【Objective】 To explore the effects of early application of erythropoietin (EPO) in patients with anemia after renal transplantation. 【Methods】 Patients who underwent renal transplantation in the First Affiliated Hospital of Soochow University were retrospectively analyzed. According to whether EPO was applied after operation, the patients were divided into EPO group and routine group. Patients with delayed renal function recovery were excluded, and the remaining patients were further analyzed. The general, laboratory and follow-up data of the two groups were compared, and adverse drug reactions were observed. 【Results】 The hemoglobin (P=0.026), red blood cell count (P=0.038) and hematocrit (P=0.011) in EPO group were higher than those in the routine group 2 weeks after operation, while the postoperative serum creatinine level was lower (P=0.001). Since the first week after operation, the reticulocyte count in EPO group was significantly higher than that in routine group (P<0.01). There was a negative correlation between hemoglobin and serum creatinine in EPO group at week 1 (r=-0.375, P=0.010) and week 2 (r=-0.386, P=0.008). During the treatment, 6 patients showed transient elevation of serum potassium, which returned to normal after symptomatic treatment, and no obvious adverse drug reactions were observed. 【Conclusion】 Continuous application of erythropoietin in the early stage after renal transplantation can significantly improve anemia in renal transplant patients and promote the recovery of renal function.

Objective:To evaluate the efficacy of concurrent radiotherapy combined with S-1 (CCRT) versus radiotherapy (RT) alone in elderly patients with esophageal cancer by Meta-analysis.Methods:The Cochrane Library, PubMed, Web of science, EMbase, CBM, CNKI, VIP and Wanfang database were searched. The eligible studies were subject to evaluation of methodological quality. The Meta-analysis was performed by the Revman 5.3 software.Results:A total of 1693 patients were enrolled in 23 studies. The results showed that CCRT increased the incidence of CR [ OR=2.08,95% CI (1.66-2.61), P<0.001] and PR [ OR=1.31,95% CI (1.08-1.60), P=0.007] and total response rate [ OR=2.99,95% CI (2.37-3.77), P<0.001]. Furthermore, CCRT improved the 1-year survival rate [ OR=2.56, 95% CI (1.94-3.38), P<0.001] and 2-year survival rate [ OR=2.33, 95% CI (1.77-3.08), P<0.001]. Meanwhile, CCRT reduced the incidence of leucopenia, thrombocytopenia, radioactive esophagitis, nausea and vomiting (all P<0.05), but there was no significant difference in the incidence of anemia and radiation pneumonia between two groups (both P>0.05). Conclusions:Available evidence suggests that CCRT combined with S-1 can improve therapeutic efficacy and prolong survival time in elderly patients with esophageal cancer, but CCRT may increase the incidence of treatment-related side effects. Due to the limitations of the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.

Objective:To systematically compare the efficacy and safety of chrono-chemotherapy combined with radiotherapy in patients with locally advanced nasopharyngeal carcinoma.Methods:Seven databases were searched, including the Cochrane Library (Issue 5, 2021), PubMed, Embase, CBM, CNKI, VIP and Wanfang Database. The method ological quality of the eligible studies was evaluated. The Meta-analysis was performed by the Revman 5.3 software.Results:Sixteen studies consisting of 1275 patients were finally included. Among them, 642 patients were treated with chrono-chemotherapy combined with radiotherapy and 633 patients received conventional chemotherapy combined with radiotherapy. Results showed that compared with conventional chemotherapy group, the effective rate was significantly elevated ( OR=1.66, 95% CI: 1.17-2.34, P=0.004), the incidence of leucopenia, thrombocytopenia, gastrointestinal reaction, grade 3-4 oral mucosal reaction and grade 3-4 radiothermitis was significantly reduced (all P<0.001), and the quantity of CD3, CD4 and CD4/CD8 was significantly increased in the chrono-chemotherapy group. Conclusion:Current evidence shows that compared with conventional chemotherapy, chrono-chemotherapy combined with radiotherapy could improve the effective rate, reduce adverse reactions and mitigate the destruction of immune function simultaneously.

Objective To explore the value of trauma-care check list (TCC) and quick sequential organ failure assessment (qSOFA) on the early diagnosis of severe trauma with sepsis,and analyze the treatment time lines.Methods Totally 120 patients with severe trauma treated in Taizhou People's Hospital from February 2017 to January 2018 were reviewed.Sixty cases adopted TCC and qSOFA trauma care integration process (integration group),and the rest 60 cases adopted systemic inflammatory response syndrome (SIRS) score and emergency surgery multi-section support process (traditional group).According to the 2016 International Sepsis Guide Criteria,the diagnostic sensitivity and specific degrees of the two groups were calculated.The treatment time node,blood loss,complication rate,postoperative survival rate,and the total length of hospital stay of the two groups were analyzed.Results Of the 60 cases in the integration group,32 cases were confirmed severe trauma with sepsis,and 27 cases were confirmed in 41 primary diagnosed patients,with a diagnostic sensitivity of 84.38％ and a specific degree of 50.00％.In the traditional group,30 cases were confirmed severe trauma with sepsis,and 25 cases were confirmed in 38 primary diagnosed patients with a diagnostic sensitivity of 83.33％ and a specific degree of 56.67％.The significant shorter MDT consultation time,primary diagnosis time of sepsis,the duration from injury to surgery time and total hospitalization time were statistically significant different between the two groups (P＜0.05).Patients in the integration group had significantly lower incidence of postoperative complications and 28-day fatality rate,but there was no significant difference between them (P＞0.05).Conclusions TCC and qSOFA score in the treatment of severe trauma can optimize salvage process,significantly shorten the treatment time,and reduce postoperative complications.Moreover,qSOFA score and SIRS score have the same effect on the early diagnosis of sepsis in patients with severe trauma.

Objective To explore the safety and efficacy of rivaroxaban after interventional treatment of pulmonary embolism.Methods Patients with acute pulmonary embolism undergoing pulmonary indwelling catheter thrombolysis at Chifeng Municipal Hospital from Jun 2016 to Jun 2017 were divided into a group of 23 patients,who afterwards receiving rivaroxaban as a long-term anticoagulant,and that of 45 patients treated with traditional anticoagulant therapy (low molecular weight heparin bridged warfarin).Results The short and mid-term follow-up for the cure rate in the rivaroxaban group was higher than that in the traditional anticoagulation group (60.9％ vs.35.6％,P ＜0.05,and 73.9％ vs.44.4％,P ＜0.05).The incidence of adverse reactions such as bleeding (4.3％) was significantly lower than that of the heparin warfarin group (28.9％),there was no recurrence of venous thromboembolism (VTE) in the rivaroxaban group,and 3 cases in the traditional anticoagulant group;there was no death in either group.Conclusions In the interventional treatment of acute pulmonary embolism,single-agent oral rivaroxaban is equivalent to low-molecular-weight heparin-bridged warfarin;rivaroxaban can effectively reduce pulmonary embolism and the occurrence of bleeding complications after endovascular intervention.

Objective To investigate the correlation between lumbar physiological curvature and Pfirrmann grading of lumbar intervertebral disc in young patients with lower lumbar pain.Methods 1 1 1 cases with lower lumbar pain were analyzed retrospectively by lumbar MRI examination.The MRI image was reviewed by two radiologists,and the degree of lumbar physiological curvature and lumbar disc degeneration were observed.Chi square test was applied to the statistical results.Results Final analysis was performed on 300 discs in 60 cases of patients with lumbar physiological curvature straightening.Among them,209 were grade Ⅰ-Ⅱ(70%),45 grade Ⅲ(15%),35 grade Ⅳ(11%)and 11 grade Ⅴ(4%)in Pfirrmann grading.In total of 255 discs of 51 cases with normal physiological curvature of the spine,there were 212 (83%)of Pfirrmann grade Ⅰ-Ⅱ,22 of grade Ⅲ(9%),19 of grade Ⅳ(7%)and 2 of grade Ⅴ(1 %).There was statistical difference between the lumbar physiological curvature straightening and the normal lumbar physiological curvature group (P< 0.05).The proportions of degeneration of Ⅰ-Ⅱ in the lumbar physiological curvature group was lower than that in normal lumbar curvature group,while the proportions of gradeⅢ,ⅣandⅤdegeneration in the lumbar physiological curvature group were higher than that in normal lumbar curvature group.Conclusion Stratification lumbar physiologic curvature is an important factor for lumbar disc degeneration and easy to cause Pfirrmann gradeⅣ-Ⅴdegeneration in young patients.

Objective Pulmonary embolism is a common cardiovascular emergency with the characteristics of high incidence,high mortality.This study compared pulmonary artery catheter thrombolysis with peripheral intravenous thrombolysis for acute pulmonary embolism in the mid-term clinical efficacy.Methods From June 2011 to September 2015,68 patients were given pulmonary artery interventional therapy,54 cases received peripheral intravenous thrombolysis;discharged patients were followed up for 3-12 months to evaluate the curative rate,effective rate,recurrence rate and the incidence of complications.Results Follow up rate was 79.5％.The cure rate of the treatment group was higher than that of the control group (47.3 ％ vs 23.8 ％,P ＜ 0.05);The significant effective rate of the treatment group was higher than that of the control group (81.8％ vs 52.4％,P ＜ 0.05);The incidence of Chronic pulmonary hypertension (1.8％) was lower than that of the control group (16.7％);There was no significant difference in improvement rate,recurrence rate and mortality.Conclusion The medium-term efficacy of pulmonary artery catheter directed thrombolysis is superior to that of peripheral intravenous thrombolysis;it can effectively reduce the incidence of chronic thromboembolic pulmonary hypertension.

Objective To evaluate indwelling intrapulmonary artery catheter thromolysis for acute pulmonary embolism.Methods From June 2011 to June 2013 56 cases of acute pulmonary embolism were diagnosed by multi-row spiral CT and admitted at the Department of Vascular Surgery.The average age was (56 ± 11) years.Inferior vena cava filter was implanted and pulmonary angiography,catheter thrombectomy,indwelling pulmonary intraarterial thrombolytic therapy was performed.Postoperatively low molecular weight heparin and warfarin was given,dosage adjusted by prothrombin international normalized ratio at 2-3.Results Mean pulmonary arterial pressure (mPAP) decreased from (43 ± 7) mmHg to (22 ± 6) mmHg (P ＜ 0.05),arterial partial pressure of oxygen (PO2) rose from (49 ± 8) mmHg to (83 ± 9) mmHg (P ＜ 0.05).Clinical symptoms significantly relieved in 51 out of the 56 cases (91％).45 patients were followed up for an average of (15 ± 4) months,with one recurrence.There was no filter migration,vena cava thrombosis,chronic obstructive pulmonary disease and other complications.Conclusions Emergency pulmonary artery indwelling catheter thrombolysis is safe and effective therapy for acute pulmonary thromboembolism.

Objective To explore the relations of morphologies of intracranial tiny aneurysms with gender,age,hypertension and aneurysm lesions of the patients.Methods A retrospective analysis of clinical data of 112 patients with intracranial tiny aneurysms,admitted to our hospital from January 2009 to December 2012,was performed; according to the aneurysm morphologies,these patients were divided into regular-shape and irregular-shape groups (n=56).The influences of age,gender,hypertension and aneurysm lesions of the patients in aneurysm morphologies were analyzed.Results Gender,age and hypertension were not the independent influence factors of aneurysm morphologies,while aneurysm lesions could significantly affect the aneurysm morphologies,being the independent influence factor of aneurysm morphologies (P=0.005).In the comparison of different distributions of tiny aneurysms,the intemal carotid artery and vertebral basilar artery had less irregular aneurysms than anterior communicating artery; the morphologies of small aneurysms in the anterior cerebral artery,posterior communicating artery and middle cerebral artery showed no significant differences as compared with those in the anterior communicating artery,which tended to having irregular shapes.Conclusion The aneurysm lesions are related to the aneurysm morphologies; anterior communicating artery is prone to having irregular-shape aneurysms.

Objective To investigate the effects of oxidative stress on homocysteine and related amino acids metabolism in methionine-loading BRL rat hepatocytes.Methods Cultured BRL rat hepatocytes were divided into control and oxidatively stressed group(100 μmol/L H2O2 was added in culture medium for 2 hours),methionine group(50 mmol/L methionine was added in culture medium for 1 hour),and oxidatively stressed + methionine group(100 μmol/L H2O2 was added in culture medium for 2 hours + 50 mmol/L methionine was added in culture medium for 1 hour).At the end of the experiment,culture fluid was collected.Homocysteine,cysteine,and glutathione were measured by high-performance liquid chromatography,and amino acids were assayed by amino acids analyzer.Results Compared with the control group,the contents of homocysteine[(3.76 ± 0.22)vs.(1.54±0.05)μmol/L,P=0.000]and cysteine[(199.80 ±8.75)vs.(99.11 ±2.47)μmol/L,P=0.000]significantly increased in methionine group,and the contents of homocysteine[(3.84 ± 0.34)vs.(1.54 ±0.05)μmol/L,P=0.000]and cysteine[(200.66±8.60)vs.(99.11 ±2.47)μ mol/L,P=0.000]also increased in oxidatively stressed + methionine group.Compared with oxidatively stressed group,the concentrations of homocysteine[(3.76 ± 0.22)vs.(1.67 ± 0.13)μmol/L,P =0.000],cysteine[(199.80 ± 8.75)vs.(82.64±15.88)μmol/L,P=0.000],and glutathione[(1.50 ±0.14)vs.(1.00 ±0.11)μ mol/L,P=0.011)]significantly increased in methionine group,and the concentrations of homocysteine[(3.84 ± 0.34)vs.(1.67±0.13)μmol/L,P=0.000],cysteine[(200.66±8.60)vs.(82.64±15.88)μmol/L,P=0.000]and glutathione[(1.40 ± 0.30)vs.(1.00 ± 0.11)μmol/L,P =0.028]significantly increased in oxidatively stressed + methionine groups.Compared with the control group,the contents of serine[(12.41 ± 1.51)vs.(24.00 ±2.54)mg/L,P =0.000],glutamate[(33.31 ±0.17)vs.(43.10 ±0.52)mg/L,P =0.000]and glycine[(6.23 ± 0.18)vs.(24.66 ± 10.87)mg/L,P =0.000]significantly decreased,while taurine [(7.99 ±0.16)vs.(6.17 ±0.15)mg/L,P =0.000]increased significantly in oxidatively stressed group.Compared with the oxidatively stressed group,the concentrations of serine[(16.98 ± 0.39)vs.(12.41 ± 1.51)mg/L,P=0.006)]and glutamate[(35.44 ±0.82)vs.(33.31 ±0.17)mg/L,P =0.002]in methionine group significantly increased,while taurine[(3.77 ±0.16)vs.(7.99 ±0.16)mg/L,P =0.000]significantly decreased in methionine group.Compared with the methionine group,the contents of serine[(12.59 ± 0.66)vs.(16.98±0.39)mg/L,P=0.008],glutamate[(30.87±0.60)vs.(35.44±0.82)mg/L,P=0.000]significantly decreased while taurine[(4.37 ± 0.12)vs.(3.77 ± 0.16)mg/L,P =0.001]in oxidatively stressed + methionine group significantly increased.Conclusion Oxidative stress can somehow promote homocysteine production in methionine loading BRL rat hepatocytes,but it is not the main effects.