0.05).The degreeⅢ～Ⅳthrombocytopenia was more common in group A than in group B,but the degreeⅢ～Ⅳhypolekocytosis and phlebitis was more serious in group B.Conclusion NC and GC for treating refractory metastatic breast cancer have a high response rate and tolerable side effects.

Objective To assess the role and its tecnhique superiority of 64-slice spiral CT angiography(CTA) in lower limb arterial diseases.Methods MSCT studies in 33 cases suspected diseases of lower limb arteries was performed,the helical scans covered the extent of renal artery to the artery of the lower extremity.3D reconstruction of vessel was done in Wizard workstation.The manifestations of MSCTA were compared with that of conventional angiography . Results Of the 693 segments of arteria , 683 were assessable on both DSA and CTA.Using the DSA images as the standard reference,the sensitivity,specificity and accuracy of CTA were 97.6%(95% CI,94.9%~100.7%),98.9%(95% CI,98.0%~99.8%),98.7%(95% CI,97.9%~99.5%)in detecting the segments occluded . With the regard the detection of segments that had more than moderate stenosis , the sensitivity , specificity and accuracy of MIP were 98.9% ( 95% CI , 97.4%~100.4%),99.4%( 95% CI, 98.7%~100.1%) and 99.3%(95% CI, 92.4%~99.9%).Conclusion In assessment of diseases of lower limb arteries with 64-slice spiral CT angiography is equal to DSA basically, it is a highly accurate and non-invasive angiography in diagnosing arterial diseases of the lower extremities.

Objective: To explore influence of exercise on cardiac autonomic nerve function in patients undergoing coronary artery bypass grafting (CABG) and its clinical significance. Methods: A total of 53 patients with coronary heart disease undergoing CABG were randomly divided into routine treatment group (n=25) and rehabilitation group (n=28, received exercise training based on routine treatment). Changes of autonomic nerve function before, second and eighth week after CABG were analyzed in two groups using time domain indexes of heart rate variability (HRV) by ambulatory electrocardiography, including standard deviation of normal to normal RR intervals calculated over the 24 h period (SDNN), standard deviation of normal to normal RR intervals in all 5 min segments of the entire recording (SDANN), root-mean square of differences between successive normal to normal intervals (rMSSD) and adjacent normal RR interval difference > 50ms stroke accounted for a percentage of 24h total RR interval (PNN50). Results: Compared with before CABG, there were significant decrease in SDNN, SDANN, RMSSD and PNN50 in both groups two weeks after CABG (P<0.05~0.01); eight weeks after CABG, above indexes recovered to levels before CABG in routine treatment group[SDNN （113.6±29.4）vs.（116.7±24.7）, SDANN（112.2±32.1）vs.（113.6±28.6）, rMSSD（21.9±8.2） vs.（23.2±7.1）, and PNN50 （7.5±4.2）vs.（8.2±3.7）] , P>0.05 all; Compared with before CABG, there were significant improvements in SDNN [(114.7±25.2) ms vs. (132.6±30.6) ms], SDANN [(111.6±23.5) ms vs. (129.2±30.8) ms], rMSSD [(24.2±8.7) ms vs. (29.9±7.5) ms] and PNN50 [(7.8±2.2) ms vs. (9.5±2.3) ms], and there were significant improvement than those of routine treatment group [SDNN （132.6±30.6）vs.（113.6±29.4）, SDANN（129.2±30.8）vs.（112.2±32.1）, rMSSD（29.9±7.5）vs.（21.9±8.2）and PNN50 （9.5±2.3）vs.（7.5±4.2）] eight weeks after CABG in rehabilitation group, P<0.05 all. Conclusion: All HRV indexes significantly decrease on two weeks after CABG in both groups, suggesting that CABG can damage cardiac autonomic nerve system. These indexes of rehabilitation group were more improvement than those of routine treatment group, suggesting exercise training can more significantly improve cardiac autonomic nerve function after CABG.

Objective To observe the therapeutic effects of balloon dilatation with ice water and room temperature water on cricopharyngeal achalasia after brainstem stroke.Methods Forty dysphagic patients with cricopharyngeal achalasia after brainstem stroke were recruited.Twenty patients assigned to experimental group were treated by balloon dilatation with ice water and low frequency elecrtrical stimulation.Twenty patients assigned to control group were treated by balloon dilatation with room temperature water and low frequency electrical stimulation.Results After treatment,36 out of the 40 patients of the two groups could eat pasty food independently without choking.Videofluoroscopic swallowing study (VFSS) showed that the cricopharyngeal sphincter relaxed and the foods passed successfully when swallowing bolus,and no aspiration happened.In comparison,the level of cricopharyngeal opening,the number of patients with nasogastric tube remained and eating normally,and the scores of functional oral intake scale (FOIS) between the two groups showed no significant difference (P ＞ 0.05).The average treatment sessions,average hospitalization days and average treatment cost in treatment group were significantly less than those in the control group(P ＜0.05).Conclusion Cricopharyngeal achalasia can be treated effectively by balloon dilatation with ice water or with room temperature water combined with low frequency electrical stimulation,but treatment course of balloon dilatation with ice water were significantly shorter than that of balloon dilatation with room temperature water.

Background Excimer laser corneal refractive surgery is widely used because it reduces the dependency of refractive error eye to glasses.However,the adverse effects of anti-inflammatory drugs is a problem after operation.Lotemax eyedrops is a kind of steroidal anti-inflammatory drug,with a good effect on the operative eye.But its influence on intraocular pressure(IOP) after long-term topical administration is less studied.Objective This study was to investigate the influence of lotemax eyedrops on IOP after long-term topical administration in myopic eyes received excimer laser corneal refractive surgery.Methods An one-month retrospective case serial study was adopted.The case history data of 1552 eyes from 1552 Patients who received excimer laser corneal refractive surgery were collected in Tangshan Eye Hospital from 2011 January to 2012 January,including 321 eyes with laser in situ keratomileusis(LASIK),608 eyes with sub-Bowman keratomileusis (SBK) and 623 eyes with femtosecond laser for flap excimer laser in situ keratomileusis(FS-LASIK).Lotemax eyedrops was topically administered after operation 4 times per day initial and then decreased 1 time weekly for 1 month.IOP was measured in before,1 week,2 weeks,3 weeks,4 weeks after operation with non-contact tonometer.The increasing range of IOP was divided into ＜5 mmHg,5-15 mmHg and ＞ 15 mmHg after operation.Optical head parameters were measured by Heidelberg retina tomography when IOP increasing after operation.Results Within 1 month,elevated IOP was found in 47 of 1552 eyes after administration of lotemax eyedrops,including 3.12％ (10/321) in the LASIK group,3.29％ (20/608) in the SBK group and 2.73％ (17/623) in the FS-LASIK group,without significant difference among them(x2 =1.95,P＞0.05).The IOP elevated 1 week after operation and remained normal after that till drug withdrawal in all eyes.There were no significant differences in the disk area (1.65 ±0.44) mm2 vs.(1.66 ±0.44) mm2,disk volume (0.40 ±0.09)mm3 vs.(0.39±0.08) mm3 and mean nerve fiber layer thickness (0.28 ± 0.08) mm vs.(0.29 ± 0.07) mm in IOP elevation duration compared with 1 month after IOP recovery(t =0.34,0.81,0.48,P＞0.05).Conclusions Topical administration of 0.5％ lotemax eyedrops after excimer laser corneal refractive surgery leads to reversible high IOP.It is very important to monitor the IOP during use of the drug.

OBJECTIVETo explore the effect of Qiling Decoction (QD) combined highly active antiretroviral treatment (HAART) on expression levels of peripheral blood Th17 and Treg cells in HIV/AIDS patients.

METHODSTotally 55 HIV/AIDS patients were randomly assigned to the treatment group (28 cases) and the combination group (27 cases). Besides, 21 HIV negative patients were recruited as the healthy control group. Those in the treatment group received HARRT alone, while those in the combination group received HAART combined QD. The observation lasted for 24 weeks. Meanwhile, according to peripheral blood CD4+ T cell counts before treatment, HIV/AIDS patients were assigned to three subgroups. For patients in subgroup 1, 1 cells/microL < CD4+ T cell counts < or = 100 cells/microL; For patients in subgroup 2, 101 cells/microL < CD4+ T cell counts < or = 200 cells/lL; For patients in subgroup 3, 201 cells/microL < CD4+ T cell counts < or = 350 cells/microL. Expression of peripheral blood Th17 and Treg cells, and number of CD4+ T cell counts were detected using flow cytometry (FCM)in HIV/AIDS patients at the pre-treatment baseline, week 4, 12, and 24, as well as those in the healthy control group.

RESULTSCompared with the healthy control group, CD4+ T cell counts and the baseline expression level of Th17 cells in the peripheral blood of HIV/AIDS patients significantly decreased, the expression level of Treg cells significantly increased P < 0.01). Compared with before treatment in the same group, CD4+ T cell counts all increased at week 4, 12, and 24 in the two treatment groups, showing statistical difference (P < 0.05, P < 0.01). There was no statistical difference in the effective rate at various CD4+ T cell levels between the two groups (P > 0.05). There was no statistical difference in expression levels of Th17 and Treg cells between the combination group and the treatment group at any time point (all P >0.05). The Th17/Treg ration significantly increased in the combination group after 24 weeks of treatment, showing statistical difference when compared with the treatment group (U = 2.135, P = 0.038).

CONCLUSIONQD could improve the immune balance of Th17/Treg cells, which might be one of its mechanisms for improving HIV/AIDS patients' immunity.

Acquired Immunodeficiency Syndrome ; drug therapy ; immunology ; Adult ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; Case-Control Studies ; Drugs, Chinese Herbal ; therapeutic use ; Female ; HIV Infections ; drug therapy ; immunology ; Humans ; Male ; Middle Aged ; Phytotherapy ; T-Lymphocytes, Regulatory ; cytology ; Th17 Cells ; cytology

OBJECTIVETo investigate the association of SOX9 expression and clinicopathologic factors and prognosis of gastric cancer.

METHODSA retrospective cohort study including 112 gastric cancer patients admitted to the Zhejiang Provincial People's Hospital from 2004 to 2006 was performed. Immunohistochemical analysis was used to evaluate the expression of SOX9 in the 112 specimens of gastric cancer tissues and 70 non-cancerous tissues adjacent to the tumor.

RESULTSLow expression of SOX9 was seen in 5(7.1%) tissues out of 70 non-cancerous tissues adjacent to the tumor. A total of 94(83.9%) patients had varying expression of SOX9, of whom 51(45.4%) had overexpression. Univariate analysis demonstrated that the expression of SOX9 was significantly associated with Lauren classification (P<0.05), tumor invasion(P<0.01), lymph node metastasis(P<0.05), distant metastasis(P<0.05) and tumor stage(P<0.05), however there was no significant association between SOX9 expression and sex, age, histological type, histology differentiation or tumor size. Kaplan-Meier analysis showed that the 5-year survival rate of patients with SOX9 over-expression was significantly lower than that of patients with low expression(29.4% vs. 49.2%, P=0.031). Multivariate Cox regression analysis showed that histology differentiation(P=0.046), tumor invasion(P=0.001), and distant metastasis(P<0.01) were independent prognostic factors for gastric cancer, however the over-expression of SOX9 was not significant(P=0.948).

CONCLUSIONSThe expression SOX9 is associated with the growth, invasion, and metastasis of gastric cancer, as well as the prognosis. However, SOX9 expression is not an independent factor for the prognosis in patients with gastric cancer.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; SOX9 Transcription Factor ; metabolism ; Stomach Neoplasms ; metabolism ; pathology

The role of general practitioners in the UK was analyzed and we found that in the UK, there was normalized general medical education system, perfect general practitioner training sys-tem, specific responsibilities and assessment index, close liaison group between primary and secondary care, strong economic supporting measures and high degree of recognition. Therefore, to deepen med-ical reform and improve basic medical service, we must accelerate general practitioners training, im-prove practice ability of general practitioners, establish the first-treatment system in community, reit-erate role of gatekeeper, enhance the payment of general practitioner and increase their sense of iden-tity. At the same time, we must strengthen the informatization construction, set up the first-treatment in the community and the patency of two-way referral system.

Objective To evaluate therapeutic effects and toxicity of advanced non-small cell lung cancer (NSCLC)treated by combining chemotherapy on ifosfamide(IFO)and vinorelbine(NVB).Methods 107 cases pa- tients with advanced NSCLC were enrolled.IFO was given in a dosage of 1.5g/m~2 on day 1 to 4.and NVB in a dosage of 25mg/m~2 on day 1 and 8.It was repeated every three or four weeks,up to two to four cycles.Results Two patients had complete response and 40 patients had partial response.The overall response rate was 47.7% ,the median survival time 10.3 months,1-year and 2-year survival rate was 42% and 12.3%,respectively.The main toxicity was bone marrow suppression.Conclusion The regimen is effective,sale and tolerable in advanced non- small cell lung cancer therapy.