Because of the lymphatic drainage of the neck area level-Ⅰb of nasopharyngeal carcinoma is particular,and skip metastasis in the cervical lymph node is rare,the involved region of level-Ⅰb lymph node metastasis rate is low in nasopharyngeal carcinoma.In the three-dimensional radiotherapy era of precision radiotherapy,there is no consensus on whether level-Ⅰb need to be prophylactic irradiated in the clinic.

Objective To evaluate the effect of preoperative intramuscular injection of of dextromethorphan in three dosages on fentanyl consumption in postoperative PCA in order to optimize its pre-emptive analgesia dose. Methods 80 ASA Ⅰ-Ⅱ patients underwent spine operations under general anesthesia were randomly divided into four groups, who respectively received intramuscular dextromethorphan 10mg (DM10 group), 20mg (DM20 group), 40mg (DM40 group), or normal saline (CON group) respectively. The PCA fentanyl consumption as well as VAS pain scores were observed 4h, 24h, and 48h after the operation. Results Although there was no significant differences in pain VAS score between the four groups, the fentanyl consumption was significantly lower in groups DM20 and DM40 compared with group CON and DM10. However, there was no significant difference between group DM20 and group DM40. Conclusion Preoperative IM dextromethorphan shows a dose-dependant fentanyl spare effect on postoperative PCA, and a dose of 20mg seems to be optimal for preoperative use.

AIM: To establish the HPLC fingprint spectrum of Radix Arnebiae as identification. METHODS: HPLC fingerprint spectrum of Radix Arnebiae collected from the seven production places and that of Radix Lithospermi from three production places were evaluated based on shikonin content. RESULTS: The major features of HPLC fingerprint of the seven production places were approximately similar to control sample there was no significant difference among the contents but Radix Lithospermi from three production places were not the same. CONCLUSION: The HPLC fingerprint spectrum of Radix Arnebiae can be used as an identification.It may provide the basis for quality control of Radix Arnebiae.

Objective To explore characteristics and treatment of the clinical crises myasthenia sufferer.Methods Retrospective analysis 32 patients with clinical data of MG crises,intravenous immunoglobulin all.Results Treating group,recovered in 1 case,the basic recovery in 4 cases,markedly effective in 6 cases,improved in 3 cases,Ineffective in 2 cases;the total effective 31.25%.Conclusion Group,recovered in 0 case,the basic recovery in 1 cases,markedly effective in 2 cases,improved in 3 cases,Ineffective in 10 cases; efficient 37.50%.Two groups of efficient comparative greup(X2 = 4.54 ,P <0.05) conclusion:Improved the patients's clinical symptoms after intravenous injection of gamma globulin,and the titer of patients with blood AchRAb significantly lower than that before treatment.

Objective To investigate the predictive value of serum glycated hemoglobin A1c (HbA1c)level and early neurological deterioration (END)in patients with acute cerebral infarction. Methods From June 2014 to January 2016,the consecutive patients with acute ischemic stroke (interval time from onset to admission < 3 days)admitted to the Department of Neurology,Suqian People′s Hospital were enrolled retrospectively. The neurological deficits of all patients were evaluated on the day of admission with the National Institutes of Health Stroke Scale (NIHSS). The symptoms of neurological deficits in patients were evaluated repeatedly for all patients within 7 days after admission. Any score increased ≥2 compared with before admission was defined as END. The 226 patients met the inclusion and exclusion criteria were enrolled,and they were divided into either an END group (n = 50,22. 1%)or a non-END group (n = 176,77. 9%)according to whether END occurred after acute cerebral infarction. Univariate analysis was used to analyze the differences between the 2 groups. Multivariable Logistic regression analysis was used to analyze the correlation between the HbA1c level and END. Results Compared with the non-END group,there were significant differences in the age,prevalence of diabetes,NIHSS score,hypersensitive C-reactive protein level,rate of ASPECT score 0-7,and serum HbAlc level in the patients of the END group (all P < 0. 05). The results of logistic regression analysis showed that the elevated hypersensitive C-reaction protein and serum HbA1c levels were the independent risk factors for END of acute cerebral infarction (OR,1. 048 and 1. 809 respectively,95% CI 1. 008 -1. 089 and 1. 429 -2. 292 respectively;P = 0. 018 and 0. 002 respectively). Conclusion The increased serum HbA1c level is an independent risk factor for END of acute cerebral infarction. It has certain predictive value for END.

Objective To investigate the level Ⅰb contouring,dose analysis and regional recurrence in level Ⅰb lymph node-negative (Ⅰb-negative) nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT).Methods One hundred ninety newly-diagnosed,Ⅰb-negative NPC patients treated by IMRT were enrolled.Level Ⅰb contouring and dose prescribing in this cohort were classified into planned prophylactic irradiation (PPI) group (56 cases) and non-planned prophylactic irradiation (non-PPI) group (134 cases).The mean dose (Dmean) of the level Ⅰb bilaterally and submandibular glands (SMGs) was recorded for comparison.Results After a median follow-up of 47 months,there was no level Ⅰb regional recurrences noted in the entire group.The mean doses of level Ⅰb and the submandibular glands were significantly lower in the non-PPI group than those in the PPI group as follows:(50.81±5.37) Gy vs (59.68±3.32) Gy for the left level Ⅰb,(51.55±5.02) Gy vs (59.66±3.85) Gy for the left submandibular gland,(51.55±5.02) Gy vs (59.66±3.85) Gy for the right level Ⅰb and (57.25±4.69) Gy vs (63.41±2.88) Gy for the right submandibular gland (all P =0.000).Conclusion In this retrospective analysis of non-randomized single institute data,it seems unlikely that PPI to level Ⅰb is necessary in Ⅰb-negative NPC patients treated by IMRT.

Objective To investigate the effect of nerve growth factor on the levels of serum S100 protein and interleukin-6 (IL-6) in patients with acute brain injury.Methods 70 cases with acute craniocerebral injury from March 2013 to May 2015 in department of cerebral surgery of Tianjin port hospital were selected and divided into two groups according to random number method.The control group (35 cases) received conventional symptomatic treatment, the study group (35 cases) received conventional treatment on the basis of mouse nerve growth factor for injection, with a consecutive treatment of two weeks.On admission, one and two weeks after admission, the Glasgow coma scale ( GCS) score was recorded, serum S100 beta protein and IL-6 levels were measured by enzyme-linked immunosorbent assay ( ELISA ) and the clinical curative effect of cerebral edema eliminate was compared.Results After two weeks’ treatment, the total efficacy in control group was lower than that in study group (77.14% vs.94.29%) ( P<0.05).The GCS score of two weeks after admission in study group was lower than that in control group, serum levels of neuron-specific enolase (NSE), myelin basic protein ( MBP) , S100βprotein and IL-6 of one and two weeks after admission in study group were lower than those in control group ( P<0.05).Conclusion The nerve growth factor could decrease the levels of serum S100βand IL-6 and alleviate inflammation in patients with acute craniocerebral injury and the effect is obvious.

Objective To report specific clinico-radiological syndromes in neuropsychiatric systemic lupus erythematosus (NPSLE).Methods Ten patients with NPSLE in Peking Union Medical College Hospital from 2005 to 2011 were studied retrospectively with magnetic resonance imaging, computer tomography or positron emission tomography. Results Posterior reversible encephalopathy syndrome was diagnosed in 2 patients with radiological features,headache and tonic-clonic seizure;3 patients with bilateral diffuse leukoencephalopathy,cognitive disorder and acute confusional state; 1 Fahr' s disease patient,with cognitive disorder and psychiatric symptom,movement disorder; 2 Parkinsonism patients with tremor and cogwheel rigidity,and 2 chorea patients. Conclusions The emergence of diffuse brain calcinosis,leukoencephalopathy and edema may happen in lupus encephalopathy particularly.Autoantibody reaction and vascular disease may play an important role in movement disorder including Parkinsonism and chorea.

Objective We conducted a case-control study to verify the association of rs2070045 SOLR1 polymorphism with PD in the northern Han Chinese population from mainland China.Methods A total of 215 unrelated Han Chinese healthy people and 377 PD patients were included in the study.According to the onset age,the PD patients were divided into 2 groups:early onset PD group (onset age ≤ 50 years old) and late onset PD group (＞50 years old).Clinical data was collected and peripheral blood genomic DNA was extracted using MALDI-TOF-PEX technology.The correlation of rs2070045 SOLR1 with Parkinson's disease was analyzed.Results Genotypic frequencies of rs2070045 SNP were investigated through the data from a total of 592 subjects including 377 PD patients and 215 control participants.Genotypes of TT,TG and GG were found in 52,182 and 143 PD patients respectively and in 31,13 and 71 Healthy controls.No significant differences were found in the genotype and allele frequency for rs2070045 between PD group and healthy control (HC) groups.The genotype for rs2070045 in the early-onset PD group was significantly different from that in the HC group (P=0.036).There were no significant differences in genotype and allele frequency between late-onset PD and HC groups.Moreover,carriers of the G-allele (genotype GG/ TG) of rs2070045 showed a significantly decreased risk of early-onset PD compared to non-carriers according to the Logistic regression analysis.Onset age of carriers (genotype GG/ TG) in late-onset PD group was lower compared to non-carries (P=0.001).Other clinical features such as gender,Hoehn-Yahr stage and disease duration had no statistical difference between carriers and non-carriers of PD patients.Conclusion We have found that rs2070045 SNP of SORL1 was associated with early-onset Parkinson's disease in the northern Han Chinese population.G-allele of rs2070045 SNP decrease the risk for early-onset PD,suggesting G-allele might be a protecting factor of early-onset PD.The influence of SORL1 gene polymorphism on Parkinson's disease warrants further investigation.

0.05). Conclusions Gastric hypersensitivity, impaired proximal gastric accommodation and delayed gastric emptying may be important but independent pathophysiological factors of FD. Different pathophysiological factors can coexist in one patient with FD.