Objective To compare the dose distribution between three-dimensional conformal radiotherapy(3D-CRT) and intensity-modulated radiotherapy (IMRT) in treating locally advanced pancreatic cancer,and report the efficacy of IMRT combined with regional chemotherapy using gemcitabine (GEM).Methods Ten patients with locally advanced pancreatic cancer were enrolled in this study.3D-CRT and IMRT plans were designed for each patient.The dose distributions of target volume and normal tissues were analyzed using the dose volume histogram (DVH).Twenty-five locally advanced pancreatic cancers patients who were treated by IMRT combined with regional chemotherapy using gemcitabine (combined group) were retrospective analyzed,as well as 25 hospitalized patients of the same period who were treated by regional chemotherapy using gemcitabine alone (chemotherapy alone group).The therapeutic efficacy and adverse events were compared between two groups.Results IMRT plans decrease the mean dose and volume of duodenum,liver,stomach,both kidney and small bowel that received highdose irradiation.The 1-,2-year survival rate of the combined group and chemotherapy alone group was 60％,28％ and 36％,12％.The median survival time of two groups was 15 and 10 months,respectively (x2 =4.16,P ＜0.05).The total response rate of the combined group and the chemotherapy alone group was 64％ and 32％,respectively (x2 =5.13,P ＜ 0.05).The upper gastrointestinal side-effect rate of the combined group was higher than that of the chemotherapy alone group(Z =-2.354,P ＜ 0.05).There was no statistic significance in hematologic toxicity,liver and renal functional damage between the two groups.Conclusions Compared with 3D-CRT plan,IMRT plan could reduce the dose of organ at risks.IMRT combined with regional chemotherapy using gemcitabine could significantly improve the survival rate of patients with locally advanced pancreatic cancer with mild adverse events.

Objective To investigate CT findings in gastric stromal tumors(GST).Methods Both plain and enhanced spiral CT findings in 46 cases with gastric stromal tumor were retrospectively analyzed.In all patients,diagnosis was confirmed with immunohistochemical markers.CT features were retrospectively studied and summarized.Statistical analysis of the shape,growth pattern,necrosis and enhancement patterns was performed with X2 test in 43 cases with single gastric stromal tumor.Results Of the 46 GST patients,43 patients had single GST and multiple GST was detected in 3 cases.In the 43 cases with single GST,tumors were found in the gastric body in 24 cases,gastric fundus in 16 cases,and in the gastric antrum in 3 cases.GST mostly grow along the vertical plane of gastric wall,with a large size but local attachment.The tumor size was less than 5era in diameter in 14 cases.Of them,ten cases had a regular shape,10 cases showed homogeneous enhancement,and 4 cases exhibited central necrosis,7 tumors showed intra-luminal growth and 5 tumors showed extra-luminal growth,while the other 2 cases involved both intra and extra lumina.Twenty-nine cases had tumors larger than 5cm in diameter.Of them,24 cases had irregular shape,27 cases showed inhomogeneous enhancement,24 cases had central necrosis,5 tumors showed intra-luminal growth and 9 tumors showed extra-luminal growth,while 15 cases involved both intra and extra lumina.The tumor size of GST closely was related to the shape,growth pattern,necrosis and the inhomogeneous enhancement patterns of the GST(P<0.05).The enhancement of the tumor was more intense in venous phase and delayed phase.Five cases showed septal enhancement,4 tumors exhibited marked enhancement in arterial phase with up to 60 HU.Conclusions CT can precisely display the location,shape and size of gastric stromal tumors.It is very helpful to provide useful information for early diagnosis and evaluation.

OBJECTIVE:To study the effect of Zuogui pill on the expression of gap junction protein 43(Cx43)in ovarian tis-sue of mice with premature ovarian failure(POF)induced by intraperitoneal injection of cyclophosphamide(CTX),and explore its mechanism in the treatment of chemotherapy-induced POF. METHODS:72 mice were randomly divided into blank group,model group,Estradiol valerate tablet group (positive control,0.00013 g/kg),Zuogui pill low-dose,medium-dose,high-dose groups (13.65,40.95,122.85 g/kg)by body mass,10 in each group. Except for blank group,other groups were reduce POF model by ip CTX,once a day,for 20 d. Meanwhile,the mice were intragastrically administrated related medicines,once a day,for 30 d. After 2 h of last administration,reverse transcription-polymerase chain reaction method and Western blot method were used to detect the Cx43 mRNA and protein expressions in ovarian tissue respectively,and immunohistochemistry method was adopted to detect the distribution of Cx43 protein in ovarian tissue. RESULTS:Compared with blank group,Cx43 mRNA and protein expressions in ovarian tissue of mice in model group were obviously weakened,and the distribution of Cx43 protein in follicle and granulocytes were obviously reduced(P<0.01). Compared with model group,Cx43 mRNA and protein expressions in ovarian tissue of mice in Estradiol valerate tablet group and Zuogui pill medium-dose,high-dose groups were obviously strengthened,and the distribution of Cx43 protein in follicle and granulocytes were obviously increased(P<0.01). CONCLUSIONS:Zuogui pill can increase the Cx43 mRNA and protein expressions in ovarian tissue of CTX-induced POF mice,increase the distribution of Cx43 in follicle and granu-locytes and gap junction function,which may be one of the treatment mechanism of POF.

Objective To evaluate the clinical application of preoperative multi-slice computed tomography (MSCT) and multi-slice computed tomography portography (MSCTP) in performing transjugular intrahepatic portosystemic stent shunt (TIPSS) combined with gastric coronary vein embolization (GCVE). Methods A total of 126 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertension were enrolled in this study. The patients were arranged to receive TIPSS together with GCVE. Before the treatment, MSCT and MSCTP were performed in all patients. By using post-processing techniques, including maximum intensity projection (MIP), multiplanar reformation (MPR), volume rendering (VR) and surface shade display (SSD), the anatomy of liver was comprehensively evaluated. Results Both MSCT and MSCTP could clearly display morphologic changes of liver , the spatial relationship of the portal and hepatic veins , the degree and extent of portal collateral circulation , and the severity of ascites, which provided important anatomical information for preoperative evaluation of TIPSS and GCVE. Conclusion MSCT and MSCTP are non-invasive and reliable examinations for the diagnosis of cirrhosis with portal hypertension, it can further clarify the diagnosis and guide the performance of TIPSS and GCVE.

Objective: To investigate the effect of knee-chest position on exhaust and defecation of gynecologic diseases patients after laparoscopic surgery. Methods: This quasi-experiment trail was conducted between July 2016 to May 2017, in a birth control ward at an obstetrics and gynecology hospital in Beijing, China. The study included a total of 258 patients who had gynecological benign diseases and received gynecological laparoscopic surgery. Participants were recruited in the trail by using a convenient sampling method with 130 patients who received gynecological laparoscopic surgery from July 2016 to December 2016 in the experimental group (on the basis of routine care, patients preformed a knee-chest position intervention after 6 hours of the surgery) and 128 patients who received gynecologic laparoscopic surgery between January 2017 and May 2017 in the control group (patients received a routine care). The primary end point was the postoperative anal exhaust. Results: The ambulation rate before post-operative ventilation of the experimental group was 21.5% (28/130) less than that of the control group (91.4%, 117/128). The difference was statistically significant (χ²=127.903, P<0.01). The incidence of abdominal distension after operation was 0, lower than that of the control group 7.0% (9/128), the difference was statistically significant (χ²=9.471, P<0.01). The postoperative exhaust time and defecation time of the experimental group was (8.17 ± 2.88) h,(27.86 ± 4.29) h, earlier than that of the control group, (21.24 ± 5.90) h,(38.69 ± 7.73) h, and the differences were statistically significant (t=22.580, 13.885, P<0.01). Conclusions Postoperative knee-chest position significantly improved the exhaust and defecation of patients with gynecological benign disease after laparoscopic surgery.

Nowadays,transjugular intrahepatic portosystemic shunt (TIPS) has already become the main means for the treatment of portal hypertension and its complications due to cirrhosis.The Viatorr stent that is specifically designed for TIPS has been available in China since the end of 2015,but it has not been widely used in clinical practice in China so far.At present,superimposed release dual-stent technology by using one bare stent and one covered stent,as simulation of Viatorr stent,to perform TIPS is still employed in many clinical centers in China.Dual stent technology carries unique advantages,although the long-term efficacy of dual-stent implantation technology is not as good as that of single-stent implantation technology.This paper aims to make a comprehensive review about the dual-stent technology used for TIPS,focusing on the dual-stent technique classification and advantages,the causes and the managements of postoperative shunt dysfunction,etc.so as to let this technique can be mnore effectively used in treating portal hypertension caused by cirrhosis.

OBJECTIVETo observe the effect of SIRT1 on intestinal barrier function of epithelial Caco-2 cells under hypoxia and investigate its mechanism.

METHODSCaco-2 cells were randomly divided into three groups: normoxia group (Nx), hypoxia group (Hx,1%O2 for 6 h) and hypoxia plus 40 μmol/L Resveratrol (agonist of SIRT1) group (Hx+Res). Transepithelial electrical resistance (TER) was determined. mRNA and protein expressions of SIRT1 and tight junctions (ZO-1, Occludin, Claudin-1) were examined by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting.

RESULTSBoth mRNA and protein expressions of SIRT1 were significantly reduced in Hx group as compared with Nx group (0.40±0.02 vs. 0.70±0.07, P=0.001; 0.37±0.03 vs. 0.76±0.03, P=0.001). The mRNA and protein expressions of SIRT1 were significantly increased in Hx+Res group as compared with Hx group(0.50±0.02 vs. 0.40±0.02, P=0.026; 0.54±0.02 vs. 0.37±0.03, P=0.011). The expression levels of ZO-1, Occludin and Claudin-1 in Hx group were lower than those in Nx group (P<0.05), however, pretreatment with Resveratrol could attenuate the decreased expression of above 3 molecules under hypoxia(P<0.05). TERs of Nx group, Hx group and Hx+Res group were (142±7) Ohm/cm(2), (94±3) Ohm/cm(2) and (119±7) Ohm/cm(2) respectively. Compare with the Nx group, the TER of Hx group was significantly decreased(P<0.05). TER of Hx+Res group was significantly increased compare with Hx group, but it was still significantly lower than that in Nx group(P<0.05).

CONCLUSIONSExpression of SIRT1 is significantly reduced under hypoxia. Activation of SIRT1 can maintain the epithelial barrier function through regulating the expression of tight junctions under hypoxia.

Caco-2 Cells ; Cell Hypoxia ; Claudin-1 ; metabolism ; Epithelial Cells ; metabolism ; Humans ; Intestinal Mucosa ; cytology ; Occludin ; metabolism ; Sirtuin 1 ; metabolism ; Zonula Occludens-1 Protein ; metabolism

Objective: To explore the effect of post-abortion care service based on Wechat follow-up on contraceptive compliance of multiple induced abortion patients, and to evaluate the satisfaction with PAC service. Methods: A quasi-experimental method was adopted. A total of 300 cases of induced abortion were selected in Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University from March 2018 to March 2019, with 150 cases from eastern branch in the experimental group and 150 cases from western branch in the control group. The control group received routine nursing care and post-abortion care service based on telephone follow-up, while the experimental group received routine nursing care and post-abortion care service based on Wechat follow-up. The missing rate of follow-up, the contraceptive method and the occurrence of unexpected pregnancy within one year after operation were collected in the two groups. Patients′ follow-up compliance and nursing satisfaction were evaluated. Results: The awareness of the risk of induced abortion in the experimental group was 90.4% (120/135) higher than that in the control group 77.5% (88/111), and the difference was statistically significant (χ² value was 9.128, P=0.010). The contraceptive consciousness of the two groups was 99.3% (134/135) and 94.6% (105/135), respectively, and the difference was not statistically significant (χ² value was 3.256, P=0.071). There was a statistically significant difference in the missing rate of follow-up between the two groups in January, March, June, and December (χ² value was 13.664, P=0.003). Compared with 19.8% (22/111) in the control group, 73.3% (99/135) patients in the study group chose high-efficiency contraception, the difference was statistically significant (χ² value was 69.795, P<0.01).There were no recurring pregnancies in the experimental group within one year, compared with 6.3% (7/111) in the control group, the difference was statistically significant (χ² value was 6.630, P=0.003). In the experimental group, the participation rate of the follow-up were (95.37±12.29)%, which were higher than that in the control group (90.77±16.49)%. The difference was statistically significant (t value was 2.438, P<0.05). The overall satisfaction score of the experimental group was 26.55 ± 2.80, which was higher than that of the control group (23.66 ± 3.32). The difference was statistically significant (t value was 7.285, P <0.01). Conclusion Post-abortion care service based on Wechat follow-up could enhance patients′ compliance and satisfaction, guide patients to choose the right contraceptive methods, reduce the rate of repeated abortion and promote female reproductive health.