[Objective]To discuss the diagnosis and treatment method of scoliosis associated with Chiari malformation.[Method]Twelve patients were suffered from scoliosis associated with Chiari malformation,in which there were 7 patients also complicated with syringomyelia.Firstly,posterior suboccipital craniectomy to enlarge foramen occipital magnum was performed,then the patients underwent the scoliosis correction with instrumentation.[Result]Preoperatively,the mean Cobbs angle on the coronal plane was 71?,and 24? postoperatively,with an average correction of 66%.During a follow-up from 1 year to 4 years,there were no release of the hook,no breaking of pedicle screw,no false articulation and no new nervous lesion,while few improving was found about the sensory disability and superficial abdominal hyporeflexia.[Conclusion]We should first consummate the examination and make a definite diagnosis for the patients who were suffered from scoliosis associated with Chiari malformation and syringomyelia;posterior suboccipital craniectomy to enlarge foramen occipital magnum or syrinx-subarachnoid space shunting should be performed firstly to reduce nervous lesion during scoliosis correction surgery.

Nasopharyngeal carcinoma (NPC) is one of the most common malignant tumor in China, Southeast Asia and North Africa region. The main treatment of NPC is radiation therapy, and concurrent chemoradiotherapy has become the standard treatment for locally advanced NPC Up to date, the targeted therapy in NPC has been gradually appreciated recently, in this paper, NPC biological targeted therapy in recent years as a progress of treatment were reviewed.
Biological Therapy ; Carcinoma ; Chemoradiotherapy ; China ; Humans ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; therapy ; Radiotherapy

BACKGROUND: Most of the scoliolosis patients with Marfan syndrome are young, and in the growth and development period. Scoliosis develops rapidly, so a great number of patients need operation. Many patients accompanied with severe cardiorespiratory disfunction, which brings about a great difficulty for operation.OBJECTIVE: To observe the effect of CD orthosis on spinal function of patients with Marfan syndrome.DESIGN: A self-control observation.SETTING: Department of Orthopaedics, Renji Hospital Affiliated to Medical College, Shanghai Jiao Tong University (i.e. Shanghai Second Medical University).PARTICIPANTS: A total of 8 severe scoliolosis patients with Marfan syndrome who were treated at Department of Orthopaedics, Renji Hospital Affiliated to Medical College, Shanghai Jiao Tong University (i.e. Shanghai Second Medical University) were enrolled from May 1999 to July 2003. Of them, there were 2 one-side curvatures, 6 two-side curvatures; 4 cases of cardiorespiratory function lost lightly, 2 cases midrange lost. Mean Cobb angle was 88°.METHODS: The patients were at prone position under general anesthesia.Incision was made at middle posterior after fixing the position. Erector spinal muscle beneath periosteum was stripped and vertebral plate to transverse process root was revealed. Claws or nails were used in multiple segments of vertebrae by CD orthosis such as CD, CD-Horison, TSRH, USS and so on.MAIN OUTCOME MEASURES: Changes of Cobb angle, height, grafting bone fusion and cardiorespiratory function of patients after operation.RESULTS: After 12-month follow-up, 8 patients were involved in the result analysis. The incision of 8 patients was healed, no infection. Scoliolosis was corrected effectively, and the height increased by 5-8 cm. Cardiorespiratory function recovered satisfactorily after operation. Grafting bone was fused. The lost Cobb's angle was less than 25° after correction.CONCLUSION: CD orthosis can correct the lateral curvature and effectively correct that of patients combined with rotational deformity, consisting of large distraction, multiple segment frame style fixation, average distributed force placement, so it is not easy to have the complications such as release, broken stick and so on. Selective multiple segment fixation and derotation are adopted, so good three-dimension correction is gained, which can reconstruct satisfactorily trunk balance, prevent post-operative loss,with less complication, high fusion rate, less correction lost. External fixation is not needed after operation, which is helpful for early rehabilitation.

Objective To explore the therapeutic effect of lung cancer Ⅳ recipe combined with chemotherapy on treating middle and advanced stages of non-small cell lung cancer (NSCLC) in the elderly.Methods A total of 77 NSCLC patients in middle and advanced stages aged 70 years and over who had heat-toxin syndrome in traditional Chinese medicine (TCM) were selected from Apr.2013 to Oct.2014 in our hospital.Patients were randomly divided into chemotherapy group (n=39) and chemotherapy + herbs group (n=38).Karnofsky assessment scale (KPS),effective rate,symptom and sign in traditional Chinese medicine,changes in the levels of high-sensitivity c-reactive protein (hs-CRP),carcino embryonic antigen (CEA),neuron specific enolase (NSE),tumor special growth factor (TSGF) were observed before and 1 and 56 days after treatment.Results There was no significant difference in effective rate between the two groups (P＞0.05).The KPS and symptom and sign in TCM were improved significantly in chemotherapy + herbs group as compared with chemotherapy group (36.7 ％ vs.26.5 ％,80.0 ％ vs.58.8 ％,respectively (x2 =2.721,6.731,both P＜0.05).There were no significant differences in hs-CRP,NSE,CEA,TSGF levels between two groups before and after treatment (P＞0.05),but hs-CRP level in both groups was decreased after treatment as compared to pre-treatment and the decvease was more obvious in chemotherapy + herbs group (51.47％ vs.23.77％,x2 =19.713,P＜0.05).Conclusions Lung cancer Ⅳ recipe can improve the main clinical symptoms,quality of life and tolerance to chemotherapy in NSCLC patients with heat-toxin manifestation in TCM.There is a correlation between heat-toxin syndrome and hsCRP level in NSCLC patients,which shows that hs-CRP probably is the material basis of the heattoxin syndrome in TCM.

OBJECTIVE:To observe the efficacy and safety of tadalafil combined with tamsulosin in the treatment of erectile dysfunction(ED) patients after four area division plasmakinetic enucleation of prostate (FPKRP). METHODS:Seventy patients with ED after FPKRP were randomly divided into control group and observation group,with 35 cases in each group. Both groups received FPKRP;control group was given Tamsulosin capsule 0.2 mg orally,once a day,1 d after surgery;observation group was additionally given Tadalafil tablet 10 mg,once a day,on the basis of control group. Both groups were treated for 3 months. Clini-cal efficacies of 2 groups were compared;international prostate symptom score,the levels of prostate specific antigen,the maxi-mal urinary flow rate,international erectile function questionnaire-5 score,life quality score and ADR were also compared before and after treatment. RESULTS:The total response rate of short-term therapy in observation group was significantly better than con-trol group,with statistical significance(97.14% vs. 71.43%,P<0.05). Before treatment,there was no significant difference be-tween 2 groups in terms of international prostate symptom score,the maximal urinary flow rate,international erectile function ques-tionnaire-5 score and life quality score(P>0.05). After treatment,international prostate symptom score and life quality score in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group;the maximal urinary flow rate and international erectile function questionnaire-5 score were significantly higher than before treat-ment,and the observation group was significantly higher than the control group,with statistical significance(P<0.05). There was no statistical significance in the levels of prostate specific antigen between 2 groups before and after treatment (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:For patients with ED after FPKRP,tadalafil combined with tamsulosin can effectively improve erectile function,relieve the lower urinary tract symptoms and improve the quality of daily life with good safety.

Objective To investigate the efficacy of different radical surgical procedures for the treatment of hilar cholangiocarcinoma.Methods The clinical data of 207 patients with hilar cholangiocarcinoma who were treated at the Southwest Hospital from June 2007 to June 2012 were retrospectively analyzed.Local resection or hemihepatectomy combined with caudate lobectomy was applied to patients with Bismuth type Ⅰ hilar cholangiocarcinoma; dumbbell type radical resection was applied to patients with Bismuth type Ⅱ hilar cholangiocarcinoma or some patients with type Ⅲ a,Ⅲ b and Ⅳ hilar cholangiocarcinoma; hemihepatectomy or extended hemihepatectomy combined with caudate lobectomy was applied to patients with Bismuth type Ⅲ a,Ⅲ b and Ⅳ hilar cholangiocarcinoma.The patients were followed up every 3 months postoperatively till December 2012.All data were analyzed using the chi-square test or Fisher exact probability test,the survival curve was drawn by Kaplan-Meier method,and the survival was analyzed using the Log-rank test.Results Of the 207 patients,124 received radical resection,including 14 received local resection,23 received dumbbell type resection,87 received lobectomy + caudate lobectomy,49 received palliative resection; 34 received biliary drainage.Four patients died perioperatively.The incidences of complications of dumbbell type radical resection,left hemihepatectomy + caudate lobectomy,right hemihepatectomy + caudate lobectomy were 21.7％ (5/23),46.6％ (27/58) and 48.3％ (14/29),respectively.The incidence of complications after dumbbell type radical resection was significantly lower than left hemihepatectomy + caudate lobectomy and right hemihepatectomy + caudate lobectomy (x2 =4.42,3.90,P ＜ 0.05).One hundred and seventy patients were followed up.The median survival time of the 112 patients who received radical radical resection was 26.5 months,and the 1-,3-,5-year survival rates were 75.9％ (85/112),42.9％ (24/56) and 28.9％ (11/38),respectively.The median survival time of the 38 patients who received palliative resection was 8.5 months,and the 1-,3-year survival rates were 31.6％ (12/38) and 0.The survival time of 20 patients who received biliary drainage was 4.0 months,and the l-year survival rate was 0.The survival rate of patients who received radical resection was significantly higher than those who received palliative resection (x2=65.32,P ＜ 0.05).There was a significant difference in the survival rate between patients who received surgical treatment and those who received biliary drainage (x2=99.97,P ＜ 0.05).Of the 112 patients who received radical resection,the median survival time of 10 patients who received local resection of tumor was 47.0 months,the 1-year survival rate was 10/10,and 4 patients survived at the end of the follow-up; the median survival time of 23 patients who received dumbbell type radical resection was 32.0 months,and the 1-,3-year survival rates were 95.7％ (22/23) and 7/15,and the survival time of 6 patients was longer than 5 years; the median survival time of 54 patients who received left hemihepatectomy or extended left hemihepatectomy + caudate lobectomy was 27.6 months,and the 1-,3-year survival rates were 42.1％ (24/57) and 38.7％ (12/32),and the survival time of 9 patients was longer than 5 years,3 patients survived at the end of the follow-up ; the median survival time of 25 patients who received right hemihepatectomy or extended right hemihepatectomy + caudate lobectomy was 28.3 months,and the 1-,3-year survival rates were 45.8％ (11/24) and 6/15,and the survival time of 6 patients was longer than 5 years,2 patients survived at the end of follow-up.The median survival time of 35 patients (patients with Bismuth type Ⅰ,Ⅱ hilar cholangiocarcinoma and Bismuth Ⅲ a and Ⅲ b hilar cholangiocarcinoma which did not invade the secondary bile duct) who received hemihepatectomy + caudate lobectomy was 32.0 months,and the 1-,3-,5-year survival rates were 91.4％ (32/35),45.8％ (11/24) and 5/16,which were not different from the survival rate of patients who received dumbbell type radical resection (x2 =0.17,P ＞ 0.05).The 5-year survival rate of patients with lymph node metastasis was 4/19,which was significantly lower than 30.4％ (7/23) of patients without lymph node metastasis (x2 =23.40,P ＜ 0.05).Conclusion Joint lobectomy and standardized lymph node dissection could help to improve the efficacy of surgical treatment for patients with hilar cholangiocarcinoma.

Surgical resection is considered to be the most effective therapy for hilar cholangiocarcinoma.Inadequate excision range is the main reason for recurrence after surgery.Extended radical resection provides better long-term survival,however,it may also increase the risk of liver failure because of the extensive hepatic resection.In present study,we showed a new operation which could excise enough length of bile ducts and avoid large volume hepatic tissue resection.The excision extension includes:segment Ⅰ,Ⅳb and partial Ⅳ,left,right and furcation of hepatic duct,extrahepatic ducts,skeletonization of hilar vessels,and dissection of at least second station lymph nodes.As the tissue resected resembles a dumbbell,this surgical technique is named dumbbell type radical resection.The operative indications include:(1) hilar cholangiocarcinoma,Bithmuth Ⅱ and Bithmuth Ⅲ with tumor limited in left or right hepatic ducts ; (2) Without portal invasion; (3) Without third station lymph node metastasis; (4) Without liver or distant organ metastasis.Twenty-three patients had undergone this operation sucessfully.Most patients have high total bilirubin levels (more than 300 μmol/L) and have not received percutaneous transhepatic cholangial drainage or biliary drainage.The average operation time was 355 minutes,and average volume of blood loss during operation was 350 ml.The total survival rate was 65.2％.One-year tumour free survival rate was 95.7％ (22/23),and three-year tumor free survival rate was 7/15.The results indicated that dumbbell type radical resection was feasible for hilar cholangiocarcinoam of Bismuth Ⅱ and Bismuth Ⅲ with tumor limited in left or right hepatic ducts.

Objective To discuss the value of 16-slice spiral CT urography in clinical diagnosis.Methods To compare the images between CR excretory urography,CT and MPR,which are the results of 26 cases who were examined by both CR and 16-slice spiral CT urography.Results From the comparison,it is found that the spiral CT urography images are better than that of the CR excertory urography,and at the same time,the relationship between the parenchyma of the renal,renal pelvis,ureter,bladder and the urinary organs and adjacent structures can be demonstrated clearly.Conclusion The scanning time of the spiral CT is shorter.The machine can not only reconstruct powerfully but also work out better images,and the result is better than CR excretory urography which can not detect some details in its images.Therefore CR excretory urogaphy can be replaced by 16-slice spiral CT urography regardless of its cost.

OBJECTIVE: To evaluate the effects of NF-κB activation on the proliferation and apoptosis throughTLR4/MyD88 signaling pathway in human nasopharyngeal carcinoma (NPC) 5-8F cell lines. METHOD: TLR4 induced by LPS is inhibited by PE anti-human. Real-Time Quantitative PCR and Western blot were employed to evaluate the efficacy of mRNA level and protein expression. The growth inhibition rate of 5-8F by Celecoxib was evaluated with MTT method. The cell cycle and apoptosis were measured with flow cytometric method (FCM). RESULT: By using the specific inhibitor, the protein and gene expression of NF-κB and MyD88 were both significantly lower than the control group (P<. 05). Meanwhile, the down-rugulation of NF-κB could inhibit proliferation of NPC 5-8F cells and promote their apoptosis (P<0. 05). CONCLUSION By inhibiting TLR4 / MyD88 signaling pathway, the expression of NF-κB in NPC 5-8F cells could decrease, then the cell proliferation was inhibited and cell apoptosis was induced. The results showed that TLR4 / MyD88 / NF-κB induced by LPS is an important pathway in the genesis and development of NPC. This study provides evidence for targeting research of NPC.
Apoptosis ; Carcinoma ; Cell Cycle ; Cell Line, Tumor ; Cell Proliferation ; Gene Expression Regulation, Neoplastic ; Humans ; Myeloid Differentiation Factor 88 ; metabolism ; NF-kappa B p50 Subunit ; metabolism ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; pathology ; Signal Transduction ; Toll-Like Receptor 4 ; metabolism

Objective To discuss the problems of using high pressure injector in the 16-detector-row CT. Methods Reviewed and analyzed the courses of using high pressure injector in the 16-detector-row CT for 799 patients. Results 774 patients obtained successful infusion,contrast medium hydrops were occurred in 20 patients,2 patients were infusion failure and 3 patients were redid for misoperation. Conclusion Master the details of operating high pressure injector can alleviate the pain of patients,and then obtain the satisfactory effect.