Objective To observe the clinical efficacy and prognosis of nimotuzumab combined with intensity modulated radiotherapy(IMRT) in the treatment of advanced local nasopharyngeal carcinoma.Methods 82 patients with advanced nasopharyngeal carcinoma were selected, and they were randomly divided into observation group(40 cases) and control group(42 cases) according to the digital table.The observation group was treated with nimotuzumab plus IMRT plus cisplatin, and the control group was treated with IMRT plus cisplatin.After 7 weeks of treatment, the clinical efficacy, adverse reactions and T cell subsets were observed.And the patients were followed up for 1 year, 2 years and 3 years to evaluate the survival rate.Results In the observation group, the total remission rate was 75.00%,which was higher than that in the control group(59.09%),the difference was statistically significant(x2=35.81,P<0.05).The CD+4,CD+8 and CD+4/CD+8 levels in the observation group were similar to those in the control group(tCD+4=0.59,P=0.56;tCD+8=1.70,P=0.01;tCD+4/CD+8=0.13,P=0.89).The incidence rates of Ⅰ degree and Ⅱ degree mucosal reaction and dermatitis in the observation group were 35.00%,40.00%,40.00%,35.00%,respectively,which were higher than 9.09%,9.09%,9.09%,9.09% of the control group,the differences were statistically significant(x2Ⅰmucous membrane=4.18,P=0.04;x2Ⅱmucous membrane=5.52,P=0.02;x2Ⅰdermatitis=5.52,P=0.02;x2Ⅱdermatitis=4.18,P=0.04).The 2-year and 3-year survival rates in the observation group were 65.50%,60.00%,respectively,which were significantly higher than 31.82%,27.27% in the control group, the differences were statistically significant(x2=4.11,P=0.04;x2=4.58,P=0.03).Conclusion Nimotuzumab combined with IMRT in the treatment of advanced nasopharyngeal carcinoma has good short-term clinical efficacy, good long-term efficacy and controllable adverse reactions.It is worthy of clinical application.

Objective Patients with Alzheimer dementia often display poor sleep. Given that the disease is often associated with low endogenous levels of melatonin, exogenous melatonin administration may lead to improvements in sleep. Methods Randomized, placebo controlled study was carried out in 41 patients with probable Alzheimer disease. Melatonin (8. 5 mg immediate release and 1. 5 mg sustained release) (n =24) or placebo (n = 17) administered at 22:00 P. M. for 10 consecutive nights. The protocol sleep was measured continuously using actigraphy. Results There were no significant effects of melatonin,compared with placebo,on sleep and circadian rhythms. Conclusion This study failed to find a beneficial effect of exogenous melatonin.

Objective This study investigates the relationship of serum irfflammatory cytokine levels with intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) after surgery.Methods A total of 32 cases with severe TBI and placement of ICP monitor were prospectively enrolled.Serum was collected before surgery and every 12 h after surgery.Cytokines levels of interleukin (IL)-1β,IL-8,and tumor necrosis factor (TNF)-α were analyzed and compared with outcome of patients.Hourly values of ICP were recorded.The degree of ICP above treatment threshold (20 mm Hg) were calculated every 12 h as pressure times time dose(PTD-ICP20),which was compared with serum cytokine levels before (Pre) and after (Post) the 12-hour time period using linear regression method.Results Serum IL-1β (P＜0.05),IL-8 (P＜0.01) and TNF-a (P＜0.01) levels elevated dramatically after severe TBI and were significantly associated with outcome of patients.Mean PTD-ICP20 was (42.9 ± 60.2)mm Hg/h and was correlated with increased Pre-IL-8 (r=0.554,P＜0.001),Pre-TNF-α (r=0.597,P＜0.001),Post-IL-8 (r=0.629,P＜0.001) and Post-TNF-α (r=0.538,P＜0.001) levels.Conclusion Serum IL-8 and TNF-α demonstrated the most promising candidate bio.rnarkers of impending ICP elevation in this study.These findings indicate a feasible way of monitoring patients with severe TBI.

Objective To design a new type of medical management system based on No 1 military medical project.Methods Data were extracted from the database of No 1 military medical project,and PB6.5 was used to develop the system.Results The medical management system was built which could be applied to information inquiry in such three levels information as hospital,department,doctor.Conclusion This new type of medical management system,with macroscopic and microscopic medical data involved in,provides ample information for the authorities of the hospital in their decision-making.

Objective To analyze and summarize the clinical effect of peripherally inserted central catheters (PICC) guided by B-ultrasound,and to discuss the catheterization skills of PICC guided by B ultrasound.Methods Retrospectively analyzed the clinical data of 102 patients recieved PICC guided by ultrasound in neurosurgery department of Chongqing emergency medical center from January 2016 to May 2017.The success rate of one-time puncture, the success rate of one-time catheter delivery and the number of complications were analyzed, and the causes and treatment methods of complications were analyzed.Results Of the 102 cases,94 cases were successfully punctured in one time,6 cases were punctured twice,and 2 cases were punctured more than 2 times.The one-time puncture success rate was 92.16%.Catheter misplacement occurred in 5 patients,and postoperative complications occurred in 2 patients.Conclusion Mastering the related angiotomy and imaging knowledge of PICC and using the B-ultrasound guidance system to insert the catheter can improve the success rate of catheterization and reduce the postoperative complications.

Spontaneous complete thrombosis with parent artery occlusion of giant intracranial aneurysms is rare.We report a patient with a rare giant vertebral artery aneurysm with spontaneous complete thrombosis and parent artery occlusion,and review the related literature,discuss its incidence,clinical presentation,pathogenesis,diagnosis,and treatment.

Objective To investigate the relationship between plasma homocysteine (Hey) level and ankylosing spondylitis (AS).To analyze the association between the NS,N10 methylenetetrahydrofolate reductase (MTFHR) gene polymorphism and AS.Methods One hundred patients with AS and 60 healthy controls were included in the study.The plasma Hey level was examined by enzyme-linked immunoadsorbent assay and MTHFR gene polymorphism was analyzed by the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP).Results Compared with heahhy controls,the plasma Hey level in AS patients was significantly higher than that of the controls (P＜0.01).There was no significant difference in the frequen-cies of MTHFR genotype and alleles between AS and the controls (P＞0.05),But the ratio of T/T genotype mutation was different between AS and the controls (P＜0.05).The plasma Hey level of T/T genotype was significantly higher than that of C/T or C/C genotype in AS and the controls (P＜0.01).Logisticalregression analysis indicated that Hey was an independent risk factor for AS (P＜0.01,0R=4.582,95%CI=1.984～10.585).Conclusion The plasma homocysteine level is significantly increased in AS patients.Hyperhomo-cysteinemia is an independent risk factor for AS.MTHFR T/T genotype mutation is an important mechanism of hyperhomocysteinemia and may be related with AS.

Objective:To explore the correlations of TNF-α-238 site gene polymorphism and the onset of Ankylosing Spondylitis(AS)in Hunan Han population.Methods:100 AS samples (including serum and whole blood) were collected from the Department of Immunology and Rheumatology of the Second Xiangya hospital from May 2008 to Jan 2009 and 90 samples of normal people were collected as control group.We detected the TNF-α-238 gene polymorphism of these subjects by using PCR-RFLP technique.The TNF-α level in the serum samples were measured by ELISA and HLA-B27 antigen was detected by flow cytometry (FCM).Then all of the data was analyzed by SPSS13.0 software.Results:There were 95 cases with the TNF-α-238 G/G genotype in 100 AS patients,5 cases with the G/A genotype.While in the control group,TNF-α-238 G/G genotype and G/A genotype were 88 cases and 2 cases respectively.There was no TNF-α-238 A/A genotype in both groups.The allele frequencies of G in AS group was higher than in the control group(98.9% vs.97.5%),while the allele frequencies of A in AS group was lower than in the control group(1.1% vs.2.5%).However,there were no significant difference both A allele frequencies and G allele frequencies (P＞0.05).In addition,the average TNF-α level in AS group was higher than in the control group significantly (10.16±1.19 pg/ml vs.5.64±1.18 pg/ml).And the average TNF-α level in AS patients with the genotype of G/A was higher than that of with the G/G genotype (13.49±1.27 pg/ml vs.9.44±1.29 pg/ml).There was a very large difference of the positive ratio of HLA-B27 between two groups (χ~2=114.975,P=0.000).After gene analysis of HLA-B27and TNF-α-238,the odds ratio(OR)was higher in both G/G genotype and HLA-B27 positive than HLA-B27 lonely.Conclusion:There is probably no relationship between the gene polymorphism of TNF-α-238 site and the onset of AS but the G/G genotype of TNF-α-238 may increase the sicken risk of AS in Hunan population.

short peptide AS1 screened from the phage random peptide library of 12 amino acids has antigenicity and can react with sera of AS patients. These findings indicate that AS1 could be one of candidate molecules of AS-specific serum markers.

Objective To investigate the clinical value of high frequency ultrasonography with E-flow imaging in the evaluation of fingertip's microcirculation changes in patients with systemic sclerosis(SSc).Methods Twenty-four SSc patients and 29 healthy subjects were involved.High frequency ultrasonography with E-flow imaging was used to observe the configuration and distribution of digital arteries in the last segment of left and right middle finger.Peak systolic velocity (PSV),end diastolic velocity (EDV),mean velocity(MV),vascular resistance index (RI) and pulsatility index(PI) of digital palmar propria arteries,nail bed arteries and finger ventral arteries were measured.Results In control group,rich blood supply was revealed within the fingertips.Digital palmar propria arteries,nail bed arteries and finger ventral arteries and their small branches were displayed clearly and continuously by E-flow imaging.While in SSc patients,the definition and continuity of fingertip's small vascular flow images were not as good as that in the control group,with the distribution of blood flow markedly reduced.compared with the control group,PSV,EDV and MV of digital palmar propria arteries,nail bed arteries,finger ventral arteries were decreased in SSc group(P＜0.01),but both RI and PI were increased(P＜0.05).There were no statistically significant differences between left and right fingertip's arteries index in normal control group (P＞0.05).But PSV,EDV and MV of left digital palmar propria arteries in SSc group were higher than that of the right(P＜0.05),whose differences bear statistic significance.Conclusions High frequency ultrasonography with E-flow imaging is sensitive and reliable to reflect fingertip's microcirculation changes and provide a new method to assess microvascular changes in SSc patients.