OBJECTEVE:To probe into the difference of drug prices between used in hospital and retailed in market.METHODS:Analysis the different reasons of drug price from drug quality assurance system,pharmaceutical care,drug using structure system and function mechanism.RESULTS&CONCLUSION:It's rational that the drug prices used in hospital high_ er than in retailed market.It's pratical and realistic attitude to the fact that the same drug has different prices in the medical market.

Objective To study the expressions of programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) in liver injury of acute liver failure (ALF) in rats and the role of PD-1/ PD-L1 in liver inflammatory injury. Methods SD rats were divided into two groups: 6 in normal group and 30 in ALF model group. The ALF models in rats were induced by D-galactosamine (D-Gal). The sera and hepatic tissue samples were collected at 12, 24, 48, 72 and 120 hours after D-Gal injection. Expressions of PD-1 mRNA and PD-L1 mRNA in hepatic tissue samples were detected by reverse transcription-polymerase chain reaction (RT-PCR). Comparison of measurement data between groups was done by t test. Correlation test was performed using Pearson linear correlation analysis. Results The levels of alanine animotransferase (ALT) and aspartate animotransferase (AST) at 12 h of D-Gal injection were (217. 3±33. 7) U/L and (397. 2± 101.3) U/L, respectively,which were both significantly higher than those in normal group [(30. 5 ±3. 1) U/L and (78. 6±4.2) U/L, respectively; t=-8. 921 and -6. 121, respectively; both P＜0.01] and peaked at 48 h.The expression of PD-1 mRNA in model group at 12 h (0. 385±0. 074) was significantly higher than that in normal group (0. 097±0.009) (t= -7. 725, P＜0.01) , and peaked at 48 h (0. 927±0. 132),then decreased obviously at 72 h. The expression of PD-L1 mRNA in the liver tissue of normal rats was very little, while that in model group was increased gradually over time, then peaked at 48 h (0. 593±0. 105; t =- 10. 076, P＜0. 01). The expressions of PD-1 and PD-L1 were positively correlated with ALT level (r=0. 807 and 0. 792, respectively; both P＜0. 01). Conclusion The expressions of PD-1/PD-L1 may play an important role in liver inflammatory injury in rat model of acute liver failure.

Objective To explore the efficacy and adverse effects of nimotuzumab combined with chemotherapy and radiotherapy in the treatment of locally advanced cervical cancer.Methods Sixty patients with stage Ⅲ cervical cancer by the histopathologic diagnosis were collected,and they were randomly divided into two groups using the random number table method.The control group (n =30)using intensity-modulated radiotherapy,intracavitary afterloading therapy and periodic chemotherapy,the observation group (n =30)in addition to the intensity-modulated radiotherapy,intracavitary afterloading therapy and periodic chemotherapy, the nimotuzumab (200 mg)was given to the patients before weekly radiotherapy.All patients were received 6 to 7 times of treatment.Results The curative effects of all the patients were evaluated after radiotherapy 3 months.In the observation group,there were 20 cases of CR,5 cases of PR,4 cases of SD,1 case of PD,the total effective rate (CR +PR)was 83.3%.In the control group,there were 1 8 cases of CR,3 cases of PR,6 cases of SD,3 cases of PD,the total effective rate was 70.0%.The difference was statistically significant (χ2 =8.356,P <0.05).The main adverse reactions in the observation group and control group included slight radioactive proctitis (1 6.7% vs 1 3.3%),radioactive cystitis (1 0.0% vs 1 0.0%),nausea and vomiting (50.0% vs 46.7%),reduction of white blood cells (40.0% vs 43.3%),with no significant differences (χ2 =3.357,P =0.71 9;χ2 =2.71 7,P =0.925;χ2 =5.882,P =0.623;χ2 =4.728,P =0.687).There were no skin rashes and allergic reactions.Conclusion Nimotuzumab can enhance the locally stage cervical cancer patients′sensitivity on radiotherapy,which can increase the efficacy and doesn′t increase adverse
reaction obviously.

Objective To explore the feasibility of application of the Monte Carlo method to simulate the whole body dose distribution in patients with total body X (γ) ray irradiation by comparing the actual measurement results.Methods A Monte Carlo model of a 6 MV Elekta Synergy Clinical linear accelerator was established by MCNPX.According to the relationship between the CT value and the density of the material,the CT of the ATOM physical phantom was converted into a voxel phantom for MCNPX calculation.The dose distribution of the whole body was simulated in the total body X (γ) ray irradiation.The simulated results were compared with the measurement values of the thermoluminescence dosimetry at different positions in the ATOM physical phantom to analyze the differences.Results The difference between the depth dose curve and the off-axis dose curve and the actual measurement values calculated by the 6 MV accelerator treatment head model in the water tank was less than 2％,with the maximum dose depth of approximately 1.5 cm and field size of 10 cm× 10 cm,which were consistent with the actual measurement values.The maximum difference between the simulated results at different locations in the body and the thermoluminescence dosimeter was approximately 4％,and the simulated results of MCNPX were almost in good agreement with the results of thermoluminescence.Conclusions The whole body dose distribution in patient with total body X (γ) ray irradiation can be accurately simulated by MCNPX.Monte Carlo simulation makes it possible to optimize the uniformity of the total body dose during the total body irradiation process.

OBJECTIVETo study tissue culture of Vinca minor and determine the content of vincamine.

METHODLeaf blades, stalks, root segment of V. minor were used as explants to study the effect of 2, 4-D,6-BA,NAA on its callus induction and vincamine contents in the orthogonal design experiment. In the peak period of callus formation, vincamine content in callus of V. minor and sterile plants was determined by HPLC. The experimental data was statistically analyzed.

RESULTThe content of 6-BA and NAA had no significant effect on its callus induction. But the content of 2, 4-D had significant effect on its callus induction. Within 20,40,60 d, the content of vincamine in sterile plant was (0.015 +/- 0.003)%, (0.097 +/- 0.001)% , (0.113 +/- 0.06)%, respectively. In the peak period of callus formation, vincamine content in callus of leaf blades, stalks, root segment was (0.024 +/- 0.0025)%, (0.016 +/- 0.0015)%, (0.010 +/- 0.0015)%, respectively. To 30 days of subculture, vincamine content in callus of leaf blades, stalks, root segment was (0.041 +/- 0.002)%, (0.019 +/- 0001)%, (0.016 +/- 0.002)%, respectively.

CONCLUSIONThe optimal hormone combination for callus initiation was MS +2, 4-D 1.0 mg x L(-1) +6-BA 0.5 mg x L(-1) + NAA 0.5 mg x L(-1). In different growth periods, vincamine content in sterile plants is significantly different. From different explants in callus vincamine content is different, in which leaves callus is significantly higher than that of stems, roots produced callus organization.

Culture Techniques ; methods ; Linear Models ; Plant Infertility ; Vinca ; chemistry ; growth & development ; physiology ; Vincamine ; analysis

Objective:To assess proton biological dose with using two kinds of relative biological effect models and to compare them with traditional clinical proton biological dose ( Dose1.1). Methods:Based on Particle simulation tools(TOPAS), physical dose, LET d and LET t were calculated in water phantom and two anthropomorphic phantoms (brain and prostate tumors) respectively. Then DoseLET d and DoseLET t were calculated according to different relative biological effect models, an RBE was 1.1 in traditional clinical proton biological dose calculation. Three kinds of biological doses were compared in the water phantom. To quantify the differences between three method in anthropomorphic phantoms, three points ( D1, D2, D3) were selected according to the physical dose to compare the biological dose. Results:DoseLET d and DoseLET t in water phantom showed the same trend with water depth and both of them were higher than Dose1.1 at the end of proton beam range. The maximal difference between DoseLET d and DoseLET t in the anthropomorphic phantoms was 10.08 cGy, where the relative difference was less than 5%. When DoseLET d and DoseLET t were compared with Dose1.1, the maximal differences in brain tumor target were 71.97 cGy and 61.91 cGy respectively, where the relative differences were less than 25%. The maximal differences in prostate tumor target were 25.95 and 19.96 cGy respectively, where the relative differences were less than 12%. However, the differences outside the target were very small, where the maximal differences in brain and prostate tumors were 5.99 cGy and 9.92 cGy respectively, and the relative differences were less than 5%. Conclusions:Biological doses calculated by two method are of little difference in both water and anthropomorphic phantoms, however, large differences were observed when they were compared with the traditional clinical proton biological dose especially in the high dose area.

Objective:To investigate the correlation between fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) and outcomes after endovascular mechanical thrombectomy (EMT) in patients with anterior circulation large vessel occlusive stroke.Methods:Using " Nanjing First Hospital Stroke Database" , consecutive patients with anterior circulation large vessel occlusive stroke received EMT treatment from June 2015 to December 2018 were enrolled retrospectively. Before EMT treatment, the distal FVH grade and the American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral circulation grade were evaluated. The modified Rankin Scale was used to evaluate the functional outcome of patients at 3 months after onset, and 0-2 was defined as a good outcome. Spearman correlation analysis was used to analyze the correlation between the distal FVH grade and the ASITN/SIR collateral circulation grade. Multivariate logistic regression analysis was used to identify the independent predictors of the outcomes. Results:A total of 117 patients with acute anterior circulation large vessel occlusive stroke were enrolled, aged 70.74±12.50 years, 72 (61.5%) were male. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 13.73±4.91. Seventy-four patients (63.2%) had a good outcome and 43 (36.8%) had a poor outcome. The distal FVH grade was grade 0 in 8 cases (6.84%), grade 1 in 34 cases (29.06%), and grade 2 in 75 cases (64.10%). Compared with the distal FVH low-grade group (grade 0-1), the high-grade group (grade 2) had a higher ASITN/SIR collateral circulation grade ( P<0.001) and lower baseline National Institutes of Health Stroke Scale (NIHSS) score ( P=0.026). Spearman correlation analysis showed that the distal FVH grade was significantly positively correlated with the ASITN/SIR collateral circulation grade ( r=0.620, P<0.001). Multivariate logistic regression analysis showed that the high distal FVH grade (odds ratio [ OR] 0.336, 95% confidence interval [ CI] 0.128-0.879; P=0.026) was independently associated with the good outcomes, while the higher baseline NIHSS score ( OR 1.036, 95% CI 0.988-1.229; P=0.048) and symptomatic cerebral hemorrhage ( OR 5.597, 95% CI 1.052-29.761; P=0.043) were independently associated with the poor outcomes. Conclusion:The distal FVHs can reflect the state of collateral circulation. The high grade of distal FVHs is associated with the good outcomes after EMT in patients with anterior circulation large vessel occlusive stroke.

Objective To investigate the surgical method and clinical outcome using the free an-terolateral thigh flap with the medial gastrocnemius artery as the recipient artery for the repair of com-plex wounds in the lower leg.Methods A retrospective analysis was conducted on the clinical data of 11 patients with complex wounds in the lower leg admitted to Suzhou Ruihua Orthopedic Hospital from October 2020 to September 2022.All patients had extensive skin and subcutaneous soft tissue defects in the lower leg and received free anterolateral thigh flap repair with the medial gastrocnemius artery as the recipient artery.The skin of donor site was directly sutured.Results All 11 free skin flap survived in 11 patients,and both the donor and recipient sites healed in stage Ⅰ.All patients were followed up after discharge,with a follow-up time of 12 to 35 months.The follow-up results at 12 months postoperatively showed good wound healing,good flap appearance and elasticity,restora-tion of normal knee and ankle joint function,and independent living ability.The donor site wounds healed well without significant scar hyperplasia.At the last follow-up,the flap sensory function was graded as S3 in 2 patients and S2 in 9 patients.The functional score of the affected limb was excellent in 5 patients and good in 6 patients,with an excellent and good rate of 100％.Conclusion The me-dial gastrocnemius artery has a suitable vessel caliber for anastomosis and a constant location.The use of the free anterolateral thigh flap with this artery as the recipient artery for the repair of severe wounds in the lower leg can effectively cover soft tissue defects and avoid injuring the residual main vessels in the lower leg,resulting in satisfactory outcomes.

Objective To investigate the surgical method and clinical outcome using the free an-terolateral thigh flap with the medial gastrocnemius artery as the recipient artery for the repair of com-plex wounds in the lower leg.Methods A retrospective analysis was conducted on the clinical data of 11 patients with complex wounds in the lower leg admitted to Suzhou Ruihua Orthopedic Hospital from October 2020 to September 2022.All patients had extensive skin and subcutaneous soft tissue defects in the lower leg and received free anterolateral thigh flap repair with the medial gastrocnemius artery as the recipient artery.The skin of donor site was directly sutured.Results All 11 free skin flap survived in 11 patients,and both the donor and recipient sites healed in stage Ⅰ.All patients were followed up after discharge,with a follow-up time of 12 to 35 months.The follow-up results at 12 months postoperatively showed good wound healing,good flap appearance and elasticity,restora-tion of normal knee and ankle joint function,and independent living ability.The donor site wounds healed well without significant scar hyperplasia.At the last follow-up,the flap sensory function was graded as S3 in 2 patients and S2 in 9 patients.The functional score of the affected limb was excellent in 5 patients and good in 6 patients,with an excellent and good rate of 100％.Conclusion The me-dial gastrocnemius artery has a suitable vessel caliber for anastomosis and a constant location.The use of the free anterolateral thigh flap with this artery as the recipient artery for the repair of severe wounds in the lower leg can effectively cover soft tissue defects and avoid injuring the residual main vessels in the lower leg,resulting in satisfactory outcomes.

Objective:To explore the feasibility of applying ArcherQA to independent dose verification of MR-guided online adaptive radiotherapy (ART) plans performed on Elekta Unity 1.5 Tesla (T) magnetic resonance-linear accelerator (MR-Linac).Methods:The dose calculation accuracy of ArcherQA under a specific magnetic field was validated using a homogeneous water phantom. A total of 32 patients who received MR-guided online ART on Elekta Unity were randomly selected by lottery, with 32 offline plans and 177 online plans for five treatment sites (brain, mediastinum, liver, kidney, and vertebral body) enrolled. Finally, the γ pass rates (threshold: 10%; criteria: 3 mm/3% and 2 mm/2%) were compared among the result upon independent dose verification of ArcherQA, measurements of ArcCheck, and calculations using the Monaco treatment planning system (TPS) to quantitatively evaluate the accuracy and efficiency of ArcherQA in independent dose verification of online plans on Elekta Unity.Results:ArcherQA was proven accurate in calculating the dose distribution of therapeutic photon beams under the specific magnetic field. With the 3 mm/3% criterion, the γ pass rates of verification result exceeded 99% in all square fields of a water phantom. Under the stricter 2 mm/2% criterion, the γ pass rates also surpassed 95% in all square fields except 20 cm × 20 cm field. Regarding the verification of treatment plans, the ArcherQA result were found to be highly consistent with those measured or calculated using ArcCheck and Monaco TPS, with the average γ pass rates exceeding 99% under the 3 mm/3% criterion and above 97% under the 2 mm/2% criterion. ArcherQA was acceptably efficient for independent dose verification of online plans, with 50 to 150 s, (108 s on average) required to complete the independent dose verification of 177 online plans.Conclusions:ArcherQA allows for accurately and efficiently calculating the dose distribution of therapeutic photon beams under a specific magnetic field, establishing it as an effective supplementary tool for independent dose calculation of MR-guided offline and online ART plans, thereby ensuring the safety of patient treatment plans.