Objective To observe the clinical effect of Wangbi tablet oral therapy combined with joint mobilization in the treatment of periarthritis of shoulder, to provide reference for the treatment of periarthritis of shoulder.Methods A total of 136 patients with scapulohumeral periarthritis in our hospital from January 2015 to June 2016 were selected as the research object, according to the order of hospitalized patients were randomly divided into observation group and control group,with 68 cases in each group, the observation group was treated with Wangbi tablet combined with joint mobilization,the control group was treated with single joint mobilization.After treatment, the clinical curative effect,complications or adverse reactions were comparedbetween the two groups, visual analogue scale(VAS)was used to compare the degree of pain of shoulder joint of patients before and after treatment, the shoulder joint function score were compared by the Japanese Orthopedic Association(JOA)'s shoulder disease score, the patients were followed up for a half a year and the Barthel index score was used to compare the daily life ability score of dynamic contrast.Results (1)The total effective rate of the observation group was(64/68), the control group was 82.35%(56/68), the observation group was significantly better than the control group(P<0.05).(2)The incidence of adverse reactions in the observation group was(8/68), the control group was 7.35%(5/68), and the safety of the two groups was good.(3)the VAS score of the observation group was(3.09±0.98), the control group was(4.53±1.02), and the pain of the observation group was significantly lower than that of the control group(P<0.05).(4)After treatment, the JOA score of the observation group was(16.54±2.36), and the control group was(12.97±2.71).The observation group was significantly higher than the control group(P<0.05).(5)The observation group treatment and follow-up of the Barthel index score was(73.11±6.21),(83.89±7.95)points, the control group was(68.41±5.65),(73.88±6.80), the activities of daily living of the observation group were higher than that of the control group(P<0.05).Conclusion There is a significant effect of Wangbi tablet therapy combined with joint mobilization for the treatment of patients with periarthritis of shoulder, the safety of the treatment is high, can reduce the pain of patients, improve the activity of shoulder joint function and activity of daily living, the comprehensive curative effect, with a high clinical value to promote.

Objective To investigate the strategy and announcements of surgery in primary retroperitoneal. tumor for improving the rescetable rate and decreasing the surgical risk.Methods Clinical data of 50 cases undergoing surgery of retroperitoneal tumor in our hospital from January 2004 to December 2008 were retrospectively analyzed.Results Tumors were benign in 20 cases and malignant in 30 cages.Complete resection was achieved in 39 cases(78%).in which combined organ resection carried out in 10 cases(20%),3 cases(6%)underwent partial resection.non-resection and had biopsy only were performed in 8 cases(16%),so the rescetable rate of this clinical weTe 84%(42/50).Conclusions Abundant preoperative preparation,wide open operation field and distinct anatomical dissection were the essential condition of the resecting primary retroperitoneal tumor.The relevant surgical skill should decrease the surgical risk.The tumor should be completely reaeeted in principle,and invaded neighboring organs should be resected with the discretion at the gane time.Completely resected was the key 10 improving the surviral rate and the strategy to decreasing the reeurence rate for recurrent retroperitoneal tumor.

ObjectiveTostudytheroleof hotshockprotein (HSP)47in tubulointerstitial fibrosis induced by transforming growth factor β1(TGF-β1),and to explore its possible mechanism.Methods Human proximal tubular epithelial cells(HK-2) were divided into threegroups:control,TGF-β1andHSP47siRNA. Theexpressionsof HSP47, collagenⅣ,fibronectin(FN),plasminogen activator inhibitor 1(PAI-1) mRNA and HSP47,collagen Ⅳ,FN protein were detected by RT-PCR and Western blotting respectively.PAl-1 protein was detected by ELISA. ResultsHK-2expressedHSP47innormalmedium. ThemRNAandprotein expressions of HSP47 up-regulated in concentration- and time-dependent manner in HK-2 cells induced with increasing concentrations of TGF-β1(0,2.5,5,10 μg/L) and with prolong times (12,24,48 h),and peaked at 10 μg/L TGF-β1 for 48 h.Similar phenomena was observed in the mRNA andproteinexpressionsof collagenⅣ, FN, PAI-1inHK-2 cellsinducedbyincreasing concentrations of TGF-β1 (0,2.5,5,10 μg/L) at different time points (12,24,48 h),and peaked at 10 μg/L TGF-β1 for 48 h.HSP47 siRNA could significantly reduce the up-regulation of mRNA and protein expressions of HSP47,collagen Ⅳ,FN,PAI-1 in HK-2 cells induced by TGF-β1.Conclusion HSP47 can promote renal tubulointerstitial fibrosis maybe through the regulation of the expressions of collagen Ⅳ,FN,PAI-1.

Objective To explore the effect of horizontal beam on IMRT plan for lung cancer.Methods Totally 18 patients were enrolled,including 10 cases of left lung cancer and 8 cases of right lung cancer.Two intensity modulated radiation therapy (IMRT) plans were generated:one was the normal IMRT plan and another was the IMRT plan including a horizontal beam (H-IMRT).MUs,sub-field and the dose distribution of target and organs at risk (OARs) were compared.Results There were no statistically significant differences between two plans in D Dminand D of PTV,the V30 and D of the ipsilateral lung,V20 and V30 of the contralateral lung,and V30 of the total lung.When the horizontal beam was added,the PTV heterogeneity index (HI) and conformity index (CI) were significantly increased (t=-9.33,10.88,P＜0.05),the other dose index in lung was inferior (t =-1.55--7.58,P＜ 0.05),whleheart sparing were clearly better (t =1.84-3.99,P＜0.05),the number of MUs and segments were less(t =12.57,3.19,P ＜ 0.05).Conclusions IMRT in the treatment of lung cancer can further improve the PTV coverage when the horizontal beam is added.However,the increasing lung volume of low dose irradiation is not conducive to lung protection.

Objective To compare the performances of Monaco and Pinnacle treatment planning systems (TPS) for volumetric modulated arc therapy (VMAT) optimization regarding lung cancer.The TPS was compared in terms of dose distributions,treatment delivery parameters and quality control results.Methods For 20 patients,including 10 cases of left lung cancer and l0 cases of right lung cancer,two VMAT plans were generated for each case:one with Monaco 3.0 TPS and the other with Pinnacle 9.2 TPS.Two plans were compared among plan dosimetrie distribution.conformity index and homogeneity index of the targets,the average dose,maximum dose,minimum dose and interested dose volume histograms of organs at risk(OAR,and delivery time and MUs of the therapy plans,the accuracy of treatment plans dose verification.Results Monaco provided better PTV coverage than Pinnacle (t =5.927-12.034,P ＜ 0.05) except Dminof PTV.Monaco had a worse sparing effect on lung than Pinnacle (t =3.545-7.485,P ＜0.05) except V10of diseased side lung and V5of total lung.In addition,Monaco had a better sparing effect on heart(t =2.836-4.011,P ＜0.05).Monaco had fewer delivery time(t =9.780,P ＜0.05)and MUs(t =5.304,P ＜0.05)of the therapy plans,and the pass rate of QA was better than Pinnacle(t =4.937,P ＜ 0.05).Conclusions For lung cancer patients,VMAT treatment plans obtained with Monaco and Pinnacle could offer clinically acceptable dose distributions.Pinnacle might have a better sparing effect on lung and fewer delivery time and MUs of the therapy plans.Monaco had a better PTV coverage and heart sparing.Moreover,Monaco had better accuracy of treatment plans dose verification.

Objective To explore the influence of the number and orientation of the beams on the optimization of IMRT plan.Methods Four IMRT plans were designed for 9 patients with cervical cancer,and 7 and 15 fields were applied.The 15-field plans had 30 segments and the 7-field plans had 55 segments.The initial beam angle degrees were 0° and 180°,respectively.Dose delivery time,MUs of plans,the dose distributions of the targets,organs at risk and normal tissues were analyzed and compared in the plans.Results Compared the plans with different beam directions under the same amount,no difference of the irradiation dosimetry in the target and organs at risk was found,except for irradiation dosimetry received by the 7-field 180° small intestine was about 4％ higher than the other three plans(F=6.164,P＜0.05).The terms of the volume of organs at risk got high dose irradiation(V40 and V30 of the rectum and bladder,V40 of the small intestine),which was similar in the 7-and 15-field plans.V20 and Dmean of organs at risk were significantly smaller(F=3.665-10.503,P＜0.05)in the 15-field plans.The 15-field plans needed a little longer treatment time(F=0.312,P＜0.05)and HI was slightly worse (F=12.933,P＜0.05),but the number of MUs was significantly reduced(F=4.650,P＜0.05).Conclusions Increasing the beam number will offset the negative impact of sub field reduction and get the similar dose distribution result.

Objective To investigate the effects of erythropoietin (EPO) on myocardial apoptosis and protein kinase B (AKT) expression in rats of chronic heart failure (CHF). Methods Thirty male adult SD rats were randomly divided into two groups, sham-operated (Sham) group (n=6) and model (Model) group (n=24). The abdominal aortic coarctation was used to build CHF model. Sixteen survived rats after operation were randomly divided into two groups including EPO group and con-trol (Control) group. EPO group was received 3 000 U/kg EPO intraperitoneal injection 3 times/week for 4 weeks, and Sham group and Control group were received same volume of normal saline. The echocardiography was used to evaluate cardiac function after 4 weeks, 8 weeks and 12 weeks of treatment. After 12 weeks, all rats were sacrificed after 24 h fasting. The cell morphology and myocardial apoptosis were observed, and apoptosis index (AI) was calculated. Myocardial P-AKT/AKT pro-tein expression was detected by Western blot assay. Results Echocardiography showed that ventricular hypertrophy was found in model group after four weeks, heart failure 8 weeks. Compared with Control group, left ventricular ejection fraction (LVEF) was significantly higher after EPO intervention for 4 weeks (P < 0.05), systolic interventricular septum thickness (IVSs), end-systolic left ventricular posterior wall thickness (LVPWs), diastolic interventricular septum thickness (IVSd), af-ter left ventricular end-diastolic wall thickness (LVPWd) were significantly lower (P<0.05). The value of AI was significant-ly lower in EPO group than that of Control group (23.87%±1.45%vs 35.58%±2.81%, P<0.01). The OD value of P-AKT/AKT was significantly decreased in Control group (0.35±0.06) than that of Sham group (0.81±0.17), the value was significant-ly increased in EPO group (1.61±0.16) than that of Control group (P<0.01). Conclusion EPO can improve heart function, inhibit myocardial apoptosis,and promote pro-phosphorylation of AKT in rats with chronic heart failure.

Objective: To investigate the stamina,the role of antioxidant system in severe acute pancreatitis(SAP),and the effect of fish oil treatment in rats.Methods:Thirty-six male Sprague-Dawley rats(SD) were randomly divided into three groups,including SAP group(sodium chloride treatment ) (group NSG,n=12),fish oil treatment group (group FOG,n=12),and control group (group CG,n=12).SAP was induced by intergraded injection of 3.5% sodium tanrocholate to biliopancreatic duct of SD rats in group NSG and FOG.The group NSG rats were treated by subcutaneous injection of sodium chloride,while the group FOG rats were treated by subcutaneous injection of fish oil for 7 days.Then the improved tail suspension test was observed at the first,third,fifth,seventh day.12 rats in each group were respectively sacrificed after 7 day.The activity of serum antioxidant enzymes (MDA,GSH-PH) and the concentration of serum amylase were measured in each group,and the levels of threshold on the area and the total immobility time were measured in each group.The severity of pancreatitis was analyzed according to the histopathological morphology.Results: Compared to group NSG,the severity of pancreatitis was significantly decreased in group FOG.The activity of MDA was significantly increased in group NSG than that in group CG (P<0.01) ,while the activity of MDA in group FOG was decreased than that in group NSG (P<0.05) .The activity of GSH-PH was significantly decreased in group NSG than that in group CG(P<0.01),while the activity of GSH-PH was increased in group GOG than that in group NSG (P<0.05).THE level of threshold on the area was decreased in group NSG than that in group CG(P<0.01),while the level of threshold on the area was increased in group GOG than that in group NSG.(P<0.01) The total immobility time was significantly increased in group NSG than that in group CG(P<0.01),while the total immobility time was decreased in group GOG than that in group NSG(P<0.05).MDA was associated with the level of threshold on the area and the total immobility time.Conclusion: Fish oil has a positive effect on the activity of antioxidant system and behavior character in SAP rats.

Objective:The paper is designed to reveal differences in stroke patients'hospitalization costs crea-ted by different socioeconomic factors , health insurance and occupational background , and analyze those differences on health outcome .Methods:18879 cases of hospitalized patients with stroke in five tertiary hospitals from four prov-inces from 2011 to 2014 were included in the database .Descriptive statistics was used to describe patients'hospitali-zation costs and health outcome .Multiple linear regression model and logistic regression were used to evaluate the im-pact of insurance and occupation .Results:After controlling for patients'social characteristics , health risks , premise during hospitalization process and clinical characteristics of patients with free healthcare costs , the socialized medi-cine was charged 19.7% higher than the private ones ( P <0.001 ), the retired people and civil servants were charged 4.2%(P<0.001) and 2.9%(P=0.049) more than farmers.The socialized medicine was also associated with health outcome.The risk of death in patients with free medical care is (OR=4.901) compared with private pa-tients (95%CI 1.652~14.537), and the retired people had increased risk of death compared with farmers (OR=2 .145 , 95%CI 1 .287 ~3 .573 ) .Conclusions: Due to the impact of social background factors , some groups are found to have a higher level of expenses than their counterparts during hospitalization , but the more hospitalization costs are not spent the better the health outcome of stroke was achieved .

Objective To observe the expression of toll like receptor 4(TLR4) Signaling and the release of inflammation factors in rat tubular epithelial cell(NRK-52E) under high glucose condition after TLR4-siRNA transfection.Methods Three TLR4-siRNA sequences were designed and synthesized.The transfection efficiency was observed by fluorescence microscope after transfection,and the expression of TLR4 mRNA was detected by real time PCR.The most effective siRNA was selected to be used for forward experiments.After transfection for 24 h,cells were stimulated with 25 mmol/L glucose and/or 10-7 mmol/L Angiotension Ⅱ (Ang Ⅱ) for 12 h,24 h; cells without stimulation were as normal control.Real-time PCR was used to analyze TLR4 and myeloid differentiation factor 88 (MyD88) mRNA expression; Western blot was used to observe TLR4/MyD88 and NF-κB protein expression.ELISA assay was used to detect the concentration of monocyte chemoattractant protein-1 (MCP-1),interleukin-6(IL-6) in cell supernatant after cells were stimulated for 24 h.Results TLR4/ MyD88 mRNA and TLR4/MyD88/NF-κB protein were highly expressed under high glucose or Ang Ⅱ co -incubated NRK-52E(P ＜ 0.01),the MCP-1 and IL-6 levels were also increased markedly compared with normal control group (P ＜ 0.01).TLR4/MyD88 mRNA and TLR4/MyD88/NF-kB protein expressions were obviously inhibited in cells that were transfected with TLR4-siRNA compared with high glucose group(P ＜ 0.01),MCP-1 and IL-6 production decreased remarkably compared with high glucose or Ang Ⅱ co-stimulated group(P ＜ 0.01).Conclusions High glucose can lead to the activation of TLR4/ MyD88/NF-kB signaling and the secretion of inflammation factors in NRK-52E,Ang Ⅱ further augments these effects.The effect can be blocked efficiently by specific siRNA gene silence.TLR4 signaling plays a pivotal role in the innate-immune inflammatory reaction in NRK-52E.