Objective To evaluate the value of tumor necrosis factor -α( TNF-α) ,leptin ( LEP) ,interleu-kin-6 (IL-6) and carcinoma embryonic antigen (CEA) in both serum and pleural effusion in differential diagnosis of tuberculosis and malignant tumor .Methods Detection were performed on tuberculosis and malignant tumor patients,comparation was conducted on the level and positive ratio of TNF -α,LEP,IL -6 and CEA in different groups.Results The levels of TNF-α,LEP,CEA in serum decreased significantly compared with malignant tumor patients[(34.45 ±17.11)μg/L vs (70.26 ±19.31)μg/L,(490.71 ±197.58)μg/L vs (2 013.62 ±596.22)μg/L, (226.81 ±87.09)μg/L vs (5 329.62 ±1 523.58)μg/L;t=5.221,9.673,12.078;P=0.012,0.031,0.000],but IL-6 was not [(159.73 ±30.33)μg/L vs (22.31 ±3.20)μg/L;t=-16.114;P=0.001];The level of TNF-α, LEP,CEA in pleural effusion was decreased significantly compared with malignant tumor patients [( 20.31 ± 5.62)μg/L vs (42.06 ±14.07)μg/L,(702.46 ±375.01)μg/L vs (4 532.27 ±2 307.83)μg/L,(112.25 ± 48.72)μg/L vs (4 190.84 ±1 534.29)μg/L;t=5.017,12.096,12.236;P=0.022,0.016,0.033],but IL-6 was not [(92.15 ±32.64)μg/L vs (10.29 ±3.91)μg/L,t=-11.583;P=0.031].The positive ratio of TNF -α, LEP,CEA in serum was decreased significantly compared with malignant tumor patients (17.8% vs 72.2%,20.0%vs 91.7%,0.0% vs 100.0%;χ2 =24.341,41.145,81.000;P =0.000,0.000,0.000),but IL -6 was not (100.0%vs 0.0%,χ2 =81.000;P=0.000);The positive ratio of TNF -α,LEP,CEA in pleural effusion was decreased significantly compared with malignant tumor patients (28.9% vs 75.0%,4.4% vs 100.0%,0.0% vs 97.2%;χ2 =17.012,73.326,77.038;P=0.000,0.000,0.000),but IL -6 was not(97.8% vs 0.0%,χ2 =77.059;P=0.000).Conclusion The level and positive ratio of malignant tumor patients are higher than tuberculo-sis patients,but IL-6 is not,these indicators are helpful in diagnosing tuberculosis and malignant tumor .

BACKGROUND:There are many methods that can repair Pilon fracture, but the effects are not ideal. With the development of science and technology, fundamental change of fracture fixation principle and innovation of technology and idea has brought new opportunities for Pilon fracture repair. Biological immobilization technology can further reduce the further damage to blood supply of bone outer membrane on the fracture end, do not disturb biomechanical environment of fracture healing, and is the new trend of present research and development. OBJECTIVE:To investigate the effect of locking compression plate fixation for repair of Pilon fracture using biological fixation technique. METHODS:Clinical data of 76 patients with Pilon fracture treated using locking compression plate fixation in the Nanhai District Economic Development Zone Guanyao Branch of the People’s Hospital from June 2008 to December 2013 were retrospectively analyzed. There were 49 males and 27 females, at the age of 39.5 years on average (range from 19 to 60 years). According to Ruedi-Algower classification, there were 54 cases of type II and 22 cases of type III. In accordance with biological fixation technique, locking compression plate fixation was applied to treat Pilon fracture. Folowing treatment, they were regularly folowed up. Reduction quality was assessed by Burwel-Charnley radiological criteria. X-ray films were reviewed to observe fracture healing. During final folow-up, ankle function was evaluated according to Baird-Jackson score. RESULTS AND CONCLUSION:A total of 76 patients were folowed up for 6 to 24 months. Reduction quality assessed by Burwel-Charnley radiological criteria was as folows: anatomic reduction of 68 cases, reduction of 8 cases, 71 cases of one-stage wound healing, and 5 cases of wound healing after dressing change, with the rate of one-stage healing of 93%. Fractures of al patients were healed. The healing time was 4 to 8.5 months, averagely 6.25 months. During final folow-up, ankle function assessed by Baird-Jackson score was as folows: there were 69 excelent cases, 5 good cases and 2 average cases. These results indicate that locking compression plate fixation for Pilon fracture obtained good stability, could effectively avoid the damage of fracture end blood supply, shorten the healing time; it was simple to operate, had smal injury to soft tissue, and was an effective fixation method to repair Pilon fracture.

Objective:To investigate the onset mechanism of cervical vertigo from the proprioceptive sensation and provide clinical basis for its treatment.Methods:Among the 121 cases that conformed to the diagnostic criteria of cervical vertigo,70 cases who presented with negative neck-rotation test and cervical vertigo without obvious vascular factors by transcranial Doppler(TCD)were assigned to the observation group,while 51 cases who presented with positive neck-rotation test and cervical vertigo due to spasm of vertebral basal artery or insufficient blood supply by TCD were assigned to the control group.The cases in the two groups were treated once every day,5 days make up one treatment course and the resuIts were statistically analyrzed after one treatment course.Results:The skull triaxial spatial offset of the cases in the two groups were significantly reduced after the treatment (P<＜0.01).However, there was no statistically significant difference between the skull triaxial spatial offset between the two groups (p＞0.05).It is not conclusive that the therapeutic effect in the two groups was significantly different after one treatment course.Conclusion:Tuina manipulation therapy can improve the skull spatial ofrset repositioning ability of the Patients.

Objective To investigate the clinical efficacy of the curettage and aspiration technique in laparoscopic radical gastrectomy for the treatment of gastric cancer.Methods The clinical data of 55 patients who received laparoscopic radical gastrectomy by curettage and aspiration technique with Peng's multifunctional operative dissector at the Shaoxing People's Hospital from June 2008 to February 2011 were retrospectively analyzed.Tumors located at the upper stomach in 10 patients,at the middle stomach in 15 patients and at the lower stomach in 30 patients.The numbers of patients had tumor in TNM stage Ⅰ,Ⅱ,Ⅲ A were 16,35 and 4.Patients were followed up via phone call and out-patient examination till October 2013.Results Laparoscopic radical gastrectomy was successfully carried out on all the 55 patients.Of the 55 patients,39 received laparoscopic distal subtotal gastrectomy and 16 received laparoscopic total gastrectomy.The operation time,volume of intraoperative blood loss,number of lymph nodes dissected,distances of proximal and distal resection margins to the tumors,time to flatus,time to fluid diet and duration of postoperative hospital stay and incidence of postoperative complications were (241 ± 42)minutes,(273±115)mL,32 ±9,(5.8±1.4)cm,(5.1 ±l.7)cm,(78 ±24)hours,(95 ±17)hours,(12 ±4)days and 7.3％ (4/55),respectively.Two patients were complicated with pulmonary infection,1 with anastomotic fistula,1 with incisional infection,and all of them were cured by symptomatic treatment.No patients died perioperatively.All the 55 patients were followed up for 12.0-55.0 months,and the mean time of follow-up was 35.9 months.The cumulative 48-month survival rate was 54.8％.The postoperative recurrence and metastasis rate was 10.9％ (6/55).Peritoneal metastasis was detected in 2 patients,liver metastasis in 1 patient,para-aortic nodes metastasis in 1 patient,residual gastric metastasis in 1 patient,and bone metastasis in 1 patient.Conclusion Laparoscopic radical gastrectomy by curettage and aspiration technique is safe and feasible,with the advantages of minimal trauma,low morbidity and quick recovery.

Objective:By comparing the comprehensive differences between volume-modulated arc therapy (VMAT)-and CyberKnife-6D Skull (CK-6D Skull) tracking technology-based stereotactic radiotherapy (SRT) plans in the treatment of multiple brain metastatic tumors, and explore the advantages of multi-target intracranial technology.Methods:Clinical data of 42 patients with more than 2 brain metastases who received STR between January 2017 and August 2018 were retrospectively analyzed. For each patient, two radiotherapy plans were designed by selecting CK-6D Skull and VMAT technologies. The quality of VMAT and CK-6D Skull was compared by calculating the gradient index (GI), dose sag volume and organ at risk (OAR) of target area. The total number of monitor unit and single treatment time were recorded to compare the execution efficiency of these two technologies.Results:The GI of intracranial 2-target and 3-target plans of CK-6D Skull technology was significantly superior to that of VMAT technology ( P<0.05). The GI did not significantly differ between the 4-target and the 5-target groups ( P>0.05). The contribution of these two technologies to the maximum dose of OAR was not significantly different ( P>0.05), whereas the treatment time of VMAT technology was shorter ( P<0.05). Conclusions:Both technologies can meet the requirements of clinical SRT for multiple brain metastatic tumors. From the perspective of treatment plan and implementation, SRT based on CK-6D skull technology is recommended for patients with less than 4 intracranial metastatic tumors, and VMAT-based SRT is considered for those with > 4 metastatic tumors. Patients with poor physical condition and difficulty in maintaining a fixed position for a long time shall give priority to VMAT technology. More differences between these two technologies in the implementation of SRT for intracranial multiple brain metastases remain to be elucidated by more case data for statistical analysis.

Objective To explore the clinical value of an auxiliary set-up method with fiducial markers and Synchrony tracking implanted in spine during Cyber-knife stereotactic radiotherapy by comparing the rotational setup errors between auxiliary setup with less than and more than three fiducial markers.Methods A total of 145 cases of tumor patients with fiducial tracking and Synchrony tracking were selected for radiotherapy,including 94 cases in the observation group (＜3 fiducial markers) and 51 cases in the control group (≥ 3 fiducial markers).Before treatment,one spinal alignment plan was added to all the cases in the observation group,and the rotation deviation of the selected spinal distance and the assisted spinal alignment correction of the fiducial marker tracking and the fiducial marker respiratory tracking were counted respectively,and the result of the rotation deviation calculated in the observation group and the control group were analyzed.Results Fiducial tracking spine auxiliary setup result:fiducial marks and selected the spine center distance ＜ 20,20-40,40-60,60-80 and ＞ 80 mm rotating statistical average deviation (0.494±0.350) °,(1.291±0.590) °,(1.705±0.739) °,(2.512±0.761) ° and (2.796± 1.081) °,respectively,rotate observation group and control group total deviation (1.742±0.784) °,(1.805±0.562) °,respectively.Synchrony tracking result in the above case rotation statistical average deviation was (1.190± 0.547) °,(1.956± 0.735) °,(2.141 ± 0.670) °,(2.957±0.648) ° and (4.027±0.695) °,respectively,while rotation total deviation in observation group and control group (2.619±0.906) °,(2.233 ±0.763) °,respectively.There was no significant difference in the rotation deviation between the assisted spinal set-fup and the calculation of rotation deviation between the fiducial tracking and the synchrony tracking (P ＞ 0.05).Conclusions In the fiducial tracking treatment,the range of rotation deviation for the spinal auxiliary set-up correction increases with the increase of the distance between the fiducial markers and the selected spinal center.When the distance between the fiducial marker and the selected spinal is less than 60 mm,the rotation deviation calculated by the spinal auxiliary setup has the same tumor rotation correction effect as that calculated by the fiducial markers.When less than 3 fiducial markers are available and the minimum distance between the fiducial marks and the center of the adjacent spine is relatively close (＜ 60 mm),the deviation of the rotation direction of the tumor can be calculated by adding the spinal auxiliary setup plan.