Objective To explore the pharmaceutical care approaches for patients with lung cancer complicated with renal insufficiency receiving pemetrexed chemotherapy. Methods An elderly patient with lung cancer complicated with renal insufficiency receiving pemetrexed chemotherapy faced inevitable safety risks.Clinical pharmacists considered it as an intervention point, and provided individual pharmaceutical care. Results Clinical pharmacists fully assessed the safety risks of the case receiving pemetrexed chemotherapy with clinicians, assisted in improving the therapeutic regimen, and carried out medication education for the patient. No serious adverse drug reactions occurred in the patient, and anti-tumor efficacy was obtained. Conclusion For patients of lung cancer complicated with renal insufficiency receiving pemetrexed chemotherapy, clinical pharmacists should focus on creatinine clearance rate, and decide whether the combined use of platinum anti-tumor drugs, non steroidal anti-inflammatory drugs and zoledronic acid can be adopted, and follow-up on adverse drug reactions and anti-tumor efficacy.

In this paper, 17 autopsy cases of poisoning by toxic plants: mushroom 4, xanthium sibiricum 3, trichosanthes kirilowii 2, aconitum chinense 3, tripterygium wilfordii 1, gelsemium elegans 1, nerium indicum 1, pachyrhizus erosus 1, dioscorea simulans 1 were reported (accident 15, suicide 2). Emphasis was put on analyses of the selective injured locations, namely, target organs or tissues, which were poisoned by these poisonous plants. The machanisms of poisoning and causes of death were approached based on the pathological changes. The associated problems of forensic medicine were discussed summarily. On the basis of author's experiences, it is essential for medicolegal examination and expertise that the body should be systematically, completely, forensic-pathologically inspected and the species of questioned poisonous plants should be identified by the associated expert. Poisoning by toxic plants is one of often contacted and difficult problems in medicolegal expertise, so that we should pay attention to it.

1. 40 cadavers were dissected in order to observe the position and formation of the osteo-fibrous canal (384 canals) of the medial division of posterior ramus of lumbar nerves together with the occurrence of the articulo-accessory (process) ligament.2. The form of the external opening of the osteo-fibrous canal may be classified into three groups; nearly circular 35.1% (151); approximately ellipsoid 32.3% (124); crack detector 28.4% (109).3. The osteo-fibrous canal consists of four walls, bounded by mammillary process, accessory process, bony wall and superior articular process ligament respectively. According to the constitution of the anterior and posterior walls of the canal, it may be divided into three categories; osteo-aponeuroticoligamentous type 29.4% (113); osteo-membranous type 66.4% (255) and bony type 4.2% (16).4. The length and width of the superior articular process ligament were measured. The sexual difference of the lengths of L_(1～5) lumbar is significant.5. The sulcus between the superior articular process and the alar portion of the sacrum was observed and measured.6. The ligament on the posterior wall of the canal is nominated as the ligament of the superior articular process.7. Based on the anatomical structures thus studied, some clinical significances were discussed.

Objective To explore the clinical effect of surgery on treating multi-extensively drug resistant (MDR) and extensively drug resistant pulmonary (XDR) tuberculosis (M/XDR-PTB) in order to provide the new approach for patients with M/XDR-PTB.Methods The information of 75 cases with M/XDRPTB were recorded and they were underwent thoracic surgery at the National Tuberculosis Center in Tbilisi,Georgia from October 2008 to February 2011.Results Of 75 patients,52 cases were MDR and 23 were XDR with PTB underwent adjunctive thoracic surgery.The following surgical procedures were performed including pneumonectomy(10％),lobectomy (51％),segmentectomy (33％).Median age was 30 years and average duration of preoperative M/XDR-PTB medical therapy was 350 days.Mean postoperative follow up period was 372 days.Of 72 patients with complete outcomes information,59 (82％) had favorable outcomes including 90％ of MDR and 68％ of XDR-TB patients.No postoperative death occurred,7 patients (9％) had postoperative complications.Univariate analysis showed that,compared with good treatment outcomes,risk factors of poor treatment outcomes included cavitary disease (62％ vs.27％,P =＞ 0.02),probability of suffering from XDR (62％ vs.27％,P =0.02),positive preoperative sputum culture (77％ vs.14％,P＜ 0.001),acceptance of sensitive drugs(1.9％ vs.2.8％,P =0.03) and major postoperative surgical complication (23％ vs.5％,P =0.03).Conclusion Patients with M/XDR-PTB undergoing adjunctive thoracic surgery show with high rates of favorable outcomes,and no surgical related death as well as the low complications rates.Adjunctive surgery appears to play an important role in the treatment of select patients with M/XDR-PTB.

Carcinoma, Squamous Cell ; Humans ; Mouth Neoplasms ; NF-kappa B ; Neoplasm Proteins

Objective To investigate the CT manifestations of pulmonary sclerosing hemangioma (PSH), and improve the CT diagnostic accuracy of the disease.Methods The CT manifestations of 5 cases with pulmonary sclerosing hemangioma which were proved by pathology were analyzed retrospectively. Results Solitary pulmonary nodule was demonstrated in all 5 cases with clear demarcation on CT. The nodule was smooth and homogeneous in density in 4 cases, and was slightly irregular with cavity in another case. After intravenous contrast administration, all the lesions were homogeneously enhanced, similar to the nearby blood vessels. The vessels linked with the lesions were found generally.Conclusion The CT is helpful for the diagnosis of PSH.

1. 40 cadavers were dissected in order to observe the position, formation and morphology of the osteo-fibrous canal (400 canals) of the posterior rami of the lumbar spinal nerves.2. The average lengths of the osteo-fibrous canals for the posterior ramus of the lumbar nerves in both sexes are: L_1 4.88mm, L_2 4.71 mm, L_3 4.61 mm, L_4 4.57mm, L_5 4.39 mm.3. The average longitudinal diameter of the outlets of the osteo-fibrous canals of the posterior rami of the lumbar nerves in both sexes are: L_1 6.38mm, L_2 6.73 mm, L_3 6.34mm, L_4 5.75mm, L_5 2.61mm.The average transverse diameters of the outlets of the osteo-fibrous canals of the posterior rami of the lumbar nerves in both sexes are: L_1 2.69mm, L_2 2.66mm, L_3 2.68mm, L_4 3.14mm, L_5 2.06mm.4. The shapes of the outlets of the osteo-fibrous canals of the posterior rami of lumbar nerves may be classified into four types: nearly circular 64.75% (259 sides); approximately ellipsoid 30.25% (121 sides); nearly triangular 3.00% (12 sides); nearly oblate 2.00% (8 sides).5. 320 inter-transverse ligaments were observed and measured.6. There was always an iliolumbar ligament interposed between L_5 and S_1.7. Further more, the authors discussed the relationship between the morphology of the nerves and the osteo-fibrous canals in connection with the possible causes of low back pain.

Objective To analyse CT signs of giant cell tumor of bone.Methods CT appearances of 42 cases of giant cell tumor of bone were reviewed.All patients were pathological proven.Results (1)Two kinds of bone destruction were seen in all ases:expansive cystic destruction and osteolytic destruction.The anterior was predominantly.(2)Most of our patients haven't bone septations in their tumors (95.2%).(3)Bone crests were usually seen in our study(63.2%).(4)Complete or incomplete sclerotic borders existed in 44.7% of all cases.(5)The inner bone soft tissues were heterogeneously in most of the patients.Fluid-fluid level can be seen in 5 cases (11.9%).(6)The outer-bone soft tissue masses were demonstrated in the majority cases with discontinuous bone shell.Conclusion CT may deepen our understanding and add imaging signs about giant cell tumor of bone;Which can enhance our diagnostic and differential diagnostic capability.

0.05),but the 24h urine zinc level increased markedly(P

Purpose To explore the diagnostic value of multiple image technique derived from dual-energy CT in arterial+parenchymal phase scan mode in detecting pancreatic adenocarcinoma so as to provide more valuable information for clinical treatment.Materials and Methods Thirty two patients with pancreatic adenocarcinoma proved pathologically underwent dual-phase scan with dual-source CT.Linear blend image,non-linear blend image and iodine map were acquired.The absolute enhancement value of tumor (AEV),the relative enhancement value of tumor (REV),enhancement ratio (ER) of tumor to pancreatic parenchyma,and the image contrast to noise ratio (CNR) were also calculated,so that the diagnostic value and the ability image in two phases to display the pancreatic adenocarcinoma lesions could be assessed.Results On arterial phase,the differences in AEV,REV and CNR value were significant among the three groups images (P＜0.05).On parenchymal phase,the difference in REV,ER,and CNR value were also significant among the three groups (P＜0.05).When the three sequences on the 2 phases were compared with each other,the differences in AEV and REV value of tumor tissues were significant among the groups (P＜0.05).Moreover,the differences of ER value in linear blend image and CNR in the iodine map were significant in dual phase enhancement (P＜0.05).Conclusion Dualenergy CT enhanced scan mode on dual phase combined with multiple sequences can improve the sensitivity in detection of pancreatic adenocarcinoma lesions.