OBJECTIVE:To analyze the rules and characteristics of the occurrence of the adverse drug reactions(ADRs) associated with traditional Chinese medicine injections so as to promote the rational drug use.METHODS:A total of 167 ADR cases induced by traditional Chinese medicine injections collected in our hospital from 2004 to 2007 were analyzed by means of Microsoft Excel.RESULTS:The 167 ADR cases were caused by a total of 17 kinds of traditional Chinese medicine injections.The drugs used for the sudden deafness or ischemic cardiovascular and cerebrovascular diseases showed the highest incidence of ADRs,much as in the use of Puerarin for injection(20.4%) and Pentoxifylline sodium chloride injection(19.8%).The most common presentation of the ADRs was lesion of nervous system(30.4%) followed by the lesion of skin and accessories(23.3%).CONCLUSION:To decrease the incidence of ADRs to a large extent,it is advisable to improve the preparation techniques and promote the quality of the traditional Chinese medicine injections,attach great importance to the principle of dialectic treatment in practice meanwhile enhancing the ADR monitoring.

Objective:To explore the efficacy and safety of 192Ir three-dimensional brachytherapy combined with intensity-modulated radiotherapy in patients with unresectable advanced obstructive extrahepatic cholangiocarcinoma. Methods:A retrospective analysis of the efficacy and safety of 18 patients with unresectable advanced malignant obstructive extrahepatic cholangiocarcinoma admitted to the Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei province from January 2014 to January 2018.All patients were pathologically confirmed and received biliary stent implantation, followed by sequential intensity-modulated radiotherapy and 192Ir three-dimensional brachytherapy.The clinical data of all patients were collected, including gender, age, clinical stage, adverse reactions, brachytherapy dose-volume parameters, changes in bilirubin levels before and after treatment, evaluation of efficacy, local control rate and survival rate. Results:All patients successfully completed the treatment.Re-examination was conducted one month after the combined treatment, of the 18 patients, 16 had partial remission (PR) and 2 were stable(SD). Among them, 14 patients had tumor shrinkage after brachytherapy compared with intensity-modulated radiotherapy, and 4 patients showed no significant change.The 6-month local control rate (LC) was 94.4% (17/18). The 1-year survival rate was 55.6% (10/18), and the 2-year survival rate was 38.9% (7/18). Statistical analysis showed that after combined treatment, total bilirubin and direct bilirubin were significantly reduced, and jaundice symptoms were significantly relieved.The adverse reactions of the patient were nausea, vomiting, fever, biliary tract infection, etc.There were no adverse reactions of grade 3 or above.Conclusions:192Ir three-dimensional brachytherapy combined with intensity-modulated radiotherapy in patients with inoperable advanced extrahepatic cholangiocarcinoma has a good local control rate and tolerable adverse reactions, but the impact on long-term survival requires a large sample of controlled studies.

OBJECTIVE To analyze the value of modified sinus CT score in olfactory function evaluation before and after functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps(CRSwNP). METHODS Fifty-four patients who underwent functional endoscopic sinus surgery for CRS with nasal polyps were enrolled in this prospective study by inclusion criteria and exclusion criteria. T&T methods and olfactory function VAS were used to analyze the subjective olfactory function and were performed preoperatively and at 6 months after surgery. In modified sinus CT score, middle turbinate and superior turbinate associated olfactory cleft areas were used to evaluate the anterior olfactory cleft score(AOCS) and posterior olfactory cleft score(POCS). Sinus CT scans Lund-Mackay scores were also collected before surgery. The correlation between the status of the olfactory cleft on CT, Lund-Mackay score and the preoperative and postoperative olfactory results were investigated.RESULTS Among 54 patients, there were 36 male and 18 female, with average age of 47.9 years old(from 24 to 67 years). There were 30 patients followed 6 months after surgery. The findings of olfactory cleft opacification and the CT Lund-Mackay scores had a positive correlation with preoperative olfactory results(P<0.001). The olfactory cleft opacification showed a stronger correlation with the preoperative olfactory results than the CT Lund-Mackay score. The AOCS was more significantly correlated with the postoperative olfactory results than the other parameters.CONCLUSION Preoperative CT findings, especially the anterior portion of the olfactory cleft had a statistically significant association with the postoperative olfactory results in patients with CRS with nasal polyps.

OBJECTIVE:To approach the feasibility of replacing pyrogen test by bacterial endotoxin test(BET)in assaying the injectio puerarin.METHODS:Kinetic turbimetric assay(KTA)was used to determine the bacterial endotoxin,and an inhi?bition and strengthen test by using the EDS-99bacterial endotoxin systems was adopted for assaying injectio puerarin.RES_ ULTS:The regression equation of standard curve was logT=2.7957—0.2422logC,r=—0.9973;Injectio puerarin did not interfere with limulus test agent in1∶60dilution.CONCLUSION:This method is slight in interference and accurate in de?tection result,and can be used in routine assay.

Objective To discuss the safety and feasibility of percutaneous transhepatic biliary preset implantation of after-loading radiotherapy catheter in treating bile duct carcinoma of ampulla.Methods A total of 10 patients with carcinoma of ampulla were collected.After percutaneous transhepatic biliary stent implantation was accomplished,the after-loading radiotherapy catheter was inserted via the guide wire.Based on the lesion's location,the positioning of both the catheter tip and the simulation radioactive source implanted through catheter was conducted.Each time before irradiation,the positions of the catheter and the radioactive source were reset under CT or fluoroscopic guidance in order to ensure that the lesion could get adequate internal irradiation dose.Results Percutaneous transhepatic biliary implantation of after-loading radiotherapy catheter and the positioning of simulation radioactive source were successfully accomplished in all 10 patients,and the total internal irradiation dose was completed within 5-7 days after catheter implantation.No severe complications occurred during the whole therapeutic process.Conclusion The technology of percutaneous transhepatic biliary preset implantation of after-loading radiotherapy catheter is safe and feasible,it carries high success rate with less complications.This therapy can improve the patency rate of biliary stent,and,as a palliative treatment,it is suitable for patients with carcinoma of ampulla.This treatment is worthy of application and promotion.

Objective To assess the efficiency and methods of the interventional management in acute mesenteric venous thrombosis (AMVT). Methods Fifteen patients with AMVT who diagnosed by imageology were treated by interventional procedures. Eight patients were treated by transcatheter superior mesenteric artery thrombolysis with urokinase, 5 cases by percutaneous transhepatic treatment, 2 cases by transjugular intrahepatic portosystemic shunt approach. Results The technical success was achieved in all the 15 cases without complications. The majority of the thrombus was cleared by interventional procedures and flow restorated on the angiograms. All the patients with follow-up from 10 to 22 months showed no recurrence. Conclusion The minimally invasive interventional techniques are safe and effective in the treatment of mesenteric venous thrombosis without necrosis.

Objective: To investigate the effect of Utrecht applicator on dosimetrics of targets and OARs in brachytherapy for advanced cervical cancer. Methods: Data of patients with locally advanced cervical cancer who received brachytherapy with Utrecht Source Applicator from 2017 to 2018 in the Department of Radiotherapy, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei province, were collected. The original plan was intracavitary /interstitial brachytherapy (IC/IS-BT). With the original contour and prescription dose unchanged, the implantation was removed and new intracavitary brachytherapy (IC) plan was designed. The dosimetric parameters of IC/IS plan and IC plan were compared and analyzed, and the effect of IS implantation on dose was evaluated. Results: The D₉₀ of HR-CTV was (88.68±1.84) Gy in IC/IS group and (85.54±0.54) Gy in IC group, with significant difference(t=6.200, P<0.05). In addition, conformity index of the IC/IS plan was significantly higher than that of the IC plan (IC/IS: 0.58±0.08, IC: 0.43±0.05; t=1.010, P<0.05). In terms of OAR, there was no significant difference in dosage between the two groups (P>0.05). Conclusions For the brachytherapy of locally advanced cervical cancer, the use of Utrecht Source Applicator can satisfy the prescription dose coverage. Adding IS insertion needle can improve the optimization space of the plan. Without exceeding the dose limit of OAR, the radiation dose to HR-CTV can be significantly increased, and the uniformity of dose distribution can be improved as well.

Brachytherapy has played an important role in localized prostate cancer. High-dose-rate brachytherapy has evolved over the decades, as either monotherapy or in combination with external beam, it offers many advantages over other treatment alternatives. Precise control over dose delivery allows for focal dose escalation while sculpting dose around organs at risk to maintain excellent tolerance. The high dose per fraction exploits the low α/β ratio of prostate cancer and triggers transcriptional changes in the tumor genome, thereby enhancing radiation sensitivity. In this article, the development, patient selection, application of techniques, clinical efficacy and adverse events for high-dose-rate brachytherapy were summarized.

Radiotherapy is one of the main treatment for esophageal cancer. With the development of radiotherapy techniques, prognostic outcomes of esophageal cancer have been gradually improved and radiation-induced heart disease (RIHD) has captivated increasing attention. Radiation-induced heart complications mainly encompass pericardial disease, cardiomyopathy, coronary artery atherosclerosis, valvular heart disease, and arrhythmias, etc. The use of modern radiotherapy techniques is expected to mitigate heart injury and reduce the risk of RIHD. Research progress on the incidence and risk factors of RIHD in esophageal cancer were described as follows.

Objective:To evaluate the efficacy and safety of 192Ir brachytherapy combined with external beam radiation for the treatment of unresectable hilar cholangiocarcinoma. Methods:The clinical data of 26 patients with unresectable hilar cholangiocarcinoma admitted to Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine from February 2016 to July 2018 were retrospectively analyzed. All patients received 192Ir brachytherapy combined with external beam radiation. First, percutaneous hepatobiliary stent implantation was given, followed by external beam radiotherapy (radiotherapy dose 45 Gy, 25 times), and then 192Ir brachytherapy (radiotherapy dose 20 Gy, 4 times), a total of 4 to 6 cycles of chemotherapy. The short-term and long-term efficacy were evaluated, and the Karnofsky performance status (KPS) score, CA19-9, total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST) level changes and percutaneous transhepatic biliary drainage (PTCD) tube indwelling time were analyzed. Adverse reactions were recorded according to the Radiation Therapy Oncology Group (RTOG) injury classification standard. Results:Three months after the end of treatment, 4 cases (15.4%) were completely remitted, 20 cases (76.9%) were partially remitted, 2 cases (7.7%) were stable, and there was no disease progression. The objective remission rate was 92.3% (24/26). The 1-year and 2-year local control rates were 75.0% and 62.5% respectively, and the 1-year and 2-year overall survival rates were 57.7% and 26.9% respectively. The KPS score was 70.39±10.76 one month after the treatment, which was significantly higher than the 60.00±10.58 before treatment ( t=-27.00, P<0.001). The levels of CA19-9 before treatment and 1 month, 2 months and 3 months after treatment were (390.88±202.62) U/ml, (322.45±204.06) U/ml, (254.00±160.49) U/ml, (182.85±124.05) U/ml, which showed a gradual decrease trend, and there was a statistically significant difference ( F=126.94, P<0.001). TBIL [(250.88±80.83) μmol/L, (153.98±61.74) μmol/L, (93.45±38.12) μmol/L, (53.82±26.75) μmol/L], DBIL [(205.82±66.68) μmol/L, (133.23±58.53) μmol/L, (64.31±36.25) μmol/L, (40.55±26.16) μmol/L], ALT [(163.92±54.12) U/L, (68.23±28.86) U/L, (45.73±21.94) U/L, (32.66±12.88) U/L], AST [(177.69±58.68) U/L, (79.23±32.87) U/L, (49.77±25.45) U/L, (35.54±16.10) U/L] showed progressive decline, with statistically significant differences ( F=315.60, P<0.001; F=385.30, P<0.001; F=284.24, P<0.001; F=311.80, P<0.001), and liver function was improved. The PTCD tube was removed after treatment in all patients, with a median time of 54 days (49-96 days). During the treatment, bone marrow suppression, nausea and vomiting, abdominal pain and biliary tract infection occurred. All of them improved after symptomatic treatment. No serious complications such as bile leakage and biliary hemorrhage occurred. Conclusion:192Ir brachytherapy combined with external beam radiation has a reliable curative effect in the treatment of unresectable hilar cholangiocarcinoma. It can improve the quality of life of patients, and the adverse reactions can be tolerated. It provides a feasible and safe treatment method for the clinic.