Objective To study the diagnosis and treatment of acute testicular torsion. Methods 17 cases of testicular torsion treated from January 1995 to December 2000 were reviewed.The diagnosis and treatment were analysed. Results The diagnosis of testicular torsion in all the 17 cases was assessed on color Doppler ultrasonics.1 case was cured by manual detorsion,2 by surgical detorsion and orchidopexy,14 by orchiectomy and contralateral orchidopexy.The fertile ability of 4 cases over 18 years old was observed,3 being normal and 1 slightly below normal. Conclusions Color Doppler ultrasonics examination can serve as a chief adjuvant diagnostic method.All cases with a torsion more than 360? and longer than 24 h will have the ipsilateral testicular loss,whereas in case the torsion is less than 360? and less than 24 h have a chance to preserve the testis by surgical detorsion and orchidopexy.

Objective To decrease radiation induced toxicities especially mucostis in patients with locally advanced nasopharyngeal carcinoma( NPC ) who underwent concurrent radiochemotherapy, the maximum tolerated dose and dose limited toxicities of capecitabine combination with cisplatin were observed. Methods From Aug 2006 to Oct 2007, 24 patients with intensity modulated radiotherapy(IMRT) and concurrent chemotherapy with capecitabine and cisplatin for nasopharyngeal carcinoma(stages Ⅲ-Ⅳ) were enrolled in this study. There were four dose-level groups of Capecitabine[625-1250 mg/(m2 ·d) , d1-14]and fixed cisplatin dose[20 mg/(m ·d) ,d1-5) ]MRI and CT scan were used for evaluation of tumor shrinkage. Treatment related toxicities were evaluated according to the common toxicity criteria( NCI-CTC Version 3.0). Results The acute side-effects include Grade 3 or Grade 4 mucosal toxicity(lasting for at least 5 d) and Grade 3 or Grade 4 non-mucosal toxicity were evaluated. Group 625 mg/m2 and Group 825 mg/m2 had none, Group 1000 mg/m2 had 6 patients and Group 1250 mg/m2 had 3 patients for mucosal toxicity, which were the main dose-limited toxicity and relevant to the dose of capecitabine apparently( P < 0. 05 ). There was also a trend of increase by the dose level of capecitabine for other toxicities. The median follow-up time for all patients was 28. 5 months. The locoregional recurrence occurred in 2 patients and distant metastasis in 2 patients. Two-year overall survival rate and locoregional control rate were 100% and 91.7%, respectively.Complete response and partialresponse were found on MRI or CT scan in patients of 29. 2% at the end of treatment and 83. 3% after three months, respectively. Conclusions The combination regimen of capecitabine and cisplatin is safe and effective according to the preliminary result. Toxicities related to radiochemotherapy for NPC were significantly associated with the dose level of chemotherapy.

Objective To evaluate the efficacy and safety of the endovascular interventional minimally invasive techniques(IMIT)for treatment of carotid artery iniury. Methods A total of 111 cases of carotid artery injury diagnosed by digital subtraction angiography(DSA)were treated with IMIT.Except for 1 case of extracranial segment injury of internal carotid artery treated with transcatheter stentgraft placement to obturate the rupture of carotid artery,the other 110 cases of intracranial segment injury of internal carotid artery(ICA)were treated with embolization with balloons in 73,embolization with coils in 12,injection of NBCA and PVA in 6,stent-graft placement in 11 and embolization with multiple materials in 8. Results Angiography demonstrated rupture of extracranial segment of internal carotid artery and arteriovenous fistula(AVF)at the neck in 1 case,traumatic carotid cavernous fistula(TCCF)in 83.traumatic pseudoaneurysm at intracranial segment of carotid artery in 14 and both TCCF and pseudoaneurysm in 13.The interventional treatment succeeded in all cases and interual carotid arteries were well protected in 62 cases.Completion angiography documented complete obliteration of the fistulas,with complete disappearance of the clinical symptoms in 110 cases and improvement in 1.Minor complications occurred in 2 cases,without death occurred.During the follow-up for 1-14 months,16 cases reexamined with DSA,which showed that the symptoms of 3 cases reoccurred,2 of whom were cured by re-embolization and 1 was under clinical observation. Conclusions IMIT including transcatheter selective embolization and stent-graft implantation is minimally invasive,safe and effective for treatment of carotid artery injury.

Objective To investigate the expression characteristics of Golgi phosphoprotein 3(GOLPH3)in human hepatocellular carcinoma (HCC)and explore its clinicopathological significance. Methods The expressions of GOLPH3 protein was detected in 132 cases of paired paraf-fin embedded HCC specimens and pericarcinoma tissues using immunohistochemical staining ,and the relation of the expression of GOLPH3 to clinicopathologic features was analyzed. Meanwhile,the expression and distribution of GOLPH3 in HCC cells was observed by laser confocal mi-croscopy. Results The positive expression rates of GOLPH3 in HCC and pericarcinoma tissues were 70.0%(92/132)and 42.4%(56/132) (P<0.001),respectively. The incidence of portal vein tumor thrombus in high and low GOLPH3 expression groups of HCC were 21.2%(14/66) and 6.1%(4/66)(P<0.05),respectively. The expression rate of GOLPH3 in HCC was significantly higher than that in pericarcinoma tissues, and the expression of GOLPH3 in HCC was positively related to portal vein tumor thrombus. In addition ,GOLPH3 was mainly expressed in cyto-plasm of HCC cells,and there was also scattered distribution in the nucleus. Conclusion GOLPH3 acts as an oncogene and may play vital roles in the carcinogenesis and development of HCC.

OBJECTIVE:To investigate the safety of induction chemotherapy and the implementation method of consolidation radiotherapy in young children with high-risk Hodgkin lymphoma(HL),by evaluating the effects of intensive induction chemother-apy on consolidation radiotherapy. METHODS:Six pediatric patients with high-risk HL received low-dose involved field radiation therapy (IFRT) via volumetric modulated arc therapy (VMAT) following 6 cycles of intensive chemotherapy [Ara-C/VP16 (cyto-sine arabinoside+etoposide),ABVE-PC(adriamycin+bleomycin+leurocristine+etoposide+metacortandracin+cyclophosphamide)and CHOP(cyclophosphamide+leurocristine+adriamycin+ prednisone)in turn]. Therapeutic efficacy and toxic effects were evaluated af-ter treatment. RESULTS:Intensive induction chemotherapy and consolidation radiotherapy were acceptable by young children,and mild acute or subacute toxic reaction were observed. Intensive induction chemotherapy didn’t affect toxic effects of consolidation ra-diotherapy. In this regimen,the cumulative doses of bleomycin and adriamycin were 20 mg/m2 and 270 mg/m2,respectively. VMAT optimized plan to ensure that the dose that involved organs received was safe. In the patient with mediastional radiation therapy,the mean lung and heart doses were 525.6 cGy and 503.9 cGy,respectively. CONCLUSIONS:It is safe to give high-risk HL young children 6 cycles of intensive induction chemotherapy(Ara-C/VP16,ABVE-PC and CHOP in turn)before radiotherapy. It is feasi-ble to conduct IFRT with 18-20 Gy and an additional 20-25 Gy boost,1.5-1.8 Gy/fraction. VMAT deserves to be advised.

Objective To observe the effect of acupuncture combined with integrated Chinese-Western neuromuscular facilitation technique on persistent vegetative state (PVS).Methods41 PVS cases were randomly divided into the observation group (n=21) and control group (n=20). The observation group was treated with acupuncture, neuromuscular facilitation technique combined with reasonable obligatory exercise, neuromuscular electrical stimulation, manipulation treatment and Chinese medicine. The control group was treated with the Western and Chinese medicines, and hyperbaric oxygen.ResultsAfter 1～3 months treatment, 7 cases cured,8 cases were markedly effective, 5 cases were effective, 1 cases were ineffective in the observation group with a total markedly effective rate (71.4%) and effective rate (95.2%). While, in the control group, 3 cases cured, 5 cases were markedly effective, 6 cases were effective, 6 cases were ineffective and total markedly effective rate was 40%, effective rate was 70%. There was a significant difference between the two groups in the total markedly effective rate and the effective rate ( P<0.05). The average PVS score increased by 7.46±1.22 in the observation group and 4.59±1.21 in the control group. Also there was a significant difference between the two groups ( P<0.001).ConclusionThe therapy of acupuncture combined with integrated Chinese-Western neuromuscular facilitation technique can markedly promote PVS patients coming round and improve patients' prognosis.

Objective To find out the significance of different radiologieal examinations in the di-agnosis of the prostate carcinoma through studying their radiological misdiagnosis rate. Methods By searching for patients having radiological examination results in the database of prostate carcinoma in Tianjin,got the patients whose examination results were different from prostate carcinoma. Analyzed the misdiagnosis rate of each kind of imaging diagnosis using x2-test retrospectively. Results In all patients searched, the misdiagnosis rate of transabdominal ultrasonography, transrectal uhrasonography (TRUS), CT , MRI was 45.1%, 10.1%, 34.5% and 7.5% respectively. Statistical analysis showed that the misdiagnosis rate of MRI was the lowest, then TRUS, and CT. Transabdominal ultrasonography had the highest misdiagnosis rate. There was not significant difference between MRI and TRUS. Conclusions As an efficient and important screening method, transabdominal ultrasonography still need to get a higher definite diagnosis rate. TRUS don't have obvious advantages over pelvis MRI in the diagnosis of prostate carcinoma except its usefulness in the biopsy of prostate. Pelvis MRI is still the most important imaging diagnosis of prostate carcinoma and should be first choice because of its noninvasive intervention, convenience and lowest misdiagnosis rate.

Objective To investigate the role of large-diameter magnetic resonance imaging (MRI) simulation in target volume delineation in radiotherapy for nasopharyngeal carcinoma (NPC).Methods Eighteen patients with NPC underwent computed tomography (CT) simulation and MRI simulation scans and localization in the same body position,with SOMATOM Sensation Open 40-row 82-cm large-diameter CT simulator and Siemens 3T MRI MAGNETOM Skyra 70-cm large-diameter simulator,respectively.The gross tumor volume (GTV) and parotid glands were delineated on all images according to the ICRU Report 50/62,and MRI was applied to observe the changes in GTV and parotid volume during radiotherapy.Paired t-test was applied to analyze the differences between GTVCT and GTVMRI and between GTVnx-CT and GTVnx-MRI.Results GTVMRI decreased significantly compared with GTVCT,and the average volume decreased from (213.64±84.59) cm3 to (199.68±84.69) cm3(p=0.006).As for the volume of primary lesions in the nasopharynx,GTVnx-MRI was significantly smaller than GTVnx-CT,and the volume decreased from (95.75± 24.76) cm3 to (88.12±26.25) cm3 (P =0.001);as for the volume of cervical lymph nodes,GTVnd-MRI was significantly smaller than GTVnd-CT,and the volume decreased from (117.89± 72.69) cm3 to (111.56± 70.69) cm3 (P=0.018).The targets delineated by CT and MRI did not overlap completely,with major differences in skull base bone and cervical soft tissue.The volume of both parotid glands delineated on MRI image was higher than that delineated on CT image,with a major difference in the deep lobe.MRI showed that GTV was reduced by 82.64± 16.87％ during radiotherapy,and the volumes of the left and right parotid glands were reduced by (32.7± 23.95) ％ and (34.7± 21.72) ％,respectively.Conclusions The delineation of target volume based on MRI simulation is more accurate than that based on CT simulation and can achieve a smaller volume range,which helps to guide target volume delineation in radiotherapy for NPC accurately.

Objective To evaluate the therapeutic effects and complications of modified facial mask for non-invasive ventilation (NIV) in elderly patients with respiratory failure.Methods A total of 132 elderly patients(107 males and 25 female,aged 78.5±8.6 years) treated with NIV from February 2008 to May 2011 were randomized into two groups:modified facial mask(group A,n=68,56 males and 12 females,aged 78.8±22.2 years) and control facial mask(group B,n=64,64 males and 13 females,aged 76.6±20.4 years).Duration of NIV,time in RICU(respiratory intensive care unit),length of hospital stay,risk for hospital acquired pneumonia (HAP),risk for invasive ventilation,cure rates,in-hospital mortality,NIV failure rate and cost were compared between the two groups.The complications of NIV,such as oropharyngeal dryness,skin damage of face and nose,abdominal bloating,gas leakage from mask were also compared between the two groups.Results Compared with group B,duration of NIV(12.2±2.3 d vs.18.4±3.6d),time in RICU(7.3±3.2d vs.14.6t5.4d),length of in hospital stay(16.6±4.2d vs.28.2±6.2)d,and cost(2.23±0.12 ten thousand yuan vs.4.23± 0.24 ten thousand yua) in group A were significantly decreased(t=9.72,14.91,13.08,10.81 respectively,all P＜0.05).The risk for invasive ventilation [2.9％ (2 cases) vs.43.8％(28 cases)],NIV failure rate [5.9％ (4 cases) vs.12.5％ (28 cases)] were also decreased in group A compared with group B(x2 =31.26,25.74,both P＜0.05).Compared with group B,The complications of NIV such as skin damage of face and nose[4.4％ (3 cases) vs.37.5％ (24 cases)],abdominal bloating [2.9％ (2 cases) vs.28.1％ (18 cases)],gas leakage from mask [8.8 ％ (6 cases)vs.50％(32 cases)] in group A were significantly decreased(x2 =31.26,25.74,all P＜0.05).Conclusions Modified facial mask for NIV is effective in the treatment of elderly patients with respiratory failure.The complications and in-hospital mortality are reduced with the application of modified facial mask for NIV and it is highly tolerated by patients.Modified facial mask for NIV is the first choice in the treatment in elderly patients with respiratory failure.

Objective To study the diagnosis and treatment of Mycobacterium avium complex lung disease with severe renal insufficiency,and to provide a basis for improving the clinical diagnosis and treatment of MAC lung disease with severe renal insufficiency.Methods Clinical data of an elderly patient with MAC lung disease confirmed by induced sputum culture and complicated with chronic kidney disease (CKD 4) was reported.The related literatures at home and abroad were reviewed.Results A male patient aged 80 years with poor nutrition was suffering from progressive weight loss,exhaustion and night sweats.His weight was only 43-44 Kg.Chest CT showed that multiple small nodules,small spot pieces of shadow and ground glass shadows in bilateral lung tissues.PET/CT indicated that spot pieces and nodules with metabolic activity in high performance.Bronchoalveolar lavage fluid (BALF) inspection was negative.MAC was identified by induced sputum culture through high permeability brine induced sputum.It was difficult to choose drugs for the treatment of MAC lung disease due to his poor kidney function [GFR of left kidney:9.0 ml /min,GFR of right kidney:18.8 ml/min].Conventional anti-mycobacterium drugs showed a low to high resistance to MAC.Moxifloxacin was discontinued for renal insufficiency.His condition was stable after choosing trimodality therapy including azithromycin 0.25 g/d tiw,rifapentine 0.3 g/d biw,ethambutol 0.375 g /d tiw and the joining immunotherapy.Conclusions PET/ CT is not useful in identifying tuberculosis and MAC lung disease.The treatment of MAC lung disease is difficult in elderly patients with severe renal insufficiency and low weight.Individual therapy combined with immunotherapy and improving the nutrition state is a good choice for the treatment of MAC lung disease in elderly patients with severe renal insufficiency.The anti-MAC drugs should be carefully selected and the adverse reactions should be closely observed in order to obtain the satisfactory clinical results.