Objective To investigate the clinical characteristics,diagnosis,therapy and maternal and perinatal prognosis of generalized pustular psoriasis of pregnancy.Methods Clinical data for seven inpatients with generalized pustular psoriasis of pregnancy were retrospectively analyzed from January 1,2005 to December 31,2012.Results Three patients had family history of psoriasis and five had previous history of psoriasis.All skin lesions were large patches of erythema,with needlepoint to miliary size pustules and scales.Two patients had oral involvement and three had nail involvement.Biopsy and bacterial culture were performed on five patients,in whom histopathological changes of pustular psoriasis were found,and bacterial culture was negative except in one patient.Among the patients,four had confirmed cause of disease; six patients were complicated with fever; four had increased leukocytes; seven had elevated neutrophils and C-reactive protein;five had increased total protein; and six had increased albumin.The disease was diagnosed according to the clinical manifestations and laboratory tests.Comprehensive treatment with glucocorticosteroids,antibiotics and local treatment were performed.Four patients had live births,and three patients underwent odinopoeia.Two babies were healthy,one had died,and another had varus foot deformity.Three patients had pustular relapse after labor.Conclusions Fetal-placental functions of patients with generalized pustular psoriasis of pregnancy should be monitored closely.Early diagnosis,treatment and termination of pregnancy can improve the maternal and perinatal prognosis.

Objective To study the relationship of matrix metalloproteinase 7(MMP7)expression to the infiltration and metastasis of malignant melanoma.Methods Various concentrations(10,20,30 μmol/L)of heparanase antisense oligodeoxynucleotide (ASODN)was used to transfect human malignant melanoma cell line A375.Then,the transfected cells were subcutaneously inoculated into the right back of nude mice.Six weeks after the inoculation,transplanted tumors were isolated from the mice,and the levels of MMP7 protein expression were assessed by SP immunohistochemistry.The expression rate of MMP7 was also examined by SP immunohistochemistry in A375 cells and in tissue samples from patients with malignant melanoma(n=30),iunctional nevus(n=30)and normal human controls(n=15).Results The expression rate of MMP-7 was 83.33%(25/30),6.67%(2/30)and 0(0/15)respectively in malignant melanoma,iunctional nevus and normal skin tissue samples;there was a significant difierence in the positivity rate of MMP-7 between the malignant melanoma group and iunctional nevus group (x2=35.62,P=0.000)as well as normal control group(x2=28.12,P=0.000),but not between the junctional nevus group and normal control group(P＞0.05).The expression of MMP-7 in transplanted tumor was decreased to a varying degreee by three levels of ASODN,and the inhibitory effects of 30 mol/L ASODN were the strongest(P＜0.05).MMP-7 protein was also highly expressed in A375 cells.Conclusions The expression of MMP-7 in cutaneous malignant melanoma is higher than that in iunctional nevus and normal skin tissue.Hpa-ASPDN significantly inhibits the expression of MMP-7 in transplanted tumors in nude mice.MMP-7 is highly expressed in A375 cells.

Objective Measure the epicondyles of the distal femur on magnetic resonance image(MRI), in order to locate presicely the surgical transepicondylar axis(STEA) in total knee arthroplasty(TKA) and to provide theoretical basis for the designing of the size of the femoral component. Methods Totally 78 normal knees of Chinese individuals were studied. The images of coronal, sagittal and traverse sections of the knee were obtained by magnetic resonance image. Measurement included the width of the STEA, distance between the epicondyles and the joint line, anterior posterior width of the medial and lateral epicondyles, posterior condyle angle. Results The width of the STEA averaged(79.55±4.90)mm in males, and femles(71.18±4.22)mm. The distance from the epicondyles to the joint line was correlated with the width of the STEA, so was the anterior posterior width of epicondyles. PCA averaged(4.22±2.07)°. Conclusion The size of the epicondyles in Chinese is significantly smaller than that of the Westerns. The ratio between anterior posterior width of the medial epicondyle and the width of the STEA is 0.84, and is 0.87 between anterior posterior width of the lateral epicondyle and the width of the STEA. The distance from the epicondyles to the joint line is helpful to locate the STEA. The reliability is poor to locate the STEA by touch or PCL.

Intensity modulated radiation therapy(IMRT)has become the mainstay of treatment modal-ity for nasopharyngeal carcinoma(NPC). The whole treatment course generally continues 7 to 8 weeks. With the radiotherapy proceeding,the patients exhibit oropharyngeal reaction aggravating,weight losing and tumor shrinking,resulting in the changes of tumor target and surrounding tissue. Those changes may influence the dose distribution of tumor and organ at risk. It is necessary to modulate target volume during radiotherapy of NPC.

Objective To investigate the expressions of stern cell markers CD133,nestin and CD44 in malignant melanoma and their significance.Methods Tissue samples were obtained from 30 patients with malignant melanoma and 30 patients with intradermal nevus.The expressions of three markers were immunohistochemically detected in the samples.Results In malignant melanoma specimens,the expression rate of CD133,nestin and CD44 was 53.33%(16/30),80.00%(24/30)and 20.00%(6/30),respectively,significantly difierent from that in intradermal nevus specimens [23.33%(7/30),53.33%(1 6/30)and 0,respectively,all P＜0.05].The percentage of cells positive for CD133,nestin and CD44 was 2.98%±5.62%,34.92%±34.89%and 1.28%±3.26%,respectively,in malignant melanoma specimens.0.10%±0.21%,7.26%±13.13%and 0,respectively,in intradermal nevus specimens;there was a significant difierence between the two groups of specimens(all P＜0.05).In malignant melanoma and intradermal nevus,the expression intensity of CD133.nestin and CD44 showed no significant correlation with patients'sex.age or disease course(all P＞0.05).ConclusionsCD133,nestin and CD44 are highly expressed in malignant melanoma,but weakly expressed or absent in intradermal nevus,suggesting that tumor stem cells might exist in malignant melanoma tissue.

BACKGROUND: Mobilizing autologous or extraneous bone marrow-derived liver stem cells may promote liver regeneration, however, its safety before the large scale clinical application needs further evaluation.OBJECTIVE: Bone marrow-derived liver stem cells (BDLSCs) were induced by culturing the rat bone marrow mesenchymal cells in the medium containing 5% cholestatic sera, and then were implanted into nude mice to observe the tumorigenicity. METHODS: Rat bone marrow mesenchymal cells (BMSCs) were isolated and incubated in the medium containing 5% cholestatic sera. Immunofluorescent stain was used to detect the expression of albumin, alpha-fetoprotein and cytokeratin18 by the cultured cells. Glycogen and urea synthesis by these cells were analyzed, respectively. BDLSCs following 14 days of culture were incubated in the skin of nude mice to observe neoplasia in local site. RESULTS AND CONCLUSION: Rat BMSCs survived in the medium containing 5% cholestatic serum and formed into small colonies on the fourth day after culture. Seven days later, the colonies expanded and there appeared some polygonal cells in the peripheral area. About 14 days later, these polygonal cells were confluent and presented the shape of cobblestone. Immunofluorescent stain showed that these cells expressed cytokeratin18, albumin and alpha-fetoprotein. Staining for glycogen displayed that glycogen granules were seen in cells. From 12 to15 days after culture, urea nitrogen concentrations in the medium were gradually increased. Rat BDLSCs were incubated in the skin of nude mice. Thirty days later, no neoplasia was found in the local site, and the tissue structure was normal. This result indicated that rat BDLSCs induced with the medium containing 5% cholestatic serum might have not tumorigenicity.

ObjectiveTo investigate the expressions ofheparinase,matrix metalloproteinase 2 (MMP2) and tissue inhibitor of metalloproteinase 2(TIMP2) in malignant melanoma lesions and their significance.MethodsSkin specimens were obtained from the lesions of 30 patients with malignant melanoma,30 patients with melanocytic nevus and the normal skin of 15 healthy controls.Immunohistochemical SP method was used to detect the protein expression of heparinase,MMP2 and TIMP2.ResultsThe malignant melanoma tissue specimens significantly differed from the melanocytic nevus and control tissue specimens in the expression rate of heparinase (63.33％ vs.6.67％ and 0.00,x2 =21.172,27.805,both P ＜ 0.01 ),MMP2 (70.00％ vs.13.33％ and 0.00,x2 =19.817,19.866,both P＜ 0.01) and TIMP2(60.00％ vs.6.67％ and 0.00,x2 =19.200,15.000,both P ＜ 0.01 ).ConclusionThe expression of heparinase,MMP2 and TIMP2 is significantly higher in malignant melanoma lesions than in melanocytic nevus lesions and normal skin tissue.

Objective To improve the effect of diagnosis and treatment in spontaneous adrenal hemorrhage. Methods Eleven cases of spontaneous adrenal hemorrhage were retrospectively summaried. Results Ten cases manifested lumbago in troubled side and 1 case was detected adrenal masses in operations of carcinoma of ureter.The functions of adrenal gland were all normal.Eleven were checked by ultrasound B of whom 3 cases had cystic masses, and strong echo of point or partition could be detected.Seven cases were manifested with low echo of masses,and 1 case of carcinoma of ureter was normal in ultrasound B before operation.Ten cases were scanned by CT.The focus was oval round shape and the border of focus was detected clearly.The value of CT ranged from 34.7 to 85.0 HU, and in 6 cases their values exceeded 50.0 HU.Among them,fluid plan could be seen in 1 case.Reinforcement CT was performed in 3 cases,and the masses were not reinforced.Three cases were scanned by MRI,and the ununion masses in area of adrenal gland were detected.There was iso signal in T1 weighted,while there was low signal in T2 weighted.Six cases underwent resection of adrenal gland; 5 cases underwent partial resection of adrenal gland and masses.The pathology of post operation were internal hemorrhage of adrenal gland medulla,and the hematoma was coated by the tissue of adrenal gland.The functions of adrenal cortex were all normal with follow up of 0.6 to 8 years. Conclusions The spontaneous adrenal hemorrhage can be diagnosed definitely by ultrasound B,CT and MRI.The symptoms of waist and abdominal pain were very distinctive with adrenal hemorrhage on both sides.The operation should be done when the adrenal hemorrhage is in one side and the hematoma exceeds 5 cm in diameter.Patrial resection of adrenal gland and hematoma should be operated for saving the normal adrenal tissues around the hematoma.

Objective To measure the displacement of the silver clips guided by kV-plain film at state of moderate deep inspiration hold(mDIBH) assisted by active breathing control(ABC) and to explore the margin of clinical target volume(CTV) to planning target volume(PTV) for breast cancer patients treated with three-dimensional conformal external-beam partial breast irradiation (EB-PBI) assisted by ABC. Methods The patients undertook CT simulation assisted by ABC to get the CT images on the respiratory condition of mDIBH. Four selected silver clips in breast cavity were delineated and the cavity based on all of the clips were delineated as gross tumor volume (GTV). Before each irradiation, two orthogonal kV-plain films were taken for the patients in the respiratory condition of mDIBH assisted by ABC device. 2D-2D auto-matie registration was performed based on pixel between the kV-plain films and the digital reconstructed radi-ographs(DRR). Then manual registration was undertook to get the shifts of the four clips separately at LAT, LNG,and VRT directions. Based on the shift data,the margins of CTV to PTV at LAT,LNG and VRT direc-tions were calculated. Results The margins from CTV to PTV were 5.00 mm,7.78 mm and 9.30 mm at LAT,LNG and VRT directions based on the clip at cephal border of the cavity. The corresponding margins were 4.40 mm,6.43 mm and 6.73 mm based on the clip at bottom of the cavity;5.04 mm,8.63 mm and 10.54 mm based on the clip at lateral border of the cavity;5.40 mm,8.59 ram and 10.81 mm based on the clip at pedal border of the cavity. Conclusions The silver clips in breast cavity can be clearly showed on the kV-plain film. The displacement of the clips can be exactly measured by registration of kV-plain film and planning DRR in condition of mDIBH assisted by ABC. The margins from CTV to PTV for EB-PBI can be calculated based on the displacement of the clips.

Objective To explore the influence of delineator and contouring criteria training on the delineation of the tumor bed and whole breast target after breast-conserving surgery.Methods Twelve brcast cancer patients after breast conserving surgery were selected.Tumor bed marked by clips was defined as gross target volume 1 (GTV1),tumor bed formed by seroma was defined as GTV2 and the whole breast was defined as clinical target volume (CTV).Five junior radiation oncologists first delineated GTV1,GTV2 and CTV for each patient following their own criteria.After contouring criteria training,they then delineated GTV1,GTV2 and CTV for the same group of patients again.The differences of the volumes of GTV1,GTV2 and CTV before and after training among different delineators were compared.One-way ANOVA or matching t-test was performed.Results The inter-delineator variability on GTV1,GTV2 and CTV delineation before training was statistically significant (F =11.16,7.54 and 3.78,P =0.000,0.000 and 0.009).After training,the inter-delineator variability on GTV1 and GTV2 delineation had statistical significance (t =4.78 and 4.24,P =0.002 and 0.005),but the inter-delineator variability on CTV delineation had no statistical significance (t =1.52,P =0.209).The coefficient of variance of the GTV1,GTV2 and CTV before and after training was significantly different (t =3.14,2.81,2.70,P =0.009,0.017 and 0.021).The matching index of GTV1,GTV2 and CTV before and after training was significantly different (F =16.08,8.61,8.48,P =0.000,0.000 and 0.000).Conclusions In delineating the target of breast cancer,application of the criteria of target delineation can reduce the difference among the delineators,especially for CTV.