ObjectiveTo evaluate the efficacy and toxicity in local regionally advanced nasopharyngeal carcinoma(NPC) patients treated by cetuximab combined with intensity modulated radiation therapy.Methods58 cases of untreated NPC patients were randomly divided into treatment group and control group.The treatment group was given the treatment of cetuximab combined with intensity modulated radiation therapy,the control group was given the treatment of intensity modulated radiation therapy.The short-term efficacy and toxicity were evaluated,followed up for 1-year the objective response was evaluated.ResultsAfter treatment and 3 months after treatment,the CR rate of the nasopharynx and cervical lymph node of the treatment group were higher than the control group,compared with control group the difference was significant(P ＜0.05) ;Follow-up rate was 100％,the median follow-up time was 12 months,all patients were no deaths in the follow-up period; the local control rate of the treatment group was 89.3％,it was higher than the control group(73.3％ ),compared with control group the difference was significant( P ＜0.05) ;The distant metastasis rate of the treatment group was 3.6％,it was lower than the control group(23.3 ％ ),compared with control group the difference was significant( P ＜0.05) ;Most acute toxicity of the two groups were 1 to 2 degrees,and the difference was not statistically significant( P ＞ 0.05 ) ; During the treatment,28 patients of the treatment group occurred acne-like rash,after symptomatic treatment and nutritional support therapy was initiated.ConclusionThe cetuximab combined with intensity modulated radiation therapy in treatment of local regionally advanced nasopharyngeal carcinoma had better efficacy and lower toxicity,the therapy method was worthy to be popularized.

Objective To evaluate the relationship between emergency department length of stay (EDLOS) and outcome of multiple trauma patients in ICU.Methods A retrospective cohort study was performed in multiple trauma patients admitted from the emergency department to ICU during 2010.Patients' data were recorded,including demographic information (gender,age,etc.),characteristics of injury (injury causes,diagnosis,ISS,GCS,emergency operation rate,type of operation),and outcome (inhospital mortality,length of ICU stay,total length of hospital stay,expenditure).Patients were assorted into delayed group (EDLOS ＞ 6 h) and non-delayed group (EDLOS ≤ 6 h),then demographic information,characteristics of injury,and outcome were compared between the two groups.Multivariate Logistic and linear regression analyses were performed to identify the correlation between EDLOS and outcome for all patients and for those with and without emergency operation.Results A total of 476 patients aged (47.5 ± 16.0) years were enrolled in the study and male patients accounted for 73.5％.Median ISS was 29 points (interquartile range,22-34 points),median EDLOS was 4.0 hours (interquartile range,2.8-6.4 hours),and inhospital mortality was 9.2％.Delayed (n =135) and non-delayed (n =341) groups were similar in age,gender,ISS,inhospital mortality (13.3％ vs 7.6％),length of ICU stay,and total length of hospital stay (P ＞ 0.05).Multivariate analysis demonstrated prolonged EDLOS increased inhospital mortality (OR=3.19,95％ CI 1.28-7.95,P ＜ 0.05),especially in patients without emergent operation (OR =4.01,95％ CI 1.31-12.27,P ＜ 0.05).However,prolonged EDLOS produced no effect on mortality in patients with emergent operation (OR =1.72,95％ CI 0.79-3.43,P ＞0.05),length of ICU stay,total length of hospital stay,and expenditure.Conclusion Prolonged EDLOS increases mortality of multiple trauma patients admitted to ICU,especially in patients without emergency operation,thus rapid transportation of these patients from emergency room to ICU will improve the outcome.

Objective To observe the effect of endostatin(Endostar) combined with radiotheraphy on the growth,microvessel density (MVD),the expressions of regulators of G-protein signaling 5 (RGSS),vascular endothelial growth factor (VEGF) and hypoxia-induced factor-1 α (HIF-1 α) ingastric transplantation tumor,and to explore underlying mechanism.Methods Thirty-two tumor-bearing mice were randomly divided into four groups including control group,ES group,RT group and ES + RT group.Then the tumor-bearing mice survival and tumor volume alterations were observed.After treatments of drug and RT,the inhibition rate of tumor growth and tumor MVD were measured.Immunohistochemical staining method was used to detect the expressions of RGS5,VEGF and HIF-1α.Results Compared with the ES group and control group,the ES + RT and RT treatment had effective anti-tumor effect(t=7.4,5.6,P ＜ 0.05),where as the ES + RT was more obvious in anti-tumor with the lowest value of MVD in tumor.Compared with the control group,the expression of HIF-1α in ES group,RT group,and especially ES + RT group was significantly reduced (t =6.5,8.2,13.1,P ＜ 0.05).The expression levels of VEGF and RGS5 wereincreased in RT group but was reduced in ES group and ES + RT group,and the expressions of VEGF and RGS5 in ES group and ES + RT group had no significant difference (P ＞ 0.05).Rank correlation analysis showed the expression of HIF-1α and the expressions of VEGF and RGS5 were positively correlated (r =0.57,0.71,P ＜ 0.05).Conclusions A possible mechanism of Endostar combined with radiotherapy on tumor growth inhibition may due to the inhibition of HIF-1α and its downstream VEGF and RGS5,and then inhibit tumor angiogenesis that results in the recovery of tumor blood vessels and tumor oxygen supplement.

Objective To observe the effects of lower limb motion control training using virtual games combined with core stability training (CST) on the lower limb motor function of hemiplegic patients after stroke.Methods Sixty hemiplegic stroke patients were divided into an observation group and a control group (n =30 in each) using a random number table.The control group was given conventional treatment and CST,while the observation group received lower limb motion control training using virtual games in addition to conventional treatment and CST.All of the patients were assessed using the Fugl-Meyer lower limb assessment (FMA),the Berg balance scale (BBS),the modified Barthel index (MBI),10 metre maximum walking speed (MWS) and functional ambulation categorization (FAC)before and after 8 weeks of treatment.Results Before the intervention there was no significant difference between the two groups in any of the measurements.After the treatment,however,the average FMA,BBS,MBI,MWS and FAC in the observation group were significantly better than those before treatment and those in the control group.Conclusions Lower limb motion control training using virtual games combined with core stability training can improve effectively the lower limb motor function of hemiplegic patients after stroke.Such a combination is worth applying in clinical practice.

Objective To investigate the relation among clinical nurses′resilience, emotional, the pressure load and self-efficacy with the 10-item Connor-Davidson Resilience Scale. Methods A total of 449 nurse in Guangzhou were recruited to investigate by 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Kessler 10 Scale (K10), General Self-Efficacy Scale (GSES), Chinese Stress Overload Scale (SOS). Results The average score was 23.6±6.7 for CD-RISC-10 , 24.4±8.2 for K10,24.7±5.7 for GSES , 63.3 ±16.6 for SOS ,and the individual vulnerability scoring was (31.2±10.0) points, events load was (32.0±7.5) points. High mental toughness of nurses in general self-efficacy scores higher than that of low mental toughness group (t=-8.53, P<0.01), in the K10 dated, S0S scores were lower than low mental toughness group (t=11.23, 7.70, P<0.01). Nurse relevant regression analysis results showed that gender, general self-efficacy, K10 dated, SOS as the main factors influencing nurses mental toughness, could explain 40%of variances. Conclusions The CD-RISC-10 can better reflect the level of clinical nurses′resilience, and the gender, self-efficacy were the main effects, as well as effectively predict the nurses′emotional distress and stress level. However how to improve the toughness of the clinical nurses need more research.

Objective To explore the effect of rituximab on serum hepcidin (Hepc), soluble CD40 ligands (sCD40L), platelet derived growth factor-BB (PDGF-BB) and lactate dehydrogenase (LDH) in patients with malignant lymphadenoma.Methods 52 patients with malignant lymphoma from the hospital were randomly divided into control group and experimental group.The control group were treated by cyclophosphamide, pirarubicin, vincristine and prednisone and the experiment group were treated on the basis of control group with rituximab.The serum hepcidin, sCD40L, PDGF-BB and LDH levels were compared after treatment.Results Compared with pre-treatment, the serum hepcidin, PDGF-BB and LDH levels were lower( P<0.05), the sCD40L level was higher(P<0.05) post-treatment.The serum hepcidin, PDGF-BB and LDH levels in experimental group post-treatment were lower, sCD40L level was higher than those in control group(P<0.05).Conclusions The rituximab could reduce serum hepcidin, PDGF-BB and LDH levels and elevate serum sCD40L level in patients with malignant lymphadenoma.

Objective To investigate the effect of exercise preconditioning on serum level of tumor necrosis factor α (TNF-α), interleukin (IL) -1β and IL-6 in rats after cerebral ischemia-reperfusion (I/R). Methods 24 male Sprague-Dawley rats were randomly divided into exercise preconditioning group (n=8), model group (n=8) and sham group (n=8). The middle cerebral arteries were occluded for 120 min and re-perfused. All the rats were evaluated with neurological deficit score 2 hours, 24 hours after I/R. The serum levels of TNF-α, IL-1β and IL-6 was detected with enzyme-linked immunosorbent, and the pathology was observed with HE staining 24 hours after I/R. Results The neurological deficit score decreased in the exercise preconditioning group compared with that in the model group, as well as the serum TNF-α, IL-1β and IL-6 (P<0.05) 24 hours after I/R. The pathological damage and interstitial edema alleviated in cerebral ischemia cortical, and the degeneration and necrosis of the neurons in the ischemic area significantly reduced in the exercise preconditioning group. Conclusion Exercise preconditioning may inhibit inflammatory response in I/R rats to protect neurological function from impairment.

Objective To observe the effect of acupuncture plus rehabilitation on neurologic deficit and the expression of vascular endothelial growth factor (VEGF) protein in cortex on the infarction side in rats with focal cerebral infarction, and to explore the action mechanism of acupuncture plus rehabilitation in promoting the recovery of impaired function in rats.Method Ninety healthy male Sprague-Dawley (SD) rats were randomized into a model group, an acupuncture group, a rehabilitation group, an acupuncture-rehabilitation group, and a sham operation group, and the five groups were further divided into three subgroups, i.e. 3 d, 7 d, and 14 d subgroups, 6 rats in each subgroup. The modified Zea-Longa method was adopted to prepare the model of middle cerebral artery occlusion (MCAO) on theright side. Rats in the acupuncture group received simulant scalp-points cluster needling; the rehabilitation group was intervened by treadmill exercise; the acupuncture-rehabilitation group was intervened by scalp-points cluster needling plus treadmill exercise; the model group and sham operation group didn't receive any interventions. The modified Neurological Severity Score (mNSS) was adopted to evaluate the rat's neurologic deficit, and Western blotting was used to detect the expression of VEGF protein in cortex on the infarction side.Result Neurologic deficit wasn't found in rats in the sham operation group. After 3-day treatment, the mNSSs in the acupuncture group, rehabilitation group, and acupuncture-rehabilitation group were insignificantly different from the score in the model group (P>0.05), while the differences were statistically significant respectively after 7-day and 14-day treatment (P<0.05). Respectively after 7-day and 14-day treatment, the mNSS of the acupuncture-rehabilitation group was significantly lower than that in the acupuncture group and rehabilitation group (P<0.05); there was no significant difference in comparing the mNSS between the acupuncture group and rehabilitation group (P>0.05). After 3-day treatment, the expression of VEGF protein in each treatment group was insignificantly different from that in the model group (P>0.05), while the expression of VEGF protein in each treatment group was significantly higher than that in the model group respectively after 7-day and 14-day treatment (P<0.05). Respectively after 7-day and 14-day treatment, the expression of VEGF in the acupuncture-rehabilitation group was significantly different from that in the acupuncture group and rehabilitation group (P<0.05); there were no significant differences in comparing the expression of VEGF at each time point between the rehabilitation group and acupuncture group (P>0.05).Conclusion Scalp-points cluster needling and rehabilitation both can improve the neurologic function in rat models of focal cerebral infarction, and enhance the expression of VEGF protein in infarction cortex, and the integration of acupuncture and rehabilitation can achieve a better result; the action mechanism is possibly related to the high expression of VEGF which can better promote the reconstruction and regeneration of the vessels in cerebral infarction area.

Objective To investigate the effect of electroacupuncture or exercise preconditioning on neurological function after focal ce-rebral infarction in rats and the possible mechanism. Methods A total of 24 male Sprague-Dawley rats were randomly divided into model group (n=6), sham group (n=6), exercise preconditioning group (n=6) and electroacupuncture preconditioning group (n=6). The model group and the sham group did not accept any treatment, while the exercise preconditioning group and the electroacupuncture precondition-ing group accepted treadmill training and electroacupuncture for two weeks, respectively. Their middle cerebral arteries were occluded with modified Longa's approach, except the sham group that was ligated the same arteries but did not result in infarction. They were evaluated with Neurologic Severity Scores (NSS) 24 hours after modeling, and the laminin expression in the ischemic area was detected with Western blotting. Results There was no neurological deficit in the sham group. The NSS was lower in both preconditioning groups than in the model group (P<0.05), but was not significant different between preconditioning groups (P>0.05). The expression of laminin was the most in the sham group, and was more in both preconditioning groups than in the model group (P<0.05), but was not significant different between pre-conditioning groups (P>0.05). Conclusion Preconditioning with exercise or electroacupuncture can both reduce the neurological deficits in rats after focal cerebral infarction, which may associate with the protection of laminin from inhibition in early stage.