Objective To study the efficiency,safety,and its impact on the functional rehabilitation of the selective 5-serotonin reuptake inhibitor(SSRI) drugs paroxetine in treatment patients with poststroke depression and anxiety.Methods The acute stroke patients at our Neurology department and old-age cadres department were selected,in which have 88 cases of poststroke patients with depression and anxiety,which were divided into paroxetine group and the control group.Paroxetine group was given Seroxat 20 ng,1 time/d + conventional treatment of cerebrovascular disease.The control group was gaven conventional treatment of cerebrovascular disease only.After 4 weeks,6 weeks of treatment,we assessed Hamilton Depression Rating Scale(HAMD),Hamilton Anxiety Scale(HAMA),neurological deficit and the state of living ability were assessed.Results There were significant differences in improvenent of depression and anxiety,neurological deficit and the capacity of the state of life between the Paroxetine group and the control group the control group of 4 weeks treatment compared with before treatment(all P＜0.05);Compared with before treatment,the control group of 6 weeks treatment compared with before treatment(all P＜0.05);Paroxetine group of 4 weeks treatment compared with before treatment(all P＜0.05);Paroxetine group of 6 weeks treatment compared with before treatment(all P＜0.05),and Paroxetine group control is obvious Improved(all P＜0.05).Conclusion Using Paroxetine to treat poststroke patients with depression and anxiety,not only could significantly improve symptoms of depression and anxiety,but also speed up the rehabilitation of limb function,efficacy reliable,and had no significant adverse reactions.So,it was an ideal medcine for poststroke patients with depression and anxiety.

Objective To explore the distribution of high-arsenic water in Shaanxi Province in order to provide theoretical basis for the control of arsenism.Methods The contents of arsenic of 4042 water sampled from 1898 nature villages in 12 counties were assessed using semi-quantitative reagent-knit,and the water samples of Shanyang County,the targeted area,was quantified using quantitative atomic fluorescent speemetry.Results The contents of arsenic of 6 water samples in 2 villages exceeded 0.05 mg/L,accounting for 0.15%(6/4042),were 0.46,0.53,0.63,0.69,0.74,1.53 mg/L,respestively,and located in Shanyang County.A crowd of 1146 exposed to hish asenic water.among whom 555 were children.Conclusions Arsenic in drink water in Shanyang County in Shaanxi Province is higher than the standard,to which a large number of people are exposed,water-improving and defluoridotion must be carried out as soon as possible,reduces harm of high arsenic.

Objective To investigate the urinary arsenic levels of exposed population in various forms of and total arsenic (TAs) content as well as their relationship with arsenic poisoning in southern Shaanxi arsenic poisoning area.Methods According to the historical data of the investigation on arsenic poisoning,11 disease villages were chosen as survey sites in Ziyang and Pingli counties,Ankang city;three neighbor villages were chosen as control sites in Baihe.Baihe was a non-endemic arsenic poisoning area county,which had the same natural environment and living habits.In the survey sites,people over the age of 40 were selected for epidemiological investigation in both heating and non-heating seasons,and 40 urine samples were collected at each severity levels of the disease and in different seasons.Meantime,20 urine samples of the same age group were collected in the control sites in each season.Hydride generation-atomic fluorescence spectrometry (HG-AFS) was used to determine TAs,liquid chromatography-hydride generation-atomic fluorescence spectrometry (LC-HG-AFS) was used to determine the amount of inorganic trivalent arsenic (As3+),dimethylarsine (DMA),monomethylarsine (MMA) and inorganic pentavalent arsenic (AS5+),and the various forms and TAs were compared between different survey sites,severity levels,ages,sexes,and seasons.Results The medians of TAs,As3+,DMA,primary methylation index (PMI),and secondary methylation index (SMI) in diseased area (35.3,2.2,24.5 μg/L;0.84,0.90) were significantly higher than those of the control group (16.0,0.6,10.3 μg/L;0.78,0.81;Z =-9.069,-7.314,-8.913,-2.183,-3.853,P ＜ 0.01 or ＜ 0.05),and the medians of TAs,As3+,DMA,and SMI (31.6,2.0,23.1 μg/L;0.91) of the normal population in the diseased area were significantly higher than those of the control group (16.0,0.6,10.3 μg/L;0.81;Z =-7.164,-6.136,-7.023,-2.916,all P ＜ 0.01).Illness had positive correlations with TAs,DMA,and ages (r =0.370,0.367,0.594,all P ＜ 0.01).Men arsenic poisoning detection rate,TAs,As3+,and DMA (59.9％,37.4,2.5,25.2 μg/L) were significantly higher than those of women (22.4％,30.0,1.6,20.9 μg/L;x2 =54.878,P ＜ 0.01;Z =-3.332,-4.449,-2.681,all P ＜ 0.01).The medians of As3+,MMA,As5+,PMI,and SMI in the heating season (1.5,2.1,1.4 μg/L;0.87,0.92) were significantly different from those in the non-heating season (2.6,3.3,3.0 μg/L;0.82,0.88;Z =-6.870,-5.512,-8.542,-2.262,-4.544,P ＜ 0.01 or ＜ 0.05).Conclusions The TAs,As3+,and DMA of urine samples are related to local arsenic background,so they have some reference value for determination of diseased areas.Men are more susceptible to arsenic poisoning than women.

Glioblastoma multiforme (GBM) is the most malignant form of glioma, and its treatment through traditional surgery combined with chemotherapy and radiotherapy has limited efficacy. Chimericantigen receptor T-cells (CAR-T) are recombinant receptors for antigen, which, in a single molecule, redirect and mediateantigen recognition, T-cell activation, and, in the case of second-generation chimeric antigen receptors (CARs) costimulation (CD28 or 4-BB), augment T-cell functionality and persistence. CARs are the focus of attention in emerging treatment options for GBM. This article mainly introduces the development process of CAR-T therapy and the recent success of adoptive transfer of CAR-T cells. Effective targets of the treatment of GBM with CAR-T according to this research are discussed as well. Some of the most extensively studied targets on GBM, especially interleukin-13 receptor α chain variant 2, epidermal growth factor receptor-Ⅷ(EGFRⅧ), human epidermal growth factor receptor 2 (ErbB2), and ephrinA2 receptor (ErbA2), and the different characteristics of each kind of alloantigen-specific CAR-T cells, are the basis for CAR-T therapy and indicate their different characteristics or utilities and the prospect of further clinical research. The discovery of selective expression of interleukin-13 receptor alpha 2 in glioma cells more than 20 years ago prompted the clinical trial of CAR-T therapy in stage I GBM tumors, and the therapy was proven safe and effective. EGFRⅧ is a neoantigen presenting only in cancer cells and glioblastoma stem cells. Its presence is correlated with poor prognosis, and a phase Ⅰ/Ⅱ trial is ongoing at different institutes. ErbB2-specific CARs were also expressed in human Tcells.Adoptive transfer of EphA2 (or ErbB2)-specific T cells resulted in the regression of glioma xenografts. Thus, target-specific CAR-T immunotherapy may be a promising approach for the treatment of different target-positive GBM. Finally, we summarize the application value and challenge of CAR-T cell therapy in the treatment of GBM.

Objective To investigate the effect of stellate ganglion block on the pain and quality of life in patients with lung cancer.Methods 90 patients with lung cancer were divided into observation group and control group according to random number table method.The control group was treated with morphine 10mg,orally,1 time/ 12h.The observation group was treated with stellate ganglion block and morphine.For the patients with poor analgesic effect,50％ doses were added gradually.The analgesic effect,quality of life and changes of immune function were compared between the two groups.Results After treatment,the VAS scores of the two groups were significantly decreased.And the VAS score reduction in the observation group was significantly better than that in the control group [(2.5 ± 0.7) points vs.(3.7 ± 0.9) points],the difference was statistically significant (t =7.060,P ＜ 0.05).The analgesic efficacy of the observation group was significantly higher than that of the control group(91.1％ vs.75.6％,x2 =3.920,P ＜ 0.05),the duration of analgesia of the observation group was longer than that of the control group (t =20.681,P ＜ 0.05).For the total morphine dosage method,the observation group was significantly lower than the control group[(143.5 ± 21.3) mg vs.(238.7 ± 38.3) mg] (t =14.572,P ＜ 0.05).After treatment,the scores of quality of life of the two groups were significantly improved,and the improvement degree of the observation group was significantly better than that of the control group [(86.5 ± 14.3) vs.(79.6 ± 15.7),t =2.179,P ＜ 0.05].After treatment,the TGF-beta level of the observation group was significantly reduced,which was significantly lower than that of the control group[(215.4 ± 38.7)pg/mL vs.(240.5 ± 41.2)pg/mL],the difference was statistically signifi cant (t =2.979,P ＜ 0.05).Conclusion Stellate ganglion block has good therapeutic effect in the treatment of lung cancer patients with pain.

Relations between doctors and patients are the most basic and important human relations in medical practice.Some reports indicate that non-technical medical factors result in most cases of physician-patient conflicts.In this paper we analyzed non-technical medical factors from the fields of society,ethics and mentality,and concluded main reasons for physician-patient conflicts are the lack of "being discreet when alone",the absence of "patients-oriented service concept",the ignorance of responsibility of "life-saving",and the missing of humanity care.

Objective To find out about rural doctors' knowledge on the basic facts about AIDS and the spread of HIV via illegal blood collection and supply and explore viable intervention methods in AIDS prevention and treatment in rural areas. Methods All the rural doctors in a certain township where the epidemic of HTV being spread via blood collection and supply was pretty serious were selected for the survey and data were collected by combining qualitative and quantitative studies. Results The survey of 33 doctors was effective( 100% ) ; above 95% had a correct understanding of the spread of AIDS through sex and blood as well as its contagiousness; 50% did not possess the knowledge that HIV could be spread to the baby by the mother but could not be spread through saliva, sweat, mosquito bites or sharing of bathtubs or toilets; above 80% knew about the objective of the blood organizers in their villages, the peak time of blood selling by the villagers, and the risks of diseases being spread via blood, and were opposed to blood selling; 27.3% once in a while used disposable syringes, and 15.2% discarded or sold used disposable syringes. Conclusion There are severe lurking perils of iatrogenic cross infection in rural areas. Rural doctors are in dire need of formal training in AIDS prevention and treatment knowledge and could be expected to become the key force in AIDS prevention and treatment in rural areas.

Objective To investigate the dynamic changes in each radical line of pelvic floor levator hiatus in female with stress urinary incontinence(SUI). Methods A retrospective analysis of MR images was performed in 30 female patients with clinically diagnosed SUI and 30 asymptomatic female volunteers recruited as reference group. All of the subjects underwent pelvic MRI scanning both in static statusand Valsalva maneuver, respectively, Valsalva was performed by attempt to forcibly urinate while holding her breath, respectively. Area of pelvic diaphragm hiatus (LHA), ntero-posterior length (LHL) and tmixmum width (LHW) were measured in horizontal axis plane of the obtained images.H line distance was measured in the midsagittal plane. Independent sample t test was performed to compare the difference in LHA, LHL and LHW between two groups. Paired t test was used to compare difference in LHA, LHL and LHW between two groups in static status and Valsalva maneuver, respectively. Results In static status, the values in LHA, LHL, LHW and H line distance for SUI groups were(28.7±19.3) cm2, (7.1±2.2) cm, (4.7± 1.6 ) cm and (5.7±1.1) cm, respectively. The parameters for the reference group were(13.1±3.7)cm2, (5.3± 0.8) cm, (3.4 ± 0.5) cm and (5.7 ± 0.9) cm, respectively. The difference in LHA, LHL, LHW between two groups was statistically significant (t=4.33, 4.36, 4.23, and P<0.01 for all indexes), whereas the difference in H line distance between two groups was no statistically significanct because of P> 0.05. In Valsalva
maneuver, LHA, LHL, LHW and H line distance were (40.0±26.0) cm2, (8.0±2.3) cm, (6.0±2.5) cm and (6.1± 1.5)cm for SUI group, and were (16.2±6.2) cm2,(5.5±1.0) cm, (3.6±0.8) cm and (6.0±1.0) cm for the reference group, respectively. The difference in LHA, LHL and LHW between two groups was statistically significant, (t=4.88, 5.36, 4.91 respectively, and P<0.01), whereas the differencein H value between two groups was no statistically significant (P< 0.05). For SUI group , the difference of LHA, LHL and LHW between static status and Valsalva maneuver had statistically significant with P<0.01. For reference group, the difference of LHA and LHL between static status and Valsalva maneuver had statistically significant(P<0.05). Conclusion Dynamic and static pelvic MRI can evaluate the morphology and variation of pelvic floor levator hiatus much intuitively and accurately. pelvic floor levator hiatus becomes enlarged in female with SUI.

Objective To investigate the MRI features of urethral sphincter in female with stress urinary incontinence(SUI) by the study of the indexes of the thickness of middle urethral sphincter, the function urethral length and bladder neck funnel . Methods Forty patients of female patients diagnosed as SUI by clinical were retrospectively as SUI group, and 40 asymptomatic female volunteers were recruited as reference group. All of the subjects were tested by pelvic MRI scanning both in static status and in the condition of Valsalva. The thickness of middle urinary sphincter was measured in the horizontal axis plane. In the midsagittal plane, the function urethral length was measured from the internal orifice to perineal fascia. The bladder neck funnel whether exist was observed from the midsagittal plane. For the comparison of the urinary sphincter thickness and urethral length of the two groups, independent sample t test was adopted. For urethral length in static status and under the condition of Valsalva, paired t test was done. For comparison of positive rate of the bladder neck funnel, Chi?squared test has been done. Results The value of the middle urinary sphincter thickness in the groups of SUI and reference were (2.23±0.68) mm and (2.69± 0.75) mm, respectively. Thus the differences of the two groups had statistical significance (t=-2.839, P<0.01 ). In the static status, the urethral length in SUI and reference group were (2.72±0.51) cm and (2.94± 0.34) cm respectively, wheras in Valsalva condition, the value were (2.33 ± 0.49) cm and (2.43 ± 0.43) cm respectively. The differences of the two groups had statistical significance in static status (t=-2.322, P=0.023), wheras there had no statistical significance in the two groups in Valsalva condition (t=-1.049,P=0.297). For SUI and reference group, both in static status and Valsalva condition, the difference of function urethral length had statistical significance (P< 0.01). The positive rate of bladder neck funnel for SUI was 72.5% (29/40), and for reference was 22.5% (9/40), the difference of the two groups had statistical significance(χ2=20.050, P<0.01). Conclusion For female SUI patients, urinary sphincter muscle is much thinner, function urethral length is much shorter and has higher positive rate of bladder neck funnel.