Obstract: Objective To study the effect of Guyanding Decoction(GYD) on the metabolism of oxygen-derived free radicals in the chicken model of knee osteoarthritis and to explore its therapeutic mechanism.Method Forty chickens were randomized into 5 groups: normal group,model group,low-dose GYD group,high-dose GYD group and Fenbid group.Low-dose group was administered 5 g/kg GYD and high-dose group with 10 g/kg GYD by gastric gavage.Fenbid group was given Fenbid 0.15 g/kg.The SOD activity and the MAD content in serum were detected in each group.Result The activity of SOD in model group was significantly lower than that in normal group(P 0.05).For the content of MDA,model group had a higher level than normal group(P 0.05).Conclusion The decoction of GYD exerts curative effect on experimental osteoarthritis by improving the activity of SOD,eliminating excessive oxygen-derived free radicals,decreasing the content of MDA,and preventing osteoarthritis patients from the injury of oxygen-derived free radicals.

Objective: To investigate the efifcacy and safety of low dose erythropoietin (EPO) for treating the patients with acute myocardial infarction (AMI) after percutaneous coronary intervention procedure.
Methods: A total of 80 patients of acute STEMI with successful PCI were randomized into 2 groups. EPO group, the patients received intravenous EPO 6000 IU in 100 ml of normal saline at immediately and 2, 4 days after PCI. Control group, the patients received 100 ml of normal saline at the same time points. n=40 in each group. The patients were followed-up for 6 months for routine blood test, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), the size of infarction, and plasma levels of BNP, hemoglobin. The major adverse cardiovascular events (MACE) and EPO related side effects were compared between 2 groups.
Results: The baseline condition was similar between 2 groups. With 6 months of treatment, EPO group showed obviously improved LVEF at 4 days after PCI, and decreased size of infarction, all P<0.05, while those indexes were similar in Control group, all P>0.05. In EPO group, with 6 months of treatment, LVESVI decreased from (49.76±32.65 ) ml/m2 to (34.78±19.98)
ml/m2, LVEDVI decreased from (92.23±27.65) ml/m2 to (84.52±25.76) ml/m2, all P>0.05, and in Control group, LVEDVI increased from (91.78±41.67) ml/m2 to (93.71±31.25) ml/m2, P>0.05. The incidence of MACE and EPO related side effects were similar between 2 groups, P>0.05.
Conclusion: Low dose EPO administration was effective and safe for treating AMI patients after PCI procedure.

BACKGROUND:The mechanism and effect of glycogen synthase kinase 3β(GSK-3β) in the differentiation of cardiac stem cel s into cardiomyocytes are stil unclear, although GSK-3βis closely related to the life activities of cel s.
OBJECTIVE:To investigate the changes of GSK-3βexpression in the treatment of myocardial infarction in rats undergoing cardiac stem cel transplantation.
METHODS:The isolation and culture of cardiac stem cel s were performed in 10 neonatal rats. Lentivirus overexpressing GSK-3βor LacZ (control) was constructed and transferred into cardiac stem cel s. Animal model of myocardial infarction was made in 30 Sprague-Dawley rats. Six weeks after model preparation, rat models were assigned into GSK-3β, LacZ or PBS group. GSK-3βor LacZ overexpressing cardiac stem cel solution or PBS in equal volume was injected into the rat myocardium, respectively. Four weeks after transplantation, the cardiac function and myocardial col agen production in rats were detected and compared.
RESULTS AND CONCLUSION:Compared with the other two groups, the left ventricular ejection fraction was significantly higher, and the left ventricular end diastolic diameter was significantly lower in the GSK-3βgroup (P<0.05). Hydroxyproline content, type I col agen mRNA, and type III col agen mRNA expression were significantly lower in the GSK-3βgroup than the other two groups (P<0.05). Findings from Masson staining showed that the content of blue-stained col agen was significantly lower in the GSK-3βgroup than the LacZ group. Moreover, lowest myocardial infarction size was found in the GSK-3βgroup (P<0.05). Al these experimental findings show that GSK-3 overexpression plays a positive role in promoting the therapeutic effect of cardiac stem cel transplantation.

Objective To investigate the value of microwave ablation in the treatment of hepatocellular carcinoma in the caudate lobe.Methods We retrospectively analyzed the data of patients with hepatocellular carcinoma in the caudate lobe treated primarily by microwave ablation from January 2011 to May 2016 in our department,and explore the safety,efficacy of microwave ablation (MWA).Results The 11 patients had been treated with microwave ablation procedure in 13 lesions,through caudate lobe epigastric puncture in 9 cases and intercostal puncture in 2 cases.A total of 2 cases did not reach the technical success due to one case treated by radiation therapy,and the other treated by repeated MWA.However,the repeated MWA of that patient failed to reach the technical success.And the effective rate of treatment was 81.8％ (9/11).Following up to October 2016,the average follow-up time was (31.5±15.4) months.There were 1 patient with extrahepatic metastasis and 4 cases of patients with intrahepatic distant recurrence,among which 3 cases underwent MWA treatment again and 1 case underwent radiotherapy.Conclusion Microwave ablation is a safe and effective therapy option for the Caudate Lobe tumor.

Objective To investigate the clinical utility of keyhole craniotomy for Cholesteatmas in the cerebello-pontine angle region presenting as Trigeminal neuralgia by using keyhole craniotomy. Methods Clinical data of 35 pa-tients with Cholesteatmas in the cerebellopontine angle region presenting as Trigeminal neuralgia was analyzed retrospec-tively. All patients received suboccipital retrosigmoid keyhole craniotomy. Thirty cases who received conventional craniot-omy group were served as control group. A comparative analysis was conducted to assess the difference between these two groups in microsurgical methods, effects and complications. Results All patients were confirmed with MR diagnosis. In keyhole group, all patients had no pain symptoms of trigeminal neuralgia after surgical operation. The symptoms disap-peared immediately in 33 cases and gradually disappeared in 2 cases within one month following keyhole craniotomy. The tumors were totally removed in 25 cases and almost completely in 10 cases. The surgical duration was shorten in key-hole group than in conventional group (126±48 vs. 216±66 min;t=2.536, P<0.05). The amount of bleeding was smaller in keyhole group than in conventional group (91.3±52.2 vs. 186.3±65.4 mL;t=2.163, P<0.05). Postoperative neurologi-cal function was assessed in House-Brackmann. In keyhole group, there were 32 cases in class Ⅰ and 3 in grade Ⅱ. Two patients had hearing loss which was improved gradually in three months. In conventional group, there were 25 cases in class Ⅰ and 5 in grade Ⅱ (χ2=4.158, P<0.05). Postoperative hearing evaluation (AAO-HNS) revealed that there were 33 cases in grade A , and 2 in grade B in the keyhole group, whereas there were 27 cases in grade A and 3 in grade B in the conventional group(χ2=5.167, P<0.05). There were no relapse of tumors and death during 3 month to 5 years follow-up. Conclusions The suboccipital retrosigmoid keyhole craniotomy is a valid choice for Cholesteatmas in the cerebellopontine angle region presenting as Trigeminal neuralgia.

Objective To compare the dosimetric difference among plans designed by 4-field,6-field TomoDirect and TomoHelical techniques in Tomotherapy system for left-breast cancer patients with radiotherapy after breast-conserving surgery.Method A total of 16 patients with left-breast cancer following breast-conserving surgery and intensity-modulated radiation therapy were enrolled in this retrospective study.The 4-field TomoDirect (TD4),6-field TomoDirect (TD6),and TomoHelical (TH) techniques were applied to design simulation plans in tomotherapy system for each patient,respectively.The differences of dose distribution and treatment parameters were analyzed in this study.Results Three plans all met the clinical requirement.Thereinto,TD4 was superior to TH in the dose limitation of organs at risk (OARs),especially the max dose of cord and right-breast,thc 5 Gy radiation volume of lung,and the mean dose of heart(F =595.60,129.24,60.44,65.37,P ＜ 0.05),but inferior to TH in dose homogeneity (HI) and conformity (CI) (F =2.78,60.93,P ＜ 0.05).However,TD6 improved TD4's HI and CI when delivered the lower OARs dose compared to TH.Meanwhile,the number of monitor units was less in TD technique and reduced the treatment times (F =24.89,3.75,P ＜ O.05).Conclusions For the radiotherapy of left-breast cancer patients after breast-conserving surgery,TD6 technique appeared to be superior,with the lower radiation dose of OARs compared to TH technique,and the better target's HI and CI in comparison with TD4 technique,especially in patients with early stage breast cancer.

Objective: To analyze the clinical features and factors associated with osteonecrosis in children with systemic lupus erythematosus (SLE). Methods: A retrospective analysis of 15 SLE patients with osteonecrosis in Department of Pediatrics, Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University from January 2013 to May 2017 was carried out.Forty-two SLE patients without osteonecrosis were selected as control group.The clinical, laboratory variables and the treatment were compared among SLE patients who were with and without osteonecrosis. Results: (1) Fifteen patients developed osteonecrosis that constituted 8.6% of all the 175 hospitalized SLE patients during the same period.(2) Of 15 patients, 2 patients were male, 13 patients were female, who developed osteonecrosis with an average age of (13.9±2.7) years (range: 10-18 years old). The duration of SLE before the diagnosis of osteonecrosis ranged from 6 days to 141 months, the median was 10 months, and 80.0% (12/15 cases) was diagnosed with osteonecrosis within 2 years of SLE diagnosis.There were 36 joints involved in 15 patients, all of which were detected by magnetic resonance imaging(MRI). The knees were the most commonly involved joints(14/15 cases, 93.3%), followed by hip and ankle joints.(3) Univariate analysis revealed that the level of Triglyceride [(2.080±1.500) mmol/L vs.(1.350±0.945) mmol/L], maximum daily dose of glucocorticoid[(1.25±0.33) mg/kg vs.(1.07±0.22) mg/kg], positive rate of gene associated with glucocorticoid-induced osteonecrosis of femoral head(100.0% vs.54.8%)were significantly higher in SLE with osteonecrosis than those in controls(all P<0.05). While the level of 25(OH)D₃[(21.37±11.29) μg/L vs.(31.45±17.73) μg/L] was significantly lower than that of controls(P<0.05). Multiple factor Logistic regression analysis showed that hypertriglyceridemia and daily maximum dose of glucocorticoid were the risk factors for osteonecrosis. Conclusions Osteonecrosis mostly occurred in children over 10 years old, knee joint involvement is the most common.The high-risk time of osteonecrosis is within 2 years of SLE diagnosis.Hypertriglyceridemia and daily ma-ximum dose of glucocorticoid are risk factors associated with osteonecrosis in children with SLE.

Objective To investigate the difference of blood supply in different areas of the normal femoral head in adults.Methods A retrospective study analyzed the DCE-MRI parameters data of 2 5 normal adults (25 right hips)in our hospital.The femoral head was assumed to be a sphere.On T1 WI of DCE-MRI,the right femoral head was divided into three parts equally in coronal,sagittal, and transverse plane respectively.Time to peak(TTP),maximum of enhancement at first past(fEmax),maximum of enhancement (Emax)were measured in three parts and compared in coronal,sagittal and transverse plane respectively.Results (1 )In coronal plane,there were no significant differences between the three parts in TTP,fEmax and Emax.(2 )In transverse plane,fEmax and Emax were lower in the transverse superior zone than that in the transverse central zone significantly (P＝0.024 and P＝0.001)and the transverse inferior zone(P＝0.005 and P＝0.018).TTP was higher in the transverse superior zone than that in the transverse central zone and the transverse inferior zone(P＝0.005 and P＝0.018).(3)In sagittal plane,fEmax and Emax were lower in the sagittal lateral zone than that in the sagittal centralzone (P＝0.019 and P＝0.041)and sagittal medial zone (P＝0.047 and P＝0.01 1).TTP was higher in the sagittal lateral zone than that in the sagittal central zone and the sagittal medial zone(P＝0.014 and P＝0.010).There were no significant differences between other paired zones of the any values.Conclusion DCE-MRI can show the microcirculation in the normal adult femoral head in a non-invasive way.According to DCE-MRI parameters,there are poor perfusions on the transversesuperior and sagittallateral zones of the normal femoral head in adults.

Objective:To investigate the risk factors of atrial fibrillation (AF) in patients with typical atrial flutter after radiofrequency ablation.Methods:This study was a case-control study. The clinical data of 120 patients with typical atrial flutter who underwent radiofrequency ablation in Xingtai People′s Hospital from January 2017 to January 2021 were retrospectively analyzed. Patients were followed up every 3-6 months for a period of 2 years, and AF occurred in 30 patients (25.0%). The risk factors of AF were analyzed with univariate and multivariate logistic regressions.Results:The mean age of patients was (62.0±6.5) years and 64(53.3%) were males. No patients in the two groups had complications such as cardiac tamponade, pulmonary embolism and cerebral infarction after radiofrequency ablation. Compared with non-AF patients, patients in AF group had older age and higher CHA 2DS 2-VASC score ( P<0.001). Multivariate regression analysis showed that age ( HR=1.09, 95% CI:1.01-1.17) and CHA 2DS 2-VASC score ( HR=3.84, 95% CI:1.87-7.89) were independent risk factors for the occurrence of atrial fibrillation after radiofrequency ablation in patients with atrial flutter. Conclusion:After radiofrequency ablation of typical atrial flutter, nearly 25% of patients will relapse into AF, old age and higher CHA 2DS 2-VASC score increase the risk of AF recurrent.

Objective To simulate the possible systematic delivery errors introduced by monitor units ( MU) and multi-leaf collimator ( MLC) in radiotherapy plans for nasopharyngeal carcinoma ( NPC) , and to analyze the dosimetric sensitivity of static intensity-modulated radiotherapy ( IMRT ) and volumetric modulated arc therapy ( VMAT) with these errors. Methods Five IMRT plans were replanned using VMAT modality with the same physical parameters, and then MU errors of 125%, 250%, and 5. 00% were introduced into IMRT and VMAT plans. Meanwhile, to simulate leaf position errors during delivery, MLC position errors (025 mm, 050 mm, 100 mm, 150 mm, and 200 mm) were introduced by modifying the original plan documents. The types of MLC errors were as follows:( 1) the MLC banks moved in the same direction;( 2) the MLC banks moved in opposing directions ( expand or contract the MLC gaps ) . The differences in dosimetric sensitivity introduced by MU and MLC errors between IMRT and VMAT plans for NPC were calculated by linear regression analysis. Results With the increase in MU errors, the doses to target and organs at risk ( OARs) of IMRT and VMAT plans increased in a linear way, and met R2=0992-1000( P<005) . For MLC errors, the average dosimetric sensitivity for target and OARs of IMRT and VMAT were-026%/mm and-065%/mm in case of offset errors, 487%/mm and 868%/mm in case of expansion errors, and -604%/mm and -988%/mm in case of indentation errors. In addition, the dosimetric sensitivity with the three types of MLC errors was greater for VMAT plan than for IMRT plan. ConclusionsMU and MLC errors have a significant effect on the dose distribution of IMRT, and particularly VMAT, for NPC. It is important to execute routine quality assurance of MLC to ensure accurate radiotherapy.