The treatment for chylothorax depends on the underlying causes and the individual clinical cir-cumstances.It is difficult to select the best treatment measure.The main options include medium-chain tri-glyceride diet,total parenteral nutrition,drug therapy,thoracentcsis,pleurodesis,pleuroperitoneal shunting,embolization or ligation of the thoracic duct.This paper provides a brief review of the treatment for chylotho-rax.

ObjectiveTo explore the clinical effect of edaravone combined with Shuxuetong in treatment of elderly patients with acute cerebral infarction.Methods120 cases of acute cerebral infarction,according to the different treatment methods,were divided into two groups.The conventional treatment was given in two groups,the control group plus Chuanqiong hydrochloride injection,and the observation group adopted edaravone and Shuxuetong.The clinical efficacy,activities of daily living(ADL) and neurological deficit score were compared between two groups.ResultsThere were 25 cases of basic recovery,18 cases of significant progress,progress in 12 cases in the observation group,total effective rate was 91.7％ (55/60),the control group was 75.0％ (45/60),the difference was statistically significant ( x2 =6.86,P ＜ 0.05 ).Observation group had statistically significant difference than the control group between ADL and neurological deficit scores ( all P ＜ 0.05 ).ConclusionOn the basis of conventional therapy,the use of edaravone combined with Shuxuetong for acute ischemic stroke patients could significantly promote the recovery of neurological function and was worthy of promotion.

Pancreatic cancer was one of common malignant tumors of the digestive tract, early diagnosis of which was difficult and surgical resection rate was low. The prognosis was poor, and its incidence increased year by year. Conventional treatment of pancreatic cancer includes surgery, radiotherapy and chemotherapy, but 90％ of the patients had lost the surgical opportunity when they see a doctor, and not sensitive to radiotherapy and chemotherapy. Relative to these traditional treatments, gene therapy is an innovative approach for the treatment of pancreatic cancer and had attracted wide attention in recent years. Many gene therapy drugs for pancreatic cancer had now entered Ⅰ / Ⅱ clinical trials. The gene therapy techniques for pancreatic cancer included antisense gene therapy, suicide gene therapy, immune gene therapy, and oncolytic virus therapy. In this article, we reviewed recent advances in gene therapy for pancreatic cancer.

Objective To investigate the influence of different scout image on the radiation dose of head and chest spiral scanning in CT using automatic tube current modulation(ATCM).Methods CT scanning was performed on the head-neck and chest phantom with ATCM.Five different scout images through the five various positions that include anteroposterior(AP),posteroanterior(PA),lateral,AP,lateral,PA and lateral.The phantom was scanned three times for each position.Then each scout image was scanned by spiral technique once more.ROI in orbital center and C5 upper edge level were selected for Head and neck phantom,ROI in the apical and tracheal bifurcation level were selected for chest phantom.The contrast to noise ratio (CNR) was measured and recorded.The organ dose of eye lens and mammary glands were measured by thermoluminescent dosimeters (TLD) in every scanning(the average of 3 measurements),The cumulative value of scout image and spiral scanning were calculated.The volume CT dose index (CTDIvol) of each scan was recorded,and the cumulative value of CTDIvol was calculated.Results In the five scout images of the head-neck phantom mode,the maximum value of accumulated radiation dose of eye lens and CTDIvol appear on PA scout image(18.354 and 26.43 mGy respectively),while the minimum value appear on the lateral scout image(11.847 and 18.20 mGy respectively).In the chest phantom mode,the maximum value of the accumulated radiation dose of the mammary gland and CTDIvol emerge from the AP scout image (6.873 and 9.42 mGy respectively),while the minimum value of the mammary accumulated radiation dose appear on lateral scout image(4.592 mGy),the minimum value of CTDIvol appear on AP plus lateral scout images(3.94 mGy).The accumulated radiation dose of eye lens and CTDIvol value in PA scout image mode were 54.9％(6.507/11.847) and 45.2％(8.23/18.20) higher than those of the lateral scout image mode.The accumulated radiation dose of mammary gland and CTDIvol value in AP scout image mode were 42.5％ (2.051/4.822) and 136.7％ (5.44/3.98) higher than that of PA plus lateral scout images mode.In the head-neck phantom mode,the CNR value of orbital center and C5 upper edge level were 102.55 to 115.89,161.01 to 204.52 respectively.In the chest phantom mode,the CNR value of the apical and tracheal bifurcation level were 82.74 to 164.00,83.12 to 121.49 respectively.Conclusion The choice of the scout image had significant effect on the radiation dose and the sensitive organ dose in CT.

Objective To investigate the influence of additional filter on image quality and radiation dose in chest digital radiography (DR). Methods The adult chest phantom was exposed under the different additional filter by 0, 1.0 mm Al,1.0 mm Al+0.1 mm Cu,1.0 mm Al+0.2 mm Cu while the kV was 110 kV and the AEC parameter selection were -4,-2, 0, 2, and 4 respectively. Image quality was evaluated by the relative noise and the contrast-to-noise ratio (CNR). The radiation dose was evaluated by the entrance skin dose (ESD) and the effective dose. Linear regression analysis was used to analyze the relationship between the ESD and the effective dose, and the correlation between the image quality and the effective dose was analyzed by Pearson correlation analysis. Results The ESD were (0.023 ± 0.004), (0.034 ± 0.007),(0.045 ± 0.009),(0.056 ± 0.010),(0.067 ± 0.012)mGy and the effective dose were(6.15 ± 0.09)×10-3,(9.02±0.15)×10-3,(11.94±0.16)×10-3,(14.89±0.09)×10-3,(17.80±0.12)×10-3 mSv when the AEC parameter selection were -4,-2, 0, 2, and 4 respectively. The effective dose was linearly positively correlated with the ESD and the regression coefficient were(r=1.000, P<0.01)under different additional filter. The ESD decreased with the additional filter increased under the same AEC, and the maximum could be reduced by 34%. The relative noise was decreased with the effective dose increased and there was a negative correlation between the two and the Pearson correlation coefficient were(r=-0.970,-0.966,-0.971,-0.971;P<0.01)under different additional filter. The CNR was increased with more effective dose and there was a positive correlation between the two and the Pearson correlation coefficient were (r=0.952, 0.947, 0.908, 0.944;P<0.05)under different additional filter. The relative noise decreased with the additional filter increased under the same AEC, and the maximum could be decreased by 13%. The CNR values increased with the additional filter under the same AEC, and the maximum could be increased by 4%. Conclusions The use of additional filter in chest digital radiography can reduce the ESD and improve the quality of the image to some extent, but the effective dose change is not significant.

BACKGROUND: In order to conserve blood and keep the operating field clean, cell saver is often used with electrocautery in hip arthroplasty. When applying the principle of thermal coagulation, electrocautery produces tissue self-burning with noxious gas byproducts, including carbon monoxide(CO). However the existing blood salvage systems do not have any reoxygenation or filtration function for CO.OBJECTIVE: To evaluate the effects of simultaneous use of electrocautery and a cell saver system on the blood levels of CO in patients undergoing hip arthroplasty.DESIGN: A comparative observation.SETTING: Department of Orthopedics, Duisburg-Essen University.PARTICIPANTS: From August 2002 to August 2003, patients undergoing hip arthroplasty including the use of electrocautery as well as intended use of a cell saver system were selected from the Department of Orthopedics, Duisburg-Essen University. Exclusive criteria: ① smoking history; ② history of anemia, hemoglobinopathy or coagulopathy; ③history of organ dysfunction, including lung, liver and kidney; ④ preoperative abnormal electrocardiogram (ECG), including cardiac ischemia and/or arrhythmia.Among all the enrolled patients, those who ultimately received the retransfusion of processed salvaged blood were counted as the observed group,whereas the others who did not receive any retransfusion for inadequate salvaged volume or possible contamination within salvaging were added as the control group, and no allogenic blood was transfused. All the patients agreed to participate in the study.METHODS: ① All the operations were performed under combined intravenous and inhalation general anesthesia. ② Electrocautery was used for coaluation during the incision of subcutaneous tissues, fascias, muscles as well as capsules. ③ A cell saver system (Haemonetics Cell Saver #5 System, manufactured by Haemonetics Corporation, U.S.A.) was applied during the operation. Salvaged blood were retransfused into the patients after the procedure of filtration and wash. ④ Blood CO-Oximetry: Blood CO levels were measured by carboxyhemoglobin (CO-Hb) concentration with a spectrophotometric blood gas analyzer (ABL 700 series, manufactured by Radiometer, Copenhagen, Denmark). In both groups, systemic blood samples were collected from a radial arterial catheter at 3 time points, including preoperatively, postoperatively and merely before the retransfusion of salvaged blood and at 6 hours postoperatively. In the observed group, additionally samples were collected instantly after skin incision from the aspirator connected to the cell saver reservoir, directly after femoral stem implantation also from the aspirator and immediately before retransfusion from the collecting sac, to reveal the trend of CO-Hb levels in salvaged blood.MAIN OUTCOMEMEASURES: CO-Hb levels in the systemic blood and salvaged blood at different time points were mainly observed.RESULTS: Totally 49 patients were involved in the analysis of results. ① General data: Forty-nine ASA Ⅰ -Ⅱ patients were enrolled in this study.There were 35 and 14 patients in the observed and control group, respectively, with 7 and 3 had a history of coronary heart diseases (heart function of class Ⅰ - Ⅱ ) correspondingly. There were no obvious differences in the sex, age, mean operative time and mean estimated blood loss between the two groups (P ＞ 0.05). The vital signs were stable in all the patients. ② CO-Hb concentration: In the observed group, the CO-Hb concentration in systemic blood at 6 hours postoperatively was significantly increased as compared with the preoperative and postoperative ones [(2.2±0.54)%,(1.6±0.34)%, (1.7±0.19)%, P ＜ 0.05]; the CO-Hb concentration in salvaged blood was (2.6±0.62)%, which was significantly higher than that in systemic blood preoperatively and postoperatively (P ＜ 0.01). In the control group, the CO-Hb concentration in systemic blood at 6 hours postoperatively had no obvious differences as compared with the preoperative and postoperative ones (P ＞ 0.05). ③ Postoperative conditions: In the observed group, sinus tachycardia and inferior myocardial ischemia were detected by ECG monitoring in 2 patients with pre-existing coronary heart disease,which complained of precardial discomfort at 4-6 hours postoperatively.Higher levels of CO-Hb were detected in salvaged blood before retransfusion (39% and 4.5%) and in systemic blood at 6 hours postoperatively(3.5% and 4.2%). No patient in the control group demonstrated symptoms of CO intoxication or cardiovascular compromise, also no abnormal changes were revealed by ECG monitoring.CONCLUSION: Retransfusion of salvaged blood in hip arthroplasty with simultaneous use of electrocautery and a cell saver system leads to a significant increase of systemic CO-Hb concentration, which can provoke the cardiovascular compromise. Therefore, it is suggested to measure CO-Hb level in salvaged blood, the retransfusion of which should be cautious, especially to patients with pre-existing heart diseases.

This study was aimed to analyze characteristics of Chinese Materia Medica ( CMM ) preparations in order to identify the long-term development direction of this discipline and suggest key questions and strategies to solve the problems. According to the development track of CMM preparation, traditional Chinese medicine (TCM) basic theories and modern new drug research techniques were combined with the author's experiences on modernization study of TCM. This article discussed key issues of CMM preparation development direction, characteristics and is-sues need to be solved and their countermeasures. The results showed that the development direction for CMM preparation discipline should entirety unify CMM preparation system. The medical resource should be convenient which include animal, plant and mineral products. The single determinacy (effectiveness, stability and controlled) and compatibility (prediction, optimization and lowest toxin) will be applied in the guidance of CMM preparation system. In order to achieve goals mentioned above, key issues need to be solved are efficiency categories for in-gredients, genetical stabilities and one sampling charge, emigration rules of properties among ingredients, the ki-netic and stable rules of ingredient extraction, controlled rules for integral models or for disorder and torrent, e-valuation rules in vivo and in vitro, microscopic and macroscopic qualities, determinacy for single administration and compatibility for combination applications. It was concluded that the CMM preparation is a series of integral unified effective ingredient preparations that behave the determinacy for single administration and compatibility for combination applications.

Objective To compare the curative effect of transforaminal lumbar interbody fusion by Wihse approach and posterior median approach in treatment of lumbar spinal canal stenosis.Methods Ninety-six patients with lumbar spinal canal stenosis were treated with transforaminal lumbar interbody fusion by Wihse approach (42 cases,Wihse group) and posterior median approach (54 cases,control group).The operation time,exposure time,exposure bleeding volume,length of incision,intraoperative bleeding volume,visual analog score (VAS) of nick at the third day after surgery,and VAS of lumbar and leg,Japanese orthopedic association (JOA) score and Roland-Morris disability questionnaire (RDQ) score at 1 year after surgery were compared between the 2 groups.Results The length of incision,exposure time,operation time,exposure bleeding volume,intraoperative bleeding volume,VAS of nick at the third day after surgery and VAS of lumbar at 1 year after surgery in Wiltse group were (5.0 ± 1.2) cm,(20.0 ± 7.6) min,(150.0 ± 8.4) min,(10.6 ±5.4) ml,(125.5 ± 10.6) ml,(4.5 ±0.6) scores and (1.0 ±0.5) scores,and in control group were (8.0 ± 1.6) cm,(35.2 ±6.8) min,(162.0 ±5.6) min,(84.5 ±7.8) ml,(186.4 ± 15.4) ml,(6.8 ± 0.5) scores and (2.5 ± 0.8) scores],there were statistical differences between the 2 groups (P ＜ 0.01).But there were no statistical differences in the VAS of leg,JOA score and RDQ score at 1 year after surgery between the 2 groups (P ＞ 0.05).Conclusion Two kinds of approach transforaminal lumbar interbody fusions all have good therapeutic effect on lumbar spinal canal stenosis,but the Wiltse approach has advantages of small incision,less intraoperative dissection,less bleeding and low incidence of postoperative lumbodynia.

Objective To investigate the value of end-tidal carbon dioxide partial pressure (PET CO2 )in fluid resuscitation in severe acute pancreatitis(SAP)patients.Methods SAP patients under mechanical ventilation with the need of a fluid challenge test were included.Hemodynamic parameter cardiac index(CI)and PET CO2 were conducted before and after the fluid challenge test.The value of ΔPET CO2 was used to predict fluid responsiveness. Results Totally 43 patients with SAP were prospectively recruited.31 patients had volume responsiveness, 12 patients had no volume responsiveness.Compared with no volume responsiveness group,volume responsiveness group led to a greater increase in ΔCI[(0.9 ±0.3)vs.(0.2 ±0.3),t =3.24,P <0.05]and ΔPET CO2 [(4.1 ± 1.9)vs.(0.7 ±1.2),t =4.01,P <0.05].ΔPET CO2 and ΔCI were correlated(r =0.74,P <0.05).The area under ROC curve of ΔPET CO2 was 0.872(95% CI 0.754 ~0.923,P <0.05).An increase of 5% in ΔPET CO2 predicted fluid responsiveness with a sensitivity of 86.7%,and specificity of 89.5%.Conclusion The change of ΔPET CO2 induced by fluid challenge test is an effective way to predict fluid responsiveness in SAP patients.

Objective To investigate the effect of glucagon-like peptide-1(GLP-1) in a dose related manner on glucose metabolism after 65% hepatectomy in rats.Methods We determined the serum glucose levels of hepatomized rats at 0,5,10,20,and 30 minutes after an intravenous glucose load(IVGTT,0.5 g/kg glucose) on the first postoperative day,and the changes of blood glucose,serum insulin and glucagon concentrations of hepatomized rats that received the volum load with normal saline or 0.3 nmol/kg GLP-1,0.45 nmol/kg GLP-1 respectively.Blood was drawn for determination of glucose(glucose oxidase),insulin,glucagon,and GLP-1(radioimmunoassay).Results The peak glucose and 30-minute glucose levels and the area under the curve(AUC 0-30) were significantly higher in the hepatomized rats compared to the control rats,which had not undergone any operation and received a same intravenous glucose load(0.5 g/kg glucose with normal saline)(P0.05).Nevertheless the peak glucose and 30-minute glucose levels and AUC 0-30 of the hepatomized rats that received with 0.45 nmol/kg GLP-1 were significantly lower compared to the rats that received the same volum load with normal saline or 0.3 nmol/kg GLP-1 respectively after liver resection.There was an increasing postoperative serum concentration of glucose,insulin,glucagon on the first day,then,the serum glucose concentration was significantly lowered after infusion of GLP-1 in rats undergoing hepatectomy(P