The multidrug resistance( MDR) has become one of the key factors in the success of chemo-therapy.Thus,overcoming multidrug resistance of tumor has become a pressing matter of the moment for tumor therapy.The mechanism of MDR is a very complicated process,influenced by many factors.Therefore,the tumor multidrug resistance mechanisms in depth study will help to select more appropriate anti-tumor drugs.In this re-view,we described about MDR mechanisms researching progress in recent years.

0 05), While the areas of myocardial necrosis in IP and NIP groups were 64 80% and 32 60%, respectively( P

Objective To evaluate the efficacy and safety of etoricoxib and meloxicam in the treatment of patients with acute gout. Methods A randomized,active comparator study was conducted at outpatients and inpatients in our hospital from January 2009 to July 2010.A total of 84patients aged (63.7± 11.0) years with an acute attack of gout were treated with etoricoxib 120 mg/d (n =48),or meloxicam 15 mg/d (n =36) for 7 d.The patient's assessment of joint pain (0- 4 point Likert scale) at drug treatment for 2-5 d was considered as the primary efficacy end point,4 h after firstly takiug the drug and 2-8 d after treatment as the secondary efficacy end point.The starting efficacy was determined until pain relieved by patient himself. The safety was assessed by adverse experiences and indexes including leucocyte, platelet,crcatinine, uric acid,alanine transaminase (ALT),aspartate transaminase (AST) and mean artery pressure(MAP). Results In 84 patients,3cases (8.3％) in meloxicam treatment and 15 cases (31.2％) in etoricoxib treatment (among which 13 cases finished treatment) discontinued therapy.The improvement scores of joint pain were (-0.41 ±0.35 vs.-0.19±0.30,P=0.005) at4 h after firstly taking the drug,(-1.66±0.58 vs. 1.38±0.44,P=0.018)at drug treatment for 2 -5 d,( - 1.83 ± 0.60 vs.- 1.85 ± 0.53,P=0.9) at 2 8 d after treatment,and (-2.64±0.45 vs. - 2.38±0.37,P=0.000) post-treatment higher than pre treatment.The starting time of pain relieving were (4.0 ± 4.6) h in etoricoxib treatment and (12.1±5.7) h in meloxicam treatment. The levels of leucocyte were decreased after treatment as compared with before treatment in both two drug treatments(P＜0.05),while no differences were found in platelet.creatinine,uric acid,ALT and AST.MAP after etoricoxib treatment was increased compared with pretreatment ( P ＜ 0.05 ). Drug related adverse experiences appeared in 15 cases (31.2 ％ ) in etoricoxib treatment and 12 cases(33.3 ％ ) in meloxicam treatment(P=1.000).The ratio of gastrointestinal tract-related adverse effects in meloxicam treatment was higher than in etoricoxib (22.2％ vs.6.2％,P＜ 0.05),while adverse effects on cardiovascular in etoricoxib treatment were comparable to that of meloxicam (16.7 ％ and 11.1 ％,P＞0.05). Conclusions Etoricoxib at a dose of 120 mg once daily may be more effective than meloxicam for acute gout in aspects of safety and tolerance.

BACKGROUND: Compared with artificial intervertebral disc replacement,prothetic nucleus replacement is easier to perform with fewer risks and requiting smaller incision.OBJECTIVE: To evaluate the effect of prosthetic disc nucleus replacement for treatment of lumbar disc herniation.DESIGN: A self-controlled trial.SETTING: Department of Orthopaedics, Zhujiang Hospital, Southern Medical University.PARTICIPANTS: Thirty-three patients including 21 male and 12 female patients with lumbar disc herniation received prosthetic disc nucleus replacement in Zhujiang Hospital of Southern Medical University from January 2002 to October 2003.METHODS: All the patients received prosthetic lumbar nucleus replacement and 3 weeks after the operation, X-ray examination was performed for observing the height and morphology of the intervertebral space. All the patients were followed up for 8 months and the therapeutic effects were assessed in a four-grade system(excellent, good, improved, poor). MAIN OUTCOME MEASURES: The change in the symptoms of low-back pain and the range of movement (ROM) of the lumbar spine.RESULTS: According to the intention-to-treat analysis, none of the 33 patients was lost to the analysis. During the follow-up, 29 patients had excellent, 3 good, and 1 poor outcome in terms of the symptoms of low-back pain and ROM of the lumbar spine, with a total rate of good outcome of 96. 97%(32/33) . X-ray examination in the 3rd month revealed normal size of the intervertebral space in 29 cases, and increased but still narrowed intervertebral space in 3 cases. No aggravation of retrograde changes was found in the adjacent segments.CONCLUSION: Prosthetic disc nucleus replacement can effectively relieve low-back pain in lumbar disc herniation, restore the spinal movement and decrease retrograde changes of adjacent intervertebral space and articular process.

ObjectiveTo investigate the changes of renin-angiotensin-aldosterone system (RAAS) and glomerular filtration rate (GFR) in epidurally-anesthetized patients undergoing gynecological laparoscopy with 15° head-down position and low insufflation pressure. MethodsTwenty gynecological patients(ASA grade I- Ⅱ )were studied during CO2 insufflation with an intra-abdominal pressure of 1012mmHg and 15° head-down position. Arterial blood samples were obtained for the measurements of serum concentrations of plasma renin activity(PRA), angiotensin Ⅱ (All), aldosterone(ALD) and β2-microglobulin(β2-MG)by radioimmunoassay at the following five time points: before insufflation, at 10min, 30min and 60 min after insufflation respectively and after desufflation. Arterial blood gas analysis was made in 10 of the cases simultaneously. ResultsCompared with preinsufflation, there was no significant decrease in the plasma levels of PRA, All ,ALD and β2-MG during CO2 pneumoperitoneum except for PRA at 10 min after insufflation(P ＜0.05). As the time of insufflation went on, the measurements above showed a tendency of slightly increase. The PaCO2 during peritoneal CO2 insufflation was increeseing ( P ＞ 0.05) and reached its maximum at 30 min after insufflation. The pH values of 30～60 min after insufflation were significantly decreased as compared with that of before insufflation. ConclusionThe epidural anesthesia may inhibit the response of RAAS to (CO2 insufflation pressure of 10-12mmHg and has no effect on GFR during gynecological laParoscopy.

This paper summarizes the perioperative nursing of 65 patients undergoing eyelid malignant tumor resection combined with primary eyelid reconstruction. The nursing care focused on routine preoperative preparations as well as postoperative care of incision dressing, dressing change, medication administration and monitoring, prevention of infections and health education. All the patients had Ⅰ-phase wound healing and good shape of eyelid repair without postoperative complications.

Objective To explore the measures for nursing patients with acute hepatic graft versus host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation. Method The clinical data of 54 patients with aGVHD after hematopoietic stem cell transplantation during January 2010 and December 2013 were reviewed for summing up the nursing measures. Results In the study, 160 patients underwent allogeneic-hematopoietic stem cell transplantation and 53 of them contracted with acute hepatic-versus-host disease. Among them, 2 cases were at degreeⅣ, 10 at degreeⅢ, 23 at degreeⅡand 19 at degreeⅠ. Forty-seven cases(87.01%) were cured after careful treatment and care , 3 ( 5 . 56%) developed into cGVHD and 4 ( 7 . 41%) died . Conclusion Enhanced observation and postoperative nursing of liver, intestine and skin together with performance of mental care and dietary nursing are effective in achieving satisfactory outcomes of GVHD.

Objective To explore the surgical management and its results of intercondylar fracture of humerus through approach of extra-articular oblique osteotomy of olecranon. Methods From March 1995 to October 2003, 26 patients of intercondylar fracture of humerus were treated surgically through approach of extra-articular oblique osteotomy of olecranon, and the fracture was reduced and fixed with "8" steel wire. The patients were 15 men and 11 women with a mean age of 43.2 years (range 19-68 years). 14 fractures occurred on the left extremity and 12 on the right. The fractures resulted from traffic accident or fall in 23 and other trauma in 3. According to AO/ASIF classifation, type C1 fracture was found in 3, C2 in 5 and C3 in 18. 5 patients suffered open fracture(Custilo scaleⅠin 3, and Ⅱ in 2). Contusion of skin occurred in 3 and multiple injuries in 5, while primary injury of ulnar nerve occurred in 4. The rehabilitation exercises began at 2-7 d post-operatively. The healing of the osteotomy was evaluated with physical examination and plain X-ray film, and the function of elbow was assessed according to Cassebaum scale. Results 21 patients were followed from 9 months to 8 years(average, 18 months). Of these 21 cases, all the osteotomies healed in 6.2 weeks averagely, no nonunion, delayed union, separation or malunion was found. Heterotopic ossification occurred in 4 cases, and obviously limited locomotion of elbow in 2. Of the 4 patients with primary injury of ulnar nerve, no breaking was found during exploration, and the nerve was displaced anteriorly. 3 of these 4 patients recovered completely, and mild sensory disturbance and dyskinesis remained in 1. The function of the elbow showed excellent in 12, good in 6, fair in 1 and poor in 2. The locomotion of the elbow averaged 110?. Conclusion The use of the approach of extra-articular oblique osteotomy of olecranon for surgical management of intercondylar fracture of humerus has many advantages, it provides satisfactory stability with simple technical procedure avoiding intra-articular invasion, it facilitates rehabilitation exercises and provides good results with low complication rate.

0.05).Conclusion The use of domestic clopidogrel in PCI patients with individualized dose is safe and effective which can further reduce bleeding complications.

Objectives:To investigate the morphologic changes of the colon in the rats after a total small bowel resection. Methods:Ten male Sprague Dawley(350～370 g) rats in the experimental group were undergone resection of total small bowel,and ten normal rats were randomly chosen as the control group.After supported by enteral nutrition for 3 months,rats were sacrificed and the colon harvested for morphologic parameters study. Results:The length,diameter,wet weight,crypt depth,mucosal thickness and kerckring height of the colon in the experimental group were significantly higher than those in the control group( P