Objective To evaluate the clinical significance of orthotopic continent detenial sigmoid neobladder.Methods 12 patients with bladder cancer were admitted and underwent radical cystectomy and detenial sigmoid neobladder.Results All the 12 patients were followed up for a mean of 18.6 months(range from 6 to 29 months).The blood Cr and BUN levels were both in the normal range without acidosis in all the cases.Only 1 had unilateral ureteral urine reflux during cystography.Of the 12 patients,11 cases(91.7%) achieved continence during daytime;2 cases(16.7%)were incontinent at night,but 1 case could control uri- nation by being woken up at night.The capacity of the neobladder was 220 to 550ml with a mean of 350ml and the maximal pressure of the neobladder during filling was 15 to 55cm H_2O(1cm H_2O=0.098kPa)with a mean of 35cm H_2O.Conclusion As a simple operation the detenial sigmoid neobladder can be performed easily with less complications and more reliable results.This operation may be generally applied in clinical practice.

[Objective]To evaluate long-term therapeutic effect of high tibial osteotomy HTO in the treatment of varus knee osteoarthritis.[Method]Eighteen males(twenty four knees)and eighty four females(ninety one knees)were accept HTO,patients were from thirty-five to sixty-five years,with average age 52.32(35～65)years.[Result]Ninety one knees were followed up from 10 years and 2 months to 21 years and 9 months,average 15 years and 1 month.HSS criterionwas used as evaluation standard,the ratio of excellent and good post operation 0.5 year,1 year,2,5,10,15 years were 98%,98%,98%,96%,78%,57%.[Conclusion]The therapeutic effect of HTO is good in the first 15 years,but it obviously degrade after 15 years,and HOA can work against time for prolongation of period before the possible later total knee replacement.

Objective:To evaluate the anti-tumor immune responses of nureplicable recombinant vaccinia virus-based vaccine expressing HPV16 L1 and L2E7 proteins.Methods:The anti-tumor effects of the vaccine were observed using mouse models of prophylactic,therapeutic and tumor excision.The cell-mediated immunity induced by the vaccine was assessed by enzyme-linked immunospot (ELISPOT) and cytotoxic T lymphocyte (CTL) assay.Results:The vaccine could protect 60% and 50% mice from the challenge of HPV16-positive tumor cells in prophylactic and therapeutic mouse model,respectively.It could protect from recurrence of the tumor in 70% mice of the excision model.The differences among the groups were significant.Strongly specific cell-mediated immunity was found using ELISPOT and CTL assay.Conclusion:The ideal anti-tumor immune responses can be induced by NTVJL1/L2E7 vaccine in mice and it can be considered to be one candidate vaccine of cervical cancer.

Natural killer cells (NK cells) are a class of cytotoxic lymphocytes and play an important role in anti-tumor immunity.There are many new advances from basic research to clinical applications in the 56th annual meeting of American Society of Hematology around the NK cells in Malignant hematological diseases.In this review,the progress will be given,which helps to understand the trend of NK cells in future clinical applications.

Objective To investigate the streptomycin(SM)-resistance of Mycobacterium tuberculosis (MTB) in urine and to examine their relationships with the mutation of rspL gene. Methods 47 strains of MTB were isolated from the urine of patients with renal tuberculosis.The mutation of rspL gene were analyzed by PCR-SSCP with silver-staining,and the strains were tested for the sensitivity to streptomycin. Results All the 47 strains had positive expression of rspL gene of MTB,with 28 SM-resistant and 19 SM-sensitive.Among the 28 SM-resistence strains 19(68%) had rspL gene mutation by SSCP testing.The 19 strains of SM-sensitive had no mutation. Conclusions Detecting mutation of MTB rspL gene in urine by PCR-SSCP can rapidly and exactly identify the MTB's sensitivity to streptomycin,which is significantly important in clinical treatment of anti-tuberculosis.

Objective To quickly pinpoint and correct errors in the application level in No.1 Military Medical Project. Methods LogMiner, a powerful tool provided by Oracle was used to mine and analyze the redo log files produced by oracle database in No.1 Military Medical Project. The basic concept, configuration and usage of LogMiner were described through an example of the Register Program in No.1 Military Medical Project. Results The errors made by Register Program was quickly pinpointed and then corrected by SQL statements provided by UNDO_VALUE field. Conclusion The method using LogMiner to pinpoint and correct the errors in the application level in No.1 Military Medical Project is simple, accurate and convenient. It should be a basic technique for maintenance personnel of hospital information system.

Objective To investigate the clinical effect of hyper-fractionated three-dimensional conformal radiotherapy (3DCRT) combined with transcatheter arterial chemeembolization (TACE) for heating patients with inoperable primary liver cancer.Methods One hundred and two patients with inoperable advanced primary liver cancer were divided by random digits table method into control group with 49 cases treated with TACE and observation group with 53 cases treated with hyper-fractionated 3DCRT combined with TACE.The short-term efficacy,adverse reaction and survival rate of the 1st,2nd and 3rd year and serum alpha-fetoprotein (AFP) expression after treatment in two groups were observed.Results The complete remission rate,progress rate and total efficiency were 17.0％ (9/53),11.3％ (6/53),73.6％ ( 39/53 ) in observation group,2.0％( 1/49 ),28.6％ (14/49),51.0％(25/49 ) in control group.There were significant differences between two groups (P ＜ 0.05).There was no statistical significance in adverse reactions between two groups ( P ＞ 0.05 ).The survival rates of the 1 st,2nd and 3rd year in control group were 51.0％ ( 25/49 ),28.6％(14/49),14.3％(7/49),the median survival time was 15 months;while those in observation groupwere 71.7％(38/53),52.8％(28/53),39.6％(21/53) and 20 months.The survival rates of the 2nd and 3rd year in observation group were significantly higher than those in control group respectively (P ＜0.05 or ＜0.01 ).The rate of patients with no obvious serum AFP protein change between observation group [ 9.8％(4/41) ] and control group [ 31.6％(12/38) ] had statistical significance (P ＜ 0.05).Conclusion Hyper-fractionated 3DCRT combined with TACE for treating patients with inoperable primary liver cancer has good clinical efficacy,it is worthy of clinical practice.

BACKGROUND:Posterior dislocation after total hip replacement is one of the most common complications that second only to loosen, and can affect the stability of the hip joint seriously. There is controversy on the effect of femoral head diameter and acetabular anteversion on the stability of hip joint in clinical study. OBJECTIVE:To investigate the effect of the femoral head diameter and acetabular anteversion on the stability of hip joint after hip prosthesis replacement. METHODS:The femoral head diameter and acetabular anteversion that affect the posterior instability after hip prosthesis replacement were measured on the cadaveric bone. The acetabular shel was inserted at 0°-20° of anteversion at five degree intervals. The femoral heads with different diameters (28, 32 and 36 mm) were used for experiment, the internal rotation degrees to dislocation caused by hip at 90° flexion and 0° adduction and at 90° flexion and 30° adduction were recorded. RESULTS AND CONCLUSION:When the cup anteversion varied from 0° to 15°, there was an increase in the degree of internal rotation angle that could cause hip dislocation with the increasing of femoral head diameter (P<0.05). When the cup anteversion varied from 15° to 20°, the increasing trend was not significant. With the hip at 90° flexion and 0° adduction, and the cup anteversion varied from 15° to 20°, the stability of 36 mm group was significantly higher than that of the 28 mm and 32 mm groups (P<0.01);the stability of 32 mm group was higher than that of 28 mm group when the acetabular anteversion in 10° or more (P<0.05);there was no significant difference in stability between groups when the anteversion less than 10°. With the hip at 90° flexion and 30° adduction, the stability of 36 mm group was significantly higher than that of the 28 mm and 32 mm groups (P<0.01);the stability of 32 mm group was higher than that of 28 mm group when the acetabular anteversion in 10° or more (P<0.05);there was no significant difference in stability between groups when the anteversion less than 10°. The results indicate that the increasing of acetabular anteversion can reduce the occurrence of dip dislocation, but when it is difficult to choice the acetabular anteversion, large-diameter femoral head is preferred to increase the stability of hip joint.

Tetrahydrobiopterin (BH4) is an essential cofactor for all three nitric oxide synthase (NOS isoforms), which plays an important role in vascular diseases. GTP cyclohydrolase 1 (GCH 1) is the first-step and rate-limiting enzyme for BH4 biosynthesis in its de novo pathway. Common GCH1 gene variant C+243T in the 3'-untranslated region predicts NO excretion. The present study examined the predictive role of GCH 1 gene 3'-UTR C+243T variant in the long-term outcome of ischemic stroke. A total of 142 patients with first-onset ischemic stroke were recruited and detected for genotype of GCH1 3'-UTR C+243T by a TaqMan SNP Genotyping assay. Subsequent vascular events and death were determined over a 5-year follow-up period. The frequency of GCH1 3'-UTR +243 C/T or T/T genotype was significantly increased in patients with endpoint events as compared with those without events (74% vs 57.8%, P=0.06). Cox regression survival analysis indicated that an increased probability of death or new vascular events was found in patients with GCH1 3'-UTR +243 C/T or T/T genotype compared with those with GCH1 3'-UTR C/C genotype (40.6% vs 25.5%), GCH1 3'-UTR +243 C/T or T/T genotype relative to GCH1 3'-UTR C/C genotype was associated with the increased risk of death or vascular events even after adjustment for other risk factors (OR=2.171, 95% CI: 1.066-4.424, P=0.033). It was concluded that GCH1 3'-UTR C+243T variant was an independent predictor of worsening long-term outcomes in patients with first-onset ischemic stroke.

Objective To investigate clinical efficacy and safety of the memantine and donepezil in the treatment of moderate to severe Alzheimer's disease,in order to provide the basis for clinical treatment.Methods One hundred and twelve cases of moderate to severe Alzheimer's disease patients were given memantine plus donepezil(observation group) ,and single use of memantine treatment(control group), and the treatment for 24 weeks.Respectively before and after treatment, Mini Mental State Scale (MMSE), Alzheimer' s disease assessment scale (ADAS-cog), Alzheimer' s disease collaborative learning, daily life ability questionnaire (ADCS-ADL) ,and neuropsychological questionnaire (NPI) score, and adverse reactions were observed in the process of two kinds of therapy, the efficacy and safety of two kinds of treatment methods were evaluated.Results After treatment, the patients in observation group with MMSE, ADAS-cog, ADL and NPI evaluation results were (12.1 ± 2.1), (32.9 ± 8.3), (33.4 ± 5.0), (6.1 ± 3.1) scores, significantly improved compared with scoring (9.9±2.8), (46.2±7.6), (42.1±6.0), (10.5±2.9) scores before treatment,and the differences were statistically significant (t =2.138,-2.411,2.398, 2.107 respectively, P ＜ 0.05).The control group after treatment in patients with MMSE, ADAS-cog, ADL and NPI evaluation results were (12.3±2.6), (33.1 ±7.2), (35.1 ±6.6), (6.7 ± 2.9) scores, significantly improved compared with scoring 11.0 ± 2.5,44.9 ± 6.9,42.2 ±6.6,10.9 ± 3.5 before treatment, and the difference had statistical significanc (t =2.101,-2.033,2.105, 2.400 respectively, P＜0.05).After treatment, the difference of patients in the two groups of MMSE, NPI score had statistical significance(t =2.553,2.176, P＜0.05).The adverse reactions in two group respectively were 32.14％ (18/56) and 26.79％ (15/56), less difference was no statistical significance (P＞0.05).Vital signs checks,regular laboratory examination and ECG examination showed no obvious abnormalities.Conclusion Memantine combined with donepezil in the treatment of moderate and severe AD patients is superior to the singleeffect of memantine, and long-term use will not increase the risk of adverse reactions, which is safe and effective in the combined application.