Objective To evaluate the effect of inpatient early palliative care (EPC) in nasopharyngeal carcinoma (NPC) patients receiving concurrent radiochemotherapy. Methods Totally 130 NPC patients were divided into the experimental group (64 cases) and the control group (66 cases) according to random digit table. Both groups received routine nursing and anti-cancer therapy, in addition, the experimental group received inpatient EPC. Psychological pain, myelosuppression and hospitalization expenses were compared between two groups. Results After the inpatient EPC intervention, the Distress Thermometer (DT) scores of the control group vs. the experimental group was 3.53±1.45 vs. 4.32±1.29, the scores of quality of life was 86.03±6.24 vs. 101.7±8.82, the incidence of myelosuppression was 95.45% (63/66) vs. 56.25%(36/64), and the hospitalization expenses of the patients was 110 862.82±4 849.58 vs 105 047.75±2 751.41 yuan, there were significant differences between the two groups (t=3.274,-11.665, Z=-6.701, t=8.441, P<0.01 or 0.05). Conclusions Inpatient EPC can be effective in reducing psychological distress, myelosuppression and the hospitalization expenses as well as improving the quality of life in NPC patients receiving concurrent chemoradiotherapy.

Objective To investigate the repair function of extracorporeal membrane oxygenation (ECMO) in vivo for the liver after cardiac death with warm ischemia injury for 30 min from cardiac death swinc.Method Ten landraces,30 to 40 kg,randomized to experimental group and control group,were used to make 30-min cardiac death models through clamping trachea after deep anesthesia.An intravenous cannula was placed through right iliac arteries and veins,and connected to ECMO extracorporeal circulation pipes in experimental group.The balloon catheter was placed to diaphragm plane through left femoral artery.The ECMO was performed to infuse abdominal organs,and pH and electrolyte were adjusted.The circulation flow rate,intraperitoneal organ perfusion pressure,venous blood gas,electrolyte,transaminase,and bile product,etc.were monitored and recorded.The livers of control group were retrieved after 30-min cardiac arrest and stored in cold UW for 4 h.Pathological tissue was sliced and stained by HE.Result After 30-min cardiac arrest,the liver showed obvious congestion appearance; pathologically,there were hepatic sinus expansion,blood cells clog,and erythrocyte aggregation.Circulating blood gas analysis revealed severe acidosis.After the ECMO recirculation started,circulation flow rate maintained to 1 L/min,the liver gradually restored bright red,pathological biopsy showed that hepatic sinus expansion disappeared,and clogged blood cells dispelled.AST was markedly increased to (226.0 ± 28.0) U/L after 30-min cardiac arrest and reduced to (150.0 ± 30.0) U/L 4 h after the ECMO recirculation.Average bile production was 7.75 ml/h.Conclusion ECMO recirculation in vivo can repair the injured livers from cardiac death donor with 30-min cardiac arrest.

Objective To study the effect of extracorporeal membrane oxygenation (ECMO) in donor preservation and organ procurement of donation after citizens' death.Method From 2013 to 2014,according to the ECMO indications,we used ECMO to provide circulation and breathing support for circulatory or respiratory function failure donation after brain death (DBD) donor and uncontrolled donation after cardiac death(DCD) donors.Through percutaneous liver puncture and living tissue rapid frozen section,the liver steatosis and fibrosis degree was determined.ECMO indications,ECMO related parameters and the result of blood gas analysis were recorded.alanine aminotransferase(ALT),aspartate aminotransferase(AST) and creatinine(Cr) before and after ECMO intervention were detected to evaluate liver and kidney function and damage.Whether the liver and kidney reached the requirements of the organ transplantation was assessed.Result The ECMO was used in 6 donors.Five cases of DBD were assisted through V-A ECMO because of circulatory or respiratory function failure.In one case of uncontrolled DCD recirculation was established through the thoracic aorta-blocked V-A ECMO.Four livers and 8 kidneys,from 4 donors,were retrieved and transplanted.Two donors' organs were discarded for damage beyond the standard.Conclusion For DBD donor with circulatory or respiratory function failure and uncontrolled DCD donors,the use of ECMO to assist circulatory and respiratory function or establish DCD recirculation can avoid liver and kidney injuries from vascular active drugs and DCD warm ischemia injury,thus,reduce the organ discarding rate of donation after citizens' death.

Objective To investigate hospitalized children's nutritional risk and malnutrition occurrence,and to provide clinical basis for nutrition support.Methods Nutritional risk screening tool STRONGkids was applied to 651 cases of hospitalized children with nutritional risk screening,and through physical measurement to assess children' s nutritional status,at the same time during the patient's diagnosis,the length of time data for analysis was recorded.Results Of 651 cases of hospitalized children,7.07％ (46 cases) were of highly nutritional risk,80.95％ (527 cases) with moderate nutrition risk,and 11.98％ (78 cases) were of low nutrition risk.Malnutrition rate was 22.58％,moderate malnutrition in 111 cases (17.05％),severe malnutrition in 36 cases (5.53％).The first three high risk diseases were congenital heart disease,chronic liver disease and chronic kidney disease(x2 =21.43,P ＜0.01).According to the result of nutrition evaluation concluded with congenital heart disease,chronic kidney disease occurred with severe malnutrition was far higher than other diseases(x2 =16.53,P ＜ 0.05).Children with highly nutritional risk were more likely to have weight loss than the children with relatively low nutritional risk (P ＜ 0.05),and their length of hospital stay were obviously longer than the children with low or moderate nutritional risk (P ＜ 0.05).Conclusions The hospitalized children have high incidence of malnutrition,and different nutritional risks lead to different clinical outcomes.STRONGkids score method helps to evaluate nutritional risk in hospitalized children and detect malnutrition and potential deterioration,which is conducive to early comprehensive nutritional assessment and proper nutritional treatment,thus to improve their clinical outcomes.

Objective To explore the arterial function of the Miao nationality people who live in natural circumstance.Methods 244 Miaos were mcmited in our studv.Right blood pressure and biochemistry examination were measured.PWV and CAVI were measured using validated automatic devices and used as indexes of arterial stiffness.Ultrasonic indexes such as carotid diameter,carotid plaque,IMT、flow-mediated dilation(FMD) were measured as well.Results Body mass index,waist-to-hip ratio,heart rates,blood lipid level and glucose had no significant difierence between male and female groups.Arterial function indexes such as C-F PWV(9.50±2.14 vs.8.81±1.69,t=2.074,P=0.006),C-R PWV(11.39±1.74 vs.10.54±1.77,t=3.506,P<0.001),R-CAVI(8.25±1.35 vs.7.41±1.20,t=4.768,P<0.001),L-CAVI(8.21±1.30 vs.7.41±1.15,t=4.616,P<0.001),R-IMT(0.67±O.12 vs.0.63±0.13,t=2.503,P=0.012) and L-IMT(0.67±0.11 vs.0.63±0.14,t=2.337,P=O.018) had significant difference between the two groups.Conclusions The medical condition of the Mians needs to be impmved.It is useful to diagnose patients and hish risk people by systemic arterial function examination.

Objective To evaluate the efficacy of transcatheter arterial embolization (TAE) in treating oronasal cavity hemorrhage,and to discuss the the occurrence and prevention of complications.Methods The clinical data of 121 patients with refractory and fatal oronasal cavity hemorrhage,who were admitted to authors' hospital during the period from December 2005 to October 2013 to receive treatment,were retrospectively analyzed.A total of 116 patients were treated with TAE,and these patients were followed up for 1-3 months to evaluate the embolization effect and the occurrence of procedure-related complications was analyzed.Results Of the 116 patients,complete control of bleeding after TAE was achieved in 96 (82.7％),rebleeding within one week after TAE was seen in 19 (16.4％) and the bleeding was controlled by medication,and in the remaining one (0.9％) re-bleeding occurred within one week after TAE and embolization therapy had to be carried out again.No obvious complications occurred in 77 patients (66.4％);maxillofacial pain and numbness,low fever,limitation of mouth opening and other mild complications were observed in 35 patients (30.1％);one patient (0.9％) developed facial skin necrosis and severe headache;and 3 patients (2.6％) showed stroke symptoms due to cerebral embolism.Conclusion For the treatment of refractory and fatal oronasal cavity hemorrhage,TAE can quickly and effectively achieve the purpose of hemostasis;careful selection of proper embolization material based on the the different causes of bleeding and the responsible blood vessels is the key to ensure a successful TAE.The common postoperative complications include postembolization syndrome,local ischemia,local necrosis caused by peripheral ischemia;the main serious complications are skin necrosis of maxillofacial region and cerebral infarction caused by ectopic embolization.

Objective To evaluate the feasibility of the posterior C2 pedicle screw placement (C2 PSP) by MPR techniques of helical CT.Methods Totally 250 patients (500 sides) who underwent head and neck CTA examination were enrolled.The bony parameters and the arterial parameters were measured after MPR.The bony parameters included pedicle diameter (D),isthmus height (T),internal height (H),and the arterial parameters included medial shifting:lateral (L),neutral (N),medial (M);and the degree of riding included below (b),within (w),above (a).The prevalence of narrow pedicles,high-riding vertebral arteries (HRVA) and the subtypes of IAVA in the general population were calculated,and the statistical analysis between narrow pedicles,HRVA,IAVA and C2 vertebral arteries groove (C2 VAG) injury were performed.Results The rate of narrow pedicles and HRVA were 14.40％ (72/500) and 24.60％ (123/500;x2=141.984,P＜0.001).When it came to the simulation of the C2 PSP inserting,the incidence of C2 VAG injuries was 19.40％ (97/500).In narrow pedicle and HRVA patients,the C2 VAG injuries incidence were higher than that of without narrow pedicle and HRVA patients (both P＜0.001).In 58 sides (58/500,11.60 ％),the narrow pedicles and HRVA occurred simultaneously.There were statistical significance differences of narrow pedicles and HRVA and the C2 VAG injuries in different types of IAVA (all P＜0.001),the subtypes of IAVA M-a consisted most common,which account for 55.56％ (40/72),46.34％ (57/123) and 48.45％ (47/97),respectively.Conclusion Most of the C2 VAG injuries happened in narrow pedicles,HRVA or IAVA M-a type patients.MPR can be used to comprehensively evaluate osseous and arterial parameters,which will provide anatomy foundation to the screw placement of C2 pedicles.

Objective To investigate the mechanisms and proliferation inhibitory effects of atractylenolide Ⅰ on SK-OV-3 and OVCAR-3 ovarian cancer cell.Methods SK-OV-3 and OVCAR-3 cells were treated with atractylenolide I with various concentrations at 24 hours,48 hours and 72 hours,and the changes in proliferation were detected by MTT assay.The cell cycles were measured by PI staining and flow cytometry,and the expressions of cyclin D1 and CDK1 were detected by ELISA assay.Western blot was then applied to investigate the effects of atractylenolide Ⅰ on PI3K/AKT signaling pathway in SK-OV-3 and OVCAR-3 cells.Results Atractylenolide I could significantly inhibit the proliferation of SK-OV-3 and OVCAR-3 cells,and its inhibitory effects were concentration and time dependent.In addition,atractylenolide I could also significantly reduce the proportion of cells in S phase and increase the proportion of cells in G2/M phase,and these effects were associated with the down-regulation of CDK1.The results of Western blot indicated that PI3K/AKT signaling pathway was involved in the inhibitory effects of atractylenolide Ⅰ on proliferation and cell cycle.Conclusion Atractylenolide I can down-regulate the expression of CDK1 in ovarian cancer SK-OV-3 and OVCAR-3 cells through PI3K/AKT pathway,which led to cell cycle arrest in G2/M phase,and played an important role in proliferation inhibition of tumor cells.

ObjectiveTo evaluate the long term outcomes, toxicities and prognostic factors of the patients in Northwest China with nasopharyngealcarcinoma (NPC)treated by intensity-modulated radiotherapy (IMRT). MethodsFrom January 2006 to December 2009, 133 NPC Patients were treated by IMRT in Xijing Hospital, the Fourth Military Medical University. There were 22 treated by radiotherapy alone, 111 treated by platinum-based current chemo-radiothreapy. The prescription dose to the gross tumor volume was 66 - 76. 6 Gy/30 - 33 fractions, positive lymph nodes was 66. 0 - 72. 4 Gy/30 - 33 fractions.The higher and lower risk clinical target volume were irradiated with 56. 0 - 63. 5 Gy/28 - 33 fractions and 50. 4 -53. 2 Gy/28 fractions respectively. ResultsThe follow-up rate was 97. 7％. Follow-up time more than 2years,3years were 37cases ,44cases. The l-,2-and 3-year overall survival (OS) were 93. 8％, 88. 3％and 83.2％ ; local control rate were 99. 2％ ,95.4％ and 95.4％ ; regional control rate ( RC ) were 99. 2％,96. 8％ and 96.8％ ; and distant metastasis-free rate (DMFR) were 82. 8％, 79. 8％ and 79. 8％ ; the disease-free survival (DFS) were 84. 3％ ,76. 7％ and 76. 7％, respectively. Multivariate analyses revealed that N stage, age and anemia before radiotherapy were independent predietors for OS (x2 =5.56,9. 10,4.89,P=0. 018,0.003,0.027), and N stage was also independent predictors for DFS (x2 =8.98,P=0.003).Thegrade 3acutetoxicitiesweremueositis(34.7％),xerostomia(20. 1％ ), skin reaction ( 1.4 ％ ) and leucocytopenia ( 1. 4 ％ ). No grade4 acute and late toxieities were detected. Conclusions IMRT with or without chemotherapy achieved good long term survival in nasopharyngeal carcinoma treated by intensity-modulated radiotherapy, especially in LC and RC. Distant metastasis becomes the main treatment failure.N stage, age, and anemia before radiotherapy were the main prognostic factors in nasopharyngeal cancer patients.

Objective To investigate the relationship between serum inflammatory cytokines and atherosclerosis in type 2 diabetic patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods One hundred and three patients with type 2 diabetes were divided into OSAHS group (OSAHS group) and type 2 diabetes mellitus group (non-OSAHS group) according to the results of polysomnography(PSG),and 35 healthy subjects were selected as control group.Serum levels of total cholesterol,triglyceride,fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein (hs-CRP) and carotid intima-media thickness (IMT) were measured,and their relationship with OSAHS were analyzed.Results The waist circumference,BMI,FPG,HbA1c,IMT,TNF-α and CRP in OSAHS group were significantly higher than those in non-OSAHS group (P＜0.05).Logistic regression analysis showed that,IMT was independently associated with TNF-α and hs-CRP.Conclusion Patients of T2DM with OSAHS have poor blood glucose control and higher incidence of atherosclerosis.High levels of TNF-α and hs-CRP may be involved in the formation of atherosclerosis and plaque occurrence and development.