Objective To evaluate short -term clinical efficacy and adverse effects of brucea javanica oil emulsion(BJOE)combined with TP regimen in treating malignant pleural effusion(MPE)of non -small cell lung cancer(NSCLC)by double -way chemotherapy.Methods Totally 91 patients with MPE of NSCLC diagnosed by pathology were builted into the central venous catheter.The patients were assigned to group A,B and C according to therapies.Group A(21 cases)accepted infusion of BJOE 60mL into thoracic cavity twice a week.Group B(33 cases) accepted TP regime therapy,which included paclitaxel(TAX)intravenous chemotherapy at a dose of 150mg/m2 and cisplatin(DDP)injecting into thoracic cavity at a dose of 60mg +0.9% sodium chloride injection 30mL in first day, the therapy was repeated every 3 weeks.Group C(38 cases)combined the therapies of group A′s and B′s.Clinical efficacy and adverse effects were evaluated after 6 weeks.Results The objective response rate(81.6%)for group C was higher than group A or B(χ2 =8.605,P <0.05),the same result were in CR ratio(55.3%)(χ2 =10.384,P <0.05)and PD ratio(5.3%)(χ2 =8.649,P <0.05).There were no serious adverse effects in the three groups.The occurring rate of white blood cell reduction in group A was lower than those of group B and C,there was statistically significance(χ2 =8.999,P <0.05).Conclusion The efficacy of BJOE combined with TP regimen in treating MPE of NSCLC by double -way chemotherapy is better than that of single chemotherapy or alone intrathoracic treatment, and the adverse effects could be well tolerated.

The incidence of high myopia has increased yearly, which has been an area of focus for investigation. The complications of high myopia are contributing factors to blindness,such as posterior staphyloma, chorio-retinal atrophy, choroidal neovascularization, optic nerve head and macular defects. The study of histological changes helps clarify the mechanism. With the development of modern technology such as spectral-domain optical coherence tomography and enhanced depth imaging-technique, histological changes in high myopia can be measured accurately. The purpose of this review is to provide an update on various pathologic changes, including in sclera, Choroid/Bruch's membrane, optic nerve, vitreous and retina.

Objective To explore the differences among CT angiography(CTA) at different doses in both lower extremity arteries,and the relationship among volume rendering(VR) image quality,CT number and standard deviation(SD) value.Method CTA in lower extremity artery was performed in 90 patients.The participants were randomly divided into three groups,including a routine group (120 kV,150 mAs),120 kV and 80 mAs group,and 100 kV and 130 mAs group with 30 cases in each group.The images were processed with VR and classified into three degrees,the first class,the second class and the third class,and VR image quality levels of three groups were compared.The receiver operating characteristic curve(ROC) was used to analyze the correlation among VR image quality level,CT number and SD value.Results The percentage of VR image level at the first class was 93.3％ in the routine group,86.6％ in the 120 kV and 80 mAs group and 96.6％ in the 100 kV and 130 mAs group.According to the correlation analysis between the SD value and VR image quality of CTA in lower extremity artery,the area under curve in ROC analysis was 0.9078.According to the correlation analysis between the CT number and VR image quality of CTA in lower extremity artery,the area under curve in ROC analysis was 0.9116.Conclusions The low-dose CAT in lower extremity artery is feasible.Application of 100 kV and 130 mAs could ensure better image quality.

Objective To investigate therapeutic effect for older patients suffering from stroke sequela combined hip fracture and discuss the influence factors of prognosis.Methods The clinical data of 62 older patients suffering from stroke sequela combined with hip fracture were retrospectively analyzed.The therapy approach included the conservative treatment group (12 cases),the joint replacement group (18 cases) and the internal fixation group (32 cases).The data of the American association of anaesthetists (ASA) score,daily life activities ability index (Barthel life index),complications,mini-mental state examination (MMSE) scale score,proximal femur trabecular bone type index (Singh index),complications after fracture (infection,recurrent stroke,bedsore,deep vein thrombosis,heart failure) were collected and analyzed.Results There was no statistical significance in terms of age,gender,ASA grade,and complications among three groups.In the conservative treatment group,the joint replacement group,and the internal fixation group,the Bart index were (52.1 ± 11.4),(74.5 ± 21.3) and (63.8 ± 15.7) respectively,and the cases of postoperative complications were 10,3 and 13.There were significant difference in terms of Bart index and complication rate among the three groups (F =2.45,P ＜ 0.05 ; x2 =9.32,P ＜ 0.05).The differences of Singh index (x2 =11.05,P ＜ 0.05) and MMSE scale score (x2 =7.40,P ＜ 0.05) were statistically significant between the conservative treatment group and the two surgical treatment groups.No significant difference were found regarding of Singh index and MMSE scale score between the two surgical treatment groups.The relationship between ASA score,complication,MMSE scale score,treatment strategies and Bart index after fracture were found (OR =5.726,7.152,0.047,1.221,and 5.312 respectively ;P ＜ 0.05).Conclusion Joint replacement treatment is a preferred choice for older patients suffering from stroke sequela combined hip fracture.The prognosis is strongly influenced by the physical and mental state of patients.Comprehensive evaluation is an indispensable step to choose treatment strategies.

Objective To investigate the protective effect of electroacupuncture pretreatment on myocardial ischemia/reperfusion (I/R) injury and its influence on high mobility group box 1 (HMGB1) expression in rats. Methods Sixty Wistar rats were randomly divided into sham operation group, myocardial I/R model group and electroacupuncture pretreatment group by random number table (each n = 20). Myocardial I/R injury model was reproduced by ligating the left ventricular branch coronary artery at about 0.5 cm below the atrial appendage lower margin for 10 minutes to occlude the blood flow, then the ligature was relaxed for 1 hour reperfusion; in electroacupuncture pretreatment group, 7 days before I/R, the electroacupuncture at Neiguan acupoint was applied once daily for 20 minutes till the 7th day when I/R was established. Under light microscope, the pathological changes of myocardial specimen stained by hematoxylin-eosine (HE) method were observed. The myocardial histopathological integral was detected by semi quantitative integral method, and the changes of histological scores in three groups were investigated. The levels of plasma HMGB1, tumor necrosis factor-α (TNF-α), cardiac troponin T (cTnT) were detected by enzyme-labeled immunosorbent assay (ELISA). The expressions of HMGB1, monocyte chemotactic protein-1 (MCP-1), TNF-αmRNA and protein in myocardium were detected by reverse transcription-polymerase chain reaction (PT-PCR) and Western Blot. Results Under light microscope, the myocardial tissue in myocardial I/R model group showed partial fracture of myocardial fibers, large patches of myocardial cell necrosis, hazy boundary, cellular condensation, rupture and dissolution or even disappearance, interstitial edema with a lot of inflammatory cell infiltration; the above myocardial tissue injury in electroacupuncture pretreatment group was significantly milder than that in myocardial I/R model group. Compared with sham operation group, in myocardial I/R model group the HMGB1, TNF-α, cTnT contents and histological score were significantly increased [HMGB1 (μg/L):9.64±1.16 vs. 2.15±0.31, TNF-α(μg/L):91±22 vs. 19±5, cTnT (μg/L):1.50±0.35 vs. 0.07±0.03, histological score:2.5±0.3 vs. 0.0±0.0, all P<0.01], HMGB1, MCP-1, TNF-α mRNA and protein expressions were increased obviously (HMGB1 mRNA: 1.42±0.16 vs. 0.02±0.00, MCP-1 mRNA:0.46±0.06 vs. 0.01±0.00, TNF-αmRNA:0.75±0.04 vs. 0.03±0.00;HMGB1 protein:1.08±0.01 vs. 0.20±0.01, MCP-1 protein:0.92±0.03 vs. 0.40±0.01, TNF-αprotein:1.10±0.02 vs. 0.35±0.01, P<0.05 or P<0.01);compared with myocardial I/R model group, in electroacupuncture pretreatment group, HMGB1 (6.58±0.73), TNF-α (63±19), cTnT (1.15±0.31) levels were significantly decreased (all P < 0.01), HMGB1, MCP-1, TNF-αmRNA and protein expressions were markedly reduced (mRNA expression was 0.74±0.12, 0.18±0.02, 0.10±0.03, and protein expression was 0.40±0.01, 0.36±0.02, 0.50±0.02, respectively all P<0.05), and histological score (1.2±1.0) was remarkably lowered (P < 0.01). Conclusion Electroacupuncture pretreatment may reduce the myocardial I/R injury in rats, and the mechanism may be related to the amelioration of inflammatory response mediated by HMGB1 at late stage.

BACKGROUND:Improper angle of prosthesis placement often induces acetabular cup impact, and limits the scope of activity of artificial hip joint, and cannot meet the requirement of daily life. At present, the angle of acetabular cup instal ation remains controversial during total hip arthroplasty. Moreover, there is lack of targeted guide for the acetabular cup instal ation during hip arthroplasty with different head-neck ratios. OBJECTIVE:To explore the safe range of the artificial acetabular cup instal ation angle for different head-neck ratios. METHODS:In accordance with the calculation formula of range of internal rotation and external rotation, abduction and adduction, flexion and extension after total hip replacement, interpretation of dynamical variety law of acetabular abduction and anteversion, and deriving inequalities depending on Widmer’s standard of artificial hip joint normal activities range:(1) external rotation range was at least 40°, and internal rotation range was at least 80°. (2) Abduction range was at least 50°, and adduction range was at least 50°. (3) Anteflexion range was at least 130°, and extension range was at least 40°. The safety scope of artificial hip joint instal ation angle at different head-neck ratios was determined by solving the above three groups of inequality. RESULTS AND CONCLUSION:The safe range of the artificial acetabular cup instal ation angle for different head-neck ratios was different. To meet the normal hip joint activities, the head-neck ratios of artificial hip should be greater than 22/12. Artificial hip joint activities gradual y increase with the enlargement of head neck ratios. With enlarging the head-neck ratios, the acetabular cup instal ation safety angle scope of abduction and anteversin gradual y increases and the extreme of abduction increases gradual y, then with anteversion increasing gradual y, the abduction upper extreme of the security scope gradual y decrease and lower extreme of the security scope gradual y increase, tending to 45° symmetrical y. When anteversion is the biggest, the abduction should be 45°.

Objective To evaluation clinical efficacy and complications characteristics of vitrectomy on type 1 diabetes of diabetic retinopathy.Methods This was a retrospective review study.From January 2010 to January 2016,18 cases (28 eyes) under the age of 30 diagnosed as type 1 diabetes of diabetic retinopathy were treated in our hospital.All the patients were performed vitrectomy.The postoperative visual acuity and complications in and after operation were observed.Results The follow-upperiod was 6-72 months with the average of 43.0 months.Postoperative visual acuity improved or remained unchanged in 23 eyes (82.1％),and decreased in 5 eyes(17.9％).Our primary anatomic success rate was 92.3％.Complication in operation was iatrogenic retinal tear in 3 eyes.Postoperative complications consisted of anterior chamber fibrin exudation in 9 eyes,hyphema in 5 eyes,recurrent vitreous hemorrhage in 2 eyes,retinal detachment in 3 eyes,rubeosis of iris in 5 eyes and neovascular glaucoma in 4 eye.Conclusion For young patients of type 1 proliferative diabetic retinopathy,vitrectomy can restore retinal anatomical structure and function.Panrentinal photocoagulation and preoperative anti-VEGF injections in vitreous is necessary with serious neovascularization-related complications.

Objective To study the rule of lymph node metastasis rate in cN 0 papillary thyroid microcar-cinoma( cN0-PTMC) and to evaluate an appropriate region of neck dissection .Methods Data of 233 cases of cN0-PTMC were retrospectively analyzed .Univariate analysis with chi-square test was used to analyze the statisti-cal correlation between gender , age, tumor diameter and lymph node metastasis respectively .Results 81 out of 233 patients(34.8%)had cervical lymph node metastasis (30.0%in central region and 9.9%in lateral region). For patients with tumor diameter ( D)≤5 mm and D>5 mm, lymph node metastasis rate in central region was 21.6%and 36.6%(χ2 =6.199,P<0.05) and it was 4.9% and 13.7% respectively in lateral region (χ2 =5.035,P<0.05).For male and female patients, lymph node metastasis rate in central region was 42.1% and 26.1%respectively(χ2 =5.224,P<0.05), and it was 21.1% and 6.3% respectively in lateral region (χ2 =10.604,P<0.01).Lymph node metastasis rate in patients≤45 years old and >45 years old was 37.9% and 21.1% respectively (χ2 =7.792, P <0.01 ) .The lateral region lymph node metastasis rate was 17.1% and 6.7%when the central region lymph node was infringed or not (χ2 =5.947, P<0.05).Conclusions All cN0-PTMC patients should have a normative central neck dissection .Male patients with PTMC and tumor diameter >5 mm should receive the lateral neck lymphoid tissue exploration during surgery in order to find subclinical metas -tasis.

This study was aimed to explore the antitumor effect of volatile oil of X ihuang pill and its immune mecha-nism in order to screen the antitumor active site of Xihuang pill. Among 70 female Wistar rats, 10 rats were random-ly selected as the blank control group; and the other 60 rats was used in the establishment of walker 256 breast can-cer cell tumor-bearing rat models. The model rats were randomly divided into the negative control group (model group), high-dose volatile oil group, middle-dose volatile oil group, low-dose volatile oil group, high-dose Xihuang pill group, and lentinan group (positive control group), with 10 rats in each group. The intragastric administration was given twice a day for 14 days. Blood was taken from the abdominal aorta. Tumor tissues was removed and weighed to calculate the tumor inhibitory rate. ELISA method was used to detect the level of IL-2, IL-6, IL-10, IFN-γ and TGF-β in peripheral blood. The flow cytometry was used to detect the content of CD3+ T cell, CD4+ T cell, CD8+ T cell, and B7-1 cell (CD80). The results showed that the tumor inhibitory rates of volatile oil of high-dose group and middle-dose group were 28.4% and 24.1%, respectively. Compared with the model group, the average level of IL-2 and IFN-γ of volatile oil of high-dose group and middle-dose group and CD3+ T cell, CD8+ T cell, B7-1 cell con-tent were obviously increased (P< 0.05). It was concluded that volatile oil of Xihuang pill had certain antitumor ef-fect, which was one of the antitumor active sites of Xihuang pill. The volatile oil of Xihuang pill upregulates the lev-els of IL-2 and IFN-γ, as well as the contents of CD3+ T cell, CD8+ T cell, B7-1 cell in order to increase the im-mune clearance function of tumor-bearing rats.

Objective To observe the efficacy and safety of preoperative concurrent chemoradiotherapy or radiotherapy alone in patients with T3,T4 or lymph node-positive rectal cancer.Methods 141 rectal cancer patients with locally advanced or node-positive based on imaging from 2000 to 2009 were retrospective analyzed.Ninety-seven patients received preoperative concurrent chemoradiotherapy and 44 received preoperative radiotherapy alone.Two-dimensional or three-dimensional radiation technique and four types of chemotherapy regimens were used.Results The following-up rate was 91.5％.106 patients were followed up for at least 3 years and 68 patients for at least 5 years.The 3-and 5-year overall survival rates were 85.8％ and 65.7％,respectively.The 3-and 5-year local recurrence rates were 9.2％ and 14.1％,respectively.The 3-and 5-year metastasis rates were 33.8％ and 45.8％,respectively.The downstaging rate was up to 59.0％ (82/139) and the rate of sphincter preservation was 65.5％ (91/139).The median disease-free survival in patients treated with preoperative concurrent chemoradiotherapy was superior to radiotherapy alone (51 months vs 31 months,x2 =12.88,P =0.000).The time to metastasis in patients with downstaging was significantly delayed than that in patients without downstaging (60 months vs 29 months,x2 =14.65,P =0.000).Most acute toxicity was grade 1 and grade 2.The incidence of delayed wound healing and anastomotic leakage was very low.Conclusions Preoperative concurrent chemoradiotherapy or radiotherapy alone has excellent tumor downstaging effect and helps in sphincter preservation,with tolerable side effects.