This article summarizes proposals of different international guidelines,clinical cases in clinical institutions at home and abroad and the latest research progress of tumor patients with implanted cardiac pacemaker.In addition,the various factors during the implementation of radiotherapy were analyzed.It is possible that reducing the risk grade and minimizing the unfavorable factors for pacemaker could be achieved by designing the scientific treatment plan and setting the reasonable radiotherapy plan.The radiotherapy plan can be established safely and effectively in malignant tumor patients with implanted pacemaker.

Objective To explore clinical effect of small dose of glucocorticoid in the treatment of AECOPD patients with severe disease associated with low levels of cortisol.Methods72 patients with AECOPD in our hospital were randomly divided into control group and treatment group.The control group was treated with conventional AECOPD method,the treatment group was treated on the base of the treatment group with a small dose of corticosteroids,CRP, IL-6, TNF-α, FEV1, PCT and other indicators, as well as patients with ventilation, shock and mortality were compared after the end of treatment.ResultsThe time of non mechanical ventilation, the time of non-mechanical ventilation, and the time of non-shock were increased, the shock and the mortality was lower in the treatment group,(P<0.05);The CRP level of patients in the treatment group was lower(P<0.05);IL-6, TNF-α, PCT levels of patients in the treatment group was lower (P<0.05);FEV1, FVC and FEV1/FVC level in the treatment group were higher(P<0.05).ConclusionSmall dose glucocorticoid can improve the pulmonary function of patients with AECOPD complicated by severe disease, and alleviate the disease, significantly reduce the levels of inflammatory factors, promote the improvement of the lung function.

Semi-purified diets containing 30 ppm or 500 ppm dl-?-tocopherol (VE) were fed for 8 weeks to young (3 months) and old (18 months) Swiss mice. The blastogenic response of splenocytes as well as serum VE and lipid peroxides (LPO) in livers were measued. The results showed that the old mice fed 500 ppm VE had a significantly higher serum VE level and blastogenic response of splenocytes to Con A and LPS than those fed 30 ppm VE (p

Objective To investigate the feasibility of spleen-preserving splenic hilar lymph nodes dissection on the radical resection for advanced proximal gastric cancer. Methods Six patients with advanced proximal gastric cancer were performed D2 lymphadenectomy from May 2012 to May 2013 in our hospital. The operation time,bleeding quantity,the number of lymph nodes,postoperative complications were re-corded. Results The surgery was successful. The intraoperative blood loss was 50 ~250 mL,with the average of 120 mL. The number of lymph nodes was 3~9 after the operation with the average of 5. One patient supervened with lymphorrhagia and recovered after treatment. During the follow-up period from one month to one year, no local recurrence and distant metastasis occurred, nor the death. Conclusion Conducting theD2 lymphadenectomy for the patients with the advanced proximal gastric cancer can preserve the spleen while safely and throughly dissect the splenic hilar lymph nodes.

Background Peters anomaly is a rare eye disease.Understanding the clinical features of Peters anomaly is helpful for us to correctly manage this disease.Objective This study was to investigate the clinical characteristics and treatment methods of Peters anomaly and provide available basis for the diagnosis and individualized treatment of Peters abnormal.Methods A descriptive study was performed.The clinical data from 8 eyes of 4 patients with Peters anomaly who were diagnosed and treated in Beijing Children's Hospital from January 1,2014 to March 30,2016 were retrospectively analyzed.The clinical manifestations of the anterior ocular segment were examined by handheld slit-lamp microscope,and corneal curvature,corneal thickness,axial length and intraocular pressure were measured.The therapy and outcomes of the patients were evaluated.Results Peters anomaly was classified into type Ⅰ,type Ⅱ and Peters plus syndrome based on the findings and literature'criteria.Regarding to the clinical findings,the adhesion of peripheral angle with cornea,shallow or disappeared anterior chamber were found in all the eyes,and these manifestations were type Ⅰ Peters anomaly and occurred in 2 eyes of 2 patients.The opacity and adhesion of the central lens capsula to corneal endothelium was seen in 6 eyes which belonged to type Ⅱ Peters anomaly.The mean corneal thickness was (680± 127) μm in 4 measured eyes,which was thicker than normal eyes;the mean corneal curvature was (37.40±1.79)D in 4 measured eyes;the mean axial length was (21.06±0.19)mm and the mean diameter of cornea was (9.4 ± 0.5) mm in 4 measured eyes.Iridocoloboma was found in 4 eyes and congenital aniridia was in 4 eyes.In addition,esotropia appeared in 1 patient,and nystagmus occurred in 3 patients.The 3 patients of type Ⅱ in this study were found to have the disorders associated with systemic neurogenic developmental abnormalities and diagnosed as Peters plus syndrome.Trabeculectomy with anterior vitrectomy was performed in 2 eyes with the intraocular pressure ＞30 mmHg(1 mmHg =0.133k Pa) and the introcular pressure reduced to below 21 mmHg after operation.Penetrating corneal transplantation was carried out on 1 eye with central opacity.However,rejection of graft occurred at 1 month and became complete cloudy at 3 months after surgery.Cataract extraction surgery was performed on 4 eyes with lens opacity and intraocular lens were implanted in 2 eyes or iridectomy was carried out in another 2 eyes,and the visual quality was evidently improved after operation.Conclusions The clinical characteristics of Peters anomaly include leukoma,shallow anterior chamber,peripheral iris adhesion with cornea and lens opacity due to adhesion of lens anterior capsule to corneal endothelium.Personalized operative regimen should be determined based on the clinical findings of the eyes with Peters anomaly.

Objective To evaluate the value of the real-time tissue elasticity imaging quantitative method in differential diagnosis of thyroid nodules.MethodsSeventy-three patients with thyroid nodules，including 95 lesions,were included in the study.A total of thyroid nodules were examined with traditional ultrasonography and elastosonography from which the strain ratios(SR)were derived，with pathologic results as the reference standard.And a receiver-operating charaeterisitc(ROC)curve was used to identify the value of optimal operating point for differential diagnosis of thyroid nodules.Results①The strain ratio of the benign lesions was 2.06 ±1.01，which was significantly different from the value of malignant lesions 5.05±2.23(P＜0.05).②The area under the curve was 0.929，which showed a high statistical significance.③It showed that the optimal operating point of ROC curve was 3.17，with high sensitivity(96.7%)，specificity(90.8%)，postive predictive value (93.3%)and negative predictive value(96.9%).Conclusions The real-time tissue elasticity imaging can provide a quantitative,noninvasive and convenient tool for evaluating the thyroid nodules.

Objective To evaluate the feasibility and safety of thoracoscopic lung cancer surgery under non-tracheal intubation anesthesia. Methods Twenty patients with peripheral lung cancer were enrolled in experimental group and control group. Then monitored and recorded Systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), electrocardiogram (ECG), heart rate (HR), Oxygen saturation (SpO2), Final moisture CO2 partial pressure (PETCO2), central venous pressure, invasive arterial blood pressure and blood glucose and the related complications like sore throat, hoarse voice, nausea and so onin such time points: before induction (T0), induction of intubation (T1), operation (T2), and sudden removal (T3) of the two groups. Results The laryngeal mask group was given a smaller stimulus to the cardiovascular system during anesthesia.The time of feeding, the exhaust, the time of getting out of bed, the average hospitalization day, the reduction of hospitalization expenses, pharynx, respiratory and cardiovascular complications were shorter and less than intubation group. Conclusion The laryngeal mask ventilation intravenous anesthesia with thoracic vagal nerve block in the thoracoscopic lobectomy is simple, safe, no intubation-related complications and single lung ventilation lung injury, in line with surgery -anesthesia overall minimally invasive development concept, worthy of clinical promotion.

Objective To explore the value of wave intensity (WI) parameters in evaluating hemodynamic changes of cardiovascular system before and after 131I therapy in hyperthyroid patients.Methods Forty-seven hyperthyroid patients were enrolled as hyperthyroid group,while 47 healthy volunteers were considered as control group.Both of the hyperthyroid and control group took WI examinations,and WI curves of their right common carotid arteries were recorded.WI parameters of WI curve were automatically measured as followed:value of the first positive peak (W1),value of the second positive peak (W2),area of the negative peak (NA),and the square root of NA (A).Twenty-five patients of the hyperthyroid group received 131I therapy were enrolled as treatment group.All these patients were followed up for 3 months.The repeatability of the WI parameters was evaluated in 10 hyperthyroid patients and 10 normal volunteers selected at random from the investigation.Results W1,W2,A in hyperthyroid group increased compared with those in control group,and independent-samples t test showed very significant difference (P=0.000,P=0.000,P=0.000).W1,A decreased after 131I therapy compared with those before treatment,and paired-samples t test showed significant difference (W1:P=0.001;A:P=0.011).A in hyperthyroid group had positive correlation with FT3 (r=0.508,P=0.003);W1 after 131I therapy in treatment group had positive correlation with FT3 and FT4 (r=0.601,P=0.002;r=0.680,P=0.00);W2 after 131I therapy in treatment group had positive correlation with FT3 and FT4 (r=0.549,P=0.005;r=0.570,P=0.004).The repeatability of W1,W2,NA and A were good by consecutive measurement of identical observer.Conclusions WI peak parameters of hyperthyroid patients were higher than those of healthy volunteers,and some sensitive parameters were decreased after 131I therapy,which may provide the basis for assessing the effectiveness of 131I therapy.

Aim To observe the effects of icariin on depressive-like behavior in prenatally stressed offsprings and explore its mechanism.Methods The model of depression was established by prenatal restraint stress on late pregnant mother, then male offspring rats were randomly divided into five groups of eight: Control, PS model, Saline group(NS), ICA(80 mg·kg-1), ICA(40 mg·kg-1).The effects of icariin on PS-induced depressive-like behaviors in male offsprings were examined by forced swimming test(FST) and open-field test(OFT).Furthermore, the protein expressions of group I metabotropic glutamate receptors(I mGluRs) and excitatory amino acid transporter 2(EAAT2) in prefrontal cortex were detected by Western blot.Results PS group exhibited depressive-like behaviors with decreased struggling time(P<0.01) and center crossing numbers(P<0.05) compared to CON, with increased protein expressions of group I mGluRs(P<0.01,P<0.05) and decreased EAAT2(P<0.05) in prefrontal cortex compared to CON.Treatment with icariin(80 mg·kg-1, 40 mg·kg-1)significantly increased struggling time(P<0.05,P<0.01) and center crossing numbers(P<0.05) in PS-exposed male offspring rats.Treatment with icariin markedly modulated the protein levels of mGluR1, mGluR5 and EAAT2 in prefrontal cortex.Conclusion Icariin has significant antidepressant effects in prenatally stressed rats, and the mechanism might be associated with the modulation of Ⅰ mGluRs.

Objective To explore the effects of bilirubin on myeloid differentiation factor phospho-p38 mitogen-activated protein kinase (p-p38MAPK) and apoptosis in splenocytes of neonatal rats.Methods Seven-day-old Sprague Dawley rats (clean grade),male or female,weighting 12.0-15.0 g,were randomly assigned to 6 groups.There were blank control group (Ⅰ),lipopolysaccharide (LPS) control group (Ⅱ),15 mg/kg bilirubin control (free-LPS) group (Ⅲ),15 mg/kg group (Ⅳa),30 mg/kg group (Ⅳb) and 50 mg/kg group (Ⅳc),and then subsequently divided into 2 h,5 h and 24 h subgroups in each groups.Some of the 200 newborn rats died amid the experiment,tinally,a total of 144 cases were involved in the analysis of results,and 8 rats in each subgroups.Newborn Sprague Dawley rats were administered at various doses of bilirubin (15 mg/kg,30 mg/kg and 50 mg/kg,respectively) intravenously; 1 h after injection,the rats were administered LPS intraperitoneally at a dose of 1 mg/kg;p-p38MAPK were detected by immunohistochemistry;Apoptosis in splenocytes was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling methods at 2 h 5 h and 24 h after the injection of bilirubin.Results 1.Expression of p-p38MAPK in each group:bilirubin in low-mid concentrations of range inhibited LPS-induced p38MAPK activation (qⅣa =20.93,10.37,respectively at 2 h,and 5 h,all P ＜ 0.01 ;qⅣ b =79.97,14.79,all P ＜ 0.01).The inhibition strengthened with increasing concentration of bilirubin.The effect was observed at 2 h,strengthened at 5 h,disappeared at 24 h.Bilirubin in the high concentrations of range stimulated the expression of p-p38MAPK (qⅣc =32.55,19.23,27.72,respectively at 2 h,5 h and 24 h,all P ＜0.01),observed at 5 h,reduced at 24 h.2.Effects of bilirubin on apoptosis in splenocytes:LPS could increased the apoptosis index (AI) of splenocytes(q =54.62,P ＜ 0.01);The AI of splenocytes had no significant change in low concentrations of range of bilirubin (q =43.92,P ＞ 0.05).Low-mid concentration of bilirubin with LPS reduced the AI of splenocytes (q Ⅳ a =4.48,P ＜ 0.01 ;q Ⅳ b =2.07,P ＜ 0.05),while high concentration of bilirubin with LPS increased the AI of splenocytes (q =5.08,P ＜ 0.01).Conclusions Bilirubin in low-mid concentrations of range could inhibit the expression of LPS-induced p38MAPK,while bilirubin in high concentrations of range stimulated the expression.As the concentration of bilirubin elevated,its inhibition was prolonged.Bilirubin in high concentrations of range bilirubin could induce apoptosis in splenocytes.The immune dysfunction in neonatal hyperbilirubinemia may have something to do with the regulation of phosphorylation of p38MAPK and activation of apoptotic pathways.