Over the past years,the non-surgical treatment of locally advanced pancreatic cancer was chemotherapy,whereas the role of radiotherapy was controversial.With the development of precise radiotherapy techniques,radiotherapy has become one of the main treatments.In addition,brachytherapy radioactive seed implantation provides a new treatment method for locally advanced pancreatic cancer.However,there are no criteria about the optimum technology,dose and concurrently chemotherapy drugs,which need further clinical research.

Objective To compare the effect of bupivacaine and levobupivacaine for caudal anesthesia in infant and children.Methods Forty patients with age 3-6 years old in the state of ASA Ⅰ grade were randomly divided into bupivacaine group and levobupivacaine group,each 20 patients.Both groups received respectively bupivacaine or levobupivacine with the same concentration and volume.The blood pressure,heart rate and pulse oxygen saturation were monitored during the operation.The degree of pain and motor was assessed after the operation.Results Bupivacaine and levobupivacaine for caudal anesthesia in infant and children could provide good analgesic effects.The scores of pain was similar between the two groups and had no statistic significance (P ＞ 0.05).The scores of motor block in bupivacaine group was significantly higher than that in levobupivacaine group after anesthesia 60,90,120 min [(1.5 ±0.6) scores vs.(0.9 ±0.3) scores,(1.0 ±0.8) scores vs.(0.1 ±0.5) scores,(0.6 ±0.5) scores vs.(0.0 ±0.7)scores],there was significant difference (P ＜ 0.05).Conclusions Bupivacaine and levobupivacaine have the same analgesic potency.Levobupivacaine is better than bupivacaine in motor block.

Objective To discuss the clinical value of united detection of myocardial enzymes and troponin in the diagnosis of hypothyroidism.Methods 27 patients with hypothyroidism were chosen as the observation group.26 healthy volunteers were selected as the control group.CK-MB,LDH,AST,FT3,FT4,TSH,cTnT,cTnI were detected.Results The levels of serum AST,LDH,CK-MB of the observation group were significantly increased,the mean value was(52.67 ± 7.32)U/L,(265.23 ± 101.34)U/L,(26.75 ± 18.75)U/L respectively,which were significantly higher than the control group,the differences were statistically significant(P ＜ 0.05).The c TnT and c TnI positive rate of patients in observation group were 70.4％ and 81.5％,compared with the control group,the rates were much higher (P ＜ 0.05).Conclusion The united detection of myocardial enzymes and troponin had high clinical value in the diagnosis of hypothyroidism.

Objective To explore the impacts of leukoaraiosls (LA) on the short-term outcome of acute cerebral infarction. Methods 204 patients after acute cerebral infarction were reviewed from January 2012 to August 2014. They were divided into 4 groups according to the brain magnetic resonance imaging: cerebral infarction without LA (LA-0), and with LA (LA-1, LA-2 and LA-3). The Logistic regression analysis was applied with the short-term outcome of cerebral infarction as the dependent variable, and 16 possible factor as independent variables. Results There were 4 independent factors risk to the worse outcome of acute cerebral infarction, including LA, age, hypertension and cerebral infarction size (OR>1, P<0.05). Conclusion LA is an independent risk factors to the worse short-term outcome of acute cerebral infarction.

Objective To discuss the effect of the occurrence of congestive heart failure on the outcome of pregnant women with pulmonary hypertension. Methods Fifty-four pregnant patients complicated with pulmonary hypertension were admitted from January 2000 through December 2010. Among them, 34 had comorbidity of congestive heart failure. The timing and mode of pregnancy termination, and perinatal outcomes were studied, and comparison was made between those with and without heart failure. Results ① Of all 54 pregnant women with pulmonary hypertension, 34 had congestive heart failure. The incidences of congestive heart failure in patients with mild, moderate and severe degree of pulmonary hypertension were 27.78% (5/18), 73.33% (11/15) and 85.71% (18/21), respectively (P<0.05).②The rate of maternal complications was 47.06% (16/34) and maternal mortality was 17.65% (6/34) in the patients with combined pulmonary hypertension and heart failure. The rate of iatrogenic fetal loss was 29.41% ( 10/34) , preterm labor 52.94% (18/34), neonatal asphyxia 35.29% (12/34) and neonatal mortality 23.53% (8/34) in case of patients with pulmonary hypertension complicated with congestive heart failure. ③The rate of Cesarean section was 91. 18% (31/34) in the patients with combined pulmonary hypertension and heart failure. ④ The rates of iatrogenic induction, premature delivery, maternal complications and mortality, neonatal asphyxia and fetal or neonatal fatality were significantly higher in women with combined pulmonary hypertension and heart failure than those with simple pulmonary hypertension ( P < 0. 05). Conclusions The risk of heart failure increases with the severity of pulmonary hypertension. The occurrence of heart failure is the most important factor affecting the outcome of patients in pregnancy already complicated with pulmonary hypertension , and Cesarean section is the safer mode of termination of pregnancy in this cohort of women.

Objective To study effects of salmon calcitonin and Heng Gu bone healing reagent on vertebral osteoporotic fracture(OPF).Methods From Nov.2007 to Dec.2009,82 cases of vertebral OPF were treated.These cases were randomly divided into treatment group and control group.The treatment group(42 cascs)were treated with salmon calcitonin and Heng Gu bone healing reagent.The control group(40 cases)received salmon calcitonin only.Pain relief of the 2 groups wag compared.Results Before treatment,the 82 patients were scored 6-9 points by visual analogue scales(VAS)and pain scores of the 2 groups were similar (P>0.05).3 days,5 days,8 days and 15 days after treatment,VAS scores of the 2 groups were significantly different(P<0.01).Compared to the control group,the treatment group had pain relief in shorter time and their bone mineral density Was better showed by the 3-month-later review.Conclusion The combination therapy of salmon calcitonin and Heng Gu bone healing reagent in treating vertebral OPF has better effect of pain relief and bone formation,which is a safe and effective method.

Objective To study the effective composition of Aster ageratoides Turcz for relieving asthma and its toxicity . Methods Seventy‐two qualified male guinea pigs ,body mass(300 ± 20)g ,were randomly divided into the control group ,aminophyl‐line group(0 .047 g/kg) and different ratio group of total saponins and total flavonoids (8∶1 ,4∶1 ,2∶1 ,1∶1 ,1∶2 ,1∶4 ,1∶8) . Every group received at dose of 0 .38 g/kg once a day for 3 days by intragastric administration .The effect of relieving asthma was taken as the indicators for the optimization of compositions ,which was detected by observing the latent period of asthma induced by acetylcholine‐histamine in guinea rats .The relaxation percentage of smooth muscle retracted by acetylcholine was detected by Pow‐erlab biological signal collecting system when aminophylline(1 .25 mg/mL) and different matching drugs(0 .02 g/mL) were added in Krebs′solution .The acute toxicities of total saponins ,total flavonoids and mixture of total saponins with total flavonoids (ratio of 1∶2) were detected by classical acute toxicity test of mice .Results Compared with the control group ,aminophylline group ,each group latent period of inducing asthma significantly or very significantly prolonged (P<0 .05) ,among them ,1∶1 ,1∶2 ,1∶4 group and other matching group were significantly different(P<0 .05) ,but 1∶2 group cited the longest incubation period .Aminophylline group and the ratio could significantly relaxe guinea pig tracheal smooth muscle retracted by acetylcholine .Aminophylline group di‐astolic percentage was the largest(24 .12 ± 1 .20)% ,all the groups were less than the percentage of diastolic aminophylline group (P<0 .05) ,but in 1∶2 group with the closest .Aster ageratoides Turcz ,tatarian aster total saponins ,total flavonoids and the ratio of 1∶2 to mice maximum tolerance was respectively 300 ,345 ,325 g/kg .Conclusion For the same total dosage ,the relieving asth‐ma effects of proportions of 1∶2 Aster ageratoides Turcz were obvious .There are no abnormal changes in the acute toxicity trila with total flavonoids ,total saponins ,as well as the ratio of 1∶2 ,safety is relatively good .

Hepatitis E virus (HEV) infection is a main global public health issue. HEV can be zoonotically transmitted across species, and swine is recognized as a major reservoir of HEV. However, information is lacking on the prevalence of HEV infection in Tibet of China, where raw pork and mixed farming of different species of domestic animals are consumed traditionally. In this study, swine serum was collected for HEV IgM and IgG antibodies test from five regions in Tibet of China. Meanwhile, HEV RNA was detected in swine sera. HEV has a high prevalence trend in Tibetan swine. Swine serum anti-HEV IgM antibody positive rate was as high as 7.6%, the positive rate of anti-HEV IgG antibody was 1.8%, the positive rate of HEV RNA also was 7.6%, the virus titers in serum was above 1.7×10⁷ copies/mL, and there were different epidemic trends in five regions. In conclusion, antibody detection and RNA detection showed that swine in Tibet had a higher incidence of HEV infection. HEV infection in Tibetan swine is more serious and management should be strengthened to avoid cross-infection between humans and animals and outbreaks in Tibet.

OBJECTIVETo investigate the association of matrix metalloproteinase-3 (MMP-3) serum level and the promoter 5A/6A polymorphism of the MMP-3 gene with atherosclerotic cerebral infarction (ACI) in a Chinese Han population.

METHODSTwo hundred and fifteen patients with acute ACI from the Department of Neurology of Taizhou Hospital and 226 healthy controls were included in the study. Serum MMP-3 level was measured by enzyme-linked immunosorbent assay (ELISA). Genotype was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for the common 5A/6A functional promoter polymorphism of the MMP-3 gene.

RESULTSThe genotype distribution of the MMP-3 promoter 5A/6A polymorphism between the ACI patients group and the control group was significantly different (chi (2)= 9.389, P= 0.002). The frequencies of the 5A allele were 14.2% and 7.7% in the ACI patients group and the control group respectively (chi (2)= 9.430, P= 0.002). Serum level of MMP-3 in the ACI patients group was significantly higher than that in the control group (t= 24.867, P= 0.000). Among the ACI patients group, serum MMP-3 levels also had significant difference between the 5A/6A+ 5A/5A and the 6A/6A genotype (t= 2.057, P= 0.041).

CONCLUSIONThe present findings suggest that serum level of MMP-3 obviously increased within 48 hours of ischemic stroke and the genetic polymorphism of 5A/6A in the MMP-3 promoter is associated with ACI and MMP-3 expression in the Chinese Han population.

Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; genetics ; Case-Control Studies ; Cerebral Infarction ; blood ; complications ; genetics ; Ethnic Groups ; genetics ; Female ; Gene Frequency ; Genotype ; Humans ; Intracranial Arteriosclerosis ; blood ; complications ; genetics ; Male ; Matrix Metalloproteinase 3 ; blood ; genetics ; Middle Aged ; Polymorphism, Genetic ; Promoter Regions, Genetic ; genetics

OBJECTIVE To report on concurrent mutations of APC and MLH1 genes identified in a family affected with familial adenomatous polyposis(FAP). METHODS The proband was diagnosed with FAP based on her clinical manifestation, family history and histopathology examination. She developed endometrial epithelial neoplasia(EIN) two years later. With peripheral blood samples collected from her and members of her family, genomic DNA was extracted, and mutations of the APC and MLH1 genes were analyzed by Sanger sequencing. RESULTS Two novel heterozygous mutations were identified respectively in the APC gene(c.637C>T, p.R213X) and the MLH1 gene(c.1153C>T, p.R385C) in the proband. The former has resulted in a truncated protein, while the latter has led to substitution of Arginine by Cystine. CONCLUSION The concurrent mutations of the APC and MLH1 genes probably underline the FAP and Lynch syndrome(LS) in this pedigree. As the first female identified with such mutations, the proband manifested later onset of symptoms with certain degree of variation. For patient with FAP, a detailed family history should be taken.Potential mutation of the APC gene should be screened.Non-intestinal manifestations should be searched. For those who have developed endometrial lesion such as EIN, mutation of the MMR gene (associated with LS) should also be screened.