Objective To study the efficacy of late course accelerated fractionation(LCAF) radio- therapy in the treatment of nasopharyngeal carcinoma(NPC).The end-po s were local control,radiation-in- duced complications,factors influencing survival.Methods From December 1995 to April 1998,178 NPC patients were admitted for radiation treatment.The radiation beam used was ~(60)Co?or 6 MV X-ray.For the first two-thirds of the treatment,two daily fractions of 1.2 Gy were given to the primary lesion ,with an interval of≥6 hours,5 days per week to a total dose of 48 Gy/40 fractions,over a period of 4 weeks.For the last one third of the treatment,i.e.beginning from the 5th week,an accelerated hyperfractionation schedule was carried out.The dose per fraction was increased to 1.5 Gy,2 fractions per day with an interval of≥6 hours,the total dose for this part of the protocol was 30 Gy/20 fractions over 2 weeks.Thus the total dose was 78 Gy in 60 fractions in 6 weeks.Results All patients completed the treatment.Acute mucosi- tis:none in 2 patients,Grade 1 in 43,Grade 2 in 78,Grade 3 in 52,and Grade 4 in 3 patients.Local control rate:the 5-year nasopharyngeal local control rate was 87.7%,and the cervical lymph node local control rate was 85.7%.The 5-year distant metastasis rate was 26.1%,and 5-year survivals was 67.9%. Sixteen patients had radiation-induced cranial nerve palsy.Conclusions With this treatment schedule, patient's tolerance is good,local control and 5 year survivals are better than control groups of conventional fractionation and hyperfractionation radiotherapy.Radiation-related late complication does not increase.Ran- domized clinical trials are being carried out to further confirm the efficacy of LCAF for nasopharyngeal carci- noma.

OBJECTIVE: To summarize the effects of glial cell line-derived neurotrophic factor (GDNF) on ischemia damage to nerve tissue and discuss the possibility of GDNF in repair of spinal cord injury based on the development of microencapsulation technology.DATA SOURCES: A search of Medline from January 1996 to October 2000 was performed for the English articles related to GDNF, ischemia damage to nerve tissue, spinal cord injury and microencapsulation technology by using the key words "glial cell line-derived neurotrophic factor, ischemia damage to nerve tissue, spinal cord injury". Meanwhile, we retrieved Wangfang database for search of the related articles in Chinese by using the same keywords in Chinese.STUDY SELECTION: Articles including intervention group and control group were selected after first review, and those which were significantly non-randomized researches were excluded. Then, the full-texts of the enrolled articles were retrieved. Inclusion criteria: ①randomized controlled study; ②the experiment/clinical research including horizontal control group. Exclusion criteria: duplicated researches.DATA EXTRACTION: Totally 300 articles were selected but only 15 were in coincidence with conclusion criteria. 285 articles were excluded, 264 of them were duplicated and non-randomized researches, and 21 were review articles.DATA SYNTHESIS: GDNF can provide nutrition to dopamine nerve cell in rat's middle brain, so as to decrease dopamine nerve cell's death. Also GDNF can protect dopamine nerve cell in cerebral infarction rats from ischemic injury, inhibit the produce of nitrogen monoxide and reperfusion injury after ischemia. GDNF is an effective protective factor against ischemia damage. Microencapsulation technology has a bright future in treating endocrinopathic neural diseases, and GDNF can play a great role in the development of microencapsulation technology.CONCLUSION: GDNF is a protective factor against ischemia damage to nerve tissue, which can be enhanced by microencapsulation technology.There is a bright future for the research on GDNF in the clinical repair of spinal cord injury.

Background and purpose:Aberrant DNA methylation that leads to the inactivation of tumor suppressor genes plays important roles in development and progression of breast cancer. Clinically, related gene methylation is considered to be a promising biomarker for tumor diagnosis and prognosis. This study aimed to investigate the methylation status ofSox17 gene in breast cancer tissue and its corresponding plasma circulating DNA, as well as to investigate its value in breast cancer early diagnosis and prognosis.Methods:TheSox17 gene promoter methylation status was detected by MSP in 86 cases of breast cancer, 36 normal breast tissues and its paired plasma DNA, the results were analyzed with corresponding clinical and pathological features.Results:The frequency ofSox17 gene methylation rate among 86 breast cancer tissues was 77.9%(67/86), and was 61.6%(53/86)in plasma circulating DNA, however, noSox17 gene methylation was found in normal breast tissues.Sox17 gene promoter methylation in plasma circulating DNA was signiifcantly associated with the methylation status in tumor tissues (r=0.502,P=0.000). In breast cancer tissue specimens,Sox17 methylation status was significantly correlated with tumor stage (χ2=6.18,P=0.041) and lymph node metastasis (χ2=13.54,P=0.001);Sox17 gene methylation rate was signiifcantly correlated with tumor stage (χ2=27.06,P=0.000), tumor size (χ2=9.65,P=0.007) and lymph node metastasis (χ2=20.80,P=0.000) in plasma samples, and there was no signiifcant difference ofSox17 gene methylation between patient age, histological grade and ER, PR, HER-2/neu status.Conclusion:Sox17 gene promoter methylation plays an important role in the carcinogenesis and development of breast cancer, and may be associated with the prognosis of breast cancer. Furthermore, methylatedSox17 gene may be a useful tumor biomarker in plasma circulating DNA for breast cancer detection and disease monitoring.

OBJECTIVE:To evaluate the pharmacoeconomic characteristics of dapagliflozin combined with metformin in the treatment of type 2 diabetes mellitus systematically. METHODS:Retrieved from Health Technology Assessment(HTA),Cochrane Library,PubMed,Embase,CNKI,Wanfang and CBM during database establishment to Jul. 2017,published pharmacoeconomics literatures about dapagliflozin combined with metformin were collected,using"sodium-glucose-transporter-2 inhibitors""SGLT2 inhibitor""metformin""dapagliflozin""cost""benefit""utility""effectiveness""pharmacoeconomic""economic"as English retrieval words and"SGLT2 inhibitor""dage liejing""metformin""cost""benefit""utility""effectiveness"as Chinese retrieval words. Outcome indexes included incremental cost,incremental effect,cost-effectiveness ratio and incremental cost-effectiveness ratio(ICER).The results of the economic research in the included literatures were evaluated systematically. RESULTS:Totally of 4 literatures were included,and all of them were cost-effectiveness analysis. Dapagliflozin was more cost-effective than sulfonylurea because the ICER of dapagliflozin were €2 709/QALY,€10 494/QALY,€7 939/QALY,€5 433/QALY,€4 767/QALY and €6 094/QALY in the UK,Greece,Denmark,Finland,Norway and Sweden,respectively,which were all lower than willingness-to-pay threshold. Dapagliflozin was more cost-effective than DPP-4 inhibitor,and the ICER were €7 200/QALY and €15 120/QALY in the UK and Greece,respectively,which were all lower than willingness-to-pay threshold. CONCLUSIONS:Current economic research shows compared with sulfonylurea and DDP-4 inhibitor,dapagliflozin is a cost-effective treatment alternative for patients with T2DM whose metformin regimen does not provide sufficient glycemic control.

Objective:To analyze status quo and trends of VIP services in the tertiary public hospitals of Shang-hai and provide references for health administrative departments. Methods:Health policies of VIP services in tertiary public hospitals were searched and analyzed, and the number of medical institutions, services, prices and service fees were analyzed from 2011 to 2013 . Results:There is a clear demand for VIP services in the tertiary public hospi-tals of Shanghai, and fees for rooms, nursing, and examinations for outpatient and inpatient care are decided by the hospitals. 89. 7% of the tertiary public hospitals in Shanghai offered VIP services, and the trend was steadily grow-ing. The four services that could be decided by hospitals varied greatly, and the service fees for inpatient care in-creased significantly. The total cost of VIP services in the tertiary public hospitals of Shanghai accounted 6. 2% of all costs, and the percentage of income from drugs was lower. Conclusions:VIP services in public hospitals have a his-torical necessity;management should be strengthened in the short term;public hospitals should strengthen their own management and provide VIP services regularly, and health administration departments should strengthen regulation. In the long run, it is suggested that public hospitals should draw lessons from international experiences to form a pat-tern of multi-level medical services and actively carry out cooperation with private medical institutions.

Objective:To study status quo of premium private health services and analyze the trend of its devel-opment. Method:The scope of premium private medical institutions was first defined. Then, seven indicators were used to analyze the allocation of resources;two indicators were used to analyze services;eight indicators were used to analyze costs. The entire situation of different styles of institutions through 2011 to 2013 was compared. Results:The results indicated that in the allocation of resources, the current level of premium private medical institutions is not high enough;large-scale construction is still at its early stages;and the medical personnel structure is not reasonable enough;as for service quantity, the total growth rate of premium private medical institutions is high but the service quantity is still far below that of the VIP services in public hospitals;as for medical expenses, premium private medi-cal institutions are charging high service fees, and the internal structure of the expenses is reasonable. Conclusions:Although the development of premium private health services is at an early stage, development prospects are promis-ing. Premium private health services should strengthen the aspects of medical technology, service levels, management capabilities, human resource building, and brand development.

OBJECTIVETo isolate and culture human umbilical cord mesenchymal stem cells (MSCs) and explore their biological features and ultrastructure.

METHODSAfter isolating MSCs from the human umbilical cord, the proliferation, cycle, and apoptosis were observed. The cell ultrastructure was observed under transmission electron microscope. The cytokines including vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), and insulin-like growth factor-1 (IGF-1) were detected using enzyme-linked immunosorbent assay.

RESULTSHuman umbilical cord MSCs had fibroblast-like morphology and increased proliferation capability. Ultrastructural analysis showed that the MSCs had active cellular metabolism and strong migration and differentiation capabilities. Meanwhile, they could secrete anti-apoptotic cytokines such as VEGF, IGF-1, and HGF.

CONCLUSIONHuman umbilical cord MSCs can secrete many anti-apoptotic cytokine and have good biological features.

Apoptosis ; Cell Cycle ; Cell Proliferation ; Cells, Cultured ; Hepatocyte Growth Factor ; metabolism ; Humans ; Insulin-Like Growth Factor I ; metabolism ; Mesenchymal Stromal Cells ; cytology ; metabolism ; ultrastructure ; Umbilical Cord ; cytology ; Vascular Endothelial Growth Factor A ; metabolism

Objective Under different standard uptake value(SUV),to assess gross tumor volume (GTV) definition for non-small cell lung cancer(NSCLC) with 18-fluoro-deoxy-glucose positron emission tomography (~(18)FDG PET) both under definite threshold (42 percent threshold) and various relative threshold (threshold SUV/maximum SUV) derived from the linear regressive function,threshold SUV=0.307?(mean target SUV)+0.588,with computer tomography (CT).Methods Of 20 patients with non-small cell lung cancer,the CT GTV (GTV_(?)).PET GTV with 42 percents threshold (GTV_(42%)) and PET GTV with relative threshold (GTV_(?)) were obtained and compared.Results The mean GTV_(42%),,mean GTV_(?) and mean GTV_(CT) was (13 812.5?13 841.4),(24 325.3?22 454.7) and (28 350.9?26 079.8)mm~3,respectively,with the difference in mean GTV among these three methods significant (F =10,P＜0.01).The GTV_(42%) was smaller than the GTV_(?) and the GTV_(CT)(P＜0.01),with i(?)significant difference between GTV_(?) and GTV_(CT)(P=0.125).Conclusion The relative threshold is more suitable to define the gross tumor volume than the definite threshold.

Objective: To verify whether there exists melatoni n(Mel) receptor in human embryonic nervous system. Methods: Spec ific binding of Mel to embryonic brain and spinal cord was measured by radioliga nd binding assay. Results: 125　I-Mel binding s ites in optomeninx was the most, in eptochiasm and sniff ball was next; GTPγS d ose-de pendently inhibited the binding. Conclusion: The results demonst rate the presence of specific binding of Mel in human embryonic brain and spinal cord. GTPγS has some effect on 125　I-Mel specific binding,support ing the theory that Mel receptor is coupled to inhibitory G-proteins.

Experiments were performed on Sprague Dawley rats with multibarrel microelectrode technique. The effects of acoustic response of A I cortex neurons produced by electrical stimulation of lateral amygdaloid nucleus (LA) and the influence of GABA were observed. Experimental results showed that iontophoretic administration of GABA caused a pronounced inhibition of the electrical activity of A-I neurons. Blockade of GABA(A) with bicuculline (BIC) facilitated the acoustic response. The acoustic response of A-I neurons was inhibited when the LA was stimulated. Iontophoretic application of GABA resulted in a similar inhibitory effect as that of LA stimulation. Blockade of GABA(A) with bicuculline reversed the inhibitory effect of LA stimulation on the acoustic response of A-I neurons. In contrast, application of strychnine, a glycine receptor antagonist, could not reverse the inhibitory effect of LA. Baclofen, a GABA(B) agonist, did not affect the acoustic response of the auditory neurons. These results indicate that GABA is the ultimate transmitter which mediates the LA stimulation-induced inhibition of the acoustic response of A-I neurons in rats, possibly via the GABA(A) receptor.
Acoustic Stimulation ; Amygdala ; physiology ; Animals ; Baclofen ; pharmacology ; Bicuculline ; pharmacology ; Cerebral Cortex ; physiology ; Electric Stimulation ; Evoked Potentials, Auditory ; physiology ; GABA Agonists ; pharmacology ; GABA Antagonists ; pharmacology ; Iontophoresis ; methods ; Male ; Microelectrodes ; Neurons ; physiology ; Rats ; Rats, Sprague-Dawley ; Receptors, GABA-A ; physiology ; gamma-Aminobutyric Acid ; physiology