The peripheral blood T lymphocyte subsets and ConA-induced suppressor cell activity (ConA-SCA) were determined in 37 patients with primary nephritic syndrome(PNS). The results showed that the patients in initial onset had the abnormal number and function of T lymphocytes, which returned to a normal level with treatment with steroid and improvement of patients'condition. The indings suggest that the immunoregulatory imbalance of this disease may be a primary change and play an important role in pathogenesis of PNS.

In order to determine the cellular immunestate in patients with multiple myeloma, T-cellsubsets in peripheral blood from 25 cases withmultiple myeloma were measured with SPA-Ig di-rect rosette assay, the activity of interleukin-2 wasinvestigated by using mice thymocyte proliferationassay. The results showed that in multiple myelo-ma, OKT_3~+, OKT_4~+ cell decreased significantly.OKT_6~+ cell increased markedly and the OKT_4/OKT_8 ratio was reduced. The activity of IL-2 in pe-ripheral blood lymphocytes of the patients withmultiple myeloma increased sharply and there wasa significant difference between the active diseaseand the remission disease. The activity of IL-2 inthe remission disease was lower than that in theactive disease but higer than that of the controlgroup. In conclusion, this study indicated thatthere were imbalance of T-cell subsets and abnor-mality of IL-2 production in patients with multiplemyeloma. The data might suggest that there wasdisorder of the cellular immunity in the course ofthe disease.

Objective To report the experience of using R 0 Swartz sheath in patients with tortuous and prolonged aorta. Methods The radiofrequency ablation procedure could not be done in 4 patients (3 patients with left side accessory pathway, and 1 with idiopathic left ventricular tachycardia) because the ablation catheter could not be put in left ventricle due to tortuous and prolonged aorta. We tried to use R 0 Swartz sheath in these patients in order to put the catheter into left ventricle via small curve of the R 0 Swartz.Results The ablation procedures were successful in these 4 patients by using R 0 Swartz.Conclusion Using R 0 Swartz sheath in patients with tortuous and prolonged aorta is helpful in making the left side ablation procedure successful.

BACKGROUND: At present, the researches on steroid-induced avascular necrosis of the femoral head are mostly concentrated on the treatment of formed necrosis. And there are fewer reports on how to prevent the ostoenecrosis of the femoral head in the course of steroid therapy.OBJECTIVE: To observe the effect of preventive medication on femoral head structure and blood flow in steroid-induced osteonecrosis.DESIGN: Randomized controlled experiment.SETTING: Department of Pharmacology, Department of Anatomy, Medical College of Shaoguan University; Department of Nuclear Medicine, Guangdong Province Yuebei People's Hospital.MATERIALS: Thirty adult New Zealand rabbits of either sex, whose body mass was (2.5±0.5) kg.METHODS: The experiment was carried out in the Central Laboratory,Medical College of Shaoguan University, the Department of Electron Microscope, the Northern Campus of Guangzhou, Sun Yat-sen University, and the Department of Nuclear Medicine, Guangdong Province Yuebei People's Hospital from April to July 2005. ①Thirty rabbits were divided randomly into 3 groups with 10 rabbits in each group: control group with intramuscular injection of 1 mL/kg normal saline twice a week and meanwhile, intragastric administration of normal saline(10 mL/d), steroid group with intramuscular injection of dexamethasone sodium phosphate(1 mL/kg) twice a week and meanwhile, intragastric administration of normal saline(10 mL/d),treatment group with intramuscular injection of dexamethasone sodium phosphate(1 mL/kg) twice a week and meanwhile, intragastric administration ofXuesaitong(25 mg/kg), Zhibituo(350 mg/kg) and alendronate(5 mg/kg)daily for 8 weeks. ②After 1 week of drug withdrawal, the blood flow of femoral head was measured in all the rabbits with radioactive microsphere technique, and the histological changes were observed under light microscope and electron microscope.MAIN OUTCOME MEASURES: ①Blood flow of the femoral head in each group.②Histological and morphological changes, and ultrastructure of the femoral head cartilage in each group.RESULTS: ①The blood flow in the treatment group was more than that in the steroid group[(0.261±0.042), (0.197±0.053) mL/(min·g), q=6.10,P ＜ 0.01]. Compared with the control group[(0.243±0.039) mL/(min ·g)],the difference was not significant. ②The number of empty bone lacunae in the treatment group was fewer significantly than that in the steroid group [(15.22±5.49), (24.78±7.87) pieces, q=6.35, P ＜ 0.01]. However, there was no difference between the treatment group and control gruop [(10.38±3.78)pieces].③In the treatment group, the bone cells were normal, the endoplasmic reticula were abundant and the cellular nuclei were of normal shape.In the steroid group, the bone cells contracted in volume, the pyknosis occurred, the chromatin gathered to the edge and the bone lacuna enlarged.CONCLUSION: While using steroid hormone for long, using Xuesaitong,Zhibituo and alendronate may elevate the blood flow of femoral head, improve the tissue structure of bone and prevent or lighten steroid-induced necrosis of femoral head.

BACKGROUND: Due to glucocorticoid (GG) is used wildly on clinic, incidence rate of steroid-induced osteonecrosis of femoral head is increased.Apoptosis of bone cells plays a key role in steroid-induced osteonecrosis of femoral head during earlier period.OBJECTIVE: To induce models of femoral head necrosis of rabbits by steroid steroid so as to observe the effect of integrated Chinese and western medicine on preventing apoptosis of steroid-induced osteonecrosis of femoral head.DESIGN: Randomized controlled animal study.SETTING: Pharmacological Department and Anatomy Department of Medical College of Shaoguan University, Pathological Department of Yuebei People's Hospital of Guangdong Province.MATERIALS: The experiment was carried out at the Central Laboratory of Medical College of Shaoguan University from April to July 2005. A total of 30 adult New Zealand white rabbits were selected and randomly divided into blank control group, steroid group and preventive medicine group with 10 in each group.Xuesai tongpian, main component of panax notoginseng saponin, was provided by Yuxi Weihe Pharmaceutical Company Limited (batch number: 200410290; 25 mg/pill); zhibituo pian, main component of shanzha, baizhu, hongqu, was provided by Chengdu Di 'ao Jiuhong Pharmaceutical Factory (batch number: 0410063, 350 mg/pill); alendronate, main component of 4-amido-1-hydroxy butylidene-1, was provided by Hainan Mankexing Pharmaceutical Factory (batch number: 040501, 5 mg/pill); dexamethasone sodium phosphate injection was provided by Henan Tiankang Pharmaceutical Company Limited (batch number: 040905, 5 g/L).METHODS: ① One week later, rabbits in steroid group and preventive medicine group were injected with 1 mL dexamethasone sodium phosphate solution twice a week to establish models of steroid-induced osteonecrosis of femoral head. Animals in blank control group did not model and were injected with the same volume of saline at the same time point. ② Rabbits in preventive medicine group were prefused with 25 mg xuesai tong, 350 mg zhibituo and 5 mg alendronate at the same time for 8 weeks. Animals in steroid group and blank control group did not treat with any medicine. Benzylpenicillin was injected into muscle of animals in each group for infection prevention with the dosage of 50 000 u each rabbit twice a week. ③ One week after discontinue, apoptosis of femoral head was detected with in situ end-labeling (ISEL) method. Ten areas were selected from each carry sheet glass to calculate numbers of apoptosis in every 100 cells. Pathological changes of ultrastructure were observed with double staining of uranium acetic acid and lead citromalic acid.MAIN OUTCOME MEASURES: ① Results of apoptosis of femoral head; ② Results of pathological changes of ultrastructure of femoral head under electron microscope.RESULTS: A total of 30 adult New Zealand white rabbits were selected in this study. Because one rabbit in preventive medicine group died during process, 29 rabbits were involved in the final analysis. ① Results of apoptosis of femoral head: Buffy granulosum positive cells, i.e. apoptosis cells,were observed in nucleus in steroid group. Numbers of apoptosis every 100cells were more in steroid group than those in blank control group and preventive medicine group (24.14±5.46, 2.47±0.76, 8.12±3.23, q=8.76, q=13.45, P ＜ 0.01), and numbers in blank control group were similar to those in preventive medicine group (P ＞ 0.05). ② Results of pathological changes of ultrastructure of femoral head under electron microscope: Volume of nucleus in steroid group was decreased; chromatin was aggregated at edge; part of chromatin was dark and thick; density of electron was increased; structure was unclear; characteristics of apoptosis were shown. Nuclear membrane in preventive medicine group was complete under electron microscope, chromatin was steady, and the nucleus was accounted for one third of cell.CONCLUSION: The integrated application of xuesai tong,, zhibituo and alendronate can inhibit hormonal-induced apoptosis of femoral head after necrosis of femoral head induced by steroid steroid.

OBJECTIVEBased on the different physiological characteristics of the mastoid skin and soft tissue of Chinese congenital microtia malformation, the Nagata two-stage method was respectively applied for ear reconstruction, and the clinic experience were investigated in this study.

METHODAccording to the mastoid skin and soft tissue difference in the thickness and tightness, 280 patients diagnosed with congenital microtia were divided into four types: thin and tight, thin and loose, thick and tight, thick and loose type. 90 cases of thin and loose type accepted the Nagata method of ear reconstruction surgery.

RESULTSWith average 7.8 months follow up, 84.4% (76/90) cases using Nagata two-stage method were satisfied with the outcome of the reconstructed ear including three dimensional position and subunit appearance. There were no postoperative complication related to chest wall deformity or affected normal physical function.

CONCLUSIONSThe Nagata two-stage method is appropriate management choice for Chinese congenital microtia. Based on the different physiological characteristics of the mastoid skin and soft tissue, the selection of different operational should be beneficial to the ear reconstruction of Chinese congenital microtia malformation.

China ; Congenital Microtia ; surgery ; Ear, External ; surgery ; Humans ; Mastoid ; Otologic Surgical Procedures ; Reconstructive Surgical Procedures ; Skin ; Thoracic Wall

Objective:To optimize the alcohol precipitation technology of Dingtongning granule and investigate the rationality of al-cohol precipitation technology by pharmacodynamics. Methods:With the yield of extract and the transfer rates of paeoniflorin and feru-lic acid as the comprehensive evaluation indices,L9(34) orthogonal test was used to optimize the alcohol precipitation technology by taking the concentration of alcohol precipitation,relative density of extract and alcohol precipitation time as the influencing factors,and the efficacy of water extract before and after the alcohol precipitation was compared through the biochemical indices of mice. Results:The optimum alcohol precipitation process was as follows:the extracting liquid was concentrated to the relative density of 1.10 g·ml-1 (25 ℃),and then 90% ethanol was added till the concentration of ethanol up to 70%,and last,the extract was stored in cold for 18 h. The efficacy had no obvious changes before and after the alcohol precipitation. Conclusion:The optimal alcohol precipitation tech-nology is stable and feasible,which can maintain the efficacy and shows good purification. The optimal alcohol precipitation technology provides experimental basis for the scientific production of Dingtongning granule.

At present,the various levels of safety evaluations of traditional Chinese medical (TCM) injections were in force in post-marketing clinical researches,while the process quality is guaranteed with difficulty.Therefore,it is requisite to call for technical guidance.By drawing lessons from the international experience of drug marketing safety evaluation and the related methods,we proposed the key techniques of quality control for clinical safety evaluation of TCM injections from the three aspects:preparation,implementation and summarization of researches,combining with the characteristics of TCM injections.The key techniques contained some scientific problems,ethics,publicity,data management,statistical analysis,specification report,etc.This paper comprehensively introduced the requisite technologies and methods over research quality,laying a foundation for the studies of post-marketing clinical safety evaluation of TCM injections.

OBJECTIVE: To investigate dosimetric characteristics and to evaluate the clinical efficacy of intensity modulated radiotherapy (IMRT) as compared with conventional radiotherapy in nasopharyngeal carcinoma (NPC). METHODS: Forty-seven NPC patients who accepted IMRT served as the IMRT group, and conventional radiotherapy plan was also made for each patient in this group using the treatment planning system. Dosiological evaluation of the 2 radiotherapy plans was made through dose volume histogram, 95% target volume dose (V(95)) and normal tissue complication probability. Another 47 patients who underwent conventional radiotherapy (CRT) at the same period formed the control group. The therapeutic effect as well as the acutes and late toxicities of normal tissues in the 2 groups were observed. RESULTS: V(95) of the IMRT was more than 96% (96.83%-99.99%) for each target area, obviously superior to CRT in the sub-clinical target area. The radiation dose of normal tissues such as the brainstem and the spinal cord in the IMRT was much less than that in the CRT. Consistant with this, the part and complete remission rate, the 3-year loco-regional progress free survival rate, and overall survival rate in the IMRT group were all higher than those in the CRT group. For most patients in the IMRT group, the grade of acute toxicities was much lower than that in the CRT group. Patients in the IMRT group showed no more than grade 3 xerostomia, while in the CRT group still 21% of the patients suffered grade 3 or higher xerostomia a year later. CONCLUSION Compared with CRT, IMRT can improve the target volume dose and decrease the dose of surrounding tissues, resulting in higher control rate and fewer side effects.
Adult ; Carcinoma, Squamous Cell ; radiotherapy ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Young Adult

Surgical treatment for bone and soft tumors of pelvis and sacrum presents a big challenge, because of the complex anatomy of sacropelvic region, large tumor volume at presentation, rich blood supply to the tumor and visceral involvemen, et al. Therefore, surgical excision and reconstruction are technically difficult for sacropelvic tumors. Extensive intraoperative haemorrhage could be life-threatening, and this issue remains a major concern. How to effectively control bleeding during surgery is critical for successful operation and patient's favorable prognosis. Some previous attempts, such as interventional selective internal iliac artery embolization or manual ligation through an additional anterior approach, were tested to be ineffective. Inspired by the success of resuscitative endovascular balloon occlusion of the aorta (REBOA) which resemble an endovascular tourniquet for traumatic hemorrhagic shock, some researchers have applied this techinique to control surgical bleeding during pelvic or sacral tumor resection.The authors have performed REBOA for more than 1 500 sacropelvic tumr surgeries since 2003 in Peking University People's Hospital. The patient age, the diameter of femoral artery and aorta, atherosclerosis, as well as tumor location, volume and expansion and blood suppy, have to be thoroughly evaluated prior to REBOA administration. Admittedly, the application of REBOA do reduce intraoperative bleeding, shorten the operation duration, improve the safety of surgery, yet some complications were observed including local hematoma at the puncture site, acute arterial thrombosis, femoral artery pseudoaneurysm or occlusio, et al. The purpose of this study is to review the literature on REBOA administration in pelvic and sacral tumors excision, with the focus on its indications, performing procedure, the safety and efficacy, and complications. Moreover, in order to popularize the clinical application of aortic balloon occlusion in the future, we summarize our experience of abdominal aortic balloon occlusion over 10 years.