Objective To understand the epidemic situation,epidemiological characteristics and clinical features of import?ed malaria in Donghai County,Lianyungang City from 2005 to 2015. Methods The epidemiological data of imported malaria in Donghai County from 2005 to 2015 were collected and analyzed by the descriptive epidemiological method. Results A total of 126 imported malaria cases were reported in Donghai County from 2005 to 2015,including 101 falciparum malaria cases (80.19%),13 ovale malaria cases(10.32%),7 vivax malaria cases(5.56%),4 quartan malaria cases(3.17%),and 1 case with mixed infection(0.79%). These cases were distributed in 14 towns,and mainly in 4 towns namely Niushan,Tuofeng,Shil?iu,and Huangchuan,and the cases in the 4 towns accounted for 63.49% of the total cases. The cases occurred in the whole year,but the peak period of the disease was in April,which was related to the returned time of these patients from foreign coun?tries. All the patients were male and aged from 20 to 55 years,and those aged from 20 to 50 years accounted for 90.70%. Con?clusions The epidemic situation of imported malaria presents a rising trend in Donghai County in recent 10 years. To control imported malaria,the above?mentioned 4 towns with more migrant construction workers and businessmen should be treated as key areas. Meanwhile,the floating population management,disposal of the malaria epidemic spots,mosquito vector monitoring as well as health education should be strengthened.

This paper, based on recent 10 years pharmacological experimental studies, reviews the effects of total flavones of epimedium on cardiovascular system, circulatory system, immune system and bone marrow system, etc.

OBJECTIVE:To observe the influence of capecitabine combined with radiotherapy on postoperative survival rate, relapse rate and survival quality of elderly patients with rectal cancer at Ⅱ-Ⅲ stage. METHODS:110 patients with rectal cancer atⅡ-Ⅲ stage were selected and randomly divided into control group and observation group with 55 cases in each group. Both group received radical resection of rectal carcinoma. Control group was given three dimensional conformal radiation therapy(3DCRT)af-ter operation;observation group was additionally given capecitabine 1 500 mg/m2,d1-14,qd,on the basis of control group. A treatment course lasted for 21 d,and both groups received 2 courses of treatment and followed up for 3 years. The survival rate and metastasis and recurrence rate of 2 groups were compared as well as KPS score before and after treatment. Toxic reaction of 2 groups was also observed. RESULTS:The follow-up total survival rate and disease-free survival rate of observation group were 89.09%and 76.36%,which were significantly higher than 74.55%and 54.55%of control group;the distant metastasis rate and lo-cal recurrence rate were 12.73% and 5.45%,which were significantly lower than 30.91% and 21.82%,with statistical significance (P<0.05). KPS score of 2 groups were increased significantly,between 2 groups before and after treatment ,with statistical signifi-cance(P<0.05);Comparison between groups(P>0.05). There was no statistical significance in the incidence of nausea and vom-iting,diarrhea and urinary tract reaction between 2 groups (P>0.05);but the incidence of bone marrow arrest in observation group was significantly higher than control group(P<0.05). CONCLUSIONS:Capecitabine combined with 3DCRT can effectively improve postoperative distant survival rate of patients with rectal cancer at Ⅱ-Ⅲ stage,and reduce the metastasis and recurrence risk;do not lower life quality and induce serious adverse reactions.

AlM:To evaluate the early diagnosis of sub-clinic stage of diabetic retinopathy.
METHODS: This was cross sectional study, multifocal retina electroretinogram ( mf-ERG ) , contrast sensitivity ( CS) and central retinal artery color Doppler examination were recorded from 30 cases ( 30 eyes ) matched control subjects, 35 cases (35 eyes) with type 2 diabetes mellitus (DM) without diabetic retinopathy ( NDR) and 38 cases ( 38 eyes ) with non-prolifera tive diabetic retinopathy ( NPDR) . One-way ANOVA and SNK-q test were used for data analysis.
RESULTS: P1 response density of NDR patients were found decrease, N1 implicit time were delayed. Which were related with the degree of retinopathy (P<0. 05);CS of NDR patients were found significant in middle and high frequency ( P < 0. 05 ), NPDR patients were found significant in full frequency ( P<0. 05 ); Central retinal artery (CRA) blood flow in the control groups and NDR groups were not found statistically significant (P>0. 05), The differences between normal group, NDR group and NPDR group were found statistically significant (P<0. 05).
CONCLUSlON: mf-ERG and CS are sensitive indexes for early evaluation of visual function in patients with diabetes mellitus, with development of the disease, CRA blood flow also appears to decline.

Objective To determine the mechanism of nitric oxide synthase(NOS) and prostacyclin(PGI2) acting on splanchnic hyperdynamic circulation of portal hypertention(PHT). Methods Ninety-six Sprague-Dawley rats were divided into three groups, namely, intrahepatic portal hypertension(IHPH, n=31), prehepatic portal hypertension(PHPH, n=33) and sham-operated controls(SO, n=32). Animals of each group were received indomethacin(INDO) either on a short term or long term with saline as control. Portal venous pressure, together with the concentration of nitric oxide (NO) and PGI2 in serum was measured. The constitutive nitric oxide synthase(cNOS)and inducible nitric oxide synthase(iNOS)activity in the abdominal aorta and small intestine of these rats were detrmined by spectrophotometry method. RT-PCR was performed to measure the levels of iNOS and cNOS mRNA in the arteries and guts mentioned above. Results Although INDO decreased the concentration of PGI2 in serum, the long-term INDO-treated group restored splanchnic hyperdynamic circulation in both IHPH and PHPH rats, concomitant with enhanced expression of iNOS and concentration of NO(P0.05). Conclusion Overproduction of NO inducing hemodynamic abnormalities of PHT is synthesized principally by increase of iNOS. There may be a possible interaction between PGI2 and NO in hyperhemodynamics of PHT, while PGI2 may not be a mediator in the formation and development of hyperdynamic circulatory state.

Objective To compare the development of intraoperative atrial fibrillation in elderly patients undergoing thoracic surgery using different anesthetic methods in a large sample clinical trial.Methods A total of 1 380 patients of both sexes,aged 60-80 yr,with body mass index of 16-33 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical operations for lung or esophageal cancer,were divided into 3 groups (n =460 each) using a random number table:general anesthesia group (group G),general anesthesia combined with paravertebral block group (group GP),and general anesthesia combined with epidural block group (group GE).After induction of anesthesia,an epidural catheter was placed at T4-7 interspace on the operated side,and 0.375％ ropivacaine 8 ml was administrated via the catheter in group GP.After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated,and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg in the 3 groups.Maintenance of anesthesia was as follows:propofol was given by target-controlled infusion with the target plasma concentration of 2.5-4.0 μg/ml in the 3 groups;intermittent iv boluses of sufentanil 10 μg were given,and the total dosage was not expected to exceed 1.0 μg/kg in group G;sufentanil 10 μg was injected intravenously when necessary in group GP;0.25％ ropivacaine 5 ml was injected epidurally every 1.5 h in group GE;bispectral index value was maintained at 40-60;rocuronium was injected intravenously according to the condition in the 3 groups.The development of intraoperative atrial fibrillation was recorded.Results The incidence of intraoperative atrial fibrillation was 6.1％,3.7％ and 2.2％ in G,GP and GE groups,respectively.Compared with group G,the incidence of intraoperative atrial fibrillation was significantly decreased in group GE (P＜0.05),and no significant change was found in the incidence of intraoperative atrial fibrillation in group GP (P＞0.05).Conclusion Compared with general anesthesia,general anesthesia combined with epidural block can decrease the development of intraoperative atrial fibrillation,it is more suitable for this type of patients,however,general anesthesia combined with paravertebral block produces no improvement in the development of intraoperative atrial fibrillation in elderly patients undergoing thoracic surgery.

Objective To investigate the mechanism of the radiosensitivity effect of Cox-2 gene in esophageal cancer.Methods Cox-2 specific siRNA was constructed and transfected to EC9706 cells to downregulate intracellular Cox-2 expression.The expressions of MMP-2,Bcl-2 mRNA,AKT and phosphorylated AKT proteins were assayed after radiation.Colony formation,cell proliferation,apoptosis and cell invasion in vitro were examined as well.One-way ANOVA method was used to analyze the data.Results Affter 2 and 4 Gy irradiation,a significant increase in the mRNA expression of Bcl-2 was observed in the Cox-2 up-regulation group (F =3.36,4.32,P ＜ 0.05).In the group of Cox-2 downregulation,the expression of MMP-2 mRNA was significantly reduced(F =3.86,8.09,P ＜ 0.05).Affter irradiation,a significant decreaseof Bcl-2 mRNA (F =3.73,5.64,P ＜ 0.05) as well as an increase of Bax(F =7.03,7.42,P ＜ 0.05) was detected,and the levels of total and phosphorylated AKT proteins had the highest level in the Cox-2 upregulation group and had the lowest level in the Cox-2 downregulation group.In the Cox-2 downregulation group,the apoptosis induction obviously increased with dose (F =317.40,P ＜ 0.05),and the proportion of cells in Go-G1 phase gradually increased but the proportion of cells in S and G2-M phases decreased,concomitant with the obvious suppression of cell proliferation,in addition,cell invasion was decreased.Conclusions Downregulation of intracellular Cox-2 mRNA expression,concomitant with subsequent downregulation of MMP-2 and Bcl-2 and upregulation of Bax,resulted in reduction of the invasion and metastatic capabilities of tumor cells,and induction of Go-G1 phase arrest and apoptosis.Downregulation of AKT and phosphorylated AKT (pAKT) protein expression might also interfere with the capability of the PI3K/Akt signal transduction pathway to resist radiotherapy.

Objective To assess the tolerance of elderly patients with esophageal carcinoma to chemoradiotherapy through.Methods A retrospective analysis of 596 elderly patients with esophageal carcinoma receiving chemoradiotherapy was conducted.Patients were divided into radiachemotherapy group and radiotherapy group,and according to age,patients were divided into four age groups (aged 70-74,75-79,80 80 and 85years and over).The tolerance to treatment was assessed by Charlson index.Results 185 patients completed chemoradiotherapy,113 patients reduced the dose of chemotherapy (reduction group),81 patients unfinished chemoradiotherapy (unfinished CRT group),160 patients completed radical radiotherapy alone (unfinished RT group),and 57 patients incompleted radiotherapy.Further analysis found that the tolerance to treatment in reduction group had significant differences between patients aged ≥ 75 years and ＜ 75 years (x2 =6.815,P=0.009),and between WIC ≥ 1 and ＜ 1(x2 =10.636,P=0.001); the tolerance to treatment in unfinished CRT group had significantly differences between aged ≥ 80 years and ＜80 years (x2 =63.842,P=0.000),and between WIC =0,1 and ≥ 2 (x2 =21.153,P=0.000).Conclusions Further age re-grouping and WIC assessment is necessary before treating esophageal cancer patients.Reduction of therapy dosage is more beneficial for patients aged ≥ 75 years and WIC≥1,and greater caution is required in chemotherapy for patients aged ≥ 80 years and WIC＞1.

Objective To investigate the effect of the extent of postoperative prophylactic radiotherapy after radical surgery on the long-term survival in patients with thoracic esophageal carcinoma.Methods A retrospective analysis was performed on the clinical data of 201 patients with thoracic esophageal cancer who received postoperative prophylactic radiotherapy after radical surgery from 2000 to 2007.The effect of the extent of radiotherapy on survival was evaluated,and the possible prognostic factors were subjected to multivariate Cox regression analysis.The Kaplan-Meier method was used to calculate overall survival (OS) rates,and the log-rank test was used for survival difference analysis.Results The 5-year follow-up rate was 97.0％.The OS rates for patients who received radiotherapy to the whole mediastinum,whole mediastinum + lymph nodes along the left gastric artery,whole mediastinum + bilateral supraclavicular regions,upper and middle mediastinum + bilateral supraclavicular regions,and whole mediastinum + bilateral supraclavicular regions + lymph nodes along the left gastric artery were 21.7％,37.1％,38.7％,34.8％,and 19.8％,respectively (P =0.406).Multivariate analysis showed that postoperative N stage was the independent prognostic factor (P =0.009).After prophylactic irradiation,metastases to the supraclavicular lymph nodes,lymph nodes in the upper and middle mediastinum,and abdominal lymph nodes were observed in 11,34,and 10 patients,respectively.Conclusions The extent of postoperative prophylactic radiotherapy after radical surgery for thoracic esophageal carcinoma only includes upper and middle mediastinum and bilateral supraclavicular regions.

Objective To explore surgical methods of removing polyacrylamide hydrogel (PAHG) and the right time of repairing the deformity of breast after removing PAHG.Methods We operated with endoscopy to remove PAHG through the lower mammary areolar incision.According to injection influence,we made the dicision whether to put the silicon gel prosthesis (hereafter referred to as prosthesis) simultaneously,and to fix the porsthesis,and to rebuild the imframammary fold of breast using biological repair membrane (hereafter referred to as membrane).Results In all 46 patients,39 patients' injection and their envelope were removed entirely.7 patients left part of the envelope because of its thin and wide characters.14 of them accepted prosthesis augmentation mammaplasty simultaneously and 5 of these accepted membrane repair.4 patients received prosthesis augmentation in stage Ⅱ.All patients' incision were primary healing.The incision scars were not obvious.1 patient with breast cancer suffered breast excision; 1 patient who received prosthesis and membrane simultaneously appeared prosthesis displacement after 3 months and fixed again.1 patient who received membrane appeared hydrops in residual cavity,and the membrane was removed finally.Conclusions This method with endoscopy through mammary areolae is necessary for cleaning PAHG entirely.We can use prosthesis to repair the deformity of breast after removing PAHG,and if necessary use membrane to fix the implant and rebuild the inframammary fold of the breast.