Objective To investigate the clinical features,diagnosis,treatment and prognosis of gastric neuroendocrine carcinoma (G-NEC).Methods Clinical data of 52 G-NEC cases were analyzed.Follow-up was conducted by telephone.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test and multivariate analysis was performed by COX proportional hazards model.Results The median overall survival rate was 19 months (range 6 to61 months),and the overall 1,3,5-year survival rates were 74％,16％ and 5％ respectively.Tumor stage surgery,vascular nerve involvement and Ⅲ and Ⅳ phase chemotherapy were related to prognosis (x2 =24.254,10.005,7.261,8.790,all P ＜ 0.05).Multivariate analysis showed tumor stage and vascular nerve involvement were independent prognostic factors (x2 =17.170,5.810,all P ＜ 0.05).Conclusion G-NEC is a highly malignant tumor with poor prognosis.Preoperative diagnosis rate is low.Surgery is the treatment of first choice.Definite diagnosis depends on postoperative pathology and immunohistochemical examination.

Magnetic resonance diffusion-weighted imaging (MR-DWI) is a functional technology at the molecular level.Compared to other imaging exams (such as DSA,CT,US),DWI is non invasive,has no radiation,and objective.Thus,it is widely accepted in clinical settings.As a means to assess the therapeutic efficacy of intervention,DWI has a promising prospect.In this article,we review the application of MR-DWI in evaluating the therapeutic efficacy of hepatocellular carcinoma intervention.

Objective To explore the regularity of changes of plasma endothelin (ET), throm-boxame B2(TXB2) and 6-keto-prostaglandin F1α(6-keto-PGF1α) and restenosis after percutaneous transluminal angioplasty (PTCA) in patients with coronary heart disease. Methods Radioimmunoas-say was applied to measuring plasma levels of ET, TXB2and 6-keto-PGF1αat 0,30 min, 1 day and 3 days after PTCA in 41 patients with coronary heart disease. Results The level of ET in the patients with coronary heart disease was significantly decreased in 30 minutes after PTCA (P＜0.05), but no significant difference was observed in 1 day and 3 days after PTCA (P>0.05). The level of plasma TXB2has no statistical difference after PTCA in 30minutes, 1 day and 3 days (P>0.05). The level of 6-keto-prostaglandin F1α(6-keto-PGF1α) of the patients with coronary heart disease was significantly declined in 30 minutes after PTCA (P<0.05) ,but no significant difference was observed in 1 day and 3 days after PTCA (P>0.05). Conclusion PTCA may lead to fluctuation of plasma levels of ET, TXB2and 6-keto-PGF1αThe clarification of changing regularity of these vasoactive substances contrib-utes to prevention of acute artery occlusion or restenosis after PTCA.

BACKGROUND: Tissue-engineered spinal cord has brought new treatment ideas for spinal cord repair.OBJECTIVE: To construct the tissue-engineered spinal cord by chitosan alginate scaffold and adipose-derived mesenchymal stem cells (ADMSCs), and to investigate its repairing effects on acute spinal cord injury in rats.METHODS: The spinal cord hemisection model was established in 48 Sprague-Dawley rats and then, rat models were randomly divided into four groups: model group, scaffold group, ADMSCs group and tissue-engineered spinal cord group,followed by direct suturing of the dura mater, implantation of chitosan alginate scaffold, implantation of ADMSCs, and implantation of tissue-engineered spinal cord, respectively. The limb motor function of rats was evaluated based on the Basso-Beattie-Bresnahan score at 1, 3, 7 weeks after transplantation. Immunofluorescence staining and hematoxylin-eosin staining of the spinal cord specimens were performed at 7 weeks after transplantation.RESULTS AND CONCLUSION: (1) Motor function of the hind limb: At 3 and 7 weeks after transplantation, the Basso-Beattie-Bresnahan score was highest in the tissue-engineered spinal cord followed, followed by the ADMSCs and scaffold groups, and lowest in the model group (P < 0.05). (2) Immunofluorescence and hematoxylin-eosin staining: in the model group, the spinal cord injury area was infiltrated with a large number of fibroblasts and inflammatory cells. In the scaffold group, there was no scar formation; neuron-specific enolase-positive cells, glial fibrillary acidic protein-positive cells and a few neurofilament protein 200-positive cells were found in the junctional area. In the ADMSCs group, the spinal cord injury area was filled with scar tissue, and a large number of glial fibrillary acidic protein-positive cells were found. In the tissue-engineered spinal cord group, there was no scar tissue, and there were a large number of neuron-specific enolase-positive cells, a small amount of CM-Dil-labeled ADMSCs and more glial fibrillary acidic protein-positive cells. Neurofilament protein 200 positive cells were connected to each other at the junction. These findings indicate that the tissue-engineered spinal cord constructed by chitosan alginate scaffold and ADMSCs can promote spinal cord repair after acute spinal cord injury.

Objective To observe the clinical effect of penehyclidine hydrochloride(Changtuoning)combined with atropine in treatment of patients with severe acute organophosphorus poisoning(AOPP). Methods The clinical data of 64 patients with severe AOPP admitted into Taizhou Municipal Hospital in Zhejiang Province and Quannan County People's Hospital in Jiangxi Province from January 2004 to September 2012 were retrospectively analyzed. Patients were divided into penehyclidine hydrochloride and atropine combined group(PH-A group,32 cases)and atropine treatment group(32 cases)depending on the difference in selection and application method of anticholinergic drugs. The application of anticholinergic drugs,length of mechanical ventilation,70%cholinesterase (ChE)activity recovery time,length of stay in hospital,incidence of complications,and cure rate were compared between the two groups. Results Compared with atropine treament group,the total usage of atropine in PH-A group was significantly decreased(mg:35.39±45.76 vs. 105.46±139.87,P<0.05),the length of mechanical ventilation (days:5.3±4.2 vs. 7.8±6.8,P<0.05),70%ChE activity recovery time(days:8.2±3.8 vs. 11.0±5.4,P<0.05), and length of stay in hospital(days:12.0±3.8 vs. 14.6±5.3,P<0.05)were significantly shortened in PH-A group, and the overall incidence of complications were significantly lowered in PH-A group〔68.75 %(22/32)vs. 93.75%(30/32),P<0.05〕. The difference in cure rate between the combined group and atropine treatment group was not statistically significant〔96.87%(31/32)vs. 90.62%(29/32),P>0.05〕. Conclusion Penehyclidine hydroehloride combined with atropine in the treatment of severe AOPP can significantly improve the therapeutic efficacy,reduce the incidence of complications and length of stay in hospital.

Objective To summarize overlapping tissue expansion of neck without platysma in repairing maxillofacial and neck scar contracture deformity.Methods Two expanders were buried in the same soft tissue pocket superficially to the platysma in an overlapping pattern,water injection were on schedule,and secondary operation was performed after 4 to 6 weeks.Results 16 cases of maxillofacial and neck scar contracture deformities were treated with overlapping tissue expansion of neck without platysma since 2004.Good results were achieved except one case of expander exposure,but the final resuit was good after suitable treatment.Conclusion The overlapping tissue expansion technique can provide much more expanded tissue and reduce complications compared with the traditional expansion technique,especially using overlapping tissue expansion of neck without platysma for repairing the defects at the maxillofacial and cervical region.

Objective To determine the optimal volume proportion of iodize d oil (Lipiodol)-ethanol mixture by comparing the clinical efficacy of transhepatic arterial embolization-ablation therapy using different volume proportion of Lipiodol-ethanol mixture in treating experimental rabbit models with VX 2 liver cancer. Methods VX2 tumor was implanted in eighteen adult male New Zealand white rabbits. The 18 VX 2 rabbit models were randomly and equally divided into the following six groups according to the Lipiodol-ethanol volume ratio ∶ group A (3 ∶ 1), group B (2 ∶ 1), group C (1 ∶ 1), group D (1 ∶ 2), group E (1 ∶ 3) and group F (1 ∶ 4). One week after the treatment, all the rabbits were sacrificed and their livers were removed and sent for pathologic examination. The tumor growth rate, the microvascular density, the apoptosis index (AI) of tumor tissues and the injury of the hepatic tissue adjacent to the tumor were evaluated. Results After the treatment, the tumor’s size was increased in group A, E and F. The tumor growth rate of group A was significantly higher than that of the other five groups , and the difference was statistically significant (P<0.05). The tumor’s size of groups B, C and D was decreased, although the difference was not significant when compared with the tumor’s size of groups E and F (P > 0.05). The proportion of ethanol in Lipiodol ∶ethanol mixture bore a negative relationship to the microvascular density counts (R2= 0.840, F = 89.432, P < 0.001). AI of group A was strikingly lower than that of groups C, D, E and F (P < 0.05). The difference in AI between group A and group B was not significant (P > 0.05), while the difference in AI between group B and group C or between group B and group F was statistically significant (P<0.05), and no significant difference in AI existed between each other among other groups (P > 0.05). The injury extent of the hepatic tissue adjacent to the tumor in group A and B was remarkably milder than that of other groups (P < 0.05). Conclusion When considered in terms of safety, the optimal volume proportion of Lipiodol-ethanol mixture should be 2 ∶ 1. Successful super-selective catheterization of the tumor feeding artery, strict and close fluoroscopic monitoring of the injection and proper increase in the proportion of ethanol can definitely improve the therapeutic efficacy.

Objective To investigate the clinical value of face scar deformity by small-capacity tissue expansion. Methods A small-capacity expander of 10~100 ml was implanted into the hypoderm, and then regular affusion was made with injection pot outside or inside. After expanding for four weeks to eight weeks, the expander was removed and the removing wound surface of scar was repaired with flap. Results After clinical application in 32 cases, there were complications such as infection and expander's exposure occurred in two cases, but the final result was good after suitable treatment. All cases were satisfied with unclear scar after 6 to 36 months’ follow-up. Conclusions Positive cosmetic effect can be received with small-capacity tissue expansion.

Objectiye To observe the prevalence of prolonged seizures and the changes of biochemical markers of myocardial injury in patients with prolonged seizures after modified electroconvulsive therapy(MECT).Methods Patients treated with MECT or simulated ECT were divided into three groups.Group Ⅰ , 26 patients,experienced at least one prolonged seizure after MECT;group Ⅱ,41 selected patients, had not prolonged seizures at all during a course of MECT treatments and group Ⅲ, 31 patients, received simulated ECT.Biochemical markers of myocardial injury, including phosphocreatine kinase (CK), MR isoenzyme of phosphocreatine kinase (CK-MB), lactate dehydrogenase ( LDH ), α-hydroxybutyrate dehydrogenase ( α-HBDH ) and cardiac troponin (cTnT) ,were measured immediately, 3 hours later and on the following day after the first prolonged seizure for group Ⅰ ,the same time points as group Ⅰ after the first treatment of MECT for group Ⅱ , immediately after simulated ECT for group Ⅲ.These indexes were compared between the patients of three groups.Results The positive rate ofcTnT was 30.8%(8/26) and 17.1% (7/41)in group Ⅰ and Ⅱ respectively, but no difference was found(P＞0.05 ).CK measured immediately after MECT in patients of group Ⅰ was significantly higher than that of group Ⅲ(P ＜ 0.05 ).CK-MB (immediately), LDH ( immediately and 3 hours later) and α-HBDH ( immediately, 3 hours later and on the following day) in patients of group Ⅰ were significantly higher than those of group Ⅱ and Ⅲ measured after MECT or simulated ECT(P＜0.05 ).Conclusion More attention should be paid that absolute or relative hypoxemia may lead to minor myocardial injury.

Objective To investigate the effects of ISO-1, a selective MIF tautomerase activity inhibitor, on liver metastasis in a BALB/c mouse model of colonic cancer. Methods Micmporous migration assay was used to determine the effect of ISO-1 on the invasion abilities of CT26 cells. Orthotopic transplantation of fresh colonic tumor fragments into the hernial sac of cecum was used in a BALB/c mouse model of eolorectal cancer. Thirty mouse models were divided into three groups and treated respectively with ISO-1 (0. 2 ml, 20 mg/kg), 5% DMSO and NS ( normal sodium) twice a week, iutraperitoneally. After 4 weeks, mice were sacrificed and the whole livers were made into serial slices to detect the occurrence of liver metastasis. Serum MIF tautomerase activities were measured using L-dopachrome methyl ester, ELISA was used to test serum VEGF concentrations. Immunohistochemical staining of CD31 was used for comparing microvascular density (MVD) of tumor tissues. Results 100 μmol/L ISO-1 treatment for 24 hours significantly reduced the average number of the cells penetrating polycarbonates, ( 151 ± 19 ) vs. ( 178 ± 9 ), P<0. 01. Serum MIF tautomerase activities were significantly inhibited after ISO-1 treatment (51% vs. 81%, P <0. 01 ). Compared with DMSO and NS treatment, ISO-1 decreased the occurrence of liver metastasis ( 10% ,60% and 70% ,respectively;x2 = 8. 30, P < 0. 05 ). Also ISO-1 decreased serum VEGF levels ( 15 ± 7 ) pg/ml, ( 63 ± 11 ) pg/ml and ( 67 ± 8 ) pg/ml, respectively; P < 0. 01 and the MVD of tumor tissues (17±4) ,(36±7) and( 38±5) ,respectively; P<0. 01. Conclusion In vitro ISO-1 inhibits the invasion ability of CT26 cells. In vivo ISO-1 reduces the occurrence of liver metastasis, possibly by a mechanism of inhibiting MIF tautomerase activities, down-regulating the expression of VEGF and reducing MVD.