Oncogenesis is a sophisticated process which is polygenic , multi-stage,and multi-step.Livin as an apoptosis inhibi-ting factor , is one of the members of apoptosis inhibiting factor family , it expresses highly in many tumor tissues , and is closely related to the occurrence and development of urological tumor .Tumor growth can be inhibited by interfering the expression of Livin in tumor tis-sue,which will reduce the resistance to apoptosis and increase the rate of cell apoptosis .In recent years , more and more attention was paid to the studies of Livin on gene targeting therapy .Further research of Livin might provide new ideas for the early diagnosis , clinical treatment and evaluation of prognosis of tumor .

Objective To discuss effective nursing measures for patients with congenital hypospadia with the application of urethral stent.Methods 142 patients with congenital hypospadia were selected and used soft stent during and after operation.The urethral orifice was kept smooth after operation and the stent was removed until 2 weeks after operation.Results Two patients complicated with urethral fistula,one was because of the poor blood supply of the skin flap and the other because of the edema of the skin flap and the remove of stent.Other patients received good treatment effect. Conclusion Application of urethral stent in patients with congenital hypospadia could reduce the incidence of infection and increase the success rate of operation.

Objective To observe the biomechanics of the anterior and posterior interosseous talo-calcaneal ligaments (ITCLs) . Methods Load-displacement characteristics of the subtalar joint were studied in 12 cadaver specimens whose ankle joints were mutilated. The ankle articular surfaces of the talus and the post-calcaneus were exposed. Bone blocks were then embedded in polymethylmethacrylate. The an-terior ITCLs were abscised in 6 of them, and the posterior ITCLs in the other 6. A multi-functional biome-chanical machine was used to perform the biomechanical tests on the specimens. Results When the anterior ITCLs were cut, the tali moved to the anterior-lateral side. When the posterior ITCLs were cut, the tali mostly moved to the anterior-interior side. Conclusions The anterior and posterior ITCLs have dif-ferent roles in maintaining stability of the subtalar joint. Since the posterior ITCLs seem more important than the anterior ones, they should have priority in ITCL reconstruction.

Objective To explore the clinical results of metacarpophalangeal(MP) intra-articular fractures treatment assisted with MP arthroscopy. Methods Five patients suffered from MP joint fractures were treated with closed reduction and K-wire fixation under the MP arthroscopy. The age of the patients was from 17 to 53 years with an average of 23.5 years. There were four males and one female. All the fractures were caused by direct trauma. The head of metacarpal bone was injured in one case while the bases of proximal phalange were involved in four cases. 2 were of simple fractures and 3 of comminuted fractures. No joint surface defects were found preoperatively. The duration from injury to surgery was from 5 days to 3 weeks. The treatment results were evaluated with respect to MP arthroscopical findings, the fracture union and the postoperative function. Results The fracture lines could be seen in 4 cases under arthroscopy except one located at the palmar aspect of metacarpal head, which was then treated with open reduction and internal fixation. During the examination with MP arthroscopy, one case each of volar plate injury and collateral ligament injury was found. The patients were followed up 3-6 months with an average of 4.8 months postoperatively. All the patients obtained fracture union with a smooth joint surface. The motion of involved MP joints achieved nearly to their normal active range in 3 cases. No pain or snapping was found during the movement of MP joints. There was also no lateral instability. Only in one case, because of the massive and comminuted fracture, the involved finger was immobilized with plaster for five weeks, the ROM of MP joint became 90? for flexion and -56? for extension at 5 months postoperatively. Conclusion It is a less invasive procedure with good results to treat MP joint fractures assisted with MP arthroscopy. It is suitable for some acute MP intra-articular fractures.

Objective To observe the clinical results of free dorsal forearm mini-osteo-cutaneous flap to repair the bone and soft tissue defect of finger. Methods The mini-osteo-cutaneous flap pedicled on the osteo-cutaneous branch of dorsal branch of anterior interosseous artery was designed on the radial side of the distal dorsal forearm along the connective line between the Lister's tubercle and the lateral epicondyle of the humerus, the point of the cutaneous branch of dorsal branch of anterior interosseous artery entry the skin was about 3.5 cm proximal to the Lister's tubercle. The dimensions of the osteo-cutaneous-flap were planned according to the defect of recipient. The incision begins along the ulnar board of the flap and the septum between the extensor pollicis brevis muscle and the extensor pollicis longus muscle was exposed, the osteo-cutaneous branch of dorsal branch of anterior interosseous artery was indentified, then the cutaneous flap and osteo-flap was raised respectively, the osteo-cutaneous branch was dissected deeply to the origin and sectioned, the donor site was closed directly. The vascular pedicle of the osteo-cutaneous flap was anastomosed with the digital artery and dorsal vein respectively. From Jul. 1999 to Jan. 2005, 7 fingers of 7 males suffered bone and soft tissue defect with the average of 25 years old ranging from 18 to 37 years old were performed. Results All the 7 free mini-osteo-cutaneous flaps were survived completely, the dimensions of the cutaneous-flap and osteo-flap were 2.5 cm ? 3.0 cm to 4.5 cm ? 3.5 cm, 2.5 cm ? 1.0 cm to 3.5 cm ? 1.2 cm respectively. The osteo-flap was united with recipient bone 2 to 3 months after the transplantation and the donor site was closed by direct suture without tension, the appearance of the reconstructed finger by mini-osteo-cutaneous flap was perfect. Conclusion The free dorsal forearm mini-osteo-cutaneous flap pedicled on the osteo-cutaneous branch of dorsal branch of anterior interosseous artery was one of the optimal flap to reconstruct bone and soft tissue defect of the finger.

Objective To improve the diagnosis and treatment of primary duodenal malignant (neoplasms)(PDMN).Methods The clinical data of 19 patients with primary malignant neoplasms of the (duodenum) were anayzed retrospectively.Results The clinical manifestations were jaudice in 9 cases, upper abdominal pain in 7 cases, gastrointestinal hemorrhage in 6 cases,abdominal mass in 3 cases,and vomitting in 1 case. Diagnostic procedure and detection rate: The detection rate of PDMN by duodenoscopy was 83.3%(15/18), by hypotonic duodenography was 82.3%(14/17), 77.8%(7/9) by CT, and 1 case by MRI.16 cases (underwent) surgery with resection rate of 68.8 %(11/16).Pancreaticoduodenectomy was (performed) in 9 (cases), simple tumor resection and regional lymphadenectomy in 1 case,resection of duodenal bulb plus partial gastrectomy in 1 case,and gastroenterostomy or choledochojejunostomy in 5 cases.The radical resection rate was 62.5%(10/16).The postoperative 1-,3-,and 5-year survival rate in radical (resection) (patients) was 90.0%(9/10),40.0%(4/10) and 30.0%(3/10),respectively.In those with (gastroenterostomy) or (choledochojejunostomy), the survival time was 6~15 months. Conclusions (Duodenoscopy) and hypotonic (duodenography) are ideal tools for the diagnosis of all locations of PDMN.(Pancreaticoduodenectomy) might result in prolonged survival of patients with PDMN.

Objective To evaluate the ability of showing the pancreatic diseases on various MRI sequences. Methods Eighty-four subjects included 50 normal individuals and 34 patients(22 patients investigated for pancreatic neoplasia and 12 pancreatitis) were presented. The MR protocol included conventional SE T1WI, FSE T2WI, Pre-and post-contrast T1-weighted fat-suppressed and GRE imaging. Results The best diagnostic information was provided by T1-weighted fatsuppressed imaging before and after gadolinium enhancement on 27 of 34 cases with abnormal pan creas, followed by immediately postcontrast GRE images. Precontrast GRE imaging better showed the features of a cute pancreatitis. FSE T2WI obviously exhibited islet cell tumor and metastases of liver from pancreatic adenocarcino ma. Conclusion The standard MR protocol included T1-weighted fat-suppressed image and dynamic GRE imaging.

In order to construct a recombinant plasmid containing short hairpin RNA (shRNA) targeting survivin and to investigate its effect on survivin expression and cell apoptosis of human retinoblastoma cell line Hxo-rb44 in vitro, RNA interference plasmid pSIRENS that can express shRNA of survivin was designed, constructed, and transfected into human retinoblastoma cell line Hxo-rb44. Survivin and c-Myc expression was detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blot. Apoptosis of Hxo-rb44 cells was assayed by Honchest33258 staining and cell growth curve was drawn. The results showed that the oligonucleotide targeting survivin was identified in pSIRENS plasmid. After pSIRENS plasmid transfected, survivin and c-Myc expression in Hxo-rb44 cells was decreased significantly. Apoptotic rate of cells was up-regulated from (3.5+/-1.29) % to (36.1+/-19.66) %. The proliferation ability of Hxo-rb44 cells was inhibited. No significant effects on survivin expression and apoptosis of the cells were found when negative control plasmid was transfected. In conclusion, the plasmid containing shRNA targeting survivin was constructed successfully. It could inhibit efficiently the expression of survivin and c-Myc in human retinoblastoma cell Hxo-rb44 in vitro. The inhibition of the expression of c-Myc might be involved in the apoptosis of Hxo-rb44 cells.

Objective To explore the necessity of EGFR?targeted therapy combined with synchronized whole brain radiotherapy ( WBRT ) for non?small?cell lung cancer ( NSCLC ) with mutated EGFR and brain metastasis by comparing the effects on prognosis between WBRT combined with tyrosine kinase inhibitor ( TKI) and TKI alone. Methods A retrospective analysis was performed in 43 patients with EGFR mutation?positive NSCLC and brain metastasis. In those patients, 24 patients received WBRT plus TKI and 19 patients TKI alone. Results The overall response rate ( RR) and 6?month intracranial disease control rate ( CR) were significantly higher in the WBRT+TKI group than in the TKI group ( 79% vs. 37%, P=0. 002;79% vs. 63%, P=0. 008). The median intracranial progression?free survival (IPFS) time was significantly longer in the WBRT+TKI group than in the TKI group ( 23. 7 vs. 8. 3 months, P=0. 025) . The multivariate analysis indicated that the control of lung cancer, WBRT+TKI, and single brain metastasis were favorable factors for substantially longer IPFS time ( P=0. 033,0. 019,0. 019) . In 23 patients with exon 19 deletion, 12 patients received WBRT+TKI and 11 patients TKI alone;compared with the TKI group, the WBRT+TKI group had significantly higher RR and 6?month CR as well as significantly longer IPFS ( 100%vs. 35%, P=0. 000;100% vs. 55%, P=0. 008;23. 7 vs. 8. 4 months, P=0. 003). In 20 patients without exon 19 deletion, however, there were no significant differences in RR or 6?month CR between the WBRT+TKI group (n=12) and the TKI group (n=8)(64% vs. 50%, P=1. 000;58% vs. 75%, P=0. 642).The median IPFS was 14. 4 and 8. 4 months ( P=0. 864) . Conclusions WBRT combined with TKI is superior to TKI alone in the treatment of NSCLC with brain metastasis. Patients with exon 19 deletion have substantially better treatment outcomes.

Objective To explore the clinical value of microsurgery in the treatment of lateral ventricle tumors. Methods Microsurgery was conducted in 14 cases of lateral ventricle trmors in this department from May 1996 to August 2002. According to the location of tumors, we selected the approach close to the focus, protected the surrounding nerve tissue and the deep venous system, and resected the tumor in fractions. Results Among the 14 cases, 13 (92.9%) received total resection and 1 (7.1%) subtotal resection. A total of 11 cases of complications occurred postoperatively, including 3 cases of intracranial infection, 2 cases of hemiparalysis, 1 case of hydrocephalus, 3 cases of frontal lobe mental symptoms, 1 case of intraventricular hematoma and 1 case of nominal aphasia. Except for 1 case of hemiparalysis who were not able to resume the ability to take care of his own basic needs, the remaining 10 cases obtained full recovery. Follow-up in 9 cases for 6～60 months (mean, 29 months) showed 2 cases of recurrence of astrocytoma. Conclusions Microsurgery offers good visualization, minimal invasion and a high total resection rate for tumor.