Objective:To investigate the efficacy of re-treatment for cervical lymph node recurrence in nasopharyngeal carcinoma patients after radiotherapy and to explore the prognostic factors.Methods:Eighty-two patients who received therapy due to cervical lymph node recurrence after deftnitive radiotherapy were reviewed.The relevant factors including sex.the interval between radiotherapy and recurrence,rN stage,recurrence site,treatment modalities,and treatment efficacy were analyzed.Subgroup analysis was performed to review the relevant factors including the involvement in the adjacent tissues,the number of positive nodes and surgical range.Kaplan-Meier method,Log-rank test and Cox method were used for statistical analysis.Results:The 1-,3-and 5-year local control rates were 58%,39.0%,and 39.0%,respectively.The 1-,3-and 5-year overall survival rates were 82.9%,47.6%.and 25.0%,respectively.The 1-,3-and 5-year overall survival rates in the radiotherapy-based treatment group were 80.8%,37.1%and 19.1%,respectively.The 1-,3-and 5-year overall survival rates in the surgery-based treatment group were 86.7%,66% and 34.2%,respectively.The efficacy of surgery-based treatment was superior to that of radiotherapy-based treatment.In the multivariate analysis,tumor recurrence site was an independent prognostic factor.Conclusion:Radical neck dissection-based treatment can achieve satisfactory efficacy for cervical lymph node recurrence after radiotherapy in nasopharyngeal carcinoma patients.

Objective To study the effect of letrozole (LE) on ovulation in patients with polycystic ovary syndrome (PCOS).Methods One hundred and sixty-four patients with PCOS were divided into LE treatment group (n=68) and chloramiphene (CC) treatment group (n=96).Growth rate of follicles,serum hormone level,endometrial thickness,and cervix mucus were observed before and after treatment.Results The growth rate of follicles was 1.67 and 1.78 mm/d,respectively,in LE and CC treatment groups (P=0.14).The serum T level on the day of LH peak was 2.1?1.9 and 2.0?1.7ng/dL,respectively,in LE and CC treatment groups (P=0.93).The serum testosterone (T) level on day of LH peak and on day 3 of menses was 2.1?1.9 and 1.4?1.5 ng/d,respectively,in LE and CC treatment groups (P=0.09).The serum E2 level on day of LH peak was 89.0?59.5 and 108.1?46.0 pg/ml,respectively,in LE and CC treatment groups (P=0.13).The endometrial thickness was 11.3?1.6 and 9.7?1.4 mm,respectively,in LE and CC treatment groups (P=0.07).The score of cervix mucus was 11.0?1.1 and 8.3?3.1,respectively,in LE and CC treatment groups (P=0.003).Conclusion Letrozole can effectively induce ovulation in patients with polycystic ovary syndrome,and does not increase serum T level.

OBJECTIVE:To investigate the thoughts and ways of clinical pharmacist in nephrology department to review medi-cal orders,and to provide reference for rational drug use in nephrology department. METHODS:Based on specific cases of nephrolo-gy department,the thoughts and ways of clinical pharmacist in nephrology department to review medical orders were investigated from several aspects,including whether the therapeutic drugs had covered all the problems,drug duplication,drug selection,usage and dosage and course of treatments,drug interaction and compatibility. RESULTS & CONCLUSIONS:By establishing rigorous and systematic review thinking mode,based on their professional specialty,clinical pharmacists of nephrology department can sort the reviewing thought,fill in the gaps of medical orders reviewing and enhance the ability of participating in the clinical practice.

Circulating microRNAs (miRNAs) is a class of non-coding small RNA molecules.As tumor biomarkers, circulating miRNAs deregulation is associated with the initiation and progression of human cancer.Studies indicate that circulating miRNAs have great potential in the early diagnosis and prognosis of primary or metastatic tumors (colorectal, breast, prostate, hepatocellular and ovarian cancer and other epithelial cancer).

OBJECTIVE To evaluate the relationship between the degree of nasal septum deviation and inferior turbinate hypertrophy with the CT. METHODS The paranasal sinus CTs of 98 cases with septum deviation were evaluated. Inferior turbinate on the deviated side of the nasal septum was considered as the control group and the inferior turbinate on the other side was taken as the study group in the same patient. The septal deviation angle, thickness of the bone, medial mucosa and lateral mucosa of the inferior turbinate were measured. RESULTS The thickness of the bone, medial mucosa and lateral mucosa of the inferior turbinate were statistically different between the study group and the control group(P<0.05). There were statistically differences between the medial and lateral mucosal thickness in study group(P<0.05). There was no positive correlation between the deviation angle and the thickness bone, medial and lateral mucosa of the inferior turbinate in the study group(P>0.05), but the value of correlation coefficents revealed the inferior turbinate bone correlated with the deviation angle most, followed by medial and lateral mucosal thickness. CONCLUSION The hypertrophy of inferior turbinate in patients with nasal septum deviation is not only caused by mucosal hypertrophy, but also by hypertrophy of the inferior turbinate bone. The preoperative CT before septoplasty can be helpful to choose the surgical methods during the operation.

Objective:To explore the hemodynamic effect of the modified Z Trendelenburg position in patients undergoing laparoscopic radical surgery of endometrial carcinoma, to provide a reference for the selection of the operative position of patients.Methods:A total of 80 patients who undergoing laparoscopic radical surgery of endometrial carcinoma from April 2017 to April 2019 in the Central Hospital of Xiangyang were recruited and assigned to experiment group and control group by random digits table method with 40 cases in each group. Patients in the experiment group were positioned in modified Z Trendelenburg position, while the patients in the control group were placed in conventional Trendelenburg position. The data of heart rate, mean arterial pressure, central venous pressure, systemic circulation resistance, cardiac output were recorded at 10 minutes before pneumoperitoneum (T 0), pneumoperitoneum immediately (T 1) and 5 minutes (T 2), 10 minutes (T 3), 30 minutes (T 4), 60 minutes (T 5) after pneumoperitoneum and 1 minute after recover horizontal position (T 6). Followed up investigation at 24 h after surgery, the degree of pain in the shoulder and the lower limbs were also recorded by Visual Analogue Scale(VAS). Results:The differences of heart rate, mean arterial pressure, systemic circulation resistance and cardiac output between the two groups had no statistical significance at T 0 to T 6 (all P>0.05). The central venous pressure were (9.86±1.95), (10.94±1.53), (11.33±2.24), (11.14±1.54),(7.75±1.59) cmH 2O(1 cmH 2O=0.098 kPa) respectively from T 2 to T 6 in the experiment group, lower than that of control group (18.83±2.82), (16.81±2.93), (16.27±3.56), (15.76±2.33), (8.92±1.68) cmH 2O at the same time, the differences were statically significant ( t values were 3.057-15.736, all P<0.05). The VAS scores of shoulder pain and low leg pain in experiment group were (3.48±1.10), (2.35±0.66) points, lower than that of control group (4.16±1.32), (2.99±1.02) points, the differences were statically significant ( t values were 2.404, 3.228, P<0.05). Conclusions:Modified Z Trendelenburg position can maintain the circulatory system hemodynamic stability, reduce the degree of shoulder pain and low leg pain after surgery in the laparoscopic radical resection for endometrial carcinoma patients.

Objective · To determine the expression of miRNA-7 in TWEAK-stimulated macrophages and their secreted exosomes;to investigate the role of exosomal miRNA-7 from TWEAK-stimulated macrophages in modulating the metastasis of epithelial ovarian cancer (EOC) cells.Methods · Real-time PCR analysis was used to determine the miRNA-7 expression in TWEAK-stimulated macrophages,their exosomes and recipient HO8910-PM cells.The activity of EGFR signaling pathway in HO8910-PM cells was detected by Western blotting analysis.AntagomiR-7 was used to downregulate the miRNA-7expressions in macrophage exosomes and then their effect on metastasis of HO8910-PM cells was examined by transwell assay.Results ·TWEAK increased the levels of miRNA-7 in macrophages and their secreted exosomes and also resulted in an elevated level of miRNA-7 in recipient HO8910-PM cells,which eventually reduced the activity of EGFR/AKT/ERK1/2 pathway.Pre-transfection of antagomiR-7 remarkably decreased the levels of miRNA-7 in macrophages,their secreted exosomes and the recipient EOC cells,with the enhancement of HO8910-PM metastasis.Conclusion · Exosomal miRNA-7 from TWEAK-stimulated macrophages plays a critical role in suppressing the metastasis of EOC cells by attenuation of EGFR signaling pathway.

BACKGROUND:Bone marrow mesenchymal stem cells (BMSCs) of mice are different from human and rats.The difficulties of culture,sustaining impermanency activity of BMSCs after passage and short-term effect of stem cells tracking limited the study of mice.OBJECTIVE:To obverse modified isolated culture method of BMSCs of mice and the feasibility of long-term fluorescent labeling stem cells.DESIGN,TIME AND SETTING:The experiments were conducted at the Affiliated Hospital of Academy of Military Medicine Science from June to December in 2008.MATERIALS:C57BL/6 mice,males and females,4-6 weeks of age,mean weighing 20 g,were used.METHODS:Stem cell culture fluid serum and liquid change manner were optimized using adherent screening and Percoll separation method.Rat BMSCs were incubated.In accordance with previous experiences of MSCs between human and macaque,Hyclonehigh-grade fetal bovine serum was selected for mouse MSC incubation.Serum was 10% of the medium.Bone marrow cells were washed out using LG-DMEM to filter bone dregs and small muscle blocks.Subsequently,samples were added on the Percoll separating medium at relative density of 1.082,and then incubated in 75 cm~2 culture flask at the concentration of 1.5×10~6/cm~2.BMSCs at the second passage were labeled with CM-Dil.MAIN OUTCOME MEASURES:Morphological changes in primary cultured and subcultured mouse BMSCs were measured.BMSC surface antigen of the second passage of mice (CD105,CD44,CD25,CD34) were determined using flow cytometry.The modified method was assessed to harvest the purity of stem cells.Activity of mouse BMSCs was identified using adipogenic and osteoplastic differentiation.The strength of fluorescent cells following multiple passage was observed.RESULTS:①The attached cells were observed 48 hours after primary cells culture and changed shuttles,triangles and flats at 7 days after culture.The figure become bunches and radial pattam at 3 passages.②MSCs highly expressed CD105,CD44 phenotypes and seldom expressed CD34 and CD45.③Spindle shape of cells gradually disappeared,with increased cell body.Some cells grew in cluster.MSCs changed figures to multilayer knots 10 days after inducing osteoplastic differentiation.MSCs became roundness and appeared fat drops in cells 9 days after inducing adipogenic differentiation.Red fat particles were shown following oil O staining.④The labeling cells gave out oranges light,and marked rates were over 80% in MSCs under the fluorescent microscope.The labeling cells were over 47% in 4 passages MSCs using flow cytometry.CONCLUSION:The modified method gained high-dosage cells in shorten culture time at passage 2 and made CM-Dil long lime labeling cells,which made more convenient for MSCs experiment on mice and stem cells tracer experiment in vivo.

Objective To observe the efficacy and safety of levofloxacin for the theatment of com-munity acquired pneumonia(CAP) in the elderly patients. Methods Thirty-six elderly inpatients with CAP between May 2005 and May 2007 were treated with levofloxacin at a dosage intravenously of 500 mg once a day for 5 to 14 days treatment. Results Streptococcus pneumoniae of multiple drugs-resistant were found in sputum of 22 patients,pseudomonas aeruginosa in 8 patients and haemophilus influenzae in 6 patients de-pending on the results of the sputum culture. The total clinical efficacy rate of levofloxacin was 75.0% and bacteria elimination rate was 82.1%,and 16.7% patients showed related side effect of diarrhea,skin-rash and kidney injury. Conclusions Levofloxacin is an effective with little side effect in treatment of CAP in the elderly.

Objective To explore the timing of surgical intervention for severe acute pancreatitis (SAP). Meth-ods One hundred and fifty-seven cases with SAP treated in our hospital from March, 1998 to December, 2007 were analyzed retrospectively. Influence of surgical intervention and conservative treatment on curative rate were e-valuated in pancreatic necrotic area and with or without infected pancreatic necrosis. Results The overall curative rate of surgical treatment and conservative treatment was 80.4%, 87.1% respectively; the two methods had no sta-tistical difference. Conservative treatment was better than surgical treatment in patients with lesa than 30% necrotic area and surgical treatment was better than conservative treatment in patients with more than 50% necrotic area. But the two methods had no statistical difference in 30% ～ 50% necrotic area. Conservative management was better than surgical management in sterile pancreatic necrosis, but surgical management was better than conservative manage-ment in pancreatic necrosis with infection or suspection of infection. Conclusion Surgical intervention treatment plays an important role in SAP patients, we should combine pancreatic necrotic area and with or without infection to choose the timing of surgical intervention for severe acute pancreatitis.