Objective:To observe the clinical efficacy and safety of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) combined with traditional medicine retention enema for treatment of chronic radiation proctitis.Methods:A total of 128 patients pathologically diagnosed as cervical cancer and endometrial cancer with grade 1-2 chronic radiation proctitis at Xiangyang Central Hospital from October 2017 to October 2019 were enrolled in a random, single-blind, control trial. The patients were divided into the control group and the experiment group according to the random number table, and the control group was given the treatment regimen of gentamicin + dexamethasone + Yunnan Baiyao retention enema, and the experimental group was given the treatment regimen of rhGM-CSF + gentamicin + dexamethasone + Yunnan Baiyao retention enema; both regimens treated twice daily for three weeks. The clinical symptom before and after enema treatment based on the subjective, objective, management and analytic (SOMA) scale was scored and the efficacy was evaluated by combining with stool routine and rectoscopy.Results:According to the SOMA scale, the scores of hematochezia, diarrhea, tenesmus, abdominal pain after enema were lower than those before enema, and the differences were statistically significant (all P<0.05); however, the scores of all symptoms before treatment of both groups were not statistically significant different (all P>0.05). The score of hematochezia in the experimental group after enema was lower than that in the control group [(0.33±0.15) scores vs. (0.48±0.32) scores, t=2.045, P=0.022], and the scores of other symptoms in both groups were not statistically significant different (all P>0.05). The overall effective rate was 79.69% (51/64) in the control group and 90.63% (58/64) in the experimental group, and difference was statistically significant (χ 2=6.485, P=0.026). All patients had no obvious adverse reactions. Conclusions:rhGM-CSF combined with traditional medicine retention enema for treatment of chronic radiation proctitis in patients with cervical cancer and endometrial cancer is highly effective and easy to operate, and patients are well tolerated, which is worthy of clinical promotion.

Objective To explore the radiosensitizatian of paclitaxel in human lung adenocareinoma cells. Methods A human lung adenocarcinoma cell line A973 was used in this study. The cytotoxicity of paclitaxel was investigated by using clonngenic assay to define the IC10,IC50 and IC90. The cells received either radiation(with different doses) alone or paclitaxel administrated before and after irradiation. Cell survival fractions were determined by clonogenic assay. Single hit multi-target model was used to determine survival curve parameters. Flow cytometry was performed to analyze the cell cycle distribution. Results The IC10, IC50 and IC90 of paclitaxel in A973 cells were 0.5,2.6 and 8.7 nmol/L,respectively. According to Do,Dq and SF2 value,the sensitivity enhancement ratio(SER) of IC10 was 0.97,1.01 and 2.00 when paclitaxel was added before irradiation, and 0.97,1.02 and 1.02 when after irradiation ; The SER of IC50 was 1.06,129.00 and 2.61 when paclitaxel was added before irradiation, and 0.94,220. O0 and 2.14 when after irradiation ;The SER of IC90 were 1.00,220. 00 and 2.09 when paclitaxel was added before irradiation,and 0.98,220.00 and 2.09 when after irradiation. The IC10 of paclitaxei failed to increase G2+M arrest of A973 cells.The maximal G2+M accumulation was reached at 2 h and 18 h after IC50 and IC90 of paclitaxel treatment,respectively. Conclusions Paclitaxel is able to enhance the radiation sensitivity of A973 cells. Sequence of treatment is not associated with radiosensitivity. Moderate and high dose of paclitaxel combined with low-dose radiation can produce the best effect of radiosensitiation.

Objective To analyze the distribution of B-cell subtypes and IgG subclasses in pa-tients with non-small cell lung cancer ( NSCLC) and to investigate their potential functions in the progress of NSCLC.Methods Flow cytometry analysis was used to detect the distribution of immature B cells, memory B cells and mature B cells in 25 healthy subjects and 55 patients who were at different clinical stages of NSCLC.Enzyme-linked immune-sorbent assay ( ELASA) was performed to measure the concentrations of IgG1, IgG2, IgG3, IgG4 and total IgG, as well as the ratio of each IgG subclass in total IgG.Results The percentages of immature and memory B cells in CD19+B cells were positively correlated with the progress of NSCLC.The ratio of IgG4/IgG gradually increased along with the development of NSCLC, while that of the other three IgG subclasses showed no significant changes as compared with that of the control group.Conclu-sion The imbalanced distribution of B-cell subtypes and the up-regulated ratio of IgG4/IgG were closely as-sociated with the development of NSCLC.This study paved the way for further investigation on more effective immune therapy strategies targeting NSCLC.

Objective To investigate the effects of water extract of Glycyrrhiza uralensis Fisch.(GUWE) on the activation of RAW264.7 cells and the possible mechanism.Methods RAW264.7 cells were treated with GUWE containing different concentrations of polysaccharide (10, 50, 100, 500 μg/ml).Viability of these cells was analyzed by MTT assay.Phagocytic activity and surface molecules expressed on these cells were detected by flow cytometry.Levels of cytokines were analyzed by ELISA.Western blot assay was performed to analyze the activation of key molecules in TLR4 signaling pathway.Results GUWE at the concentration of 500 μg/ml significantly decreased the viability of RAW264.7 cells, but significantly increased the viability of RAW264.7 cells at concentrations of 50 μg/ml and 100 μg/ml.GUWE significantly enhanced the phagocytic activity of RAW264.7 cells as well as the expression of cytokines and costimulatory molecules in a dose-dependent manner.Further analysis indicated that the activation of RAW264.7 cells induced by GUWE was suppressed by TLR4 inhibitor.Moreover, GUWE enhanced the phosphorylation of NF-kB p65 and TLR4 downstream mitogen-activated protein kinases (MAPKs) including p38, extracellular signal-regulated kinase (ERK) and c-Jun NH2-terminal kinase (JNK).Conclusion This study indicates that GUWE promotes the activation of RAW264.7 cells through TLR4 signaling pathway.

Objective To investigate the effect of the focus intervention on the rehabilitation of patients with total hip replacement. Methods From March 2014 to March 2016, selected 166 cases of elderly patients with total hip replacement, the patients were divided into observation group (89 cases) and control group (77 cases) according to admission orders, 77 cases from March 12014 to February 282015 are classified as the control group, whereas 89 cases from March 12015 to February 292016 are classified as the experimental group. The observation group was treated with focus intervention, and the control group received routine nursing care, observed two groups postoperative rehabilitation effect, the incidence of postoperative lower extremity venous thrombosis and infection, and patient satisfaction with care, etc. Results The postoperative recovery of hip function in the observation group was better than that in the control group (Z=-2.787, P<0.05), the excellent and good rate was 88.76％(79/89), and the excellent and good rate in control group was 80.52％(62/77). The incidence of postoperative lower extremity venous thrombosis and infection in the observation group were 3.37％(3/89) and 2.25％(2/89), significantly lower than the control group12.99％(10/77)and 10.39％(8/77), the difference was statistically significant (χ2=5.289 and 4.835, P<0.05). The VAS scores of the observation group and the control group were (2.43 ± 0.84) points and (2.59 ± 0.91) points, the difference was not statistically significant(t=-1.177, P>0.05). The nursing satisfaction in observation group was 92.13％(82/89), significantly higher than that in the control group72.73％(56/77), the difference was statistically significant (χ2=11.089, P < 0.05). Conclusion The focus intervention on the functional recovery of patients with total hip replacement may have some help, reduce complications and improve patient satisfaction.

Objective To evaluate the role of spinal sigma-1 receptors in the maintenance of bone cancer pain (BCP) in rats and the relationship with extracellular signal-regulated kinase (ERK).Methods Part Ⅰ Twenty-four female Sprague-Dawley rats,weighing 180-220 g,were randomized into 2 groups using a random number table:sham operation group (S group,n =4) and BCP group (n =20).BCP was induced by inoculating Walker 256 mammary gland carcinoma cells into the medullary cavity of the right tibia.Four rats were sacrificed on day 10 after inoculation in S group or on day 3,5,7,10 and 14 after inoculation in BCP group,and the L4-6 segments of the spinal cord were removed to measure the expression of sigma-1 receptors by Western blot.Part Ⅱ Forty female Sprague-Dawley rats,weighing 180-220 g,were randomized into 4 groups (n =10 each) using a random number table:sham operation group (S group),sigma-1 receptor inhibitor BD1047 group (BD group),BCP group,and BCP + BD1047 group (BCP + BD group).On day 10 to 14 after inoculation,normal saline 20 μl was injected intrathecally once a day in S and BCP groups,or BD1047 120 nmol/20μl was injected intrathecally once a day in BD and BCP + BD groups.Mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured one day before inoculation,on day 3,5 and 7 after inoculation,and on day 10,12 and 14 after administration.After measurement of MWT on day 14 after inoculation,the rats were sacrificed and the L4-6 segments of the spinal cord were removed to determine the expression of phosphorylated ERK (p-ERK) by Western blot.Results Part Ⅰ Compared with group S,the expression of sigma-1 was significantly up-regulated and peaked on day 10 after operation in group BCP.Part Ⅱ Compared with S group,no significant changes were found in MWT and p-ERK expression at each time point in BD group,and MWT was decreased and p-ERK expression was up-regulated in BCP and BCP + BD groups.Compared with group BCP,after intrathecal injection of BD1047,MWT was significantly increased and the expression of p-ERK was down-regulated in BCP + BD group.Conclusion Spinal sigma-1 receptors are involved in the maintenance of BCP in rats possibly through promoting phosphorylation of ERK.

Objective To analyze the epidemiological characteristics of overseas imported malaria reported in Chongqing City from 2011 to 2015,so as to provide the evidence for improving the imported malaria control strategies. Methods The epi-demiological data of overseas imported malaria cases were collected and analyzed descriptively for the species,original coun-tries,diagnosis and treatment in Chongqing City from 2011 to 2015. Results A total of 148 overseas imported malaria cases were reported in Chongqing City from 2011 to 2015,in which 96(65.54%)cases were falciparum malaria,and 37(24.32%) cases were vivax malaria;125(84.46%)cases were infected in Africa,and the rest of 23(15.54%)cases were infected in Southeast Asia. Most of the patients were 30 to 50 years old male workmen,and the ratio of male to female was 11.42:1. There was no obvious seasonal distribution among the reported timelines of the cases;however,there were two small peaks from June to August and from January to February. The median interval time of imported malaria cases from malaria onset to see a doctor was 1 day and from seeing the doctor to get malaria diagnosis was 2 days. The patients'first selected institutions were county medical institutions(50 cases,33.78%),then provincial medical institutions(36 cases,24.325%)and private doctors(20 cases,13.51%),and only 79(53.38%)patients got malaria diagnoses in their first selected institutions. The standard treatment were provided to 142(95.54%)cases. There were 43(29.05%)patients had serious complications and three patients were dead. Conclusion It is very important to enhance the multi-sector's collaboration to establish the collaborative investigation mechanism for screening malaria patients,and strengthen malaria health education for overseas workers and training courses in primary care medical institutions.

The clinical data of a case of Weave syndrome admitted in the Department of Endocrinology, Children′s Hospital of Nanjing Medical University in October 2018 were retrospectively analyzed.The patient was a 9 years and 2 months old girl, who was hospitalized because of " growing too fast for 9 years" . After birth, the child is found to grow fast and have mental retardation, slurred speech, a blurred vision, a long face, a protruding forehead, ocular hypertelorism, epicanthus, nasal bridge pit, finger pads on both hands and feet, uncoordinated gaits, and intoeingpigeon toes.A novel heterozygous c. 1720A>G (p.K574E) mutation was detected in the exon 15 of the EZH2 gene of the patient.This mutation has not been reported at home and overseas.Sanger sequencing revealed that the patient′s parents did not carry the mutation.The disease is an autosomal dominant genetic disorder, and the parents and sibling of the patient have no corresponding symptoms, so it is inferred that the mutation is spontaneous.Based on the peculiarity of the face, clinical manifestations and the results of molecular genetics, the child was diagnosed as Weaver syndrome.

Objective:To investigate the enantiomer separation for atropine by capillary electrophoresis .Methods:Capillary elec-trophoresis was used with an elastic quartz capillary column (60 cm ×75 mm, effective length of 40 cm).The concentration of phos-phate buffer was 30 mmol· L-1 .The high and time of injection was 10 cm and 5 s, respectively.The detection wavelength was 225 nm.The best separation conditions were selected including the type and concentration of chiral resolving agent , pH of the buffer solu-tion, operating voltage and organic solvent.Results:The optimum conditions of separation were as follows:the pH of buffer solution was 7.0, the concentration of S-β-CDP was 10 mg· ml-1 , and the operating voltage was 12 kV.Conclusion: The method is simple and fast, which can be used to se parate the optical isomers of atrpo ine.

Objective To discuss the levels of evidence provided by different study designs.Methods Websites of N Engl J Med, JAMA, Lancet, and BMJ were accessed to identify research articles (systematic review and meta-analysis included) published in 2009. A standardized data collection form was established using Epidata 3. 1 software to extract the "title", "country of lead author", "clinical problem" (such as treatment, diagnosis, etc. ) and "study design" of eligible studies. Descriptive statistics was conducted with SPSS 13.0. Results Over all, 844 studies were included, among which 35.7% were RCT,9. 4% systematic review and Meta-analysis, and 54. 9% other types of studies. Regarding clinical problems,34. 2%, 19. 7%, 13.7%, 6. 0% and 5. 1% of the included researches addressed the issues of treatment,etiology/risk factors, prevention, disease frequency and prognosis, respectively. The study designs that were most frequently adopted to explore these problems were RCT (70.6%), cohort study (44. 6% ), RCT (68. 1% ), cross-sectional study ( 56. 9% ), and cohort study ( 93.0% ), respectively. Conclusions High-level evidence does not come exclusively from RCT and systematic review, as each type of study may have its unique value in health related research. The clinical problem of interest, the previous work that has been done to approach the same issue, as well as other factors should be taken into account when deciding whether the selected study design is appropriate.