This review analyzed the effect of folic acid on pemetrexed efficacy and toxicity, especially high-does folic acid supplementation. The optimal duration for supplementation prior to the first dose of pemetrexed has not been defined. The review also explored whether total plasma homocysteine levels can be as a marker to predict and avoid toxicity from pemetrexed therapy.

Objective To study the Dai medicine Yapa Tang inhibition on mice Lewis lung carcinoma growth and metastasis,and to explore the impact of the drug on mice immune function. Methods Subcutaneous injection LLC(Lewis lung carcinoma cells)in C57BL/6 mice’s right armpit was to establish rat models. 60 successful tumor-bearing mice were selected and thenafter inoculating LLC were randomly divided into 6 groups, namely the control group,Yapa Tang low-dose group,Yapa Tang mid-dose group, Yapa Tang high-dose group,cyclophosphamide group and Yapa Tang mid-dose combining cyclophosphamide group.Then,after inoculated 3 days,each group was administrated with medicines.The first four groups wereintragastricly administrated with 0.9% saline, low-dose, mid-dose and high-dose Yapa Tang with0.4ml respectively;the cyclophosphamide group was administrated with cyclophosphamide,and Yapa Tang mid-dose combining cyclophosphamide group was administrated with middle dose Yapa Tang and cyclophosphamide. After 21days, blood was taken from eyeballs. Tumor tissue, spleen, thymus were gotten and weighted to calculate inhibitory rate,spleen and thymus index, enzyme-linked immunosorbent assay (Elisa) was adopted to detect Interleukin-2(IL-2), Interleukin-10(IL-10)and their contents. Results The tumor weight of Yapa Tang high-dose group, cyclophosphamide group and Yapa Tang mid-dose combining cyclophosphamide group was 3.46±0.39, 2.39±1.04 and 2.30±0.76 respectively,all lower than the control group, which was 5.21±0.50, showing significant difference(P<0.05), with the inhibition rate were33.69%, 54.12%, 56.00%. The thymus and spleen index of Yapa Tang low-dose group, middle-dose group and high-dose group was2.16±0.69, 2.24± 0.76, 2.23 ± 0.63, 16.82 ± 3.14, 15.82 ± 1.72, 17.08 ± 3.65, significantly higher than that of the control group,which was1.94±0.6, 15.17±3.53. The IL-2, IL-10 level of control group were(883.54±181.49)ng/L, (1 106.86±343.79)ng/L. Yapa Tanggroupsshowed an increase in IL-2(1 732.29±100.52)ng/L, (1 813.33± 168.32)ng/L, (2 275.63 ± 394.76)ng/L and the decrease in level of IL-10, respectively were(834.02 ± 271.97)ng/L, (636.83±270.56)ng/L, (682.08±147.85)ng/L, with significant difference. Conclusion Yapa Tang can inhibit lewis lung cancer grow and reduce the number of lung metastases, regulate immune cytokines IL-2 and IL-10, and promote the immunity of tumor-bearing mice.

It provides a new approach to treat myelodysplastic syndromes when decitabine comes out.In order to improve the understanding of the role of decitabine and to provide a reference for the clinical treatment of middle-risk and high-risk myelodysplastic syndromes,this article mianly summarized drug combination,prognostic molecular markers,and reviewed the mechanism of action,main medication regimen in recent 5 years for the treatment of middle-risk and high-risk myelodysplastic syndromes with decitabine.

Objective To investigate the roles of Xenon-CT cerebral blood flow perfusion imaging in cerebral revascularization before surgery and efficacy evaluation.Methods The clinical data of 15 patients with symptomatic cerebral artery stenosis/occlusion of anterior circulation were analyzed retrospectively.Eight patients were treated with endovascular stenting,1 was treated with internal carotid endarterectomy,and 6 were treated with superficial temporal artery-middle cerebral artery bypass grafting.The regional cerebral blood flow (rCBF) detected by Xenon CT within 2 weeks before and after procedure and the modified Ranking scale (mRS) scores at 6 months after procedure were compared.Results (1) The mean rCBF value of 12 patients with abnormal blood perfusion of target vessels before procedure was 30±10 ml/(100 g·min) and that was 32±14 ml/(100 g·min) after procedure.Compared with before procedure,the difference was statistically significant (P<0.05).The mean rCBF value of 3 patients with normal blood perfusion of target vessels before procedure was 48±6 ml/(100 g·min) and that was 50±7 ml/(100 g·min) after procedure.Compared with before procedure,the difference was not statistically significant (P>0.05).(2) The postoperative mRS score was decreased in 8 cases and stable in 7 cases.Compared with before procedure,there were significant differences in mRS scores after procedure in 15 cases (P<0.05).During the follow-up period,none of the patients had new neurological impairment.Conclusion Revascularization can improve the presence of hemodynamic disorders in patients with symptomatic anterior circulation cerebral artery stenosis or occlusion of the target blood vessels in the distal local cerebral perfusion and neurological deficit symptoms.The patients with abnormal perfusion of preoperative Xenon-CT cerebral blood flow perfusion imaging may be more beneficial than those with normal perfusion.

Objective To investigate the efficacy of the hospital intensive treatment by auto-CPAP on elderly patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to analyse the possible factors related to the effectiveness.Methods Subjects were selected from elderly OSAHS patients over 60 years old.The eligible subjects were divided into intensive treatment group and non-intensive treatment group (non-ITG).Patients in intensive treatment group were intensively treated using auto-CPAP for 3 consecutive days,assisted with targeted health education and guidance,and making proper adjustments to parameters of the auto-CPAP according to treatment outcomes at the previous day.But those in non-intensive treatment group were just treated with auto-CPAP for only 1 day,supplemented by regular health education and guidance.The apnea-hypopnea index (AHI),minimum oxygen saturation (SaO2min),mean oxygen saturation (SaO2mean) and the time spent at SaO2 lower than 90％ (tSaO2＜90％),the occurrence of clinical symptoms and adverse effect,Epworth sleepiness scale(ESS) were compared between both groups.The correlation analyses were also conducted.Results ESS (3.58±3.76 vs.6.84 ± 3.22),AHI [(7.85±6.53) time/h vs.(10.42±7.27) time/h] and tSaO2＜90％[(5.65±15.43) min vs.(15.26±33.14) min] were lower(t=6.902,2.760,2.765,allP＜0.05),while SaO2mean [(96.57±1.53)％ vs.(94.63±1.38)％] and SaO2min [(88.24±4.43)％ vs.(83.28±5.06)％]were higher(t=-9.870,-7.740,both P＜0.05)in intensive treatment group than in non intensive treatment group.The occurrences of clinical symptoms and adverse effect (except for skin allergy) were decreased in intensive treatment group versus non-ITG (all P＜0.05).The AHI after intensive treatment was decreased in females versus males [(7.85±5.19) times /h vs.(11.27±7.78) times/h,t=2.133,P＜0.05].BMI,age,gender and the state of OSAHS were correlated to AHI,SaO2 mean,SaO2 min and tSao2＜90％ after intensive treatment (all P＜0.05).Conclusions The hospital intensive treatment can improve the clinical results and decrease the occurrences of clinical symptoms and adverse effect for elderly OSAHS patients,and is expected to improve therapy compliance,and its curative efficacy is correlated to BMI,age,gender and state of OSAHS before therapy.

Objective To investigate the possible correlation of the clinical parameters, such as age, obesity, Epworth sleepiness score (ESS), with the severity of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS). Methods One hundred and forty-eight patients with snoring during sleep admitted from May to Jul. 2008 were asked to answer the questions from a questionnaire concerning snoring, daytime sleepiness, and habits such as smoking and drinking, etc. All patients underwent at least a polysomnography (PSG) and the physical examination included height, weight, and body mass index (BMI). Age, BMI, the lowest SaO_2(%), ESS score, the biggest reduction of oxygen (%), a total suspension of time, the average correlation between respiratory disorder index (RDI) applied computing Pearson correlation test. Simple snoring and OSAHS group of mild, moderate and severe inter-group comparison analysis using generalized linear models. Results The prevalence of OSAHS was increased with age, higher in males than in females. A statistically significant correlation between ESS, BMI, the lowest SaO_2 with the RDI was detected. The difference of ESS, the lowest SaO_2 and the BMI was significant between the different serious patients (P<0.05). Conclusions OSAHS has a high morbidity rate in outpatients with snoring. Age and obesity are liability factors of OSAHS. BMI, the lowest SaO_2, ESS and RDI have well correlationship, which can be used to assess the pathogenetic condition, even make a primary diagnosis.

Objective To study the association of metabolic syndrome (MS)with cardiovascular disease (CVD).Methods According to the diagnostiv criteria for MS,1457 MS patients as the research objects,who were screened out of the tangshian harbor economic development zone hospital.All patients were detected with waist circ-umference,seat systolic blood pressure(SBP),diastolic boold pressure(DBP),fasting Plasma glucose(FPG),total cholesterol(TC),low -density lipoprotein cholesterol(LDL -C),high density lipoprotein cholesterol(HDL -C),tri-glyceride(TG).By 3 years follow -up and the carotid ultrasound detection of carotid intima -media thickness(IMT), all the patients were divided into three groups according to the diagnosis:event group (Coronary heart disease +Hypertensive heart disease,stroke,Coronary heart disease +Hypertensive heart disease +stroke)and control group. Results The patients′SBP[(145.5 ±15.7)mmHg,(149.9 ±13.8)mmHg,(156.3 ±14.6)mmHg],DBP [(92.5 ±8.7)mmHg,(97.9 ±9.0)mmHg,(101.0 ±10.0)mmHg],FPG[(6.3 ±2.6)mmol/L,(6.0 ± 2.5)mmol/L,(6.9 ±2.6)mmol/L],TC[(5.46 ±1.28)mmol/L,(5.10 ±1.15)mmol/L,(5.37 ±1.21)mmol/L], LDL -C[(3.40 ±0.75)mmol/L,(3.08 ±0.65)mmol/L,(3.24 ±0.72)mmol/L],TG[(3.44 ±1.60)mmol/L, (3.31 ±1.52)mmol/L,(3.38 ±1.58)mmol/L]of the event group were significantly higher than the control group [(139.2 ±17.4)mmHg,(85.6 ±9.1 )mmHg,(5.5 ±2.1 )mmol/L,(1.4 ±0.4 )mmol/L,(2.59 ± 0.64)mmol/L,(2.61 ±1.28)mmol/L]and HDL -C[(1.13 ±0.38)mmol/L,(1.2 ±0.4)mmol/L,(0.9 ± 0.23)mmol/L]was significantly lower than the control group[(1.4 ±0.4)mmol/L](P <0.05).Detection rates of all the event groups were significantly higher in age[(53.4 ±6.4)years,(54.6 ±6.6)years,56.3 ±6.8)years], hypertensive heart disease(67.8%,74.8%,88.0%),high blood sugar(46.7%,42.9%,49.7%),and carotid atherosvletosis (19.9%,18.9%,29.3%)than the control group[(47.2 ±6.5)years,47.2%,24.3%,5%)](P <0.05).Conclusion There was a correlation between Mdtabolic syndrome and Cardiovascular disease.

Objective To investigate the diagnosis and treatment of anorectal malignant melanoma,in order to regulate surgical methods and explore multi-modality treatment.Methods Clinical pathological features,diagnosis and treatment procedures of 38 patients with anorectal melanoma were reviewed,and their correlation with prognosis were analyzed.Results In 38 patients,10 of them were male and 28 were female,with the mean age of 58.7 years old (ranged 28-75 years old).28 patients underwent abdominoperineal resection,10 patients underwent wide local excision.The 1-,3-,and 5-year disease-free survival rates were 64.9 ％,18.5 ％ and 5.7 ％,respectively.The 1-,3-,and 5-year overall survival rates were 85.8 ％,24.1％ and 6.4 ％,respectively.Tumor thickness (≥ 1.51 rm) and tumor diameter (≥3 cm) were associated with lymph metastases (x2 =13.093,4.449,P =0.011,0.020),tumor thickness was also associated with distant metastases (x2 =11.965,P =0.018).According to the Kaplan-Meier method,comprehensive treatment after surgery had significant effects on disease-free survival (x2 =7.441,P =0.006).Tumor thickness,lymph metastases,and clinical staging had significant effects on overall survival (x2 =16.741,16.474,16.775,P =0.002,0.000,0.000).Cox proportional hazards model indicated that comprehensive treatment after surgery was the independent prognostic risk factors of disease-free survival (95 ％ CI 1.420-17.621,P =0.012).Tumor thickness and lymph metastases were the independent prognostic risk factors of overall survival (95 ％ CI 0.250-0.949,1.033-2.573,P =0.035,0.036).Conclusion Early detection,reasonable surgical procedure,generalized systemic focus on immunotherapy treatment are the key to improve quality of life and prolong the survival time of anorectal malignant melanoma patients.

Objective To explore the effect of the joint edaravone in early rehabilitation on the prognosis of patients with ischemic stroke.Methods The general branch of Kailuan group of patients with ischemic stroke who were conformed to the 1995 national conference on the 4th cerebrovascular diagnostic criteria with head CT or MRI imaging diagnosis,were collected from January 2012 to December 2014.A total of 324 cases were the first onset,who had been treated with conventional drugs,and were randomly divided into the observation group(edaravone associated with early rehabilitation)and the control group(early rehabilitation)with 162 cases in each group.Patients of the observation group were given venous application of edaravone and received the standardized rehabilitation treatment within 48 hours.The control group were given standard rebabilitation therapy at 2 weeks after attacked.NIHSS and MMSE scores of the two groups of patients were evaluated at the beginning of the rehabilitation course,4 weeks and 12 weeks of the treatments.Results There were no statistically significant difference and the clinial manifestations of the lesion site between the two groups of patients on admission.At the beginning of the rehabilitation,the NIHSS and MMSE score of control group were statistically significant different from that of observation group [NIHSS:(14.8 ±5.3)vs.(16.1 ±5.1),PNIHSS =0.049;MMSE:(15.9 ±6.3)vs.(14.2 ±6.2),PMMSE =0.041].The sec-ond and third evaluation were respectively conducted at 4 weeks[NIHSS:(10.1 ±6.3)vs.(8.2 ±5.7),MMSE:(17.7 ±5.5)vs.(20.9 ±5.9)]and 12 weeks[NIHSS:(6.6 ±4.9)vs.(4.7 ±3.6),MMSE:(21.0 ±4.8)vs. (24.6 ±4.9)].The results of the observation group were significantly better than the control group(P4W NIHSS =0.036,P4W MMSE =0.035;P12W NIHSS =0.006,P12W MMSE =0.003),and the differences were statistically significant. Conclusion Edaravone associated with early rehabilitation can obviously improve the prognosis of patients with ischemic stroke.

OBJECTIVE:To observe the clinical efficacy and safety of edaravone combined with early rehabilitation in the treat-ment of cerebral hemorrhage,and to provide clinical evidence for rehabilitation management and drug treatment of cerebral hemor-rhage patients. METHODS:168 patients with cerebral hemorrhage,collected from neurology department of our hospital during Jan. 2012 to Dec. 2014,were randomly divided into observation group and control group with 84 cases in each group. Both groups re-ceived routine treatment;observation group was additionally given edaravone intravenously on the basis of routine treatment,and be-gan to receive standardized rehabilitation treatment within 48 hours after the onset of symptom;control group began to receive stan-dardized rehabilitation treatment 2 weeks after the onset of symptom. NIHSS and MMSE score of 2 groups were conducted before re-habilitation treatment,and after 4 and 12 weeks of treatment. RESULTS:There was no statistically significant difference in lesion site and clinical manifestations between 2 groups on admission(P>0.05);both NIHSS and MMSE score of observation group were better than those of control group after 4 and 12 weeks of treatment,there was statistical significance(P<0.05). CONCLUSIONS:Edaravone associated with early rehabilitation can obviously improve the prognosis of patients with cerebral hemorrhage.