OBJECTIVE:To explore therapeutic efficacy and safety of Puerarin injection for elderly female patients with osteo-porosis and unstable angina pectoris,and its effects on serum inflammatory factors. METHODS:Totally 107 elderly women with osteoporosis and unstable angina were analyzed retrospectively and divided into control group(53 cases)and observation group(54 cases) according to drug use. Control group was given routine treatment as Caltrate D,Alendronate sodium tablet,Glyceryl trini-trate tablet ,Metoprolol tartrate tablet,Atorvastatin calcium tablet,Trimetazidine hydrochloride tablet. On the basis of control group, observation group was additionally given Puerarin injection 4 mL added into 5% Glucose injection 500 mL intravenously,once a day. Treatment course of 2 groups lasted for 2 weeks. Therapeutic efficacies of 2 groups were observed as well as the levels of se-rum inflammatory factors(hs-CRP,TNF-α,MMP-9,sCD40L),and the occurrence of ADR. RESULTS:The total response rates of angina pectoris and osteoporosis pain in observation group were significantly higher than control group,with statistical signifi-cance (P<0.05). Before treatment, there was no statistical significance in serum inflammatory factors as hs-CRP, TNF-α, MMP-9,sCD40L between 2 groups (P>0.05). After treatment,the levels of hs-CRP,TNF-α,MMP-9 and sCD40L in 2 groups were significantly lower than before,and the observation group was significantly lower than the control group,with statistical sig-nificance(P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:Based on routine treatment,Pu-erarin injection shows significant therapeutic efficacy for senile female osteoporosis patients with unstable angina and can significant-ly reduce the levels of serum inflammatory factors with good safety.

Objective To compare the differences and characteristics of the dose distribution of the two optimization methods in the three dimensional brachytherapy,and provide the basis for clinieal treatment.Methods Excel 2007 was used to generate random number.And a total of 21 patients of cervical cancer were selected from those who have completed the treatment.Inverse simulated annealing optimization (IPSA) plans were designed for graphical optimization (GO) plans.The dose volume histogram (DVH) parameters of the targets (V100％,V150％) and the organs (D1 cm3,D2cm3) of the two methods were analyzed.Results The targets dose of both plans could meet the prescription requirements.There was no statistically significant difference in the dose parameters of all targets (P ＞ 0.05).The closes of D1 cm3 and D2cm3 in the bladder of IPSA plan were significantly lower than that of the GO plan (t =3.596,3.490,P ＜ 0.05).There was no statistically significant difference in the dose parameters of rectum (P ＞ 0.05).Conclusions For cervix brachytherapy,the GO and IPSA have no effect on targets dose,but IPSA optimization can reduce the maximum dose of bladder.

Objective o investigate the prophylactic and therapeutic effects of montelukast,a cysteinyl leukotriene receptor-1 (CysLT1R) antagonist,on the delayed neuropsychological sequelae (DNS) in rat model of carbon monoxide (CO) poisoning and to explore the possible underlying mechanism.Methods A total of 90 rats were acclimated for one week prior to screening rat by Morris water maze test.Ten rats were randomly assigned to control group (Con group),and the remaining 80 rats were subjected to modified method of intraperitoneal injection of CO gas to establish animal model of acute CO poisoning,Thereafter,the survival rats randomized into CO poisoning group (Mod group),low-dose montelukast group (ML group),medium-dose montelukast group (MM group),high-dose montelukast group (MH group) (n =10 each).Montelukast was accordingly administered via intragastric tube at different intervals (30 min,4 h and 12 h) after CO poisoning,and then montelukast was administered every 12 hours for 7 consecutive days.The rats of control group and Mod group received equal volume of normal saline instead at given intervals.Twenty-one days after CO exposure,the average escape latency was measured by Morris water maze test to screen DNS rats followed by H-E staining to observe the pathological changes of cortex and hippocampal CA1 region and TUNEL was used to assess the apoptosis of neurons in cortex and hippocampal CA1 region after rats sacrificed.Results All CO-exposed rats exhibited cognition function lowered,and the escape latency (seconds) in Mod group (43.3 ± 15.5),ML group (31.5 ± 13.2) and MH groups (30.1 ± 12.2) was significantly prolonged compared with Con group (12.1 ± 3.0) (P ＜ 0.05),whereas the difference between MM group (15.0 ± 6.6) and Con group was statistically insignificant (P ＞ 0.05).Compared with Mod group,the escape latency in montelukast treatment groups was shortened,whereas the significant difference in escape latency only found between Mod group and MM group (P ＜ 0.05).Except for Con group,DNS was evident in CO-exposed groups,and the numbers of DNS rats in Mod,ML,MM and MH groups were 8,5,1,4,respectively,which made statistically significant differences to Con group (P ＜ 0.05) except MM group.The DNS incidence in MM group was lower than that in Mod group (P ＜ 0.05).Mod group exhibited severe histopathological injury to the brain,with evident apoptosis of neural cells,whereas in the groups with montelukast treatment,histopathological damage to the brain was mitigated and the number of apoptotic neuronal cells was diminished noticeably in MM group.Conclusion Montelukast can ameliorate the cognitive function of rats,decrease the incidence of DNS and reduce the apoptosis of neural cells as well as attenuate neuronal cell injury,thus exerting neuroprotection against DNS in rats with CO poisoning.

Objective To investigate the therapeutic effect of oxiracetam combined with dexamethasone for treatment of patients with severe acute carbon monoxide poisoning (ACOP).Methods Eighty-seven patients with severe ACOP admitted to Affiliated Hospital of Xuzhou Medical University from January 2013 to July 2016 were enrolled, and they were divided into observation group (47 cases) and control group (30 cases) according to random number table method. The two groups were given conventional nerve nutrition, hyperbaric oxygen and symptomatic treatment, while in the observationgroup, on the basis of conventional treatment the patients received intravenous drip of dexamethasone 5 mg (with addition of normal saline 100 mL), once a day for consecutive 3 days, and intravenous drip of oxiracetam 3.0 g plus 100 mL normal saline, once a day for consecutive 7 days. The changes of mini-mental state examination (MMSE), Barthel index and Glasgow coma scale (GCS) were observed after discharge for 30 days, and the differences of the incidence of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and hospitalization time between the two groups were compared.Results After treatment the MMSE and GCS scores of the two groups were higher than those before treatment, and the Barthel score was lower than that before onset. After discharge for 30 days, MMSE score (26.93±2.92 vs. 24.20±6.82), GCS (14.41±1.32 vs. 13.98±2.13), Barthel (94.78±12.62 vs. 85.25±19.57) of the observation group were significantly higher than those of control group, and the incidence of DEACMP was obviously lower than that in the control group [8.5% (4/47) to 17.5% (7/40)], the differences between the two groups being statistically significant (allP < 0.05); the hospitalizationtime of the observation group was shorter than that of the control group (days: 10.81±5.49 vs. 13.05±6.84), but there was no significant difference between the two groups (P > 0.05).Conclusion Early combined application of oxiracetam and dexamethasone can significantly improve the cognition and self-care abilities and reduce the incidence of DEACMP in patients with severe ACOP after discharge for 30 days.

Objective To study the impacts of different applicators on dose distribution in 192 Ir brachytherapy. Methods The inner tubes of two cylinder applicators from Nucletron,#101?001 and#084?350, were made of plastic and stainless steel, respectively. The cylinder parts of them were made of plastic, and had four different radiuses:1?00 cm, 1?25 cm, 1?50 cm, and 1?75 cm. EGSnrc program was used to simulate dose distribution when applicators were present in a phantom, and the results calculated by the treatment planning system were compared with the results of EGSnrc. The impacts of applicators on dose distribution were analyzed with different materials, thickness, and numbers of resident source. Results There was no significant relationship between dose deviation and the radius for the two applicators. When an applicator was present, the actual dose delivered to a patient was smaller than the planned dose. The dose deviation of the applicator#101?001 was no more than 1%, while the dose deviation of the applicator#084?350 was close to 3%. The dose deviation remained the same when the number of resident source changed. Conclusions The plastic applicator, if possible, is the best choice for brachytherapy right now. In a long term, in order to promote the accuracy of brachytherapy, current dosimetry algorithm should be improved, and the impacts of the applicator made of metal, such as stainless steel, on dose distribution should be taken into account.

Objective To study the clinical characteristics which are related to malignancy in pancreatic intraductal papillary mucinous neoplasm (IPMN) with an aim to provide evidence for clinical practice.Methods Using PubMed,all pancreatic IPMN related articles with positive pathologic results before July 30th,2011 were studied.A pooled analysis was carried out on the morphological features of the disease.The analysis included gender,diameter of main pancreatic duct,diameter of cystic lesion,mural nodules and histological types (benign/malignant) of the neoplasm.Results 98 articles (including 1902 cases) were collected and analyzed.1025 cases were benign (53.89％) and 877 cases (46.11 ％) were malignant.Morphologically,there were a correlation between main pancreatic duct dilatation (≥5 mm),cystic lesion of large size (≥30 mm),presence of mural nodules and malignancy.The OR (95％ CI) were 5.591 (3.657-8.548),3.633 (2.626-5.027) and 4.983 (3.872-6.412) respectively.Conclusions A main pancreatic duct dilatation (≥5 mm),cystic lesions of large size (≥30 mm) and presence of mural nodules prompt the tumor to be malignant.In clinical work,the management of pancreatic IPMN should be made prudently based on comprehensive analysis of clinical features and the patient's status and intent.

Objective To investigate the relationship between the immunohistochemical types and the pathological types of pancreatic intraductal papillary mucinous neoplasms (IPMN).Methods Literatures on the diagnosis and treatment of pancreatic IPMN published before June 30,2011 in the PubMed database were retrieved.The literatures adopted were scored by the case reports quality assessment list.The correlation analysis between the immunohistochemical types and the gender,pathological types,characteristics of benign or malignant tumor and morphological types were analyzed.All data were analyzed using the Pearson chi-square test or multiple regression analysis.Results Thirteen literatures were adopted,the scores were 31-45 (full mark:50),and the mean score was 37.The clinical data of 826 pancreatic IPMN patients who were comfirmed by pathological examination were collected,and there were 4 immunohistochemical types:(1) The gastric type (363 patients).Of the 271 patients who underwent gender analysis,there were 195 males and 76 females,with the median age of 65.6 years.Of the 225 patients who underwent pathological types analysis,there were 146 cases of adenoma,34 cases of borderline tumor,24 cases of carcinoma in situ,21 cases of invasive carcinoma,the benign tumor was accounted for 86.68％ (293/338).Of the 215 patients who underwent morphological type analysis,there were 34 cases of main pancreatic duct type,151 cases of branch duct type and 30 cases of mixed type.(2) The intestinal type (327 patients).Of the 269 patients who underwent gender analysis,there were 184 males and 85 females,with the median age of 64.5 years.Of the 262 patients who underwent pathological types analysis,there were 28 cases of adenoma,43 cases of borderline tumor,91 cases of carcinoma in situ,100 cases of invasive carcinoma,the benign tumor was accounted for 29.21％ (85/291).Of the 151 patients who underwent morphological type analysis,there were 63 cases of main pancreatic duct type,54 cases of branch duct type and 34 cases of mixed type.(3) The pancreatobiliary type (92 patients).Of the 78 patients who underwent gender analysis,there were 41 males and 37 females,with the median age of 69.2 years.Of the 81 patients who underwent pathological types analysis,there were 4 cases of adenoma,1 case of borderline tumor,21 cases of carcinoma in situ,55 cases of invasive carcinoma,the benign tumor was accounted for 5.75％ (5/87).Of the 34 patients who underwent morphological type analysis,there were 7 cases of main pancreatic duct type,18 cases of branch duct type and 9 cases of mixed type.(4) The oncocytic type (44 patients).Of the 37 patients who underwent gender analysis,there were 24 males and 13 females,with the median age of 60.3 years.Of the 33 patients who underwent pathological types analysis,there were 18 cases of carcinoma in situ,15 cases of invasive carcinoma,and all of them were with malignant tumors.Of the 36 patients who underwent morphological type analysis,there were 9 cases of main pancreatic duct type,16 cases of branch duct type and 11 cases of mixed type.The immunohistochemical type of pancreatic IPMN was correlated with gender,pathological type and characteristics of maglignant or benign tumors (x2=10.626,281.839,333.212,r =0.097,0.569,0.625,P ＜ 0.05).The result of the chi-square test between the immunohistochemical types and the morphological types was statistically significant (x2 =50.732,P ＜ 0.05),but there was no correlation between them (r =0.010,P ＞ 0.05).Conclusion The immunohistochemical type of pancreatic IPMN is correlated with gender,pathological type and the characteristics of maglignant or benign tumors,which provide references for the diagnosis and prognosis evaluation of pancreatic IPMN.

AIM: To compare the effects of ceftibuten and ofloxacin in treating urinary tract infections (UTI).　METHODS: The 102 UTI patients (M 45, F 57; age 49 a±　s 13 a) were divided randomly into two groups (each group including 51 patients). The ceftibuten group (31 secondry UTI patients and 20 primary UTI patients) were given ceftibuten 400 mg, po, qd for 10.4 d±2.7 d. The ofloxacin group (30 secondary UTI patients and 21 primary UTI patients) were given ofloxacin 100 mg, po, tid for 10 d±3 d.　RESULTS: The total effect rate of two groups was 92 % and 76 %(P<0.05) respectively. The total bacterial clearance rate of two group was 92 % and 78 % (P>0.05) respectively. 　CONCLUSION: Ceftibuten is more effective than ofloxacin in treating UTI patients.

ObjectiveTo analyse the clinical characteristics of pancreatic intraductal papillary mucinous neoplasm (IPMN) which coexists with extrapancreatic malignancy (EPM),with an aim to provide strategies for clinical diagnosis and treatment.MethodsThe PubMed was used to search for the pancreatic IPMN related articles with positive pathologic results.A pooled analysis was then performed.The ratio ofpancreatic IPMNs coexisting with EPMs and the locations (or the type) of EPMs were analyzed.ResultsAfter a strict process of screening,18 articles met the pre-determined standardsand were accepted.Of the 1327 patients,363 had coexisting EPMs (27.35％).There were 392 EPMs in these 363 patients.The EPMs occurred in almost all the systems of the body,especially in the digestive tract and its related organs,which accounted for 63.06％ of the EPMs. Conclusions There is a tendency for patients with pancreatic IPMN to have coexisting EPM. More than half of these EPMs are malignant tumors in the digestive system. When pancreatic IPMN is diagnosed,the clinician should be aware of the possible coexistence of an EPM and should look for the possibility of a new EPM developing in a patient after treatment of pancreatic IPMN.

Objective To optimize the cerebral ischemia-reperfusion process for acute ischemic stroke patients,so as to reduce the time of in-hospital delays.Methods A multi-disciplinary management team was established to design the flowchart of the cerebral ischemia-reperfusion process for acute ischemic stroke patients.By applying Healthcare Failure Mode and Effect(HFMEA) management mode,intervention was conducted and its effect was analyzed.Results After implementation of the HFMEA intervention,the door to needle time(DNT)was reduced from 88 (42,140) minutes to 45 (37,59) minutes(P＜0.001);the ratio of patients with the DNT＜60 minutes increased from 20％ to 87.7％(P＜0.001);the door to cerebral ischemia-reperfusion time was shortened from 207(169,227) minutes to 165(155,185) minutes (P＜O.05).There was no significant difference in the incidence and mortality of symptomatic cerebral hemorrhage between before and after intervention (P＞0.05).Conclusion Utilization of HFMEA to optimize the emergency cerebral ischemia-reperfusion process can effectively reduce the in-hospital delays of acute ischemic stroke patients.