OBJECTIVE:To explore the clinical efficacy and safety of Leukotriene receptor antagonist combined with Gluco-corticoid nasal spray(called“intranasal steroid”for short)in the treatment of different degree of adenoidal hypertrophy(AH)com-plicated with allergic rhinitis (AR). METHODS:240 AR children with AH were randomly divided into control group,intranasal steroid group and drug combination group,with 80 cases in each group. Control group was given physiological seawater,3 presses each nostrile,in the morning and evening. The intranasal steroid group received Momestasone furoate nasal spray,one press each nostrile,qd. Drug combination group was additionally given leukotriene receptor antagonist Montelukast sodium chewable tablet,4 mg for under 5 year-old and 5 mg for 5-year-old or above,qd,at bedtime. Treatment course of 3 groups lasted for 12 weeks. The change of clinical symptoms and signs(such as nasal obstruction,snore,mouth breathing,etc)and adenoid/pharyngeal ratio(A/N ratio)were compared among 3 groups after treatment as well as the occurrence of ADR. Each group was divided into two sub-groups (medium and severe) according to the severity of AH so as to evaluate therapeutic efficacy. RESULTS:21 children withdrew from the study,including 11 cases in control group,6 in intranasal steroid group and 4 in drug combination group. After treatment,clinical symptom score and A/N in subgroups of drug combination group and intranasal steroid group were all lower than those of control group,with statistical significance(P<0.05). There was no statistical significance in clinical symptom score and A/N between drug combination group and AR complicated with medium AH subgroup from intranasal steroid group(P>0.05). Clini-cal symptom score and A/N of AR complicated with severe AH subgroup from drug combination group were lower than intranasal steroid group,with statistical significance (P<0.05). No obvious ADR occurred in 3 groups. CONCLUSIONS:Intranasal steroid alone and intranasal steroid combined with leukotriene receptor antagonist can improve clinical symptom of AR patients with AH, and reduce adenoid volume. It is suggested to use intranasal steroid firstly for medium AH complicated with AR,and additionally use Leukotriene receptor antagonist for severe AH complicated with AR.

Objective To explore the protocol of tissue matching and anti-rejection therapy in highly sensitized patients (HSP). Method The panel reactive antibody (PRA), human leukocyte antigen (HLA) matching and renal transplantation outcomes of 45 HSPs were retrospectively analyzed. Results Hyperacute rejection occurred in 2 patients. Acute rejection occurred in 9 patients and reversed by anti-rejection therapy. One year patient/graft survival rate was 95.6% / 91.1% respectively. Conclusions To avoid specific antibody through HLA matching is the key point for successful renal transplantation of HSP. Antithymocyte globulin (ATG) induction therapy combined with tacrolimus, mycophenolate mofetil therapy can decrease the rate of acute rejection and prolong graft survival.

Objective To investigate the relation between serum homocysteine(HCY) and the development of atherosclerosis(AS).Methods Diet contained 1% methionine was fed to make models of hyperhomocysteinemia and atherosclerosis in 18 male New Zealand rabbits. Hyperlipemia group was as control group. Ultrasonographic image was performed in 0,4,8 weeks respectively with HP 8500 and recorded the stenosis and plaque of abdominal aorta compared with pathology.Results Stenosis and plaque of abdominal aorta were observed in 4 weeks in high fat diet group. Stenosis and plaque of abdominal aorta were observed in 8 weeks in high methionine diet group.This results were confirmed by pathology anatomy.Satistically,significant correlation was found between AS and hypercholesterolemia or hyperhomocysteinemia respectively.But there was no correlation between hypercholesterolemia and hyperhomocysteinemia. Conclusions Hyperhomocysteinemia is an independent important risk factor of atherosclerosis.

Objective To explore the effects of gestation exposure to dibutyltin dilaurate (DBTD) on the activity of enzymes in the testis and the spermatogenesis function in the mature male offspring of Wistar rats. Methods The pregnant rats were treated with DBTD by gavage at the doses of 0, 10, 20 and 30 mg/kg for days, from 12th-20th days of gestation. On 70th postnatal day, 10 male offspring rats were selected randomly from each group for measurements of the viscera coefficient of testis and the sperm count in epididymis, the activity of enzymes of testis was determined by spectrophotometry. Results There were no significant differences seen in the body weight gain of pregnant rats from days 12-20 of gestation, litter size, sex ratio of fetuses and body weight of male offspring rats between the experimental groups and the control group. The testis weight and viscera coefficient of testis in 30 mg/kg group increased significantly compared with the control group(P

Objective To study the effects of di-butyltin dilaurate (DBTD) exposure on pregnancy outcome in Wistar rat and evaluate it's effect on sexual development of fetuses. Methods Timed pregnancy rats were treated with corn oil or DBTD (10, 20, 30 mg/kg body weight) from days 12-19 of gestation. On gestational day (GD) 20, dams were sacrificed to investigate the pregnancy outcome. Results There was a downtrend in weight of dams on GD20 as the DBTD exposure dose increased. The weight of dam's utero significantly decreased in 30 mg/kg group. A significant decrease in fetal weights was observed in all DBTD groups, and fetal sizes in 20, 30 mg/kg groups. Exposure to DBTD from GD 12-19 resulted in a distinct increase in normalized anogenital distances in female fetuses, but no effects were seen in male ones. DBTD exposure did not result in external malformations, however, delayed ossification of fetal phalanges was observed in all DBTD treated groups. Dead fetuses and absorbed embryos were observed in 20, 30 mg/kg DBTD groups. Conclusion The results of the present paper show that DBTD exposure has some adverse effects on fetal development and may exert a masculinizing effect on female fetuses.

Objective To assess the effect of ursedeoxycholic acid (UDCA) withdrawal in primary biliary cirrhosis (PBC). Methods Twenty seven patients who were biochemically normalized for more than 6 months were derided to two groups. Group A discontinued UDCA, Group B received UDCA 13-15 mg'kg·-1·d-1.The two groups were well matched in age, sex, and disease duration. The patient# were followed-up for 12 months. Results Two patients withdrawal the therapy because of imcompliance. Therefore, there were 12 patients in Group A, 13 patients in Group B for analysis. Two patients (17%) showed disease progression in group A in 3 months and 12 months during follow-up respectively, which were indicated by the doubling of serum bilirubin concentrations above normal limits, and none in group B. Disease relapse rate was 92% and 15%, respectively, and the difference was significant (P<0.05). Alkaline phosphates (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamy-hranspeptidase (GGT) deteriorated significantly, but serum bilirubin level remained unchanged. All other laboratory tests values remained unchanged. Conclusion long-term UDCA therapy is recommended in PBC patients, even though they achieve biochemical normalization.

BACKGROUND:With the prevalence of total hip arthroplasty,the demand for revision has been increased due to the prosthesis life and various complications.OBJECTIVE:To retrospectively analyze the reasons and clinical effectiveness of revision,clinical application of revision prosthesis,and related revision techniques.METHODS:Clinical data of 85 patients undergoing total hip revision were analyzed retrospectively.Among which,there were 23 cases of biological T.O.P acetabular cup (allograft bone graft) plus polyethylene liner,51 cases of titanium mesh cup plus bone cement fixation,and 11 cases of common acetabular cup;common hip stem in 63 cases (including 47 cases of bone cement fixation);lengthened hip stem in 34 cases (16 cases of modular prosthesis and 18 cases of bone cement fixation).Subsequently,the hip function was assessed by Harris hip scores.RESULTS AND CONCLUSION:All cases were followed up,and the mean follow-up was 30.2 months.(1) The average Harris hip scores changed from preoperative 30.07 to postoperative 90.32.The wound healed well,no dislocation or infection,and the hip function was improved significantly.(2) To conclude,aseptic loosening of the prosthesis is the main cause of reversion occurred,followed by prosthesis dislocation.Acetabular wall bone defect and decrease in bone mass are the main problems in revision.Adequate preoperative preparation for possible and unexpected events,and reasonable selection of prosthesis according to the bone defects will be helpful.Noticeably,early arthroplasty reversion will obtain good clinical efficacy.

Objective To compare the clinical outcomes of gefitinib and erlotinib treating non-small-cell lung cancer (NSCLC)with epidermal growth factor receptor (EGFR)mutation in either exon 19 or 21 . Methods A total of 242 patients diagnosed as NSCLC with EGFR mutation in either exon 19 or 21 from May 201 3 to December 2014 in our hospital were chosen in this study.According to age,sex,smoking history,eastern cooperative oncology group performance status and types of EGFR mutation,all the patients were matched to 121 pairs,and randomly divided into group A and B.Patients in group A received gefitinib treatment,and those in group B received erlotinib treatment.Based on the response evaluation criteria in solid tumors (RECIST),overall response rate (ORR),disease control rate (DCR),progression-free survival (PFS)were assessed.To assess the independent risk factors for PFS by univariate and multivariate Cox regression analysis.The subgroup analysis was performed for the 63 NSCLC patients using these two drugs as the first-line treatment.To evaluate the adverse drug reactions and quality of life between A and B groups.Results The median PFS of group A and B were 11 .6 months and 9.5 months,respectively,with no significant difference (HR =0.39,P >0.05).The ORR and DCR in the two groups were 76.9%,74.4% (χ2 =1 .03,P =0.58)and 90.1 %,86.8% (χ2 =1 .46,P =0.31 ). The independent risk factors of poor PFS were ECOG PS≥2 (HR =2.60,95%CI:1 .54 -4.43,P =0.001 )and non-adenocarcinoma (HR =3.61 ,95%CI:1 .54-8.66,P =0.003).For patients receiving these two drugs as the first-line treatment,there was no significant difference between two groups in overall response rates (76.6% vs. 90.2%,χ2 =0.83,P =0.12)and median PFS (11 .6 months vs.14.4 months,HR =0.59,P >0.05).The adverse drug reactions were significant differences in emotion function (F =10.27,P =0.03),diarrhea (F =10.24,P =0.03)and pain (F =9.02,P =0.04).After receiving drug treatment,the quality of life scores were improved,and most of the differences were statistically significant between A and B groups(P <0.05). Conclusion As for NSCLC with EGFR mutation in either exon 1 9 or 21 ,both gefitinib and erlotinib are well tolerated and have similar clinical effectiveness.

Objective To observe the clinical curative effect of Huoxue-Zhitong decoction combined with mannitol in the treatment of swelling and pain after operation of tibiofibular fracture. Methods 86 patients with swelling after the operation of fracture of tibia and fibula were randomly divided into two groups, with 43 cases in each group. The observation group was treated with intravenous rapid infusion of mannitol, the control group was treated with Huoxue-Zhitong decoction combined with intravenous rapid infusion of mannitol. Swelling, pain visual analogue scale (VAS) score of limb of patients at 1 D and 10 d after operation, time of detumescence and acesodyne and the total efficiency of the treatment between the two groups were compared. Results The indices of the two groups mentioned above at 7 d after the operation significantly decreased, the value in the observation group was lower than the control group (1.3 ± 0.7 cm vs. 1.9 ± 0.9 cm, t=3.451; 1.5 ± 0.6 points vs. 1.9 ± 0.7 points, t=2.845; all P<0.01); The detumescence and acesodyne time of the observation group was shorter than those of the control group (8.6 ± 1.7 d vs. 9.8 ± 2.3 d, t=2.751; 5.5 ± 1.4 d vs. 6.7 ± 1.7 d, t=3.573; all P<0.01), the total efficiency in the observation group was superior to the control group, there were statistically significant differences (97.7% vs. 83.7%; χ2=4.961, P=0.026). Conclusions Huoxue-Zhitong decoction combined with mannitol is effective and safe in the treatment of swelling and pain after operation of tibiofibular fracture.

Objective To investigate the clinical efficacy of liver transplantation for liver cirrhosis and portal hypertension.Methods The clinical data of 181 patients with liver cirrhosis and portal hypertension who were admitted to the People's Hospital of Peking University from January 2000 to January 2012 were retrospectively analyzed.The efficacy of liver transplantation for liver cirrhosis and portal hypertension was investigated.The indications of liver transplantation included repeated upper gastrointestinal hemorrhage,failure of medication,surgical treatment and interventional therapy,and portal hypertension combined with hepatic functional decompensation.Orthotropic liver transplantation or piggyback liver transplantation was selected according to the condition of the patients.The pressures of the portal vein were detected before and after the transplantation of the liver graft by the manometer tube.The incidence of postoperative complications was detected.Patients were followed up regularly till December 2012.The varices and rebleeding of the esophageal veins and the survival of the patients were monitored.The survival rates was calculated using the Kaplan-Meier method,and the measurement data were analyzed using the t test.Results Of the 181 patients,65 received orthotropic liver transplantation,and 116 received piggyback liver transplantation.The operation time,volume of blood loss and anhepatic phase were (485 ± 97) minutes,(4 380 ± 1 993) mL and (56 ± 24) minutes,respectively.T tube was placed in 157 patients.The portal vein pressure was detected in 102 patients.The portal vein pressures before and after liver transplantation were (32 ± 11) cmH2O (1 cmH2O =0.098 kPa) and (21 ± 6) cmH2O,respectively.There was significant difference in the portal vein pressure before and after liver transplantation (t =2.412,P ＜ 0.05).Severe infection was detected in 23 patients,acute renal failure in 20 patients,severe abdominal bleeding in 6 patients,vascular complications in 5 patients and primary graft non-function in 2 patients after liver transplantation.A total of 181 patients were followed up for 6-131 months.One hundred and thirty-eight patients received endoscopy or upper gastrointestinal imaging at 1 year after liver transplantation.The varices were disappeared in 112 patients and alleviated in 26 patients,with the overall alleviation rate of 85.71％ (138/161).Four patients were complicated with upper gastrointestinal rebleeding within 1 year after liver transplantation,and the rebleeding rate was 3.70％ (4/108).The condition of 3 patients was alleviated by haemostatics and endoscopic treatment,and 1 patient died of liver failure caused by rebleeding.The 1-month,1-,5-year survival rates were 86.8％,84.9％ and 77.4％,respectively.Twenty-three patients died.Fifteen patients died of multi-organ dysfunction syndrome,5 died of vascular complications (2 died of hepatic artery thrombosis,2 died of portal vein thrombosis and 1 died of anastomotic stricture of vena cava),2 died of primary graft non-function,and 1 died of respiratory complications.Conclusion Liver transplantation is an efficient method for the treatment of liver cirrhosis and portal hypertension with the advantages of low rebleeding rate and ideal efficacy of reducing portal vein pressure.