Primary CNS lymphoma (PCNSL) is a rare malignancy with peculiar clinical and biologic features,aggressive course,and unsatisfactory outcome.the particular microenvironment of this malignancy,and sanctuary sites where tumor cells grow undisturbed, strongly affects treatment efficacy. The execution of prospective trials is also difficult because of the rarity of the tumor and the impaired general condition and poor performance status of patients. Chemotherapy is indispensable for the treatment of PCNSL. High-dose methotrexate is the most effctive drug.PCNSL is sensitive to irradiation,but responses to radiotherapy alone are short-lived. MTX-based chemotherapy followed by whole-brain radiotherapy prolonged survival but is associated with delayed neurotoxicity especially in patients older than 60 years. A new approach is attempted to treat PCNSL with chemotherapy alone with defered radiotherapy in old patients with similar survival rencenfly. High-dose chemotherapy with autologous stem cell transplantation HDC/ASCT yielded promising results for recurent PCNSL.Clinical investigation with Temozolomide or rituximab have been reported.Further studies with these new drugs are needed.

Metabolic memory means if the hyperglycemia can't be controlled at early stage of diabetes,chronic complications such as diabetic retinopathy (DR) will continue to develop even if the blood glucose level maintains normal level at later stage.Oxidative stress plays an important role in the metabolic memory of DR,which interacts with the nitrative stress,advanced glycation end products,genetic modification and endoplasmic reticulum stress in the pathogenesis of DR.Further elucidation of the relationship between oxidative stress and metabolic memory of DR can open the way for the discovery of novel therapeutic targets to prevent DR progression.

Objective To evaluate the effectiveness of water jet debridement combined with negative pressure wound therapy (NPWT) for the treatment of early infection after fracture internal fixation.Methods The study cohort included 6 men and one woman with an average age of 43.6 years (range,from 36 to 58 years) who had presented with early infection after fracture internal fixation from October 2013 to March 2015.All the patients sustained closed fractures initially.The wound debridement was done within 3 to 5 days after the infection was confirmed.The length and depth of an incision was determined by the methylene staining range.Water jet was used to eliminate the dying tissues thoroughly from a shallower layer to a deeper layer while the internal fixator was retained.The wound was closed by full thickness sutures in a sparse fashion for drainage.Sensitive antibiotics were systematically administered for all the patients.The NPWT device was kept for 5 days.Results All the wounds healed uneventfully after an average of 18 days (range,from 10 to 25 days).The mean follow-up time was 12 months (range,from 8 to 24 months).No antibiotics were used during follow-up.There were no local or systematical symptoms like new sinus,broken wound or fever.Bony callus formed at the fracture sites after an average of 4.3 months (range,from 2.5 to 8.0 months) and no fracture nonunion happened.All the fractures healed after an average of 10.1 months (range,from 5.5 to 16.0 months).All the patients were satisfied with their treatment outcomes.Conclusion Since water jet provides simple,rapid and radical debridement while NPWT simplifies operative procedures and promotes wound healing,combination of the two can be an effective treatment for early infection after fracture internal fixation.

Objective To investigate the pressure sources of caregivers in need of hematopoietic stem cell transplantation (HSCT) and to provide evidence for targeted intervention. Methods According to Hill′s ABC-X family pressure model, 12 main family caregivers were received semi-structured in depth interviews with phenomenological methods. Results Pressure sources of caregivers for HSCT patients were summed up to 7 aspects: search of donor, isolation with patient during transplantation, lack of knowledge in patient care, family resource difficulties, family economic overburden, social role transformation and uncertainty of disease prognosis. Conclusions The pressure sources of caregivers for HSCT patients is a persistent process, which is over layed as the patient′s condition worsens. The analysis on the pressure sources of primary family caregivers is becoming a new topic in HSCT nursing area.

Objective:To investigate the effects of LPS on the IL-6 expression in osteoblasts.Methods:Rat calvarial osteoblasts were primarily cultured. LPS from Escherichia coli with different concentration were administrated. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to identify the IL-6 mRNA expression of the cells. The intensities of electrophoresis bands were measured. Enzyme-linked immunosorbent assay (ELISA) was used to detect IL-6 protein production. The data were analyzed with SPSS 10.0 software package.Results:E. coli LPS with concentrations of 1?10-5 g/L-1?10-3 g/L induced IL-6 mRNA and IL-6 protein expression in osteoblasts. Statistically significant differences were detected at concentrations 1?10-4,1?10-3 g/L E.coli LPS.Conclusion:LPS can increase the expression of IL-6 in osteoblasts in the gene and protein levels. IL-6 may play an important role in the alveolar bone metabolism.

The level of HLA-antibody and sensitization can be predicated by the determination of panel reactive antibody(PRA)which is of great significance in preventing hyperaeute and accelcrated rejection.The sensitivity of PRA is markedly higher than CDC.The level of PRA(positive rate above 50%)is closely relevant,to the degree of rejection and the decrease of graft survival.Although plasma exchange(PE)can be used to decrease the level of PRA before transplantation to prevent hyperacute and accelerated rejection,good HLA-matching is more important in securing a successful graft patient.Control study between random panel lymphocytotoxicity test(RPLT)and PRA showed that RPLT is a simpler and more dependent and more easily practised method to predict the sensitivity of recipients of renal transplantation.

Objective To observe the effect of different doses of propofol injection and propofol medium/long-chain fat emulsion injection in short time infusion on plasma ketone body ratio,to eva-lute its effecton hepatic energy metabolism.Methods Forty patients,aged 18-50 years old,ASA Ⅰ orⅡ undergoing selective surgery were randomly divided into 4 groups with 10 cases in each;propofol injection 4 mg·kg-1·h-1 maintain anesthesia (group L4 ),propofol injection 6 mg·kg-1·h-1 maintain anesthesia (group L6 ),propofol medium/long-chain fat emulsion injection 4 mg·kg-1·h-1 maintain anesthesia (group M4 ),propofol medium/long-chain fat emulsion injection 6 mg·kg-1·h-1 maintain anesthesia (group M6 ).MAP,HR,SpO2 and PET CO2 were recorded before anesthesia induction (T0 ),after tracheal intubation (T1 ),after 2 hours infusion of propofol (T2 )and operation completed (T3 ).The blood samples were collected at T1 and T2 to detect the level of acetoacetate,β-hydroxybu-tyrate and to calculate the blood ketone body ratio (the ratio of acetoacetate andβ-hydroxybutyrate). Results MAP,HR,SpO2 ,PET CO2 at T0-T3 and acetoacetate,β-hydroxybutyrate,blood ketone body ratio at T1 ,T2 showed no significant statistic difference.Conclusion Different doses of propofol and different doses of propofol medium/long-chain fat emulsion injection in short time continuous in-fusion has no obvious effect on hepatic energy metabolism;same dose of propofol injection and propo-fol medium/long-chain fat emulsion injection in short time continuous infusion has no obvious effect on hepatic energy metabolism.

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 whether BNP(brain natriuretic peptide) could be relatively objective index for comprehensive risk stratification of exercise rehabilitation nursing in young and middle myocardial infarction patients. Methods BNP concentration and LVEF were measured respctively in young and middle myocardial infarction patients. Then the risk stratification was administrated based these index respectively and Barther Scores and significant statistical differences were calculated according to homogeneity test for variance. Results Blood BNP concentrations in acute phase among the divided group based on EF risk stratification were significant difference,hence the standard deviation is large,which led to variance nonhomogeneity,and stracification difference between groups is not clear and across-talking. Exercise rehabilitation nursing scores based on echocardiography EF value had significant difference even veariance is nonhomogeneity,hence the differ-ence is not clear beween groups.Exercise rehabilitation nursing scores based on BNP was administrated and significance is clear beween groups. Conclusions BNP concentration and LVEF value had certain relationship and cross-talking among them.Risk stratification based on BNP concentration had objective instructions for exercise rehabili tation nursing in actue infarction myocardial pa-tients.

Objective To assess the efficacy of clinical intervention of early swallowing syndrome on neonates. Methods Eighty-six cases of normal newborns were enrolled in the study, including 44 cases of natural delivery,32 cases of cesarean section,8 cases of premature infant. The cases started vomitting before feeding the milk, became more severe after feeding the milk. once the pathological factors were excluded, the cases were treated with breastfeeding, warm water enema, massaging the lower abdomen, 1% sodium bicarbonate solution to the gastric lavage. Results A variety of clinical interventions on the control of neonatal swallowing syndrome results are obvious. Conclusions Early detection early intervention can prevent complications occurring.