Objective To discuss the effect of three-dimensional conformal hypofractionated high-dose radiotherapy on non-small cell lung cancer in the elderly. Methods All patients were treated by the same way of fraction radiotherapy,with a prescription dose of 4-5?Gy,every other day,to a total dose of 48-55?Gy. Results Complete response was observed in 23(51.1%) patients,partial response in 15(33.3%) patients, with the overall response rate of 84.4%. The overall 1-,2-,3-year survival rates were 66.7%,48.9% and 39.1%.Conclusions Three-dimensional conformal hypofractionated high-dose radiotherapy is safe and effective, giving mild untoward side-effects.

Objective To study the effect of transcatheter arterial chemoembolization(TACE) combined with three-dimensional conformal radiotherapy(3DCRT) for inoperable primary liver cancer.Methods Ninety-six such patients were prospectively randomized to TACE therapy alone group(TACE group-,47 patients) and TACE+3DCRT group(combined group-,49 patients).Results The overall 1-,2-,3-year survival rate was 82%,63%,43% in the combined group.It was 55%,28%,15% in the TACE group.The difference between the two groups was significant(P0.05).Conclusion Transcatheter arterial chemoembolization combined with three-dimensional conformal radiotherapy is more effective than transcatheter arterial chemoembolization therapy alone for inoperable primary liver cancer,without inflicting more treatment-related toxicities.

Objective To investigate the scintigraphic features of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) and to explore the clinical significance of 99Tcm-EHIDA hepatobiliary scintigraphy.Methods Hepatobiliary scintigraphy with 99Tcm-EHIDA was performed in 28 genetic confirmed NICCD cases (16 males,12 females,1-8 months).Normal dynamics (i.e.,time-activity curve) of the tracer in heart,liver and kidneys was defined as normal hepatic uptake function.Decreased liver uptake of the tracer and/or prolonged heart and kidneys radioactivity retention was defined as impaired hepatic uptake function.Normal or delayed biliary excretion was defined as radioactivity appearing in the bowel within 60 min or after 60 min.Occluded biliary excretion was defined as absent bowel radioactivity within 24 h.The characteristics of hepatobiliary scintigraphy and their relationship with levels of serum total bilirubin (TB),direct bilirubin(DB),ALT,total bile acid (TBA) were retrospectively analyzed.Statistical analysis was performed using Kruskal-Wallis rank sum test.Results Of 28 NICCD patients,20 showed normal uptake while 8 had impaired hepatic uptake.Ten of twenty patients with normal uptake function showed normal biliary excretion and the others showed delayed biliary excretion.Four of eight cases who presented impaired hepatic uptake function were with delayed biliary and the rest displayed biliary excretion occlusion.Compared with the patients with normal hepatic uptake function,patients with impaired hepatic uptake had significantly higher levels of TB and DB (TB:183.6(128.7-280.9) mmol/L vs 105.5(80.0-141.7) mmol/L,Z=-2.25;DB:135.6 (95.7-212.6) mmol/L vs 73.1(53.9-97.9) mmol/L,Z=-2.73; both P＜0.05).Compared with the cases with normal biliary excretion function,patients with delayed biliary excretion had significantly higher levels of TB,DB and TBA (TB:137.5 (122.0-170.9) mmol/L vs 81.7(65.7-93.5) mmol/L,Z=-3.92;DB:96.5 (81.1-108.0) mrrol/L vs 54.1(45.3-72.6) mmol/L,Z=-3.74; TBA:245.6(183.9-299.2) mmol/L vs 136.0(73.5-163.2) mmol/L,Z=-2.57; all P＜0.05).The levels of TB (262.0(152.1-542.8) mmol/L) and DB (192.7(118.1-407.2) mmol/L; both Z=-2.82; both P＜0.05) were the highest in patients with occluded biliary excretion.Compared with the patients with delayed excretion,the occluded excretion subgroup had significantly higher levels of ALT (71.5 (48.5-144.8) U/L vs 20.0(16.5-27.7) U/L,Z=-2.66,P＜0.05).Conclusion 99Tcm-EHIDA hepatobiliary scintigraphy may evaluate hepatic uptake and excretion function of the NICCD infants.When the hepatic uptake is remarkably decreased,the occluded biliary excretion can be shown.

Objective To investigate the clinical manifestations,laboratory tests,and image modalities on rheumatoid arthritis (RA) accompanied with atlanto-axial joint involvement.Methods Sixty-four cases of RA accompanied with cervical vertebra involvement were divided into 2groups by lesion location.Twenty-two cases were RA accompanied with atlanto-axial joint involvement,while 42 cases were RA with cervical vertebra other than atlanto-axial joint involvement.The age,course,clinical manifestations and the lab results were compared between the two groups by t test,Chi-square test and Fisher's exact probability.The X-ray,CT and magnetic resonance imaging (MRI) for cervical vertebra were analyzed in RA with atlanto-axial joint involvement.Results Compared with non-atlantoaxial cervical group,the disease course [(15±10) years vs (8±9) years,t=3.030,P=0.004],upper cervical vertebra pain (73％ vs 7％,x2=29.75,P＜0.01),lower cervical vertebra pain (9％ vs 40％,x2=6.813,P=0.009),cervical activity limitation (68％ vs 14％,x2=19.023,P＜0.01),upper cervical vertebra pressing pain (100％ vs 7％,22=52.297,P＜0.01),lower cervical vertebra pressing pain (9％ vs 60％,x 2=15.056,P＜0.01) and erythrocyte sedimentation rate (ESR) [(73±34) mm/1 h vs (53±37) am/1 h,t=2.039,P=0.046)] were significantly different in atlantoaxial joint lesions group.CT combined with MRI exams had high diagnostic..value in RA with atlanto-axial joint involvement.CT scan had the conformed diagnostic value.Sixteen cases were positive (73％) by MRI scan,while 3 cases (14％) by X-ray.Conclusion Timely CT scan and/or MRI scan for RA patients with neck pain in upper cervical vertebra,long disease course,cervical activity limitation and high ESR are helpful for early diagnosis of atlanto-axial joint involvement.

OBJECTIVE: To study the expression of CD68 antibody marked tumor associated macrophage TAMs and matrix solution element MMP-7 in laryngeal squamous carcinoma tissue and the relationship with clinicopathological parameters, so that to explore the relationship between the expression of the two molecular markers and laryngeal cancer tissue microvascular density (MVD). METHOD: Immunohistochemical method was employed to detect the expression of CD68 and MMP-7 in 65 cases (laryngeal squamous carcinoma tissue in 45 cases; peritumoral nontumor tissue in 20 cases) and CD 34 antibody marked MVD expression. RESULT: CD68 positive rate in squamous carcinoma tissue (82.2%, 37/45) is obviously higher than that in the peritumoral tissue (15%, 3/20) (P < 0.05), and MMP-7 positive rate in squamous carcinoma tissue is significantly different from that in peritumoral tissue (71.1%; 25%) (P < 0.05). The expression rate of CD34-MVD in laryngeal squamous carcinoma tissue( 26.52 +/- 6.36 )is higher than that in peritumoral tissue (12.23 +/- 4.01) (P < 0.05). In lymph node metastasis group, the positive expression rates of CD68 and MMP-7 are higher than those in the group without lymph node metastasis. MMP-7 showed no correlation with cancer stage, and CD68 was related with cancer stage; CD68, MMP-7 and CD34- MVD have positive correlation. CONCLUSION The high level of expression of TAMs and MMP-7 in laryngeal cancer tissue and the positive correlation with MVD illustrate that both of the markers play important roles in promoting laryngeal squamous carcinoma tissue metastasis and angiogenesis, which can be used as important markers to evaluate the invasion and metastasis of laryngeal cancer.
Adult ; Aged ; Antigens, CD ; metabolism ; Antigens, CD34 ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Carcinoma, Squamous Cell ; blood supply ; metabolism ; pathology ; Humans ; Laryngeal Neoplasms ; blood supply ; metabolism ; pathology ; Lymphatic Metastasis ; Macrophages ; cytology ; metabolism ; Male ; Matrix Metalloproteinase 7 ; metabolism ; Microvessels ; Middle Aged ; Neoplasm Staging ; Neovascularization, Pathologic

Objective To explore the mediating effect of organizational commitment on the relationship between perceived professional benefit and turnover intention among clinical nurses. Methods A total of 456 nurses from 3 hospitals in Hangzhou were investigated with Occupational Benefit Questionnaire,Organizational Commitment Scale and Turnover Intention Scale. Results The score of perceived professional benefit, organizational commitment and turnover intention were(135.41 ± 19.01), (16.10 ± 2.87),(76.28 ± 15.80) respectively. Pearson correlation analysis showed that there was a significant positive correlation between perceived professional benefit and organizational commitment(r=0.476, P<0.01),and a significant negative correlation to turnover intention(r=-0.313, P<0.01),and a significant negative correlation between organizational commitment and turnover intention(r=-0.525, P<0.01).Organizational commitment played a partial mediating effect between perceived professional benefit and turnover intention among nurses. Conclusions Nursing managers should attach an importance to enhance organizational commitment,and take effective measures to improve perceived professional benefit, as well as establish an effective incentive mechanism, fully mobilize positive factors to reduce the nurses ' turnover rate and stable the nursing team.

Objective To evaluate the common traditional Chinese medicine syndrome types, therapies and formulas of the wind of four fossae. This will provide reference for the formulation of the guideline for the diagnosis and treatment of traditional Chinese medicine in the wind of four fossae. Methods Delphi method using questionnaires were developed based on literature about TCM syndromes and treatment of the wind of four fossae. The questionnaire were sent to 25 experts nationwide for 2 rounds. The database of the collected data was established. The mean, full score ratio, rank sum and coefficient of variation were described and by SAS 6.12 statistical software. Results A total of 21 valid questionnaires were recovered in the first round and 23 valid questionnaires in the second round. The active coefficient of the experts was 84% and 92%, respectively. The results showed that syndromes of newborn heat, damp heat retention, spleen deficiency and blood dryness, wind dampness accumulating skin, blood deficiency and wind dryness demonstrated high concensus. The consistency scores' mean of 5 syndromes were 1.67, 1.90, 1.83, 1.71 and 1.90. The sum of degrees of 5 syndromes were 37, 40, 42, 36 and 40. The ratio of full scores of 5 syndromes were 0.81, 0.90, 0.87, 0.71 and 0.90. The coefficient of variations of 5 syndromes were 0.32, 0.16, 0.27, 0.27 and 0.16. The therapy of syndrome of newborn heat was clearing away the heart-fire and inducing diuresis by the sanxin daochi decoction; The therapy of syndrome of damp heat retention was clearing heat and removing dampness by longdan xiegan decoction; The therapy of syndrome of wind dampness accumulating skin was dispelling wind and eliminating dampness by xiaofeng san; The therapy of syndrome of spleen deficiency and blood dryness was enriching blood and moistening dryness by danggui decoction; The therapy of syndrome of blood deficiency and wind dryness was replenishing qi to invigorate the spleen and enriching blood to calm endogenous wind by shenling baizhu power and danggui decoction. Conclusion Questionnaire survey could quantify the opinions of experts, and provide reference for the establishment of guideline for the diagnosis and treatment of traditional Chinese medicine in the wind of four fossae.

OBJECTIVETo establish an animal model of sulfur mustard (SM)-induced acute lung injury in rats through different routes and compare the morphological changes in lung tissue and cells.

METHODSOne hundred and thirty-six male rats were selected and randomly divided into 5 groups, namely peritoneal cavity SM group (n=32), trachea SM group (n=32), peritoneal cavity propylene glycol group (n=32), trachea propylene glycol group (n=32), and normal control group (n=8). The rats in peritoneal cavity SM group were injected intraperitoneally with diluted SM (0.1 ml, 8 mg/kg), and the rats in trachea SM group were injected intratracheally with diluted SM (0.1 ml, 2 mg/kg). Once the rats were sacrificed at 6, 24, 48, and 72 h after SM treatment, morphological changes in lung tissue and cells were observed by light and electron microscopy.

RESULTSIn the peritoneal cavity SM group, the epithelial cells of bronchioles maintained intact with increased exudate and bleeding in alveolar cavity and large areas of pulmonary consolidation under the light microscope. In the tracheal SM group, focal ulcer formed in the epithelial cells of bronchioles with increased exudate and bleeding in alveolar cavity, partial pulmonary consolidation, and compensatory emphysema in peripheral alveolar space under the light microscope. The alveolar interval areas were widened obviously in both groups in a time-dependent manner. Under the electron microscope, we observed local loss of cellular membrane in type I alveolar epithelium, broken or lost microvilli in cells of typeⅡalveolar epithelium and fuzzy mitochondrial crista as well as the appearance of ribosome detached from rough endoplasmic reticulum in both two groups. Compared with those in the trachea SM group and the control group, the ratio of the alveolar septum average area to the visual field area in the peritoneal cavity SM group at 6, 24, 48, and 72 h was significantly higher (P<0.05).

CONCLUSIONThe lung tissue injury through the intraperitoneal route is more severe than that through the tracheal route, while focal ulceration of bronchioles epithelial cells appears in the case of tracheal route. The degree of injury increases over time in both groups, and the cellular damage is approximately the same in both groups.

Acute Lung Injury ; chemically induced ; pathology ; Animals ; Disease Models, Animal ; Lung ; pathology ; Male ; Mustard Gas ; toxicity ; Peritoneum ; Pulmonary Alveoli ; pathology ; ultrastructure ; Rats ; Trachea

Objective: To study the application value of improved early warning score in the practice of theory and practice interactive infiltration training mode for neurosurgery interns. Methods: A total of 84 neurosurgery interns were selected as study samples and randomly divided into control group and intervention group by random double blind method, each group had 42 interns. The control group adopted the interactive infiltration model of theory and practice. The Intervention group adopted the interactive infiltration training mode of theory and practice under the improved early warning scoring system design. Statistics and comparison of the performance of the two groups of trainee nurses, the evaluation of teaching teachers and patients, the self-evaluation of trainee nurses, and the occurrence of nursing errors during the internship. Results: The related examination results between the two groups showed significance (t value was 7.182,5.462,5.530, P<0.01). The evaluation for nursing students by teachers and patients also showed significant difference (t value was 6.989-8.790, P<0.01). The incidence of error event in the intervention group was 9.52% (4/42), lower than that in the control group [30.95% (13/42)]. There was statistical difference between two groups (χ² value was 14.227, P<0.01). Conclusions The application of the improved early warning score in the theory and practice interactive infiltration training mode of neurosurgery interns can improve the satisfaction of teachers and patients to interns, enhance the self-satisfaction of interns and reduce the incidence of nursing errors of interns.

Objective: To investigate the mechanisms of miR-375 affecting the proliferation and invasion of hepatoma cells via targeting YAP (Yes-associated protein). Methods: The cancerous tissues and corresponding para-cancerous tissues of 70 patients with hepatocellular carcinoma (HCC) who underwent surgical resection at the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2015 to December 2016, as well as the hepatoma cell lines SMMC-7721, Hb611, HepG2 and BEL-7405 were collected for this study. qPCR method was used to detect the expression level of miR-375 in collected HCC tissues and different hepatoma cell lines; Dual luciferase reporter gene assay was used to verify the interaction between miR-375 and YAP; The relationship between miR-375 and clinicopathological features of HCC patients was also analyzed; MTT assay was used to detect the effect of miR375 on the proliferation of hepatoma cells; Transwell invasion assay was used to detect the invasive ability of hepatoma cells after inhibiting the expression of miR-375; Western blotting was used to detect the expression of YAP in HepG2 cells. The nude mouse model of subcutaneously transplanted xenograft was established, and the tumor volume and mass of transplanted hepatoma cells were detected after inhibiting the expression of miR-375. The expression of YAP in xenograft of nude mice was detected by immunohistochemistry and Western blotting. Results: The expression of miR-375 and YAP in HCC tissues was significantly higher than that in para-cancerous tissues (all P<0.05). The expression of miR-375 in HepG2 cells was the highest (P<0.05). miR-375 could specifically bind to the 3' UTR of YAP and regulate the expression activity of YAP. After inhibiting the expression of miR-375, the proliferation and invasion abilities of HepG2 cells were reduced (all P<0.05); The tumor volume and mass of transplanted xenografts were significantly reduced (both P<0.05); The expression of YAP protein in the transplanted xenografts was down-regulated (P<0.05). Conclusion: miR-375 plays an important role in the occurrence and development of liver cancer, and can influence the malignant biological behaviors of hepatoma cells by targeting and regulating the expression ofYAP.