in intima thicken group was significantly higher than that in the control group and plaque formation group((307.32 ± 13.68)μmol/L and (327.84 ± 17.96)μmol/L, P ＜ 0.05). The serum level of indirect bilirubin and total bilirubin in plaque formation group was (10.96 ± 0.58) μmol/L and (15.91 ± 0.71) μmol/L respecitively, which were significantly lower than those in the control group ((15.09 ± 2.21) μmol/L and (20.59 ± 2.43) μmol/L,respectively) and the intima thicken group((15.09 ± 2.21) μmol/L and (20.59 ± 2.43) μmol/L, respectively) (Psignificantly lower than that of (5.70 ± 0.28) μmol/L in the control group(P ＜ 0.05). Conclusions Bilirubin and uric acid play different roles in carotid artery plaque formation during different stage.

Objective:To analyze the adverse drug reactions(ADR)and clinical application of thalidomide to provide useful reference for rational medication in clinics. Methods:The case reports and literatures from foreign countries on the clinical medication of thalidomide were analyzed and summarized. Results:The ADR of thalidomide included gastrointestinal reaction, hematotoxicity,cadiovascular toxicity,neurotoxicity,skin lesion,pulmonary embolism and so on. Its new medication methods were widely used in clinics. Conclusion:Clinicians and pharmacists should pay more attention to the medication risks and rational use of thalidomide in order to assure the safety and effectiveness of clinical drug use.

OBJECTIVE:To explore how to establish good procedure,system and mode of drug management,dispensing and application,in order to provide reference for risk management and rational use of rabies vaccine. METHODS:The use of rabies vaccine and storage temperature monitoring in our hospital during 2013-2014 were analyzed statistically,and risk management and use of rabies vaccine in our hospital were analyzed,and management measures and attentions were put forward. RESULTS:The amount of vaccinum rabiel (Vero cell) and human rabies immunoglobulin in our hospital were increased in 2014,compared to 2013. The position labeled with #1 in storehouse and that of labeled with #1 and #2 in dispensing store could meet the storage condi-tion of rabies vaccine. Risk management could be carried out in fields of drug requisition,cold chain management,drug manage-ment and drug dispensing. ADR should be paid attention. CONCLUSIONS:It is of significance to develop risk management and ra-tional medication guidance of rabies vaccine.

Objective To investigate the charateristics and prognostic value of computed tomography (CT) of retropharyngeal lymphadenopathy (RLN) in nasopharyngeal carcinoma (NPC).Methods From 1991 to 2006, CT images were analyzed for 588 patients with histologically proven NPC treated with radiation therapy in our hospital.The survival rate was evaluated by Kaplan-Meier method.Results RLN metastases were presented in 392 patients, with unilateral side in 254 patients and bilateral sides in 138 patients.The 5-year distant metastasis-free survival (DMFS) rate of patients with and without RLN metastasis was 66.6% and78.6%(χ2 = 10.78,P=0.005) ,with 69.7% and 62.2%(χ2 =2.31,P=0.129) for patients with unilateral and bilateral sides involvement.The DMFS rate was similar between the mild and moderate enhancement of RLN (67.6% and 58.9% ,χ2=2.77,P =0.096).The survival rate of RLN with homogeneous density was better than heterogeneous density (71.5%, 53.3% and 32.5%,respectively, χ2= 10.51, P = 0.001, χ2= 24.28, P = 0.000).The survival rate of patients with well boarded RLN was better than those with ill boarded RLN and obviously adjacent tissue involvement (65.5%, 51.8%and 50.0% , χ2 =8.20,P=0.004, χ2 =5.31 ,P=0.021).Conclusions The prognosis is poor with RLN metastasis, lymph node enhancement, heterogeneous density in nodes and ill boarded RLN.

Objective To evaluate the outcome of Stage Ⅱ nasopharyngeal carcinoma(NPC) trea-ted by conventional fractionation radiotherapy. Methods From January 1990 to May 1999,216 patients with untreated stage Ⅱ NPC were irradiated by 6 MV photons and 9-12 MeV electrons with linear accelera-tor. Of 26 patients with residual lesions after 70 Gy irradiation, 18 received intracavitary brachytherapy and 8 received stereotactic irradiation boost. Results The 10-year overall survival (OS) of patients with T2 N0 M0, T1N1M0 and T2N1M0 disease were 90%, 80% and 75.2% (χ2 = 3.26, P =0. 200), respectively. The corresponding disease-free survival(DFS) and distant metastasis-free survival(DMFS) were 79% ,60% and 62.6% (χ2 = 5.87, P = 0.053) ;90% ,74% and 68.0% (χ2 = 7.09, P = 0. 030), respectively. In uni-variate analysis, T stage had no impact on OS, DFS or DMFS (χ2 = 0.44, P = 0. 500 ; χ2 = 0.44, P = 0.500 ; χ2 = 0.25, P = 0. 610), while N stage significantly influenced DFS and DM FS (χ2 = 5.86, P = 0. 015 ; χ2 = 5.31 ,P = 0. 021). Multivariate analysis showed that N stage was an independent prognostic factor for DFS and DMFS(χ2=5.03,P=0.025;χ2=6.47,P=0.01). Conclusions Stage Ⅱ NPCwithposifivelymph node treated by radiotherapy alone is inadequate. In order to improve DFS and DMS, combined chemo-radio-therapy should be considered.

Objective To investigate the clinical features,treatment outcome and prognosis of pa tients with nasopharyngeal adenoid cystic carcinoma(ACC).Methods From March 1963 to August 2002, 33 patients with ACC were retrospectively reviewed.Among them,13 received multimedality therapy(S + R in 9 and R +S in 4) and the remaining 20 received radiotherapy alone.The interval between the first visit and clinical diagnosis was 12 months(1.0-36.4 months).The misdiagnosis rate was 55% (18/33),with the most common error of otitis media.The clinical symptoms of ACC were similar to those of squamous carcino ma in nasopharynx,though the cervical lymph node metastasis was rare(12%) and cranial nerve invasion was common (58%). ResultsAfter a median follow-up of 60.8 months (5.0-245.2 months),the 5-and 10-year overall survival rates,free-disease survival rates,local regional control rates and metastasis-free sur vival rates were 66% and 29% ,41% and 27% ,61% and 40% ,62% and 62% ,respectively.Among the 20 patients(61%) with recurrence,15 had local regional failure(13 in situ and 2 in cervical lymph node) ,and 9 had distant metastasis(5 in the lung,2 in the lung and bone,1 in the liver and I in the bone).Univariate analysis showed that clinical stage was a prognostic factor(Ⅰ + II vs Ⅲ + Ⅳ,P = 0.009),while treatment modality(radiotherapy alone vs multimodality therapy) was not. ConclusionsNasopharyngeal ACC is a locally aggressive disease with a long course.Either radiotherapy alone or muhimodality therapy(S + R/R + S) is effective in the treatment.

Objective To evaluate the efficacy of intensity-madulated radiotherapy(IMRT) as the primary treatment in nasopharyngeal carcinoma (NPC). Methods Between November 2001 and March 2006,147 newly diagnosed NPC patients were treated with IMRT. The disease was Stage I in 3 patients, Stage Ⅱ in 35,Stage Ⅲ in 67 and Stage Ⅳ in 42. For T1-2 disease,the prescription dose was 70 Gy to the gross tumor volume( GTVnx) and positive neck nodes ,60 Gy to the planning target volume I, and 50-56 Gy to the clinically negative neck. For T3-4 disease,the prescription dose was 74-78 Gy to GTVnx. The local control rate(LC),overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) were estimated by Kaplan-Meier method. Results The 3-year LC, OS, DFS and DMFS of the whole group were 93.2% ,93.5% ,72.6% and 74.4% ,respectively. T stage was a significant predictor of LC and OS. For patients with T1-2 and T3-4 disease,the LC was 100% and 86.9% (P=0.007) and OS was 95.5% and 91.3% (P=0.030), respectively. N stage was a significant predictor of OS, DFS and DMFS(P=0.03,0.004 and 0.0004,respectively). The grade Ⅰ+ Ⅱ and Ⅲ acute toxieities of parotid were 96.6% and 1.4%. The rate of grade Ⅱ xerostomia at 3-month, 6-month, 1-year and 2-year after radiotherapy were 43.0%, 12.0% ,4.9% and 3.2%. Conclusions The treatment results are promising according to our target definition and dose prescription protocol for nasopharyngeal carcinoma.

Objective To study the dynamic change of anatomy and dosimetry distribution and its influence during intensity modulated radiation therapy(IMRT) for nasopharyngeal carcinoma(NPC). Methods From June 2006 to August 2007,12 patients with stage Ⅲ-Ⅳ NPC receiving initial IMRT concurrently combined with chemotherapy were included in the study. The target volumes and,involving organs were contoured on the first set of spiral CT images. When IMRT planning was finished,a second CT scans was acquired to rectify the treatment center. Weekly spiral CT images acquired during the treatment period according to the same treatment center were fused with the first CT images. In order to determine the best time of replanning, modified plan target volume( PTV1 ) and normal organs( parotids and outline) were contoured on the fusion interface by a single physician. Changes of each structure throughout treatment period were measured by a system software. Then the dose distributions were computed and evaluated for replanning CT using the same beams arrangement in the original plan. Cumulative dose was estimated compared with the original plan. Results The volume of outlines and parotids decreased gradually, and the change came to peak in the fifth week. So the fifth and first week CT scans were selected as research objectives. No significant changes in maximal and mean dose was observed in the brainstem, spinal cord or mandible. Despite volume changes,D99 and D95 of the PTV1 did not change siguificantly(P＞0.05). D95 of the bilateral parotids increased significantly ( PL = 0.03,PR = 0.01 ). Conclusions During IMRT for NPC, the volume of PTV1, the outlines and parotids decrease,and the change come to peak in the fifth week. Comparing to the first treatment plan, the dose parameters of the parotids increase significantly in the second plan based on the fifth week CT,but those of the brainstem,cord,mandible and PTV1 change slightly.

Objective To investigate the changes and the mechanism of blood perfusion in perfusion weighted image ( PWI)-diffusion weighted image ( DWI) mismatched regions after infarction and to assess the effect on prognosis .Methods We assessed 84 patients with acute cerebral infarction within 72 hours of onset in the territory of anterior circulation , who admitted to Affiliated Drum Tower Hospital , Nanjing University Medical School between January 2009 and June 2011.All patients were imaged with 3.0 T MRI on day one.The patients were divided into mismatched group (31 patients) and matched group (53 patients) according to the basis of PWI-DWI.The two groups received the same treatment including anti-platelet, oxygen free radical scavenger and lowing cholesterol therapy .Barthel index was used to evaluate neurological deficit on day 0, day 12 and three months later.We also compared the perfusion parameters of day 0 with day 12 by PWI from mismatched group.Results On day 12, the value of relative cerebral blood flow increased by 7.37%(t=-2.076, P<0.05) and the value of relative mean transit time decreased by 11.06%(t=2.972,P<0.01) compared with that on day 0 from mismatched group.However, there was no significant difference in Activity of Daily Living scale ( ADL) score between the two groups after 12 days′treatment.After three months, the patients of mismatched group had higher ADL score (75.48 ±3.26) than that of matched group (66.23 ±3.04; t=2.079, P<0.05).Conclusion The patients of mismatched group had better neurofunction than matched group , possibly related to improvement of perfusion in mismatched area.

To investigate the clinical characteristics and angio-architecture features of patients with dural arteriovenous fistulas (DAVF).The clinical data of 48 patients with DAVF were analyzed retrospectively.All patients were diagnosed by digital subtract angiography and 43 cases were also examined by MRI.Patients were divided into the bleeding group and non-bleeding group,whose clinical features and angio-architecture were compared.Of 48 cases,13 patients demonstrated intracranial bleeding,and men were more common in bleeding group (M/F:10/3) than in non-bleeding group (M/F:15/20) (P =0.036).The Cognard scores of bleeding group and nou-bleeding group were 3.77 ±0.28 and 2.49 ±0.21,respectively (P =0.002) ; however,there was no significant difference in age and the number of feeding artery between two groups.The results indicate that male patients with high Cognard scores tend to intracranial bleeding.