Search

Objective: To explore the related factors affecting the outcome of treatment free remission (TFR) in patients with chronic myeloid leukemia (CML). Methods: Clinical data of CML patients with automatic discontinuation of tyrosine kinase inhibitor (TKI) from the CML cooperative organization of Henan province between June 2, 2013 to March 27, 2021 and the follow-up time was ≥ 6 months were retrospectively analyzed. Log-rank test was used for univariate analysis and Cox proportional risk regression model was used for multivariate analysis. Results: A total of 135 patients were enrolled, and 69 patients (51.1%) were femal and 66 patients (48.9%)were male. Median age was[ M ( Q 1 , Q 3 )] 49 years (38, 58)at discontinuation.Before discontinuation, 72 patients (53.3%) were on treatment with second-generation TKI, 63 patients (46.7%) were on treatment with IM, 17patients (12.6%) had a history of TKI reduction/withdrawal;median duration of treatment was months 84 (68, 108) for all patients;median time of TKI treatment to DMR was months 12(8, 26);median duration of DMR was months 65 (54, 84), and 9 patients (6.7%) had unsustained DMR.The median follow-up time was months 16(6-96), 35 patients (25.9%) lost MMR at a median months 3(1-22), overall estimated TFR was 74.1%.The univariate analysis results showed that:second-generation TKI was used, the time of TKI treatment to DMR was ≤12 months, DMR duration time ≥48 months, had sustained DMR, without TKI reduction/withdrawal history were favorable factors affecting of TFR in patients with TKI discontinuation (all P <0.05).The TFR rate of the second-generation TKI therapy group was significantly higher than the IM therapy group (81.9% vs 65.1%, P =0.019).The multivariate analysis results showed that second-generation TKI treatment[ RR =0.451, 95%CI (0.227-0.896), P =0.023] and had sustained DMR [ RR =0.120, 95%CI (0.053-0.271), P <0.001] were the protective factors of TFR in patients with TKI discontinuation. Conclusions: Treated with second-generation TKI and had sustained DMR are the protective factors of TFR in patients with TKI discontinuation.The CML patients who had sustained DMR more≥48 months before TKI discontinuation showed a better TFR.

Objective: To investigate all coding regions of amyotrophic lateral sclerosis (ALS)-related gene Senataxin (SETX) in sporadic amyotrophic lateral sclerosis patients of Chinese origin. Methods: From January 2010 to December 2014, the peripheral venous blood samples and clinical data were collected from 311 patients with sporadic amyotrophic lateral sclerosis (SALS) and 311 healthy controls who were of Chinese ancestry from the Department of Neurology, Chinese PLA General Hospital.Genomic DNA was extracted from peripheral venous blood of all participants using standard methods. The coding regions of SETX were amplified by polymerase chain reaction (PCR) and screened for mutations using next-generation sequencing technology. The online software SIFT and PolyPhen-2 were used to analyze the conservation of an altered amino acid and predict the potential pathogenicity of identified mutations. The SPSS 22.0 software was used to analyze the clinical feature of all participants. Results: Tenkinds of rare and one novel nonsynonymous mutations were identified and were absent in 311 controls. Twelve (3.86%) patients carried one SETX gene mutation. Five (1.61%) out of above-mentioned 12 patients carried highly pathogenic mutations including p. Pro1868Leu (c.5603G>A), p. Pro1331Leu (c.3992G>A), p. Glu756Val (c.2267T>A), p. Leu564Val (c.1690A>C), and p. Asn144Ser (c.431T>C). Patients carried SETX mutations were not different from other patients in onset age. Conclusion: Mutations in SETX are likely to be a pathogenesis for Chinese sporadic amyotrophic lateral sclerosis.

Objective: To explore the role of spinal microglial CX3CR1/ERK5 pathway in the development of neuropathic pain., Methods: The model of spinal nerve ligation (SNL) was established by ligating the L5 spinal nerve with 6-0 silk thread in male Sprague Dawley rats. The expression of activated ERK5 (p-ERK5) was examined by immunohistochemistry test. To detect the role of ERK5 in neuropathic pain, PWT and PWL were measured after an intrathecal knockdown of ERK5. For determining the regulating effect of CX3CL1/CX3CR1 on the activity of microglial ERK5, CX3CR1 was blocked by an intrathecal injection of anti-rat CX3CR1 antibody and the activity of spinal ERK5 tested. Then whether an intrathecal knockdown of ERK5 could reverse the effect of CX3CL1 on pain hypersensitivity and microglia activation was investigated., Results: ERK5 was activated in spinal microglia after SNL compared to the sham group (61.75 ± 11.52 vs 2.2 ± 0.12; 58.01 ± 10.45 vs 1.1 ± 0.11) . The knockdown of ERK5 by an intrathecal injection of antisense oligonucleotides suppressed the mechanical (15.42 ± 3.46 vs 22.73 ± 3.21g; 13.63 ± 2.88 vs. 21.42 ± 4.12g) and thermal hyperalgesia (13.48 ± 2.01) vs (18.05 ± 3.71) s; (11.6 ± 2.33) vs (17.73 ± 1.42) s induced by nerve injury. The blockage of CX3CR1, a receptor of CX3CL1, significantly reduced the level of ERK5 activation following SNL (30.12 ± 8.60) vs (58.25 ± 11.5); (49.5 ± 12.12) vs (35.51 ± 3.74) (P < 0.05). In addition, the antisense knockdown of ERK5 reversed the CX3CL1-induced hyperalgesia and spinal microglia activation., Conclusions: CX3CL1/CX3CR1 regulates nerve injury-induced pain hypersensitivity through ERK5.

Objective: To explore the efficacy and safety of combined inflating lung and insufflating calf pulmonary surfactant under general anesthesia for treating postoperative intractable atelectasis., Methods: From August 2006 to January 2013, 15 patients with obstinate postoperative atelectasis receiving pressure control lung expansion were enrolled. The bronchial cannula was intubated into the affected side to assist the expanding of the lung, and the calf pulmonary surfactant was insufflated selectively. The chest auscultation and computed tomography (CT) scan was performed at 1 d and 5 d after the procedure respectively, to evaluation the effect. The airway pressure, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and oxygen saturation (SpO2) were recorded before the treatment, during the treatment and after the treatment.Monitoring arterial blood gas before and after treatment., Results: After the expansion of the lung and insufflation of calf pulmonary surfactants, the iconographic scan showed that collapsed alveolar was reinflated in 12 (80.0%) patients at 1 d after the treatment and in 14 patients(93.3%) at 5 d after the procedure.There were not notable vital sign change and complications during the treatment.At after the treatment, 1, 3, 5 and 7 d after the treatment, PaO2 was higher (P < 0.05), and there were not significantly difference in the PaCO2 and pH (P > 0.05) ., Conclusion: Combined pressure control lung expansion with selectively insufflating calf pulmonary surfactant under general anesthesia may be an effective therapy for postoperative intractable atelectasis.

Objective: To explore the histological outcomes of tendon-bone healing in anterior cruciate ligament (ACL) reconstruction with cortical press-fit bolt (CPB)., Methods: Twenty-four healthy female or male New Zealand White rabbits (2-3 months old) underwent bilateral ACL reconstruction with extensor digitorum longus tendon. A random method was used to decide one knee would receive the routine ACL reconstruction (control group) and another cortical press-fit bolt fixation (experimental group). After general anesthesia, extensor digitorum longus tendon was harvested and ACL reconstruction performed. All animals were sacrificed at 4, 8 and 12 weeks postoperation. Radiological and histological examinations were made at each timepoint. The specimens were stained with different methods to observe the pathological changes of tendon graft, bone tunnel and cortical press-fit bolt., Results: More revascularization and massive new bone were found in tendon-bone junction of experimental group at 4, 8 and 12 weeks postoperation. The circum-graft new vessel proportion of the experimental and control groups were 0.48 ± 0.12 and 0.26 ± 0.05 respectively (P < 0.05). In the experimental group, more cartilage cells were present in tendon-bone junction at 12 weeks and the circum-graft new bone areas in two groups were 0.41 ± 0.11 and 0.21 ± 0.10 mm(2) respectively (P < 0.05)., Conclusion: Cortical press-fit blot may improve tendon-bone healing after ACL reconstruction in rabbits. The application prospects of this procedure are promising.

Objective: To explore the effect of dexmedetomidine in acute postoperative pain and remifentanil-induced hyperalgesia., Methods: From January 2011 to June 2012, 120 patients scheduled for elective abdominal surgery under general anesthesia were included in this study. All patients received intravenous remifentanil infusion during operation, and dexmedetomidine was given after anesthesia induction. The postoperative mechanical pain threshold, pain visual analog scale (VAS) score, morphine consumption, and score of sedation (Ramsay) was recorded., Results: Relatively large-dose intraoperative remifentanil resulted in lower mechanical pain threshold and higher dose of postoperative morphine consumption. Dexmedetomidine reduced postoperative morphine consumption significantly, and increased Ramsay scores, but had no effect on mechanical hyperalgesia., Conclusion: Dexmedetomidine can alleviate the acute postoperative pain effectively, but the effect is not dependent on inhibiting remifentanil-induced hyperalgesia.

Objective: To investigate the role of P2Y12 receptor in rat bone cancer pain model and its influence on p38MAPK (Mitogen-activated protein kinase)., Method: A total of forty female SD rats, weighting 200 - 250 g, were randomly divided into 5 groups (n = 8): normal group (group N), sham group (group S), vehicle group (group DA), cancer group (group A), and analgesia group (group MA). Rats in group N were untreated, rats in group S were injected with Hank's solution 10 µl into the left tibial metaphysis; rats in group DA, group A and group MA were injected with Walker 256 cancer cells (10 µl, 2×10⁷ cells/ml) into the left tibial metaphysic to establish the model of bone cancer pain. Catheterization was simultaneously made in four groups between L3 and L4 vertebra except group N. Saline (0.9%, 15 µl) was injected in group S and group A, DMSO (5%, 15 µl) was injected in group DA, and MRS2395 (400 pmol/µl, 15 µl) was injected in group MA on day 9 to 12 post-inoculation. Mechanical withdrawal thresholds were measured on left hind paw before and every 10 min after intrathecal injection. Rats were euthanized after measuring mechanical withdrawal threshold at day 12 post-inoculation. L4-6 sections of spinal cord were collected to determine the expression of p-p38MAPK by immunohistochemistry and immunofluorescent., Result: Compared to that in group N (36.1 g ± 4.0 g) and group S (38.9 g ± 5.2 g), mechanical withdrawal thresholds in group MA (19.8 g ± 5.0 g) were decreased on day 9 post-inoculation (P < 0.01), and the expression of p-p38MAPK in spinal cord was increased on day 12 (P < 0.01). Compared to that in group DA (17.7 g ± 3.0 g) and group A (19.1 g ± 2.5 g), mechanical withdrawal threshold in group MA was obviously increased after intrathecal injection, peaked at (26.5 g ± 4.7 g) (P < 0.05); compared with group DA (number 43.4 ± 3.8, IOD 569 ± 27) and group A(number 45.0 ± 2.6, IOD 594 ± 22), the expression level of p-p38MAPK in spinal cord in group MA at day 12 was significantly decreased (number 20.9 ± 2.2, IOD 246 ± 25) (P < 0.01); Mechanical withdrawal threshold in group MA was still lower than group N and group S, while the expression of p-p38MAPK was higher than group N (number 9.9 ± 2.4, IOD 82 ± 28) and group S (number 10.9 ± 2.2, IOD 109 ± 25) (P < 0.01). Immunofluorescent showed that p-p38MAPK was colocalized with microglia in spinal dorsal horn, but not with neurons and astrocytes., Conclusions: These results demonstrate rat bone cancer pain could partially relieved after intrathecal injection of P2Y12 receptor inhibitor MRS2395 through inhibiting the phosphorylation of p38MAPK in spinal dorsal horn.

Objective: To explore the reproducibility and stability of brain functional area in the response of language tasks during Chinese word processing with functional magnetic resonance imaging (fMRI) by follow-up scanning so as to provide rationales for clinical preoperative localization and the mechanisms of recovery from aphasia., Methods: The fMRI data were collected by scanning semantic and phonologic judgments in 15 healthy volunteers. Each subject was scanned twice by the same fMRI procedure of both language tasks with an interval of 1 month. By analyzing the effective overlapping average activation maps, the reproducibility of inter-subject imaging result for two language tasks were estimated by selecting the main language areas, such as Broca's area and Wernicke's area as the region of interest (ROI). By individually calculating the spatial distance of ROI centroid coordinates in the same activating range before and after test, the inter-subject stability in between-session was calculated quantitatively., Results: Both language tasks activated more than one language-related brain areas in cerebral hemispheres. Both language tasks induced significant BOLD response in Broca's and Wernicke's areas with a tendency of left lateralization. The number of subjects in terms of the activation of both language tasks in Broca's and Wernicke's areas accounted over a half of the total subjects. As compared with the phonologic judgment task, the semantic judgment task showed better reproducibility in Broca's area. In the same spatial distance of ROI centroid coordinates, the stability of Broca's area was higher than that of Wernicke's area while the stability of semantic judgment in Broca's area higher than that of phonologic judgment., Conclusion: Such main language domains as Broca's and Wernicke's areas can be effectively activated by both semantic and phonologic judgments. By comparison, semantic judgment in Broca's area shows a higher level of reproducibility and stability. Thus it is applicable for clinical preoperative localization and the mechanisms of recovery from aphasia.

Objective: To evaluate the efficacies of arthroscopic debridement and removal of osteophyma for olecroanon and olecranon fossa plasty for posterior impingement of elbow joint., Methods: Between 1999 and 2008, a total of 21 cases were diagnosed with osteoarthritis and posterior elbow impingement. There were 15 males and 6 females. And there were 16 right and 15 left cases. They included volleyball players (n = 7), tennis players (n = 7), golf enthusiasts (n = 4) and fencers (n = 3). The average duration of onset-operation was 3.5 years (range: 2.5 - 8). Arthroscopic exploration revealed synovial hyperplasia hypertrophy, cartilage degeneration and olecranon fossa hyperplasia with deformed olecranon fossa. Debridement and plasty were performed. Loose bodies were removed from elbow joint in 6 patients. Partial resection of posterior olecranon tip was performed and osteophytes or fibrous tissue removed in this area. Dynamic observation showed no posterior elbow impingement., Results: Postoperative follow-up was conducted in 19 cases and 2 cases became lost to follow-up. The average follow-up period was 25.3 months (range: 18 - 42). All patients were evaluated preoperatively and postoperatively with the Hospital for Special Surgery Elbow Assessment Scale. The outcomes were excellent (n = 12), good (n = 7) and fair (n = 2). Postoperative patients elbow swelling and pain relieve, sports and life function returns to normal, elbow flexion and rotating mobility obviously improved. With the elbow radiological films to measure the range of motion, the average range of motion was 90.5° preoperatively and improved to 130° postoperatively. There was significant improvement in all cases., Conclusion: Posterior elbow impingement is caused by hyperextension trauma and elbow overuse during specific sporting activities. Arthroscopic debridement and olecroanon or olecranon fossa plasty demonstrates excellent results for posterior impingement of elbow joint.

Objective: To explore the serum levels of MMP-2 in early breast cancer and its clinical significance and correlation with the circulating tumor cells in the patients., Methods: The serum levels of MMP-2 in breast fibroadenoma (n = 10) and breast cancer (n = 72) were detected by enzyme-linked immunosorbent assay (ELISA). And CK19 mRNA was measured by quantitative reverse transcription-polymerase chain reaction in blood as an index of circulating tumor cells in the patients., Results: The serum level of MMP-2 in breast cancer was significantly higher than that in breast fibroadenoma (12.24 vs 2.21 µg/L, P = 0.003). Subgroup analysis showed that the serum levels of MMP-2 were higher in HER-2 positive patients than those in HER-2 negative ones (16.77 vs 10.02 µg/L, P = 0.022). CK19 mRNA was found in blood samples from 30 cases of breast cancer and the positive rate was 41.7%. However, it was not detected in the patients with breast fibroadenoma. The mean levels of serum MMP-2 were (15.48 ± 2.02) and (7.16 ± 1.55) µg/L in CK19 positive and negative patients respectively. Significant difference existed between two groups (P = 0.013)., Conclusion: The serum level of MMP-2 in early breast cancer is closely correlated with blood micrometastasis. And its high level may be an important contributing factor for the metastasis of breast cancer.

Objective: Recombinant human endostatin (rh-Endostatin), a protein modified by an additional nine-amino acid sequence to the N-terminal of endostatin, is a novel antiangiogenesis drug developed in China. The preclinical data suggested that it can inhibit proliferation and migration not only in endothelial cells, but also in some types of tumor cells. Theoretically, antiangiogenesis drugs should also be effective in the therapy of other solid tumors, including breast cancer. Here a prospective, randomized, controlled, phase II trial of combining rh-Endostatin and neoadjuvant chemotherapy was performed to evaluate its efficacy and safety profiles in patients with breast cancer., Methods: A total of 68 patients with pathologically confirmed breast cancer were randomly assigned to receive the neoadjuvant DE regimen (docetaxel: 75 mg/m(2), d1, epirubicin: 75 mg/m(2), d1) every 3 weeks with or without rh-Endostatin (7.5 mg/m(2), d1-d14). Surgical resection was performed after 3 cycles of neoadjuvant treatment. The primary end-points were objective response rate (ORR) and pathological complete response rate (PCRR) while the secondary end-points quality of life (QOL) and toxicity., Results: Among all of them, 64 were assessable for efficacy and 68 for toxicity. The ORRs were 90.9% (30/33) and 67.7% (21/31) in the combination and control groups respectively (P = 0.021). The stratification analysis showed that rh-Endostatin was more effective in the treatment of pre-menopausal and Eastern Cooperative Oncology Group (ECOG) = 0 patients (P < 0.05). The PCRRs were 15.2% (5/33) and 6.5% (2/31) in the combination and control groups respectively (P = 0.428). No significant difference was identified in QOL score and side effects (P > 0.05)., Conclusions: Compared with DE regimen alone, the combination of rh-Endostatin with DE chemotherapy may achieve a higher ORR with no increased toxicity in breast cancer patients. Thus it can be utilized safely and effectively in the neoadjuvant treatment of breast cancer.

Objective: To investigate the feasibility of method improved for developing septic shock rats model., Methods: Studies were performed on 60 adult male Sprague-Dawley rats. They were randomized into sham group and standard CLP (J Group) group (n = 20), A (n = 10), B (n = 10), C (n = 10) group and J group was further to two subgroups (n = 10) J1 and J2 group. The ligated distance of A, B and C group were 20%, 30%, 50% of the cecum respectively. Standard CLP procedures were made in J group as described previously. Sham group just sham operated. MAP was monitored continuously in A, B, C and J1 groups for 5h, and the MAP dropped to 70% of the baseline was defined as septic shock, MAP was monitored for more than 10 hours until it reached 70% of baseline or lower in the J2 group. The white blood cell count, endotoxin and histopathological changes in lung and renal tissue were observed in each groups., Results: At 5h after operation, there is no change of MAP in sham, J1, A and B groups, but it dropped to 70% of the baseline [(73 ± 10) mmHg] in C group. Compared with sham group, the level of endotoxin [(17 ± 5) vs (456 ± 28) vs (596 ± 29) vs (982 ± 11) vs (209 ± 40) pg/ml] and white cell count [(6.3 ± 3.7) vs (4.6 ± 1.4) vs (3.7 ± 1.2) vs (3.3 ± 2.6) vs (4.2 ± 1.2)×10(9)/L] was significantly higher and lower respectively in A, B, C and J1 groups. Obvious pulmonary and nephridia tissue edema, inflammatory cell infiltration was observed in C group, but the inflammatory cell infiltration was not found in A, B and J1 groups, The manifestations of J2 group rats is similar with C group., Conclusions: The rat model produced by ligating 50% cecum can reproduce the pathophysiology of septic shock, and the time needed to prepare septic shock was significantly shorter. The improved model has application value for septic shock study.

Objective: To explore the pathological changes in patients with leukoaraiosis (LA) by magnetic resonance spectroscopy (MRS) and examine its relationship with cognitive function., Methods: Twenty-three LA patients and 23 age and gender-matched healthy subjects were recruited from the Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University between August 2010 and November 2010. All participants underwent the neuropsychological tests. Multi-voxel chemical shift imaging was performed and the regions of interest were positioned in bilateral frontal white matter. The relative metabolite ratios, involving N-acetyl aspartate/choline ratio (NAA/Cho), N-acetyl aspartate/creatine (NAA/Cr) and choline/creatine (Cho/Cr), were estimated. The correlation of the MRS data and the performance of cognitive function was analyzed., Results: The LA patients were associated with a worse performance of mini mental state examination (MMSE) versus the healthy controls (24 ± 3 vs 28 ± 1, P < 0.05). Univariate analysis of the MRS data revealed the ratios of NAA/Cho and NAA/Cr significantly decreased in bilateral frontal white matter lesions in the LA group versus the control group (1.72 ± 0.20 vs 1.96 ± 0.36, 1.67 ± 0.17 vs 1.85 ± 0.21, P < 0.05). The values of NAA/Cr and NAA/Cho in normal appearing white matter increased versus the LA group (1.83 ± 0.24 vs 1.72 ± 0.20, 1.78 ± 0.28 vs 1.67 ± 0.17) and decreased versus the control group (1.83 ± 0.24 vs 1.96 ± 0.36, 1.78 ± 0.28 vs 1.85 ± 0.21). But no significant differences were found (P > 0.05). The ratio of Cho/Cr did not differ among 3 groups (P > 0.05). The pathological change of NAA/Cr in white matter lesion in LA patients was markedly correlated with the performance of MMSE (r = 0.47, P < 0.05)., Conclusion: NAA may be a marker of axonal loss/dysfunction in LA patients. And the changes of NAA/Cr have a positive correlation with cognitive impairment.

Objective: To explore the characteristics of cognitive impairment in patients with leukoaraiosis (LA)., Methods: Forty-six LA patients and 38 age and gender-matched healthy subjects were recruited from the Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University between September 2010 and March 2011. All participants underwent the neuropsychological tests recommended by the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards (NINDS/CSN). The were divided into 3 different groups (mild, moderate and severe) according to the Fazekas scale. The differences of neuropsychological performances were compared among 3 groups., Results: The LA patients were associated with comprehensive cognitive function deficits, including MMSE (24.4 ± 3.2 vs 28.3 ± 1.2), MoCA (20.4 ± 3.0 vs 26.2 ± 0.8), digital span forward (5.7 ± 0.9 vs 6.8 ± 1.0), digital span backward (3.5 ± 0.7 vs 4.1 ± 0.7), Stroop-B (69 ± 13 vs 43 ± 5), Stroop-C (141 ± 42 vs 65 ± 10), trail making test-A (73 ± 15 vs 31 ± 7), trail making test-B (126 ± 18 vs 82 ± 6) and digit symbol test (25 ± 6 vs 37 ± 5, P < 0.05). However, there was no difference in the performance of verbal fluency (12.7 ± 2.5 vs 13.4 ± 2.5, P > 0.05). Correlation analysis showed that the severity of LA had a negative correlation with the performance of MoCA (r = -0.601, P = 0.002)., Conclusions: The LA patients are closely correlated with cognitive impairments of attention, memory, executive function and information processing speed. It may be attributed to the frontal-subcortical circuitry dysfunction.

Objective: To explore the therapeutic feasibility of percutaneous puncture and neurolytic thoracic sympathetic nerve block under the guidance of computed tomograph (CT)., Methods: From September 2009 to August 2010, 23 cases with primary palmar hyperhidrosis underwent percutaneous puncture and neurolytic thoracic sympathetic nerve block at our hospital. The puncture of thoracic sympathetic nerve was guided by CT through the gap of T3-4. The screen showed the direction of needle and the location of needle tip at the upper joint of costal head beside T3 body and outside of costal pleura. A mixed injection of 1% lidocaine and 30% iohexol was administered. On CT, lidocaine was found to cover the area where the thoracic sympathetic nerve was located. And after several minutes, the patient's palms turned warm and dry from cool and wet without the onset of Horner's syndrome. Then 2.5 ml of absolute alcohol was injected to block the thoracic sympathetic nerve., Results: CT could guide the needle to the right position. And the injectate spreaded to the site of thoracic sympathetic nerve. At 5 min after anesthetic injection, the palmar temperature raised an average of 2.86°C and the amplitude of pulse rose over 55%. Palmar hyperhidrosis was cured in 19 patients by one attempt and 4 patients required a second block with absolute alcohol. No complication occurred and there were 2 patients with tendency of recurrence during a follow-up period of 8 - 18 months., Conclusion: The CT-guided therapy of percutaneous puncture and chemical neurolysis of thoracic sympathetic nerve block is both feasible and efficacious for palmar hyperhidrosis.

Objective: To explore the effects of anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope for the emergency treatment of uveitic acute angle closure glaucoma (ACG)., Methods: In early stage, 14 uveitc acute ACG patients received anterior chamber paracentesis plus pupillary block relief while another 10 uveitc acute ACG patients underwent laser peripheral iridectomy (LPI). The intraocular pressure (IOP), degree of Tyndall, degree of pupillary block and severe adverse events were recorded at each observation timepoint., Results: The IOP values for the paracentesis plus pupillary block relief group were (9.2 ± 2.1) mm Hg, (12.4 ± 3.7) mm Hg and (14.1 ± 2.6) mm Hg at 1, 48 h and 10 d vs (24.5 ± 7.1) mm Hg, (22.2 ± 8.6) mm Hg and (19.3 ± 9.3) mm Hg respectively for the LPI group. The inflammatory reaction of anterior chamber was more relieved in the paracentesis plus pupillary block relief group at Day 10. Pupillary block was observed in 1(1/14) patient from the paracentesis plus pupillary block relief group and 6 (6/10) patients from the LPI group at Day 10. Mild hemorrhage at pupillary margin was observed in 2 cases from the paracentesis plus pupillary block relief group. Both were self-absorbed within 10 days., Conclusion: Anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope is the safe and effective emergency treatment for uveitic acute ACG. And it may offer a basis for further therapy.

Objective: To explore the effects of combined enteral nutrition (CEN) on the hemorheologic parameters and the changing levels of inflammatory factors in an animal model of severe acute pancreatitis (SAP)., Methods: The experimental animals were divided randomly into 3 groups, i.e. early enteral nutrition (EEN) group, CEN group and parenteral nutrition(PN)group (n = 20 each). Enteral nutrition was administered to the EEN and CEN group animals at 24 h and 72 h post-modeling respectively. The PN group animals were supported by parenteral nutrition all time. Hemorrheologic indices of all experimental animals were examined on Days 1, 3 and 7 post-modeling. And the inflammatory factors were examined on Days 1 and 7., Results: Compared with the EEN and PN groups, some hemorrheologic indices of the CEN group decreased significantly (P < 0.05) on Day 7 post-modeling. They included blood sedimentation, hematocrit (HCT), whole blood high-cut reduction viscosity and whole blood low-cut reduction viscosity. As compared within the CEN group, each hemorrheologic index was lower on Day 7 than that on Day 1 (P < 0.05). Except for whole blood high-cut reduction viscosity and erythrocyte aggregation index in the EEN group after a 7-day nutrition support, there was no significant change for all hemorrheologic indices in the PN group. As to the level of inflammatory factors, the values of interleukin 8 (IL-8) and tumor necrosis factor-α (TNF-α) in the CEN group were lower than those in the PN group on Day 7 post-modeling (P < 0.05). The values of IL-8 and IL-6 in the CEN group were lower than those in the EEN group on the same day (P < 0.05). As compared within the CEN group, the values of IL-6 and TNF-α were lower on Day 7 than those on Day 1 post-modeling (P < 0.05)., Conclusion: The modulatory mechanism of EN over SAP should be achieved by correcting hemorrheologic index change and lowering the level of inflammatory factors. A proper timing of EN is probably the most optimal nutrition support mode of SAP therapy.

Objective: To study the registration method based on structured light scanning for navigation assisted spinal surgery and assess its accuracy so as to construct a registration system for the navigation assisted spinal surgery using structured light scanning., Methods: Both the computed tomographic (CT) dataset and the structured light scanning images of thoracic vertebra were obtained. The pre-registration and multi-segment iterative closest point (ICP) algorithm were used for the registration of CT images and structured light images. Four segmentations were selected from the surface of thoracic vertebra and placed into different combinations. The accuracy for each combination was studied. Noise and perturbation were exerted to structured light and registration accuracy was studied. And calf vertebra was used for further verification., Results: A combination of pre-registration and multi-segment iterative closest point (ICP) algorithm was competent for the registration of CT scanning data and the structured light scanning data. The registration error was less than 1 mm when two and more segments were selected for registration combination. The registration error was less than 1 mm when noise was exerted., Conclusion: With a high accuracy and a perturbation resistance, a combination of pre-registration and multi-segment registration algorithm based on structured light scanning is competent for the registration of CT scanning data and structured light scanning data.

Objective: To investigate the effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperative intractable atelectasis., Methods: For this prospective study, we recruited 18 patients with pulmonary atelectasis who could not been relieved by bronchoscopic suctioning, closed thoracic drainage, backslap, blowing hall and other routine treatments for over a week. After bronchial intubation, ipsilateral lung was expanded with a constant pressure. And the therapeutic effect was evaluated by chest radiographic examination and auscultation at the following day., Results: Collapsed lung tissue were examined in 15 patients (83.3%) after the first treatment and in 2 patients (11.1%) after twice inflation. And another case failed even after three times treatment. During the procedure, the vital signs of all patients were stable and no complication occurred., Conclusion: Constant-pressure expanding of ipsilateral lung during bronchial intubation is a safe and effective treatment for postoperative intractable atelectasis.

Objective: To evaluate the efficacy of sternocleidomastoideus radiofrequency carbonation with local anesthesia under arthroscope for the treatment of congenital muscular torticollis in adults., Methods: Twenty-six cases of congenital muscular torticollis were treated by radiofrequency carbonation with local anesthesia under arthroscope. The right side was in 14 patients and left in 12. There were 11 males and 15 females with an average age of 22 years old. Sternocleidomastoideus and clavicula were pre-operatively marked. Through an artificial lacuna, arthroscope and radiofrequency probe were inserted., Results: The mean follow-up period was 25 months (range: 15 - 71). According to the motion deficits, craniofacial asymmetry, head tilt and subjective assessment, there were 19 excellent and 7 fair outcomes. Most patients showed a marked improvement in neck motion and head tilt with satisfactory functional and cosmetic outcomes. There was no nerve or vascular injury, no recurrence, infection and scar. The overall efficacy was satisfactory., Conclusion: The radiofrequency therapy for torticollis with local anesthesia under arthroscopy has a satisfactory efficacy. The advantages are minimal trauma, simple procedure, less pain and better cosmetics.

Objective: To investigate and compare the analgesic effect of a periarticular multimodal drug injection and patient-controlled epidural analgesia (PCEA) in total knee arthroplasty (TKA)., Methods: Thirty-six patients undergoing unilateral TKA were randomly divided into two groups (A and B). Group A received a periarticular injection of ropivacaine, morphine and epinephrine at operation and Group B did not. All patients received postoperative patient-controlled epidural analgesia (PCEA). Preoperative baseline data, surgery-related conditions, postoperative VAS (visual analog score), range of motion (ROM), time of opening PCEA, drug dosage in PCEA and side effects were recorded respectively., Results: At 6, 12 hour VAS in Group A was lower than Group B (P < 0.05). The time of opening PCEA in Group A was longer than Group B (P < 0.05). The drug dosage in PCEA in Group A was less than Group B (P < 0.05). There was no difference of surgical conditions, ROM, 24/48 hour VAS and side effects between two groups (P > 0.05)., Conclusion: Periarticular drug injection during TKA can relieve pain early after TKA, prolong the time of opening PCEA and reduce the drug dosage in PCEA.

Objective: To explore the clinical presentation, therapy and prognosis study of primary cutaneous anaplastic large cell lymphoma (PCALCL)., Methods: We reviewed and analyzed ten cases of PCALCL receiving treatment at our hospital from January 1999 to January 2009., Results: There were 8 males and 2 females with a median age of 48 years old (range: 22 - 69). There were single subcutaneous nodule (n = 7) and multiple nodules (n = 3). And the lesions could be found on head and neck (n = 5), trunk (n = 3) and all over body (n = 2). The lesions appeared red, solid and stable subcutaneous nodules. Partial lesions had a spontaneous regression and new nodules appeared at the same or different sites. Two patients had lymphadenopathy and one had bone involvement with anaplastic lymphoma kinase (ALK) positive and high cell proliferation ratio index (ki-67 > 80%). Seven cases with single lesion received surgical excision plus radiotherapy, chemotherapy or radiochemotherapy, one case recurred, six cases survived without disease. Three cases with multiple lesions received systemic chemotherapy mainly in combination with radiotherapy or biotherapy, two cases recurred and one case survived without disease. The median follow-up was 44 months (range: 9 - 95), progression free survival 89% and overall survival 100%., Conclusion: PCALCL is found more commonly in males. Visceral and lymph node involvement are rare. The patients with single lesion have a longer disease-free survival than those with multiple lesions after surgical excision in combination with chemotherapy or radiotherapy. Multiple lesions can not be cured.

Objective: The efficacy of standard chemotherapy regimen on lymphoblastic lymphoma (LBL) is unsatisfied. This study was to evaluate the efficacy and safety of modified Hyper-CVAD regimen on Chinese patients with LBL., Methods: Clinical records of 20 LBL patients who received modified Hyper-CVAD regimen in Cancer Hospital of Chinese Academy of Medical Sciences, from June 2004 to June 2008, were retrospectively analyzed in terms of response and toxicity., Results: By May. 2009, the median follow-up time was 17 (4-36) months. The 20 patients totally received 62 cycles regimen A and 29 cycles regimen B. 17 patients were assessable in efficacy, the total response rate (RR) was 88.2% with complete response (CR) rate of 41.2%. 15 patients received modified Hyper-CVAD regimen as first-line therapy (75.0%), and RR was 100% with CR rate of 50.0% (7/14). The RR of salvage therapy was 33% without CR achieved. The major toxicity was myelosuppression, the incidence of grades 3-4 neutropenia, thrombocytopenia and anemia was 95.0%, 75.0% and 40.0%, respectively. No treatment-related death was observed., Conclusions: Modified Hyper-CVAD regimen was a promising regimen for the patients with LBL, and toxicity was within acceptable limits.

Objective: To investigate the situation of perioperative blood transfusion in Grade III-A hospitals in Zhejiang province, in order to provide statistics for improving appropriateness of blood transfusion., Method: The questionnaire was conducted in 9 Grade III-A hospitals in Zhejiang province according to "The Technical Criterion of Clinical Blood Transfusion". The data including total quantity, whole blood and component blood transfusion in 2007 were analyzed., Results: Among 19 102 cases, the percentage of component blood transfusion was 99.3%, but 44.1% transfusion is conducted just according to doctors' experience without any medical indication, including 603 patients not re-examining the level of Hct or Hb in 72 h after operation. For the patients with complete transfusion record, the irrational rate of whole blood, RBC and platelet transfusion were 39.2%, 39.2%, 43.7%, the mainly reason was the relax demand on the transfusion indication., Conclusions: Although Grade III-A hospitals in Zhejiang did fairly well in perioperative blood component transfusion, there are still some seriously unreasonable phenomenons. Every medical organization should pay more attention to improve the quality of clinical blood transfusion.

Objective: To evaluate the curative effect of RIGIDfix tibial and femur cross pin system used for hamstring grafted reconstruction of anterior cruciate ligament (ACL) in arthroscopy., Methods: Thirty two cases with ACL ruptures were reconstructed arthroscopically with hamstring grafts and the grafts fixed with RIGIDfix cross-pin on both femoral and tibial sides. They included 18 males and 14 females with a mean age of 28 (20-45) years old; the mean time from injury to operation was 3.6 (2.5-6) months. And each knee was checked by MRI and X-ray preoperatively. Through arthroscopy, we found 19 ACL ruptured from femoral attachment point, 13 from tibial point, 3 cases combined with medial meniscus injury and 4 cases with articular cartilage injury of medial femoral condyle. After semitendinosus or gracilis harvesting, the hamstring grafts were pre-tensioned and woven, the diameter of 4 or 5 strands grafts was 7-8 mm. To position and drill tibial tunnel on ACL stump of tibial crest, and to drill femoral tunnel at 10:00 to 11 o'clock of femoral intercondylar fossa transtibial with knee flexed to 90 degree, the depth of femoral tunnel was 30 mm. The RIGIDfix guide was inserted through tibial tunnel up into the femoral tunnel to drill the sleeve and interlocking Trocar across the lateral femur and keep the two sleeves fixed to the lateral femur. Insert RIGIDfix guide into the tibial tunnel, keeping the top of guide 2-3 mm beneath the endostoma of tibial tunnel, drill the sleeve and interlocking Trocar across the lateral tibia and keep the two sleeve fixed to the lateral tibia. The graft was pulled into the tunnel (the 30 mm mark on the graft should be at the edge of femoral hole) to insert the RIGIDfix cross pins from femoral tunnel to tibial tunnel, while inserting the second, third, fourth cross pin, the graft should be kept under tension. Then a knot was tied through tibial bony bridge using the Enthibond thread switched to the end of tendon grafts. We finally observed the tension of tendon grafts and the impingement of fossa intercondylic under arthroscopy., Results: With a 16-month follow-up evaluation, all of the patients' injured knees were stable and the average Lysholm knee score increased from 62.5 to 94.5. Rulermetr device values were less than 2 mm of sagittal displacement in 28 patients and 4 mm in 4. Postoperative Lachman was negative in 30 patients and weakly positive in 2. According to the IKDC scores, 30 patients reported normal function, 2 reported nearly normal function and none reported abnormal or severely abnormal function., Conclusion: The grafting method of fixing both femur and tibia sides with absorbable cross pins is feasible. In this way, the graft is stabilized to allow for reconstruction. A surgeon should refrain from dissecting the tendon and enlarging the tunnel so as to promote the healing of tendon and bone.

Objective: The fixation strength of the hamstring tendon graft on the tibial side is considered the weak point in anterior cruciate ligament (ACL) reconstruction. This work tested the hypotheses that some of these devices will resist graft slippage under loads better than others, and that some will have higher ultimate strength than others., Methods: Fourteen fresh frozen human cadaver knees underwent fixation of the hamstring tendon harvested from the knee to be used as graft material to reconstruct the ACL and were divided into two equal groups based on the fixation methods: bioabsorbable interference screw group and Intrafix group. A MTS 858 MiniBionix II testing machine was used to carry out tensile testing under an axial load parallel to the tibial tunnel with a velocity of 10 mm/min. Ultimate failure load, displacement of 100N, displacement of 400N, stiffness and mode of failure were recorded respectively., Results: The maximum load for the Intrafix fixation group was (719.094+/-160.478) kgxmxs(-2), significantly higher than that of the bioabsorbable interference screw fixation group [(476.640+/-64.226) kgxmxs(-2), P<0.05]. The displacement levels of 100 kgxmxs(-2) and 400 kgxmxs(-2) for the Intrafix fixation group was (1.025+/-0.326) mm and (4.728+/-1.992) mm respectively, not significantly different from those of the bioabsorbable interference screw fixation [(1.335+/-0.539) mm and (7.564+/-4.307) mm respectively, t=0.2173, 0.0944, both P>0.05], and the stiffness of the Intrafix fixation group was (96.770+/-36.848) kgxm(-1)xs(-2) not significantly different from that of the bioabsorbable interference screw fixation group [(63.976+/-31.003 kgxm(-1)xs(-2)), t=0.0967, P>0.05]. After randomized t-test of significance, the displacement levels of 100N and 400N of these 2 groups were not significantly different., Conclusion: Both tibial site fixation with bioabsorbable interference screw and that with Intrafix in ACL reconstruction with 4-stranded hamstring tendon grafts can meet daily physiological demand. Tibial site fixation with Intrafix shows a higher failure load.

Objective: To assess the value of computer navigation technique in spinal pedicle screw insertion., Methods: 95 patients undergoing spinal pedicle screw internal fixation were randomly divided in 2 groups:navigation group (n=36) undergoing pedicle screw insertion with computer-assisted navigation technique, and conventional group (n=50) undergoing pedicle screw insertion using conventional anatomic landmark combined. The 2 groups were compared in respect to screw canal preparation time, accuracy of screw position, and incidence of postoperative complication., Results: 206 screws were inserted in the navigation group, 169 being with excellent outcome (82.0%), 29 with good outcome (14.1%), and 8 with bad outcome (3.9%). Nine patients in the navigation group failed to adopt the computer-assisted navigation technique because of different reasons. 285 screws were inserted in the conventional group, 257 being were excellent outcome (90.2%), 28 with good outcome (9.8%), and none with bad outcome. The general fitness rate of the navigation group was 96.1%, not significantly different from that of the conventional group (100%, P>0.05). The screw canal preparation time of the navigation group was (360+/-22) sec, significantly longer than that of the conventional group [(56+/-8) sec, P<0.001)]. No postoperative complication was found in both groups., Conclusion: The accuracy of pedicle screw insertion using preoperative CT-based navigation technique is not different from that using conventional anatomic landmark, but the operation time is significantly prolonged. Preoperative CT-based navigation technique has limited value in spinal pedicle screw insertion.

Objective: To analyze the difficulty in diagnosis of pituitary hyperplasia secondary to primary hypothyroidism and reasons of misdiagnosis., Methods: Ten patients with clinical manifestations of primary hypothyroidism, 3 males and 7 females, aged 7 - 26, underwent MR imaging and serum hormone examination before and after thyroid hormone replacement therapy. T1-weighted images without and with contrast material enhancement in sagittal and coronal planes were obtained. Serum free triiodothyronine, free thyroxine, thyrotropic-stimulating hormone and prolactin (PRL) levels were measured., Results: Obvious symmetrical enlargement of the pituitary gland with homogeneous signal intensity was revealed by MRI in all the patients. The height of the pituitary ranged 1.2 - 2.2 cm. The pituitary glands appeared homogeneously enhanced after Gd-DTPA administration. After 3 - 6 months of L-thyroxin replacement therapy, follow-up MRI showed that the pituitary glands reduced in size markedly in 9 cases, and the plasma thyroxine, TSH, and PRL levels of these 9 cases turned normal. One patient was misdiagnosed as with macroadenoma and was treated with gamma knife, resulting in permanence hypothyroidism., Conclusion: Symmetrical enlargement of pituitary gland with homogeneously enhancement on MRI has great diagnostic value in pituitary hyperplasia with primary hypothyroidism. Thyroid hormone replacement therapy can cause regression of the enlarged pituitary, thus avoiding unnecessary surgery.

Objective: To evaluate the effects of surgical treatment with cervical esophagogastrostomy by left thoracic esophagectomy on esophageal carcinoma., Methods: The clinical data of 3169 patients with esophageal carcinoma, 2115 males and 1054 females, aged 60.9 (30-82), that underwent cervical esophagogastrostomy by left thoracic esophagectomy from Jan. 1990 to Dec. 2000 were analyzed retrospectively., Results: The incidence of complication was 8.6% (273). The operative mortality was 0.6% (19). The 1, 3, and 5 year survival rates were 81.5%, 51.6%, and 32.1% respectively. Manometric examination of the digestive tract showed that the post-operative resting pressure of residual esophagus above the anastomotic stoma was (16+/-11 mm Hg), significantly higher than that of the cervical esophagus of the normal controls [(4+/-3) mm Hg), P<0.01]., Conclusion: Reducing incidence of gastroesophageal reflux and improving the quality of life of patients, cervical anastomosis should be recommended as the first choice procedure in treatment of upper and middle segment esophageal carcinoma.

Objective: To investigate the effect of a novel analgesic disposable urinary catheter invented by the authors in prevention of restlessness caused by catheter-related bladder discomfort (CRBD) in general anesthesia patients in anesthesia recovery period., Methods: Two hundred patients, who underwent general anesthesia for general surgical operation, were divided randomly into 2 equal groups: observation group, undergoing insertion of F16 novel analgesic disposable Foley urinary catheter after inducement of general anesthesia, and control group undergoing insertion of conventional F16 Foley urinary catheter after induction of anesthesia. The rate of restlessness caused by CBRD and the rate of catheter pulling-off were compared., Results: The CRBD rate of the observation group was 9%, significantly lower than that of the control group (61%, P < 0.01), the rate of CRBD-caused restlessness of the observation group was 0, significantly lower then that of the control group (23%, P < 0.001). The extent of CRBD of the observation group was significantly lighter than that of the control group., Conclusion: The catheter inserting after the induction of anesthesia is an element related to the restlessness in anesthesia recovery period and other serious postoperative complications. The novel analgesic disposable urinary catheter effectively prevents CRBD-caused restlessness in general anesthesia patients in the anesthesia recovery period.

Objective: To study the pathological change of benign hyperplastic prostate after removal of the innervation of cholinergic parasympathetic pelvic nerve., Methods: Sixty-five male spontaneous hypertension rats (SHRs) were randomly assigned into 3 groups: operation group (n = 30) undergoing truncation of bilateral originating branches of parasympathetic pelvic nerve of major pelvic ganglion (MPG) followed by cystostomy, sham operation group (operation control group, n = 30) undergoing cystostomy, and normal control group (n = 5) not undergoing operation. 3, 7, 11, 15 and > or = 21 days after operation 6 rats from the 2 operation groups and 1 from the control group were sacrificed to observe the gross morphology and histological and cellular changes of the prostate glands., Results: The prostate of the operation group on post-operational day 7 showed mild granular solidification and such change progressed gradually over time, the ratio of prostate wet weight/rat body weight was (0.4764 +/- 0.0125) mg/g on day 3, then gradually decreased, and became (0.2749 +/- 0.0197) mg/g > or = 21 days post-operationally; while the ratio of prostate tissue dry weight/wet weight on day 3 was (0.1966 +/- 0.0062), then gradually increased, and became (0.2596 +/- 0.0035) > or = 21 days post-operationally. HE staining showed that the glandular structure gradually became dilated and rounded, with accumulation of prostatic fluid. The glandular epithelial cells showed gradual degeneration, necrosis, and detachment. The glandular epithelium became progressively thinner, the smooth muscles elongated and thinned progressively, and the stromal components showed mild to moderate overgrowth. Electron microscopy showed that the glandular cells gradually underwent vacuolar degeneration and the structures of the basement membrane became fuzzy. The smooth muscle cells degenerated mildly, and the fibroblasts and collagenous fibers in the stroma overgrew slowly. All these histological changes were not found in the sham operation control and normal control groups., Conclusion: Remarkable atrophy occurs in benign hyperplastic prostatic gland after radical removal of the innervation of cholinergic parasympathetic pelvic nerve. Such operation may represent a novel therapy for BPH.

Objective: To present the experience in a technique used to treat intractable postherpetic neuralgia (PHN)-percutaneous dorsal root ganglion (DGR) radiofrequency thermocoagulation guided by CT scanning., Methods: Sixteen PHN patients underwent puncture of radiohealing needle into the superior 1/3 of the corresponding intervertebral foramen guided by CT. Electric stimulation test and impedance test were conducted to confirm the right spot. Radiofrequency heat coagulation therapy under the condition of 90 degrees C 90 s was performed for 3 cycles. Then mixture of betamethasone and lidocain was injected and the needle was pulled out. CT was conducted to observe if pneumothorax occurred. The patients were followed up for 2-16 months., Results: Radiofrequency thermocoagulation was performed on 45 target dorsal root ganglia in 16 PHN patients with the effect of immediate disappearance of hyperalgesia. Remaining spontaneous pain was seen in 5 cases, however, with decreases of attack frequency and severity. The visual analogue pain scale score was decreased from 7-9 before the procedure to 2-3 after the procedure. No relapse was found during the follow-up., Conclusion: Selective percutaneous DRG radiofrequency thermocoagulation guided by CT scanning is effective in treatment of PHN.

Objective: To investigate the effect of chemokine stromal cell-derived factor-1 (SDF-1) and its receptor CXCR4 on the peritoneal carcinometastasis of gastric cancer., Methods: Human gastric cancer cells of the lie NUGC4 and mesothelial cells of the line HMrSV were cultured. RT-PCR was used to detect the expression of CXCR4 and SDF-1 mRNA in the NUGC4 and HMrSV cells. The proliferation of NUGC4 cells was detected by MTT method. In mesothelial cell adhesion teat NUGC4 cells were cultured with confluent HMrSV mesothelial cells in 24-well plate and then divided into 3 groups: chemokine group, added with SDF-1, antibody blocking group, in which the NUGC4 cells were pre-incubated with CXCR4 monoclonal antibody for 2 h and then SDF-1 was added, and control group added with only culture fluid. Microscopy was used to calculate the number of gastric cancer cells adhered with mesothelial cells. In the mesothelial cell migration test HMrSV cells were put in the upper chamber of a Transwell chamber so as to cover the infiltration membrane. This Transwell chamber was put into a culture plate, NUGC4 cells, divided into 3 groups as mentioned above were put into the upper chamber, 24 h later HE staining and microscopy were performed to calculate the number of the NUGC4 cells that penetrated the membrane. BALB/c nu/nu female nude mice underwent intraperitoneal injection of NUGC4 cells, and then with PBS or AMD3100, small molecular specific antagonist, one day after the cancer cell injection once a day for 2 weeks. Then the mice were killed to observe the intraperitoneal tumorigenesis., Results: CXCR4 mRNA was highly expressed in the NUGC4 cells but only very weekly expressed in the HMrSV cells. SDF-1 mRNA expression was seen in the HMrSV cells but in the NUGC4 cells. Anti-CXCR4 monoclonal antibody (McAb) inhibited the proliferation of NUGC4 cells significantly (P < 0.05). In mesothelial cell adhesion test, the number of the NUGC4 cells adhered with HMrSV cells after SDF-1 stimulation was 84.4 +/- 21.2, significantly higher than that of the control group (43.6 +/- 12.4, P < 0.05). The number of migrating NUGC4 cells in the chemokine group was 170.8 +/- 24.2, significantly higher than hat of the control group (102.8 +/- 18.2, P < 0.05); and the number of migrating NUGC4 cells in the antibody blocking group was 114.7 +/- 20.3, significantly lower than that of the chemokine group (P < 0.05). The survival time of the mice injected with both NUGC4 cells and AMD3100 was (43.8 +/- 2.8) days, significantly longer than that of the control group [(28.2 +/- 2.5) days, P < 0.01]. The tumor number of the AMD3100 group was (64.6 +/- 8.2), significantly lower than that of the control group [(103 +/- 12.4), P < 0.01]., Conclusion: SDF-1 and its receptor CXCR4 play an important role in the development of peritoneal carcinometastasis from gastric cancer. Interfering with the SDF-1/CXCR4 biological axis may become a potential strategy in the prevention and treatment of peritoneal carcinometastasis from gastric cancer.

Objective: To investigate the expression of RhoC in prostate cancer cells with different metastatic potential and the correlation with invasiveness., Methods: Expression of RhoC mRNA and protein in human prostate cancer cell subclones PC-3M-2B4 with non-metastatic potential and PC-3M-1E8 with highly metastatic potential was detected by RT-PCR and Western blot. Eukaryotic expression plasmids of RhoC were constructed and transfected into PC-3M-2B4. The biological effects were observed, including in vitro invasion by Boyden chamber assay, motility by would healing assay, alteration of microfilament network by the staining of TRTIC-phalloidin, activities of matrix metalloproteinases (MMP) by gelatin zymography analysis and expression of p-Akt by Western blot assay., Results: The expression levels of RhoC mRNA and protein varied in the two different metastatic subclones of human prostate cancer cell. RhoC was significantly upregulated in the highly metastatic subclones in comparison to the nonmetastatic counterpart (P < 0.01). As shown in Boyden chamber assay, the invasive capacity of transfected cells overexpressing RhoC was significantly promoted as reflected by more penetrating cells (125.21 +/- 10.43) than the antisense transcripts (46.22 +/- 8.12), the negative (53.77 +/- 8.56) and blank controls (57.68 +/- 7.25). Further study by would healing assay indicated that cells overexpressing RhoC were more motile in actin-based active movement (would healing ratio after 16 h of the sense transcripts, antisense transcripts, negative controls and blank controls was 62.38 +/- 2.36, 29.47 +/- 1.86, 32.23 +/- 2.43, 31.88 +/- 2.67 respectively). The TRITC-phalloidin staining revealed less actin filament bundles and a fuzzy network of shorter filaments in the sense transcripts. In addition, MMP-2 activity and p-Akt expression level were upregulated in the sense transcripts., Conclusion: RhoC overexpression could promote the invasive capacity of human prostate cancer cell in vitro and it's expression level correlated positively with the metastatic capacity of human prostate cancer cell, so RhoC may be a potential target in the development of a novel strategy for treating metastasis of prostate cancer.

Objective: To investigate the frequencies of immunologically competent cells (ICCs) in the liver-infiltrating lymphocytes (LILs) and peripheral blood and their possible role in pathogenesis in patients with chronic severe hepatitis B (CSHB)., Methods: LILs were isolated from the liver tissue samples from 11 CSHB patients and 5 normal controls (NCs) by the method of combined grinding with semi-frosted microscopic slides and sedimentation of hepatic cells. The frequency of isolated ICCs, including CD3(+), CD4(+), and CD8(+) T-cells, NK cells, NKT cells, and B cells was examined and compared with that of the circulating ICCs in the CSHB patients. Comparison was conducted between the CSHB patients and the controls., Results: (1) In the CSHB patients, the frequencies of CD4(+) T cells and B cells in LILs were 17% +/- 6% and 3.0% +/- 1.0% respectively, both significantly lower than those in the circulating blood (32% +/- 8% and 21.4% +/- 12.2% respectively, both P < 0.01); however, the frequencies of CD8(+) T cells, NK cells, and NKT cells in LILs were 38% +/- 13%, 34% +/- 18%, and 10% +/- 4% respectively, all significantly lower than those in the circulating blood (26% +/- 6%, 15% +/- 9%, and 6% +/- 4%, all P < 0.05). (2) The frequencies of infiltrating CD3(+) T cells and CD4(+) T cells of the CSHB patients were both significantly higher than those of the NCs (P = 0.042 and P = 0.001); and the frequency of infiltrating CD8(+) T cells of the CSHB patients was higher than that of the NCs, and the and the frequencies of infiltrating NK cells and NKT cells in LILs were lower than those of the NCs, however, not significantly. (3) Compared with the liver tissues from the NCs, the liver tissues from the CSHB patients exhibited a significantly higher ratio of liver-infiltrating CD4(+) T cells to peripheral blood CD4(+) T-cell subsets (P = 0.001), and significantly lower ratios of liver-infiltrating NKT cells and B cells to the peripheral blood NKT-cells and B cells (P = 0.029 and P = 0.001 respectively)., Conclusion: The abundant infiltrating immune active cells, especially the CD4(+) T cells, CD8(+) T cells, and NK cells, may be the causal factors that drive the progressive development of CSHB.

Objective: To compare the expression profiles of differential proteins between retinoic acid resistant and sensitive cells and screen the proteins related to retinoic acid (RA) resistance by proteomic analysis., Methods: The total cellular proteins from the RA sensitive cells of the line NB4 and the RA resistant cells of the line MR2 obtained from a patient with acute promyelocytic leukemia (APL) were separated by two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and analyzed by PDQuest v7.1 analysis software to screen the differential protein spots. Differentially expressed spots were analyzed by mass spectrometry for peptide mass finger (PMF) data and identified by Mascot software and SWISS-PROT protein database. The differentially expressed proteins were verified by Western blotting assay and semi-quantification RT-PCR., Results: 2-DE patterns of APL cell lines with high-resolution and reproducibility were obtained. The average spots of the RA resistant cell line MR2 and RA sensitive cell line NB4 were 890 +/- 45 and 912 +/- 56 respectively. 57 significantly differentially expressed protein spots were screened, among which 23 protein spots were founded to be upregulated and 34 protein spots down regulated in the RA resistant cell line MR2. 25 differential protein spots were identified by mass spectrometry and 17 proteins were successfully assigned to 13 gene-reading frames, of which one was unknown function protein (FLJ00279) and the others were included in the categories of oncoprotein (DJ-1), transcription factor (MYC promoter-binding protein 1), molecule chaperone (HSP70, HSP60 and protein disulfide isomerase), metabolism protein (prohibitin, triosephosphate isomerase 1, and calreticulin), signal transduction (Rho GDP dissociation inhibitor), and cytoskeleton (ACTG1 protein, Beta 5-tubulin, and keratin 10). The results of Western blotting were similar to those of 2D-PAGE and showed differential expression of DJ-1 and calreticulin in several isoforms. Semi-quantification RT-PCR analysis showed that there was no correlation between the protein expression changes and mRNA levels of HSP70 or HSP60. Those results indicated that post-translational events might modify or shear the protein content of the specific spots., Conclusion: The utilization of two-dimensional polyacrylamide gel electrophoresis coupled with mass spectrometry is effective in screening the all-trans RA resistance-associated proteins and could provide novel clue for study of elucidating all-trans RA resistance mechanisms.

Objective: To summarize the experience in treatment of ethmoid sinus malignant tumors via trans-cranio-naso-orbital approach. Post-operationally follow-up was conducted in 27 cases for 3.5 years (3 months to 7 years)., Methods: The clinical data of 39 patients with ethmoid sinus malignant tumors, 25 males and 14 females, aged 42 (20 - 65), with the chief complaints of nasal airway obstruction, rhinorrhagia, nasal neoplasm, exophthalmos, decreased vision, facial numbness, disturbance of consciousness, etc, who underwent resection of tumor via trans-cranio-naso-orbital approach retrospectively. Pre-operational MR showed that the tumor invaded the anterior cranial fossa in 38 cases, invading the orbit in 31 cases, invaded the pterygopalatine fossa in 5 cases, invaded the middle cranial fossa and cavernous sinus in 3 cases., Results: Tumor total removal was achieved in 32 cases (including removal en bloc in 9 cases), and subtotal removal in 7 cases. Pathological examination diagnosed 10 cases as with olfactory neuroblastoma, 8 cases with adenocarcinoma, 7 cases with squamous cell carcinoma, 6 cases with pallima carcinoma, 4 cases with unclassified sarcoma, 3 cases with undifferentiated carcinoma, and 1 case with schneiderian carcinoma. Postoperatively, temporal CSF leak was found in 5 cases. There was no intracranial or wound infection. Local recurrence was found in 8 cases, 1 case had lung metastasis, and 4 cases died 1 month to 6 years postoperatively., Conclusion: Adequate exposure of the ethmoid sinus tumor involving the anterior cranial fossa and orbit can be obtained via suitable trans-cranio-naso-orbital approach, and by this approach the tumor can be removed en bloc. This approach is relatively safe and with few complications.

Objective: To investigate the frequency, distribution, and feature of lymph node metastasis in thoracic esophageal carcinoma, and to provide evidence for lymph node dissection and the multidisciplinary therapy for patients with esophageal carcinoma postoperatively., Methods: The clinical data of 623 patients with thoracic esophageal carcinoma who had undergone esophagectomy plus lymph node dissection were studied to analyze the characteristics of lymph node metastasis., Results: Totally 3689 of lymph node groups (with 8603 nodes) were dissected. The lymph node metastasis rate was 47.2% and lymph node metastasis ratio was 10.3%. No lymph node metastasis was found in the patients of Tis stage, while lymph node metastasis was found in the patients of other stages. There were significantly differences in lymph node metastasis rate and ratio among the patients of different T stages (chi2 = 38.407, P = 0.00, and chi2 = 118.438, P = 0.000). The higher the T stage, the higher the lymph node metastasis rate and ratio (r = 1, P = 0.000, and r = 1, P = 0.000). Different pathological types of esophageal carcinoma had different lymph node metastasis ratio (chi2 = 84.577, P = 0.000), however, there was no significant difference in lymph node metastasis rate among different pathological types (chi2 = 6.284, P = 0.179). The patients with squamous carcinoma had the lowest lymph node metastasis ratio and lymph node metastasis rate. The lymph node metastasis was mainly regional and extended vertically in both directions. Leaping over metastasis was another feature. All segments of thoracic esophageal carcinoma, especially lower thoracic esophageal carcinoma, could metastasize to the celiac lymph nodes., Conclusion: Lymph node dissection should be carried out properly in treatment of esophageal carcinoma and regional celiac lymph nodes should be explored and dissected more cautiously. Because surgical treatment is relatively radical in treatment of esophageal carcinoma, and taking the trend of lymph node metastasis and other indication into account, rational multidisciplinary therapy conducted as soon as possible should be adopted in the treatment of esophageal carcinoma.

Objective: CD4(+)CD25(high) regulatory T cells (Treg) have been shown to play an important role in maintaining peripheral tolerance against self and foreign antigens, and in suppressing T cell immune response. Our aim was to characterize circulating Treg in HBV-infected patients., Methods: Treg in peripheral blood from 72 chronic hepatitis B (CHB) patients, 16 acute hepatitis B (AHB) patients and 32 healthy subjects were quantitatively analyzed using flow cytometry. Serum HBV markers were evaluated for each subject. HBV-DNA levels were measured using real-time RT-PCR., Results: CHB patients presented a higher fraction of circulating Treg (3.9% +/- 1.4%) than those in AHB patients (3.1% +/- 0.9%) (P < 0.05), but were similar to healthy controls (3.5% +/- 0.7%). CHB patients with greater than 10(7) copies/ml of serum HBV DNA loads had a higher frequency (4.5% +/- 1.9%) of circulating Treg than health controls (P < 0.01) and the patients with less than 10(7) copies/ml of serum viral loads (3.4% +/- 0.7%). A correlation was found between circulating Treg and HBV DNA level (r = 0.32, P < 0.01). Furthermore, Treg was more frequent in convalescent phase (6.0% +/- 1.7%) than in early acute phase (3.0% +/- 0.6%)., Conclusion: Increased peripheral Treg is found to be associated with HBV replication in chronic hepatitis B. In acute HBV infection, Treg is less frequent in early phase. The related mechanisms is under further investigation.

Objective: To investigate the effects of homologous conduits with valves in the treatment of complex congenital heart disease with insufficient pulmonary blood flow in children., Methods: Homologous conduits with valves were used in the right ventricular outflow tract reconstruction among 212 pediatric patients with complex congenital heart disease with insufficient pulmonary blood flow, aged 2.6 (0.5 - 15). The patients were followed up for 2.6 years (6 months to 7 years) and underwent echocardiography to assess the degree of pulmonary insufficiency and calcification of blood vessel., Results: The success rate of operation was 96.5% (204/212). The ratio of right ventricle to aortic pressure was less then 0.55. During the follow-up, echocardiography showed valvular regurgitation and calcification of the blood vessel in 34 patients, 23 (11.2%) being mild, 7 (3.42%) being moderate, and 4 (1.96%) being sever. 170 patients did not show obvious pulmonary insufficiency., Conclusion: Application of homologous conduits with valves in the treatment of complex congenital heart disease with insufficient pulmonary blood flow in children shows excellent early results in preventing pulmonary insufficiency.

Objective: To evaluate the diagnostic value of spiral CT and its reconstruction techniques in the diagnosis of extraluminal type gastric stromal tumors., Methods: The data of spiral CT performed 1 week before operation of 17 extraluminal type cases, 11 males and 6 females, aged 35.5 (13-67), from 33 patients of gastric stromal tumors proved by pathology and immunohistochemistry, were analyzed retrospectively., Results: The accuracy rates of level diagnosis and qualitative diagnosis of extraluminal type gastric stromal tumor by spiral CT were 88.2% and 82.4% respectively. The main CT manifestations included: (1) extraluminal mass connected with the gastric wall, with round or lobulated margin and characteristic horn-like appearance and direct invasion, more than 5.0 cm in diameter; (2) inhomogeneous density of mass, including mild to moderate uneven enhancement in artery phase and obvious enhancement in vein and delay phase in 15 cases, and obvious enhancement in artery phase and decrease of enhancement in portal vein phases in 2 cases. (3) Irregular niches and sinus in the margins of the intraluminal masses (n = 11) and unclear border of the masses and invasion into nearby structures (n = 9); (4) connection of the tumor and stomach wall by broad boundary or failure to distinguish the tumor and stomach wall; and (5) invasion to the surrounding tissues and organs as a sign of malignant tumors., Conclusion: Spiral CT and its reconstruction techniques have important value in level diagnosis and qualitative diagnosis of extraluminal type gastric stromal tumors.

Objective: To evaluate the effectiveness of endoscope in the treatment of optic nerve injury., Methods: Thirteen patients with fracture at the inner and lower walls of optical canal underwent endoscopic decompression. The posterior 1/3 of the middle concha, the posterior ethmoid sinus and sphenoid sinus were opened, chips of bone and old hematocele were scavenged, and the optic ring of the optic canal was polished; however, the sheath of the optic nerve remained intact. In 2 cases with the dura broken at the cranial part of optic nerve, the broken site was covered with mucosa of middle concha, and the sphenoid sinus and the middle nasal meatus were covered with oil ribbon gauze. Three days after the operation, the ribbon gauze was pulled put, however, if cerebro-spinal fluid leakage was suspected, the ribbon gauze was pulled out 7-10 days after. After the operation the visual acuity improvement reaching one grade or more and improvement of visual field were defined as effective., Results: Five of the 6 patients without light perception before the operation showed improvement in visual acuity. The other 7 patients with residual visual acuity all recovered to different extents., Conclusion: A mini-invasive surgery, decompression of optic canal with endoscope is effective in decompressing optic nerve, decreasing the injury of optic nerve, and the patients recover quickly after operation.

Objective: To investigate the quality of life of Chinese malignant patients who treated with the high dose chemoradiotherapy combined with autologous stem cell transplantation (ASCT)., Methods: The data of 89 patients who answer the EORTC QLQ-C30 Chinese version 3.0 after finished ASCT and disease free were analyzed using SPSS 10.0., Results: The score of global health status and functional assessment were near or over 80, more than 80 percent of patient had good or very good global health status or function, the patients who were experiencing moderate or severe financial dysfunction, fatigue, dyspnea, sleeping disturbance and diarrhea were in 72.5% (65/89), 50.6% (45/89), 42.7% (38/89), 33.7% (30/89) and 32.5% (29/89) respectively. The score of dyspnea in female patients was significant higher than male patients (P = 0.024). The score of global health status (P = 0.000), physical function (P = 0.000), role function (P = 0.031) and social function (P = 0.029) became higher significantly with time from transplantation and the score of fatigue became lower (P = 0.020). The Hodgkin's lymphoma patients had higher score significantly in nausea & vomiting (P = 0.002) and dyspnea (P = 0.006) than NHL. The age at transplantation and evaluation took none effect on the score., Conclusion: Most patient have good global health status and function after autologous stem cell transplantation, they are more suffered from financial dysfunction, fatigue, dyspnea, sleeping disturbance and diarrhea. Females have more dyspnea symptoms, the quality of life of patient will improve gradually with the time from transplantation, the Hodgkin's lymphoma patients have more symptoms than non-Hodgkin's lymphoma patients, we do not find any effect of age at transplantation and assessment on the quality of life.

Objective: To investigate the clinical effect of early stage operation for optic nerve sheath meningioma., Methods: Retrospective study The clinical data of 21 cases of optic nerve sheath meningioma, 6 males and 25 females, aged 39 (12-60), with the chief complaints of loss of vision in 13 eyes (including 6 blind eyes) and proptosis in 8 eyes who underwent resection of the tumors via transcranio-orbital approach were analyzed retrospectively. Radiology showed 15 tumors growing along the optic nerve and enclosing it (flat type), 5 of which showed intracranial invasion; and other 6 of which had the tumors located on one side of optic nerve with spherical shape (nodular type) without intracranial invasion. The patients were followed up for 2-6 years., Results: Total resection was accomplished in 15 cases, and partial removal in 6 cases. Function of oculomotor nerve was preserved in 17 cases, and function of abducent nerve was preserved in 18 cases, visual function was successfully preserved in the 2 cases of small tumor. Tumor recurred in two cases., Conclusion: Resection of optic nerve sheath meningioma via transcranio-orbital approach has the advantage of totally removing the tumor and preserving the function of the oculomotor and abducent nerves, preventing tumor from intracranial invasion. Early stage operation is recommended. Visual function may be preserved in the cases of small tumors.

Objective: To study the effect of nonmyeloablative allogeneic peripheral blood stem cell (NST) transplantation combined with imatinib in the treatment of chronic myeloid leukemia (CML)., Methods: Ten CML patients, 5 males and 5 females, aged 21-41, 3 in chronic phase (CP), 4 in accelerated phase (AP) and 3 in blast crisis phase (BP), were treated with imatinib (400-1500 mg/d) before (n = 10) and/or after (n = 6) NST transplantation. The donors were HLA-identical (n = 4), 5/6 antigen-matched (n = 2), 4/6 antigen-matched (n = 2), 3/6 antigen-matched (n = 1) siblings or haplo-identical mothers (n = 2). The preparative regimen included cytoxin (CTX), Ara-C, and fludarabine combined with antithymocyte globulin (ATG) or anti-CD3 monoclonal antibody. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine (CSA) and mycophenolate mofetil (MMF), or with low-dose methotrexate (MTX) or zenapax., Results: All the 10 patients showed donor cell chimerism at different degree: three had full chimerism (> 95%) and seven mixed chimerism (44%-95%). Mixed chimerism in 6 cases had been transformed into full chimerism during 1.5-10 months after NST transplantation through immunosuppressive agent withdrawal, donor peripheral blood stem cell/donor lymphocyte infusion or treatment of imatinib. The time needed for increase of the number of neutrophils to more than 0.5 x 10(9)/L was 16 d days (10-21 days). The time needed for increase of the number of platelets more than 20 x 10(9)/L was 10 days (4-15 days). 6 cases had I-II degrees acute and chronic GVHD of skin. 2 case had III-IV degrees chronic GVHD. 2 cases died of transplantation-related complication 27 and 45 days after transplantation respectively. One patient died of III-IV degrees cGVHD. Seven patients remained alive after a median follow-up of 14.5 months (7-23 months). The time needed for bcr/abl becoming negative was 33-130 days. None case relapsed during the following-up., Conclusion: An effective and safer method for CML, especially advanced CML treatment of NST transplantation combined with imatinib before and after transplantation reduces the leukemic cell load before transplantation, inhibits the proliferation of residual leukemic cells, promotes full chimerism change and enhanced the effect of graft versus leukemia.

Objective: To evaluate the role and effect of neuro-navagation in the surgical treatment of fibrous dysplasia of the skull and to discuss the indication and advantages of transcranial optic nerve decompression are discussed., Methods: Fifteen patients with fibrous dysplasia of skull, 6 males and 9 females, aged 10.3 (5 approximately 21), were surgically treated by transcranial approach. The location of lesion, symptoms and signs, CT characteristics, surgical approaches, and outcomes were analyzed. The postoperative outcomes of visual acuity were grouped into 5 categories: blindness, light perception, hand motion, counting fingers, and recognizing acuity chart. Improvement of visual acuity of one grade or more or increase of 0.1 by acuity chart, and improvement of visual field were defined as effective., Results: Fibrous dysplasia of skull in children most often involved the frontal, sphenoid, and ethmoid bones and resulted in stenosis of optic canal and superior optic fissure. The most common symptoms were decreased vision, proptosis and facial asymmetry. 13 patients underwent decompression of optic canal in lateral side, and two patients in both side. All the cases had pathological diagnosis of Fibrous dysplasia of the skull. After 3-to-25-month follow-up, improvement was found in 11 eyes (65%), and no improvement was found in 6 eyes (35%). Decreased vision was not seen., Conclusion: Transcranial optic nerve decompression is an effective treatment for decreased vision induced by Fibrous dysplasia of the skull.

Objective: To investigate expression of midkine (MK) in hepatocellular carcinoma (HCC) and its relationship with HBV infection., Methods: Expression of MK mRNA, MK protein and HBV DNA were determined in 62 cases of human HCC and 10 cases of controls with in situ hybridization and immunohistochemistry., Results: Positive rates of MK mRNA and MK protein in carcinoma tissue were 74.2% and 75.8% respectively, which were higher than in paratumorous liver tissue and normal controls (P < 0.01). Positive rate of HBV DNA in the nuclei of carcinoma tissue (62.9%) were higher than in paratumorous liver tissue (6.5%) (P < 0.01). There was a significant relationship between expression of MK mRNA and MK protein in the carcinoma tissue and HBV DNA in the nuclei of carcinoma tissue., Conclusions: HCC overexpresses MK at the mRNA and protein level. The overexpression of the MK protein might be correlated with the existence of HBV DNA in the nuclei of carcinoma tissue.