Objective To prospectively and directly compare the capability of whole-body DWI,MRI and/or CT (MRI-CT),and whole-body DWI with MRI-CT for assessment of lymphatic metastases in non-small cell lung cancer (NSCLC) patients.Methods The institutional review board approved this study; informed consent was obtained from patients.A total of 56 NSCLC patients underwent whole-body DWI and thoracic CT scan prospectively.Conventional MRI was performed in suspicious lymphatic metastases parts within one week after inspection.Final diagnosis of the lymphatic metastases in each patient was determined on the basis of results of all radiologic and follow-up examinations.Two chest radiologists independently assessed all examination results and used a five-point visual scoring system to evaluate the probability of metastases.Final diagnosis based on each of the methods was made by consensus of two readers.Receiver operating characteristic (ROC) analysis was used to compare the capability for lymphatic metastases assessment among whole-body DWI,MRI-CT and whole-body DWI with MRI-CT.The detection abilities of lymph nodes with different size were compared with x2 test.Value of apparent diffusion coefficient (ADC) in the differential diagnosis of benign and malignant lymph nodes was compared with the variance analysis.Results (1) Lymph nodes metastases were divided into 3 groups according to the length diameter (＜ 2,2-3,＞ 3 cm).A statistically significant difference (x2 =13.819,P ＜ 0.01) was found in detection of lymph nodes (＜ 2 cm) among whole-body DWI,MRI-CT and whole-body DWI with MRI-CT(within the 123 lymph nodes,109,98 and 117 were detected respectively),whole-body DWI with MRI-CT was superior to conventional MRI-CT(x2 =13.324,P＜0.01).There were no statistically significant difference between the other 2 groups (in the length diameter 2-3 cm group,43,40 and 45 of all 46 lymph nodes were detected respectively by whole-body DWI,MRI-CT and whole-body DWI with MRI-CT,x2 =3.816,P ＞ 0.05,while in the length diameter ＞ 3 cm group,all of the 27 lymph nodes were detected by each of them.(2) Conventional MRI-CT was superior to whole-body DWI in the diagnosis of lymph node metastasis in NSCLC.The area under ROC curve value of whole-body DWI with MRI-CT(Az =0.978),the sensitivity,specificity,accuracy (97.4％ 、88.9％ 、86.3％ respectively) were significantly higher than conventional MRI-CT or whole-body DWI.(3)The ADC value of malignant lymph nodes were significantly lower than those of benign [(0.79 ± 0.15) × 10-3 mm2/s vs (1.59--0.15) × 10-3 mm2/s,F =332.813,P ＜ 0.01].The sensitivity,specificity,accuracy were 100％ with the cut-off value of 1.06 × 10-3mm2/s.Conclusions Whole-body DWI is the beneficial supplements of MRI-CT and can be used as a earlier clinical technique in patients with suspected NSCLC lymph node metastasis.Combined with ADC value,it can be used for assessment and differential diagnosis of lymphatic metastases in NSCLC patients.

Objective To investigate the application of whole-body diffusion-weighted imaging (WB-DWI),and to detect bone metastasis in malignant tumor patients.Methods A total of 118 malignant tumor patients prospectively underwent WB-DWI,standard MRI/CT in suspicious bone metastases parts within one week after inspection.Final diagnosis of the bone metastases in each patient was determined on the basis of results of all radiologic and follow-up examinations.The differential diagnosis value of apparent diffusion coefficient (ADC) in benign and malignant bone metastases was compared with the variance analysis.Results Area under ROC curve value of WB-DWI with standard MRI/CT (0.999) was larger than that of WB-DWI (0.944) and standard MRI/CT (0.983),and the specificity,accuracy and positive predictive value were also the highest(100.0 ％,97.4 ％,100.0 ％).The ADC values of malignant bone metastases were significantly lower than those of benign lesions[(0.71±0.15)×10-3 mmTs vs (1.50±0.23)×10-3 mm2/s] with a statistically significant difference(F =261.587,P ＜ 0.001).Conclusion WB-DWI is the beneficial supplements of standard MRI/CT.Which can be used for assessment and differential diagnosis of bone metastases in malignant tumor patients combined with ADC value.

【Objective】To explore the role of cell cycle regulators in nasopharyngeal carcinoma (NPC) relapse.【Method】To assay p53,MDM2,p21ras and p21WAF1 proteins by LsAB immunohistochemical technique in 69 cases of primary and relapsing NPC tissues.【Results】As compared with primary NPC,the expression rate of p53 or MDM2 protein in relapsing NPC was similar (78% to 80%,84% to 83%),and the expression rate of p21ras or p21WAF1 protein in relapsing NPC was obviously descended (73% to 93%,52% to 84% );the high-expression rate of p53 protein in relapsing NPC was similar (42% to 51%),the high-expression rate of MDM2 protein in relapsing NPC was obviously risen (57% to 32%),and the high-expression rate of p21ras or p21WAF1 protein in relapsing NPC was obviously descended (16% to 65%,17% to 46%).Among of them,the significant rise of MDM2 protein expression level in relapsing NPC mainly occurred in the patients of group 2 which relapsing-interval was shorter than 34 months,P<0.05;the significant descent of p21ras or p21WAF1 protein expression level in relapsing NPC occurred in the patients of group 2 and group 1 which relapsing-interval was equal to or longer than 34 months,P<0.02,respectively.【Conclusions】The overexpression of p53 and MDM2 proteins and the low or negative expression of p21WAF1 protein after clinical cure might still play an important role in NPC relapse,the obvious rise of MDM2 protein level and the obvious descent of p21WAF1 protein level might further accelarate the process of NPC relapse.

Moyamoya disease may cause subarachnoid hemorrhage because of its feature of spontaneous occlusion of the circle of Willis with vascular network abnormal hyperplasia on the base of the brain.This article reviews the disease characteristics of moyamoya disease-related subarachnoid hemorrhage,the correlations between bleeding mechanisms,disease progression and bleeding,as well as its therapeutic measures.

Objective To assess the therapeutic effect and opportune time of surgical treatment of hepaticolithiasis . Methods The clinical data of 92 patients with hepaticolithiasis who underwent surgical treatment were analyzed retrospectively. Results (1) The incidence of postoperative complications was 14.1% (13/92 cases), in choledochoscopy group it was 9.3%(4/43 cases) and in the non choledochoscopy group 18.4%(9/49 cases) ; in the emergency operation group it was 36%(9/25 cases) and in selective operation group 5.97%(4/67 cases) . (2) The incidence of residual stones was 22.9%(21/92 cases); in choledochoscopy group it was 13.9%(6/43 cases) and the non choledochoscopy group 30.6%(15/49 cases); in emergency surgery group it was 36%(9/25 cases) and in selective operation group 17.9%(12/67 cases).(3)One pationt died from ACST two days after operation . All of the patients were followed up for 4-10 years; there were 80 cases (86.9%) who had a good therapeutic outcome. Conclusions Logical surgical procedure associated with choledochoscopy and appropriate timing of surgical intervention can markedly improve the effect of surgical treatment of hepaticolithiasis and reduce the incidence of postoperative complications.

OBJECTIVE: To investigate the clinical feature, diagnose and therapeutic methods of paraglottic space primary paraganglioma. METHOD: One case of paraglottic space primary paraganglioma was reported and the relevant literatures were reviewed. RESULT: One case showed a hoarse voice, who was cured after the surgery of neck incision. NSE and CgA were positively expressed. CONCLUSION Paraganglioma of the paraglottic space is very rare. The diagnosis of paraglottic space primary paraganglioma bases on histopathology and immunohistochemistry. The immunohistochemistry and clinical character must be comprehensively analyzed to increase the diagnosis accuracy.
Female ; Glottis ; pathology ; Humans ; Middle Aged ; Paraganglioma ; pathology ; surgery

Objective To investigate the strategy and efficacy of enteral nutrition support of patients with spontaneous intraventricular hemorrhage-induced coma.Methods 139 patients were randomly divided into study group (treated with enteral nutrition mixed suspension,n =67) and control group (treated with normal full nutritional homogenized product,n =72) with a random number generating software.Enteral nutrition support was administered in 6-48 hours after admission.The total daily intake of enteral nutrition preparation was 1 000 ml (4 186.8 kJ),supplemented by liquid food.Body weight,serum albumin,serum total protein,hemoglobin,lymphocyte count,incidence of infection,level of consciousness and incidence of complications were compared between the two groups.Results In the third week after onset,the serum albumin [(32.1 ± 3.3) g/Lvs.(30.5±2.3) g/L,P=0.041],total protein [(62.2±3.2) g/Lvs.(56.9±2.7) g/L,P=0.039],and hemoglobin [(125.5 ±5.7) g/Lvs.(120.7 ±6.4) g/L,P=0.027] were significantly higher in the study group than in the control group.The Glasgow score in the second week in the study group was 13.1 ± 1.9,significantly higher than that in the control group (11.0 ±2.3) (P =0.037);the incidence of nosocomial infection was significantly lower in the study group than in the control group [17.9％ (12/67) vs.29.2％ (21/72),P =0.021];the proportion of patients with abnormal blood test results and that of patients having fever for more than 7 consecutive days were both significantly lower in the study group than in the control group [31.3％ (21/67) vs.38.8％ (28/72),P=0.042;37.3％ (25/67) vs.41.7％ (30/72),P =0.047].The two groups showed no significant difference in the incidence of intracranial infection after external ventricular drainage (P =0.235).Conclusion For patients with spontaneous intraventricular hemorrhage-induced brain dysfunction,enteral nutrition support with enteral nutrition suspension could effectively improve nutritional status,reduce complications,therefore conducive to recovery.

Objective To analyze the potential factors affecting the prognosis of patients with sepsis and evaluate their values in predicting the disease outcome. Methods A clinical prospective study was conducted. Fifty-three septic patients admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangzhou Medical University from October 17th, 2012 to August 8th, 2013 were enrolled, and in the same term 35 volunteers having passedphysical check-up were assigned in the healthy control group. According to the severity of the patients, they were divided into sepsis, severe sepsis and septic shock groups. Furthermore, based on the difference in scores of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), the patients were divided into low-risk (APACHE Ⅱ scores < 10), middle-risk (APACHE Ⅱ scores 10 - 19) and high-risk groups (APACHE Ⅱ scores≥ 20 ). According to whether the coagulation dysfunction occurred or not and whether the dysfunction was adjusted or not at the end of observation, the septic patients were divided into non-coagulation defect group, and adjusted and non-adjusted coagulation defect groups. After entrance of groups, the clinical data, including gender, age, body temperature, blood pressure, prothrombin time (PT), prothrombin time activity (PTA), activated partial thromboplastin time (APTT), international normalized ratio (INR), levels of D-dimer, fibrinogen (Fib), blood lactate, and serum procalcitonin (PCT) were recorded, and APACHEⅡscore was calculated. In 24 hours after admission, blood samples were collected, and the levels of interleukins (IL-6, IL-8) were tested by Bio-Plex 200 System. The prognostic factors related to sepsis were screened by binary multivariate logistic regression analysis. The receiver operating characteristic curve (ROC) were used to evaluate the prognostic values of blood lactate, PCT, IL-6, IL-8 and APACHE Ⅱ scores for patients with sepsis. Results Fifty-three patients were enrolled, including 17 patients in sepsis group in which blood coagulation dysfunction occurred in 8 cases, of them 7 being adjusted, and 5 died; 15 patients in severe sepsis group, in which blood coagulation dysfunction occurred in 7 cases, of them 2 being adjusted, and 7 died;21 patients in septic shock group in which blood coagulation dysfunction occurred in 18 cases, of them 4 being adjusted, and 18 died. Both IL-6 and IL-8 levels of sepsis group were significantly higher than those in healthy control group (both P<0.01). Univariate logistic regression analysis showed that the grade of sepsis severity, APACHEⅡscore, IL-6, IL-8, blood lactate, PCT and coagulation dysfunction were related to the prognosis of septic patients. Multivariate logistic regression analysis confirmed that blood lactate concentration [β=0.891,χ2 = 5.872, P = 0.015, odds ratio (OR) = 2.438, 95% confidence intervals (95%CI) was 1.186 - 5.013] and coagulation function status (non-adjusted coagulation defect group:β=3.563,χ2=9.980, P=0.002, OR=35.286, 95%CI was 3.868-3.563) were independent prognostic factors of septic patients. The ROC curve analysis showed:for the level of blood lactate, the area value under ROC curve (AUC) was 0.767, the best cutoff value was 2.15 mmol/L with the Youden index of 0.386;for PCT, the AUC was 0.698, the best cutoff value was 9.39μg/L with the Youden index of 0.406;for IL-8, AUC was 0.686, the best cutoff value was 20.06 ng/L with the Youden index of 0.312;and for IL-6, AUC was 0.681, the best cutoff value was 45.44 ng/L with the Youden index of 0.406. Multivariate logistic regression analysis confirmed that the plasma levels of IL-6 and IL-8 were the independent risk factors of septic patients' coagulation function. The IL-6 concentration of non-coagulation defect group was significantly lower than that in adjusted coagulation defect group (ng/L:29.26 vs. 67.98, P<0.05) and non-adjusted coagulation defect group (ng/L:29.26 vs. 128.00 P<0.05). There was no significant difference in IL-6 level between the adjusted and non-adjusted coagulation defect groups (P>0.05). The IL-8 level of non-coagulation defect group was significantly lower than that of adjusted (ng/L:24.67 vs. 27.23, P<0.05) and non-adjusted coagulation defect groups (ng/L:24.67 vs. 60.14, P<0.05). There was no statistically significant difference in IL-8 concentration between adjusted and non-adjusted coagulation defect groups (P>0.05). Conclusions The grade of sepsis severity, APACHEⅡscore, whether existence of coagulation dysfunction being present or not and whether its presence being adjusted or not during the septic patients' stay in ICU, the levels of blood lactate, PCT, IL-6 and IL-8 on the first day in ICU are significantly correlated to the prognosis of septic patients. Whether the existence of coagulation dysfunction being present or not, whether coagulation dysfunction being adjusted or not and the blood lactate level are the independent prognostic factors of septic patients, and the plasma concentrations of IL-6 and IL-8 are the independent affecting factors of whether coagulation dysfunction occurring or not, therefore they have predicting value concerning the occurrence of coagulation dysfunction in septic patients.

Objective To observe the morphological changes of rats' pancreas and nitric oxide (NO) and endothelin(ET) in the blood serum in rats after exposure to different pulses of high power pulse microwave (HPPMW).Methods SD-rats were irradiated with 104,105 and 4 × 105 pulses of HPPMW,respectively.After gloss observation,the histopathological changes of pancreas were observed through biological microscope and electroscope.The changes of amylase,nitric oxide and endothelin in blood serum were detected by biochemical and radio-immunological methods. Results Compared with the blank control,no apparent abnormality could be observed in the pancreas of all groups.The dilatation of capillary could be observed in each experimental group by microscope.The ultrastructure changes of pancreas were most serious in 4 × 105 pulse group,especially at 24 and 48 h after irradiation.Compared with the control group,the levels of serum amylase were decreased (F =12.58,11.73,P ＜ 0.05),while ET were increased (F =4.50,4.49,P ＜0.05) at 24 and 48 h after irradiation.The levels of NO in serum were increased ( F =17.51,41.72,19.98,32.64,P ＜ 0.05 ) at each time-point.The level of NO went up with the increase of pulses.Conclusions HPPMW has damage effects on the pancreas in rats.The pulses with the pancreas can lead to severity of the damage. The mechanism of HPPMW may be involved in the enhancement of ET and NO in serum.

Objective To study the safety, reasonableness and feasibility of D 3 lymphadenectomy(LC) for advanced right colon cancer(ARCC). Methods 97 cases of ARCC were divided randomly into two groups: D 2.LC group (55cases) and D 3 LC group (42cases). The climical data between D 3 LC and D 2LC were compared. Results Comparing to D 2 LC,D 3 had higher operative invasive degree, but the incidence of postoperative complications did not increase, the ratio of the curable resection and the three-year and five-year survival rate after operation were significantly higher (88.1% and 73.8% vs 72.8% and 52.7%) (all P