Objective To assess the feasibility of applying intensity-modulated radiotherapy(IMRT)simultaneous integrated boost(SIB)to replace conventional radiotherapy(CR)plus brachytherapy of whole pelvis in locally advanced cervical eaneer(LACC).Methods Five LACC patients based difference position of uterus were chosen and worked out CR and IMRT SIB plans respectively.Dose distributions were compared between IMRT SIB and CR.Results When uterus was in ante-,neutral-,retro-pnsition and deviation respectively,IMRT SIB could provide enough and homogeneous dose distribution for target volume and reduce irradiated volumes and doses for organs at risk(recta,bladder and small intestine)than CR.The doses of the A,B,and fundus of uterus were higher in IMRT SIB than CR.However,in ease of small intestine was close to or encircled the uterus,the targets volume dose would be inadequacy.Conclusions LACC IMRT SIB's dose distribution is better than CR(except excess ante-position)and may help to treat those patients who couldn't be suitable with brachytherapy.

Objective To prepare the quantum dots(QDs) (CdTe-MPA)-loaded polymer(lactic-coglycolic acid,PLGA) microbubbles(MBQDs@PLGA) as dual-modality imaging agent for both fluorescent and ultrasonic imaging ability.Methods The MBQDs@PLGA were generated by the double emulsion technique,then filling in C3F8 after freeze-drying.Confocal laser scanning microscope(CLSM) and transmission electron microscope(TEM) were used to confirm the load of quantum dots in the MBs.Fluorospectro photometer spectra of the MBQDs@PLGA were analyzed to demonstrate the fluorescent imaging ability and determine the encapsulation efficiency by using the regression equation.Imaging experiments was applied to validate the fluorescent and ultrasonic imaging ability of the MBQDs@PLGA both by imaging of the model in vitro and by imaging of ovarian tumor blood vessels of tumor-bearing nude mouse in vivo.Results At excitation 272 nm the MBQDs@PLGA peak of the emission spectrum was 549 nm,and the encapsulation efficiency was 54％.The average diameter of MBQDs@PLGA was (1.7 ±0.2)μm,CLSM and TEM results confirmed the QDs-loaded in MBQDs-PLGA.The imaging results of MBQDs@PLGA showed a dual-modality imaging ability both fluorescent and ultrasonic imaging.Conclusions MBQDs@PLGA present fluorescence-ultrasound dual mode imaging performance by the QDs embedding in polymer microbubbles,and explore a new development train of thought of multi-mode imaging agent.

Objective To investigate the expression of Toll-like receptors(TLRs) in condyloma acuminatum(CA) lesions and their possible roles in the pathogenesis of CA. Methods The expressions of TLR1-10 mRNA level in the lesions of CA and in the cervix scrape cells from the patients with human papillomavirus(HPV) negative chronic cervicitis were detected by real-time quantitative fluorescent PCR. HPV typing was detected by HPV GenoArray test kit. Results Low-risk HPV type 6 and type 11 were the most prevalent types in the forty CA cases with positive rate of 77.5% and 55% respectively. 55% CA patients were found infected with more than two types of HPV. 35% CA patients were concurrently infected with high-risk HPV. The expressions of TLR3, 7, 8 mRNA were higher than other TLRs and the expression of TLR9 mRNA was lower than others in the lesions of CA. No significant differences of the TLR1-10 mRNA levels were found between HPV6 and HPV11 positive CA lesions, so did it between low-risk and high-risk HPV concurrent infected CA lesions. The expressions of TLR1-3, TLR5-8, TLR10 mRNA, especially TLR2, TLR7 and TLR8 in the lesions of CA were significantly higher than that in cervix scrape cells of HPV negative chronic cervicitis. There were no significant differences of TLR4 and TLR9 mRNA levels between the two groups. Conclusion There were higher expressions of some TLRs (3, 7, 8) and lower expression of TLR9 in the lesions of CA. Compared with HPV negative chronic cervicitis, the expressions of TLR1-3, TLR5-8, TLR10 mRNA in the lesions of CA were up-regulated. The expression profile of TLRs in different type of HPV infected CA lesions had no significant differences. Our results suggested that the expression profile of TLRs in CA may be associated with the HPV infection. Whether it was associated with the immune escape mechanism and persistent infection of HPV need further demonstration.

Background Serum cystatin C levels can be used to predict morbidity and mortality in patients with cardiovascular disease. However, the clinical relevance of serum cystatin C levels in patients with hypertensive left ventricular hypertrophy (LVH) has rarely been investigated. We designed the present study to investigate whether serum cystatin C levels are associated with cardiac structural and functional alterations in hypertensive patients. Methods We enrolled 823 hypertensive patients and classified them into two groups:those with LVH (n=287) and those without LVH (n=536). All patients underwent echocardiography and serum cystatin C testing. We analyzed the relationship be-tween serum cystatin C levels and LVH. Results Serum cystatin C levels were higher in hypertensive patients with LVH than in those without LVH (P＜0.05). Using linear correlation analysis, we found a positive correlation between serum cystatin C levels and interven-tricular septal thickness (r=0.247, P＜0.01), posterior wall thickness (r=0.216, P＜0.01), and left ventricular weight index (r=0.347, P＜0.01). When analyzed by multiple linear regression, the positive correlations remained between serum cystatin C and interventricular septal thickness (β=0.167, P＜0.05), posterior wall thickness (β=0.187, P＜0.05), and left ventricular weight index (β=0.245, P＜0.01). Con-clusion Serum cystatin C concentration is an independent marker for hypertensive LVH.

ObjectiveAnalyze preoperative clinical relevanted factors of acute type A aortic dissection with hypoxemia according to a group clinical data.MethodsFrom January 2011 to June 2011,we have collected 54 preoperative cases of acute type A aortic dissection,including 42 males,12 females,aged 28-73 years old,onset to treatment time is 0.4-14.0 days.General information:age,gender,time of onset,body mass index,hypertension,diabetes mellitus,smoking,drinking,heart ejection fraction,prothrombin time,quantitative fibrinogen,fibrinogen degradation products,D-dimer,C-reactive protein,procalcitonin,ICU time,length of hospital stay.According to the blood gas analysis of quiet state case without oxygen,with PaO2 ＜ ( 100-age ×0.33 ±5) mm Hg is for the hypoxemia group,equal or higher than this is no-hypoxemia group.ResultsNo-hypoxemia group has 14 cases,11 males,3 females,average aged (51.14 ± 14.24) years old,including 12 operation patients ( no death) and 2 no-operation patients(2 cases death).Hypoxemia group has 40 cases,31 males,9 females,average aged (50.53 ± 9.73 ) years old,including 33 operation patients(2 cases death) and 7 no-operation patients(7 cases death).There is no significant difference in age,gender,time of onset,hypertension,diabetes mellitus,smoking,drinking,cardiac ejection fraction,prothrombin time and fibrinogen.There is statistically significant on body mass index,fibrinogen degradation products,D-dimer,C-reactive protein,procalcitonin,ICU time and length of hospital stay time ( P ＜ 0.05 ).ConclusionPreoperative hypoxemia with acute type A aortic dissection is associated with obesity,excessive inflammation and activation of coagulation and fibrinclytic system,and hypoxemia may prolong the time of operative patients with acute type A aortic dissection in ICU and hospital.

AIM To study the effect of azone on transdermal absorption of 6-gingerol.METHODS In vitro transdermal diffusion test was performed by TP-6 horizontal diffusion pool.In vitro rat skins were selected as permeation barrier,the effects of different concentrations of ethanol and azone on permeation performance of 6-gingerol were investigated.RESULTS Both 30％ ethanol and 3％ azone contributed to the significant permeation enhancement of 6-gingerol.CONCLUSION This research can provide reference for the preparation of transdermal drug delivery systems containing 6-gingerol.

OBJECTIVETo study spiral CT cholangiography (SCTC) before treatment in patients with obstructive jaundice due to unknown cause.

METHODSBetween October 1998 and November 2000, a total of 59 patients with obstructive jaundice of unknown cause were examined by two-phase enhanced spiral CT (eSCT). Twenty-nine of these cases were excluded because they had had T-Bil of > 34 micromol/L so that their biliary duct system could not have been visualized. The remaining 30 patients were 17 male and 13 female with an age range of 31 - 76 years (mean 56.6). Pathologically, the lesion was proven to be carcinoma of pancreatic head (n = 9), Vater's ampulla carcinoma (n = 4), extrahepatic or hilar cholangiocarcinoma (n = 13), hepatocellular carcinoma (n = 1), chronic pancreatitis (n = 1) and cholelithiasis (n = 2). SCTC was performed through intravenous injection of 20 ml 50% Cholografin within 20 min before eSCT. SCTC was undertaken with parameters of a slice thickness of 2 - 3 mm, a table feed of 3 - 5 mm, a gantry time of 0.75 sec, a reconstruction interval of 1 - 2 mm, a pitch of 1.1 - 1.2, a voltage of 120 kV, a current of 220 - 240 mA, a matrix of 512 x 512 and a scan range from the level above hepatic hilum to the third segment of duodenum within 60 - 105 min following the injection. Both reconstructed SCTC source images and later eSCT scans were considered as axial CT (ACT). Multiplanar reconstruction (MPR) was obtained immediately on the operator console. 3D imaging adopted in our study was volume rendering technology (VRT) that was processed on the Siemens 3D Virtuoso workstation within 30 min. Opacification of biliary tree (OBT) analyzed by Grades 1 to 5 and image quality (IQ) assessed by 4 scales as excellent, good, fair and poor were investigated in ACT, MPR and VRT, respectively. The correlation between total OBT, which was the highest among the 3 image methods in the same case, and T-Bil, D-Bil, ALT, severity of the biliary obstruction (SBO) as well as level of the obstruction was analyzed.

RESULTSIn OBT, no statistically significant difference was found in the five grades by the three imaging techniques (P > 0.05), the distribution of percentages being 0, 0, 13.3%, 30.0% and 56.7% in ACT, 0, 6.7%, 20.0%, 30.0% and 43.3% in MPR and 0, 0, 13.3%, 40.0% and 46.7% in VRT. The evident correlation between total OBT and D-Bil (r(s) = -0.719), ALT (r(s) = -0.544) and SBO (r(s) = 0.650) was showed. In IQ, only a statistical significance existed between ACT and MPR (P = 0.034), having the scales "excellent to poor" in percentages of 93.3%, 6.7%, 0 and 0 for ACT, 66.7%, 30.0%, 3.3% and 0 for MPR and 70.0%, 23.3%, 6.7% and 0 for VRT, respectively.

CONCLUSIONAccording to our study, spiral CT cholangiography is very useful for the evaluation of selected patients with suspected obstructive jaundice before treatment.

Adult ; Aged ; Bile Duct Neoplasms ; diagnostic imaging ; Cholangiography ; methods ; Female ; Humans ; Image Processing, Computer-Assisted ; Jaundice, Obstructive ; diagnostic imaging ; Male ; Middle Aged ; Pancreatic Neoplasms ; diagnostic imaging ; Tomography, Spiral Computed ; methods

AIMTo explore the effect of propofol preconditioning on cardiomyocyte apoptosis and cytochrome C release from mitochondria during mild hypothermic ischemia/reperfusion in isolated rat hearts.

METHODS50 isolated SD rat hearts perfused on Langendorff apparatus were randomly divided into 5 groups (n=10): control group (C), DMSO group (D), 3 different concentrations of propofol groups of 25 micromol x L(-1) (P1), 50 micromol x L(-1) (P2), 100 micromol x L(-1) (P3) propofol respectively. All of the isolated rat hearts were subjected to 31 degrees C mild hypothermic ischemia for 55 min followed by 60 min reperfusion. The D, P1, P2, P3 groups were preconditioned by perfusing with K-H solution containing 20 micromol x L(-1) DMSO and 25, 50, 100 micromol x L(-1) propofol respectively for 10 min and then followed by 5 min K-H solution washing out before ischemia. The preconditioning procedure was repeated twice. Hemodynamics of the hearts was recorded after equilibration(baseline values) immediately before ischemia, 30 min and 60 min after reperfusion respectively. Cardiomyocyte apoptosis rate and contents of cytosolic and mitochondrial cytochrome C were measured at the end of reperfusion.

RESULTSAfter 30 min and 60 min reperfusion, LVEDP was significantly lower and LVDP was significantly higher in P3 group than those in C group ( P < 0.05, P < 0.01). Compared with C group, cardiomyocyte apoptosis rate of the hearts decreased significantly in P2,P3 groups at the end of reperfusion (P < 0.05, P < 0.01). Cytochrome C level increased significantly in mitochondria but decreased significantly in cytosol in P2, P3 groups as compared with C group (P < 0.05, P < 0.01).

CONCLUSIONPropofol preconditioning decreased cardiomyocyte apoptosis, protected the heart against 31 degrees C mild hypothermic ischemia/reperfusion injury by attenuation of the release of cytochrome C from mitochondria to cytosol.

Animals ; Apoptosis ; drug effects ; physiology ; Cytochromes c ; metabolism ; Hypothermia, Induced ; In Vitro Techniques ; Ischemic Preconditioning ; methods ; Male ; Mitochondria, Heart ; metabolism ; Myocardium ; metabolism ; pathology ; Propofol ; pharmacology ; therapeutic use ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; prevention & control

OBJECTIVETo summarize current understanding of the roles of anti-inflammatory and proinflammatory mechanisms in the development of atherosclerosis and acute coronary syndrome and to postulate the novel concept of inflammation stress as the most important factor triggering acute coronary syndrome. Moreover, markers of inflammation stress and ways to block involved pathways are elucidated.

DATA SOURCESA literature search (MEDLINE 1997 to 2002) was performed using the key words "inflammation and cardiovascular disease". Relevant book chapters were also reviewed.

STUDY SELECTIONWell-controlled, prospective landmark studies and review articles on inflammation and acute coronary syndrome were selected.

DATA EXTRACTIONData and conclusions from the selected articles providing solid evidence to elucidate the mechanisms of inflammation and acute coronary syndrome were extracted and interpreted in the light of our own clinical and basic research.

DATA SYNTHESISInflammation is closely linked to atherosclerosis and acute coronary syndrome. Chronic and long-lasting inflammation stress, present both systemically or in the vascular walls, can trigger acute coronary syndrome.

CONCLUSIONSInflammation stress plays an important role in the process of acute coronary syndrome. Drugs which can modulate the balance of pro- and anti-inflammatory processes and attenuate inflammation stress, such as angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers, statins, and cytokine antagonists may play active roles in the prevention and treatment of acute coronary syndrome when used in addition to conventional therapies (glycoprotein IIb/IIIa receptor antagonists, mechanical intervention strategies, etc).

Angina Pectoris ; etiology ; Arteriosclerosis ; etiology ; Biomarkers ; blood ; Blood Vessels ; physiopathology ; Humans ; Inflammation ; complications ; drug therapy ; physiopathology ; Myocardial Infarction ; etiology ; Stress, Physiological ; complications ; Syndrome

Objective To explore the safety and feasibility of performing total thoracoabdominal aortic aneurysm repair (tTAAAR) under normal thermia and non-cardiopulmonary bypass fashion by comparing surgical indications and details of different surgical strategies in tTAAAR.Methods From February 2009 to May 2011,46 consecutive patients with extensive Crawford Ⅱ thoracoabdominal aortic aneurysm (TAAA)underwent total thoracoabdominal aortic aneurysm repair( tTAAAR ) in An Zhen Hospital.The patients were divided into 2 groups ( A and B) according to their different surgical strategies.Patients in group A underwent total thoracoabdominal aortic aneurysm repair with deep hypothermia and circulatory arrest.Patients in group B underwent total thoracoabdominal aortic aneurysm repair in a normal thermia and non-circulatory bypass was performed via a combined left thoracoabdominal incision.After established the bypass from descending aorta to bilateral iliac arteries under normal thermia,the reestablishment of intercostal arteries and visceral arteries was followed with subsection circulatory arrest.The clinical results of these 2 groups were analyzed by SPSS 18.0.Results Patients in group A underwent total thoracoabdominal aortic aneurysm repair with deep hypothermia and circulatory arrest have higher mortality rate and transient nervous dysfunction rate (26.67％ vs 3.20％,P =0.033 ; 33.30％ vs 3.30％,P =0.018,respectively) than patients in group B underwent total thoracoabdominal aortic aneurysm repair in a normal thermia and non-circulatory bypass.Statistical significance was also observed between group A and circulatory arrest and group B in operation time,descending aortic clamping time,and transfusiori volume of red blood cells ( P ＜ 0.05 ).Average age,sex,pathological type,the maximal diameters of aneurysm,preoperative complications,visceral ischemia time,spinal cord ischemia time,ICU treatment time,intubation time,respiratory complications,plasma dosage,platelets dosage,RBC dosage,thoracotomy hemostatic,spinal cord injury,renal insufficiency were found no statistical significance(P ＞ 0.05 ) between two groups.In addition to death and paraplegia,the others were cured.Conclusion The normal thermia and non-cardiopulmonary bypass tTAAAR is a safe and feasible therapeutic strategy for TAAA patients.A bypass from descending aorta to iliac arteries can be built under normal thermia in TAAA patients,which is the indication of this new technique.Reestablishment of intercostal arteries is an important protective adjunct to avoid spinal cord injury.