Objective To evaluate the application of three dimensional conformal radiotherapy (3D-CRT) for non-small cell lung carcinoma (NSCLC) based on CT simulation in different respiratory phases in patients gaed≥70 years. Methods A total of 51 patients gaed≥70 years (range 70-88 years, mean age 73.5 years) with NSCLC were treated by 3D-CRT alone, using CT images of different respiratory phases. The case numbers at Ⅰb, Ⅱb, Ⅲa, Ⅲb and Ⅳstage were 3, 7, 19, 17 and 5, respectively. Both gross tumor volumes (GTV) at the end of inspiration and expiration were fused to a total GTV which was close to motorial range of tumor in respiration, and the expansion of clinical target volume/ planning target volume (CTV/PTV) need not include respiratory motion moreover. Compared with plans of classic 3D-CRT, the efficacy, prognostic factors and side effect of this treatment were evaluated. Results Compared with the traditional expansion of CTV/PTV, the volumes of PTV in this scheme were averagely 19.3% lower (median, 17.5%),and the volumes of lung that received equal dose to tumor were averagely 21.8% lower (median, 19.9%). The 1-, 2-and 3-years total survival rates were 70. 6%, 54.9% and 29.4% with a overall tumor response rate of 78.4%. KPS scores and node stages were independent prognostic factors, age was not. Conclusions CT simulations in different respiratory phases can effectively reduce PTV and improve the life quality without affecting the therapeutic effect in senile patients with NSCLC, and can be well tolerated.

AIM: Tumor necrosis factor-?(TNF-?) participates in the establishment of inflammatory lesions in pneumonia.High production of TNF-? may relate to the severity of pneumonia.There have already been several studies examining the association between pneumonia and single nucleotide polymorphisms(SNPs) that affect cytokine productivity.SNPs of TNF-?,-1 031,-863,-857,-308 and-238 have been identified.The variant alleles of these SNPs have suggested to be related to high TNF-? production and the severity of pneumonia.Therefore,the aim of this study is to examine the association between the severity of pneumonia in Chinese and the following SNPs: five in the TNF-? gene promoter(-1 031,-863,-857,-308,-238).METHODS: A total of 117 Chinese individuals were enrolled in this study.They were 67 patients with pneumonia and 50 healthy subjects.TNF-? was genotyped by polymerase chain reaction-restriction fragment length polymorphism for all subjects.The frequency distributions of genotypes in different groups were analyzed by SPSS 11.5 program.RESULTS: Frequency of subjects who carried at least one variant allele in TNF-?-1 031,-863,-857,-308,-238 SNPs among pneumonia patients was significantly higher than that in healthy subjects.And frequency of subjects who carried variant allele in TNF-?-863,and-308 SNPs among severe adult community acquired pneumonia patients was significantly higher than that in common pneumonia patients.CONCLUSION: TNF-?-863 and-308 SNPs appear to be associated with severe adult community acquired pneumonia in Chinese populations.

[Objective]To explore and analyze Professor GUO Weifeng's clinical experience in treating posterior circulation ischemic vertigo. [Methods] By learning with the teacher, collection of relevant information and medical records ,to expound Professor GUO Weifeng 's academic thoughts and clinical experience in posterior circulation ischemic vertigo, from aspects of etiology, pathogenesis, and syndrome differentiation and treatment variation, prescription medication, summarizing the characteristics of his prescriptions and ways of treatment as well as exemplifying them. [Results] Professor GUO Weifeng through many years of clinical practice proposes that the basic pathogenesis of this disease is liver with kidney deficiency and hyperactivity of liver-yang. Because of its more associated with obesity and high blood pressure, high blood lipids, diabetes, always mingle phlegm and stasis. The main treatment method is to nourish the Yin of liver-kidney, pacify liver and extinguish wind. Then, transform phlegm and disperse blood stasis. If pathogenic into collateral for a long time,we need using insect drug for treatment. Clinical treatment should be based on positive and evil of the partial ups and downs, the disease of both, flexible adjustment of medication, it is not limited by present method. [Conclusion] Professor GUO Weifeng 's clinical experience in treating posterior circulation ischemic vertigo is effective and worthy of wide application.

The essence of training for clinical postgraduates is comprehensive capacity,including clinical and scientific research capacity,and the demand for the former is relatively higher than the latter. By means of discussion on the source and the educational system for postgraduates,we try to train clinical anesthesiology postgraduates with high diathesis and meet the needs of clinical anesthesia.

Clinical practice is an important teaching stage for interns of anesthesiology in medical universities.We discuss advantages and disadvantages for different teaching modes in the course of clinical practice,aiming at choosing a better one to optimize practice quality and bringing up graduates with high diathesis.

Objective To study protective effects of Wuzi Yanzong Fang on DNA damage induced by cyclophosphamide (CTX) in mice, and explore its mechanism. Methods BalB/c mice were randomly divided into normal group, model group, Wuzi Yanzong Fang low dose group and Wuzi Yanzong Fang high dose group. Mice in Wuzi Yanzong Fang groups were pretreated with Wuzi Yanzong Fang for 7 days, then the mice in Wuzi Yanzong Fang groups and model group were intraperitoneally injected with CTX (100 mg/kg) every other day for three times, and mice in Wuzi Yanzong Fang groups were continued administered with Wuzi Yanzong Fang. Animals were sacrificed in twelve hours after the final treatment of CTX. ELISA was used to detect 8-OHdG content in serum, and single cell gel electrophoresis to detect DNA damage in bone marrow cells. Results Wuzi Yanzong Fang low dose group and high dose group reduced the level of 8-OHdG in serum. Wuzi Yanzong Fang significantly decreased Olive tail moment, tail moment, tail length and tail DNA%in mouse bone marrow cells. Conclusion Wuzi Yanzong Fang has good protective effects on DNA damage caused by CTX.

In order to compare the difference of cyp2e1 gene expression between patients with hepatic cirrhosis and obstructive jaundice,and to investigate the pharmacologic significance behind this difference,liver samples were obtained from patients undergoing hepatic surgery with hepatic cirrhosis( n =7),obstructive jaundice( n =6) and normal tissue of hepatic angioma (controls, n =6). Total hepatic RNA were extracted using the one step method, cyp2e1 cDNA probe prepared by primer randomly marked method, and difference of cyp2e1 expression was compared among patients by Northern blotting.Compared with control group, the expressions of cyp2e1 in liver tissue among patients with obstructive jaundice were evidently reduced, while expression of this gene in cirrhosis liver was unaltered. CYP2E1 isoenzyme encoded by cyp2e1 decreased among patients with obstructive jaundice as expression of cyp2e1 gene significantly reduced, liver ability for metabolism of inhalant anesthetics declined consequently, under some special conditions, hepato nephric toxicity of anesthetics might be aggravated.

Objective To evaluate the role of large conductance calcium-activated potassium (BKCa) channels in vascular hyporesponsiveness in rats with obstructive jaundice.Methods Eighteen male Sprague-Dawley rats,weighing 180-200 g,were randomly divided into 3 groups (n =6 each) using a random number table:control group (group C),sham operation group (group S),and bile duct ligation group (group BDL).Obstructive jaundice was produced by common bile duct ligation.At 7 days after surgery,blood samples were collected for determination of the levels of serum total bilirubin (TBL),direct bilirubin (DBL),indirect bilirubin (IBL),alanine aminotransferase (ALT),and aspartate aminotransferase (AST).Thoracic aortic rings were prepared,and the endothelium was removed.The aortic rings were sequentially perfused with different concentrations of norepinephrine (NE) and sodium nitroprusside (SNP),and the maximum amplitude of contraction and dilatation of aortic rings was recorded.The aortic rings were then perfused with BKCa channel blocker Chtx with the final concentration of 10 7 mol/L,followed by perfusion with different concentrations of NE and SNP again,and the maximum amplitude of contraction and dilatation of aortic rings was recorded under each concentration.The percentage of maximum contraction and dilatation (maximum amplitude after Chtx administration÷maximum amplitude before Chtx administration× 100％) was calculated.Results Compared with C and S groups,the levels of TBL,DBL,IBL,ALT and AST in serum were significantly increased,the maximum amplitude of NE-induced contraction of aortic rings was decreased,and the percentage of the maximum NE-induced dilatation of aortic rings was increased,the maximum amplitude of SNP-induced contraction of aortic rings was increased,and the percentage of the maximum SNP-induced dilatation of aortic rings was decreased in group BDL.Conclusion Excessivc opening of BKCa channels may be involved in the mechanism of vascular hyporesponsiveness in rats with obstructive jaundice.

Objective To evaluate therapeutic effect of endoscopy on duodenal papilla tumor. Methods Clinical data of patients who underwent the endoscopic duodenal papilla tumor resection in Zhongshan Hospital were retrospectively studied from April 2007 to May 2014. Results A total of 21 patients underwent 28 procedures. Postoperative biliary stent were retained in 6 cases (6/28) , with no perforation or postoperative pancreatitis. Delayed bleeding occurred in 7 cases (7/28) and controlled by endoscopic hemostasis, and no death occurred. Mean follow-up was 31. 5 months. There were 6 recurrent cases, and mean recurrence time was 14. 1 months. All these recurrent cases are treated by endoscopy treatments or surgery. Conclusion Endoscopic treatment of duodenal papilla tumor is safe, effective and minimally invasive, but the occurrence of delayed bleeding is worth concern.