Objective To investigate the effect and the mechanism of parecoxib sodium pretreatment on permeability of blood-brain barrier in a rat model of focal cerebral ischemia-reperfusion injury.Methods Sixty male SD rats weighing 300g were randomly divided into 5 groups (n=12 each):sham operation group (group S);focal cerebral I/R group (group I/R);parecoxib sodium 5 mg/kg pretreatment group (group L);parecoxib sodium7.5mg/kg pretreatment group (group M);parecoxib sodium 10 mg/kg pretreatment group (group H) Middle cerebral artery occlusion models were made by reforming Longa suture method in SD rats.Thirty minutes before ischemia,rats in group L,M and H were injected with 5 mg/kg、7.5 mg/kg and 10 mg/kg parecoxib sodium through the internal jugular vein.Group S and group I/R received equal volume of normal saline.ELISA technique was used to determine the content of S100 β,TNF-α,IL-1 β in Plasma.The changes of cerebral water content and the Evans Blue exudation from brain capillaries were observed.Results Pretreated with parecoxib sodium (5mg/kg、7.5 mg/kg and 10 mg/kg),the content of S100 β,TNF-α,II-1 β in plasma were reduced.The cerebral water content and the EB in brain were reduced.Pretreated with parecoxib sodium 10 mg/kg,Longa scores were reduced.Conclusion Pretreatment with Parecoxib can protect blood-brain barrier against focal cerebral I/R injury by inhibition of the inflammatory reaetion.

Objective To evaluate the effect and patient 's tolerance on late-course high-dose radiotherapy (LCHDRT) combined with concurrent chemotherapy for locally advanced non-small cell lung cancer (NSCLC).Methods 73 NSCLC patients were entered into this study from May 2000 to May 2006.The treatment regime consisted of conventional radiotherapy first (40 Gy,20 f,4 w),followed by LCHDRT (24-30 Gy,6 f,2 w,tumor α/β =10 Gy,BED =81.6-93 Gy) combined with concurrent chemotherapy.Conventional irradiation field encompassed the primary lesion,hilum of lung and mediastinal lymph drainage region.LCHDRT focused on the primary lesion only,with ≥95 ％ isodose curve covering the planning target volume (PTV) and the target dose was prescribed to PTV.Supraclavicular metastases lymph node was treated by 6 MV X-ray and electron beam to a total dose of 65-70 Gy.Chemotherapy regime consisted of vinorelbine (25 mg/m2,d1,8 iv) and cisplatin (30 mg/d,d1-3,iv gtt) in the lst and 5th weeks.Results Leukopenia and radiation-induced pneumonitis,as shown by the WHO staging system were the most common acute toxicities.In V20≤25 ％,17.2 ％ (5/29) patients happened radiation-induced pneumonitis only.But in V20 ＞ 25 ％ and ≤ 30 ％,65.9 ％ (29/44) happened radiation-induced pneumonitis (x2 =16.63,P ＜ 0.01).It showed that patients accompany increment of V20,the happening rate of radiation-induced pneumonits probability was increased.The other acute toxicities such as nausea,fever,radiation-induced esophagitis,hemoglobin decrease and thrombocytopenia were mainly grade 1 or 2.After symptomatic treatment,all patients completed the planned treatment without interruption except 4 patients above 70 old years of grade 3 radiation-induced pneumonitis.Late lung radio-fibrosis was 34.3 ％ (25/73).Before the end of the second month after treatment,the complete response (CR) and partial response (PR) rates were 17.8 ％ (13/73) and 69.9 ％ (51/73),respectively,with CR+PR rate of 87.7 ％.The 1-,3-,5-year local control and overall survival rates as monitored by the x2 test method were 82.2 ％,60.3 ％,50.7 ％ and 57.5 ％,23.3 ％,13.7 ％,respectively.Conclusion LCHDRT combined with concurrent chemotherapy shows a promising results,but the rational time-dose-fraction model still need further observation.

Objective To evaluate the CT findings of multicentric Castleman disease(CD).Methods The CT findings of thorax and abdomen in a patient with multicentric CD biopsy-proved were retrospectively analyzed, and a literature review was conducted.Results The patient had systemic symptoms, polyclonal hypergammaglobulinemia, extensive lymph node enlargement and mild enhancement, and specific pulmonary infiltration. The lung lesions on thin-section CT were showed poorly-defined centrilobular nodules, ground-glass attenuation, thin-walled cysts, thickening of the bronchovascular bundles, and interlobular septal thickening. The above were highly coincident with that in the literatures.Conclusion Multicentric CD is characterized by the presence of systemic symptoms, extensive lymph node enlargement and mild enhancement, and specific pulmonary lesions when infiltrated. Typical manifestation might suggest multicentric CD.

BACKGROUND:Elderly patients with degenerative lumbar degeneration often appear insufficient holding power of pedicle screw in spine surgery, which is prone to occur de-pinning and leads to insecure fixation. How to increase the holding power of screws has become a hot research. OBJECTIVE:To observe the early clinical effect of pedicle screws with cement augmentation for treating lumbar degenerative diseases in elderly patients. METHODS:A total of 65 old patients with lumbar degenerative diseases received a treatment between August 2012 and April 2014, and were divided into two groups according to the treatment strategy:treatment group (n=24;internal fixation of pedicle screws with cement augmentation) and control group (n=41;routine internal fixation of pedicle screws). General conditions of patients in two groups were observed and compared. Visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) score system were used for evaluating the lumbar and back pain, and restoration of neurological function in lower limbs respectively. RESULTS AND CONCLUSION:Al of the patients successful y received the surgery and then were fol owed up from 3 to 20 months. The anterioposterior and lateral X-ray film revealed no loosening, loss, fracture of the screws, and no loss of intervetebral space height was found. There was no significant difference in the blood loss and hospital stay between two groups (P>0.05). JOA at postoperative 3 and 6 months, and VAS score at postoperative 3 months were significantly improved after the treatment of pedicle screws with cement augmentation, when compared to control group (P<0.05). VAS scores showed no difference at 6 months postoperatively in two groups (P>0.05). Pedicle screws with cement augmentation for treating lumbar degenerative diseases have the advantages of improving the screws holding strength, reconstructing the stability of lumbar vertebra and obtaining clinical efficacy on degenerative spine.

Objective To explore the proper method of rehabilitation after operation of arthroscopic rotator cuff repair.Methods A total of 86 cases treated by arthroscopic rotator cuff repair in Beijing Jishuitan Hospital from March 2002 to December 2006 were included in our study and randomly divided into two groups which are normal group and intensive group. The two groups were treated with same rehabilitation protocol but had different frequency in hospital. American Shoulder& Elbow Surgeons′ Score (ASES score) and Guides to the Evaluation of Permanent Impairment (GEPI) were adopted before operation and one year follow-up. Results There were no significant difference between two groups in ASES and GEPI scores before the operation(P>0.05). Comparing with preoperation, there were significant difference between the two groups in ASES and GEPI scores 1 year after operation(P<0.05). Comparing with the normal group, the intensive group have higher ASES scores than that of normal group and lower GEPI scores than that of normal group 1 year after operation (P<0.05). The range of motion of active forward flexion and external rotation were tested at the 7th week, 12th week and 1 year after the operation, all the result of intensive group were better than that of normal group (P<0.05).Conclusion Customized and systematic shoulder rehabilitation training therapy for the patients with rotator cuff repaired is an effective method to restore the function of shoulder joint. Intensive treatment has better result.

Objective To analyze the characteristics of proximal deep vein thrombosis (DVT) after total joint arthroplasty.Methods 40 cases of proximal DVT were collected from May 2007 to October 2016 which were all diagnosed by lower limb venography or sonography.There were 9 males and 31 females aged from 38 to 86 years,average 67 years,and body mass index was from 16.94 to 31.25kg/m2,with an average of 24.3 kg/m2.29 cases of THA patients and 11 cases of TKA patients.The anatomical distribution,size,radiological performance,local physical findings were recorded and multivariable analysis was performed to evaluate the relationship between distribution of proximal DVT and related parameters including age,gender (male/female),side of leg(left/right),surgery type(knee and hip),preoperative diagnosis(femoral neck fracture/other disease),time of diagnosis with DVT (during hospitalization/after discharge).Results Among 40 proximal DVT cases,31 cases diagnosed by phlebography and 9 cases were diagnosed by ultrasound.2 cases were isolated proximal DVT while 38 cases connected with distal DVTs.9 cases of blood clots in the proximal and distal thrombosis connected discontinuously.There was no isolated proximal DVT in TKA group and 10 cases (90.9％) of blood clots in the proximal and distal thrombosis connected continuously while there were 2 cases (6.9％) isolated proximal DVTs in THA group and 21 (77.8％) of blood clots in the proximal and distal thrombosis connected discontinuously,and there was no statistic significant difference between the two groups.The average length of proximal was 8.85±9.3 1cm (range from 2-35cm) with 5.0±2.05 cm in TKA group and 10.31 ± 10.55 cmin THA group.A significant difference was found between the 2 groups (P=0.014).13 cases located in femoral veins and upper venous region which were all from THA group.There was a significant difference in the distribution between surgery type and preoperative diagnosis.However,there was no significant difference between other potential factors and distribution of proximal DVT.25 cases accepted the evaluation of symptom of DVT before scanning.However,no significant difference were found in edema,VAS score,Homans sign,Neuof sign between 9 TKA and 16 THA cases.Conclusion Proximal DVTs after knee and hip arthroplasty are more preferred to connect with distal DVT continuously.Surgery type and preoperative diagnosis have a significant effect on the distribution of proximal DVT.Proximal DVTs in THA and patients with preoperative femoral neck fracture could be more easily involving femoral veins and upper parts.

Objective To analyze the pathogenic bacteria and drug resistance of peritoneal dialysis-associated peritonitis(PDAP),and provide a clinical reference for the rational use of antibiotics.Methods The demographic data of PDAP patients admitted to the peritoneal dialysis(PD)Center of the First Affiliated Hospital of Soochow University from July 1,2015 to December 30,2021 were collected,and the pathogens,drug resistance and prognosis were retrospectively analyzed.Results A total of 150 episodes of PDAP occurred in 92 patients.The positive rate of PD fluid culture was 61.33％,including 65 cases(70.65％)of Gram-positive(G+)bacteria,mainly Staphylococcus and Streptococcus.Gram-negative(G-)bacteria were in 16 cases(17.39％),mainly Escherichia coli and Enterobacter cloacae.There were 11 cases(11.96％)of multiple infections,including 5 cases of combined fungal infection.From 2016 to 2021,the incidence of G+bacteria-related PDAP decreased from 14 to 8 cases.G+strains were resistant to methicillin(35.00％),and were sensitive to linezolid(100.00％),teicoplanin(100.00％)and rifampicin(100.00％).The sensitivity rate to vancomycin was 98.59％.G-strains were sensitive to ceftazidime(86.36％),ceftizoxime(88.89％)and amikacin(100.00％).The MIC of vancomycin against Staphylococcus showed an upward trend in 2019-2021.The overall cure rate of PDAP was 81.33％in patients who responded to antibiotic treatment,and the cure rate of G+bacteria was higher than that of multiple infections(89.23％vs.36.36％,P＜0.01).The outcome of patients with multiple infections,especially those with concurrent fungal infection was poor.Conclusion The incidence of PDAP in the PD center has shown a decreasing trend in recent years.G+bacteria are still the main pathogenic bacteria causing PDAP,and they are highly resistant to methicillin,so vancomycin should be used as empirical therapy.For G-bacteria,cefotaxime and amikacin can be chosen as empirical therapy.There is a drift in the MIC values of vancomycin against Staphylococcus in the study period,so it is necessary to monitor the MIC of vancomycin against Staphylococcus and its changing trend.

Objective To evaluate the feasibility of anticoagulant therapy for acute proximal deep vein thrombosis without inferior vena cava filter placement for femoral neck patients before hip arthroplasty.Methods From January 2013 to August 2017,9 femoral neck fractures patients with acute proximal deep vein thrombosis before hip arthroplasty were enrolled into this study.There were 3 men and 6 women.The average age was 76.44±5.39 years old (range,69 to 83 years old).The average injured time before admission was 4.00±4.06 days.All patients received anticoagulant therapy without placement of inferior vena cava filter before hip arthroplasty.Four patients received Rivaroxaban 10mg,two times per day,while two patients received Enoxaparin 0.4 ml,two times per day;3 cases received Batroxobin 0.5 ml,every other day combined with Rivaroxaban 10 mg one time per day or Enoxaparin 0.4 ml,one time per day.The size of thrombus before and after treatment,changes of coagulation markers,the outcome of thrombosis before surgery,during surgery,postoperatively and during follow-up,the related complications were recorded.Results The diagnosis time for proximal DVT was 3.89±3.01 days after admission.8 patients showed proximal DVT combined with distal thrombus and 1 patient showed isolated proximal DVT.The average length of proximal thrombus was 10.78±6.10 cm (range,4.0-20.0 cm).The mean duration of treatment was 14.22±7.03 days.The results showed 5 proximal DVTs have complete disappeared,3 cases significantly improved,and 1 case had no change but showed stable.After treatment,the length of the proximal thrombus was significantly decreased (10.77±6.10 cm vs.4.39±6.50 cm),there were statistically significant between two groups (t=3.429,P=0.009);D-dimer was significantly lower after treatment (10.47±4.87 μg/ml vs.2.59± 1.60 μg/ml) with statistical difference (t=4.970,P=O.O01).However,no statistical significance was found in other coagulation parameters such as plasma prothrombin time,the international normalized ratio,activated partial thromboplastin time,thrombin time,fibrinogen.Incision exudate occurred in one patient and anticoagulant therapy was paused,however,two days later,DVT recurred and then the patient received continuous therapy with drug anticoagulation.The average time for postoperative follow-up was 8.3±7.6 months.At the latest follow-up,4 cases had thoroughly recovered with the thrombi fully resolved;4 cases had significantly improved including three thrombi partly locating in the muscular veins and one partly locating in the infra-popliteal vein.One case became more severe after discharge and received continuous anticoagulant therapy.No death,symptomatic pulmonary embolism,bleeding and other adverse events occurred.Conclusion Inferior vena cava filter placement for femoral neck fracture patients with acute proximal venous thrombosis before hip arthroplasty may not be potent.Anticoagulant therapy which make the proximal thrombus completely dissolved or stabilized before surgery may be effective.