Objective To compare the clinical effects and safety of surgical clipping and intravascular interventional therapy in treatment of intracranial wide-necked aneurysm.Methods The clinical data of 158 patients with intracranial wide-necked aneurysm from February 2010 to February 2013 were retrospectively analyzed,all patients were divided into two groups:surgical clipping group with 92 cases and intravascular interventional therapy group with 66 cases,the postoperative curative effects,treatment time,hospital stay,hospital expenses and postoperative complications between two groups were compared.Followed up for 10-46 months,the recurrence rate were compared.Results The good prognosis and defective rates between surgical clipping group and intravasular interventional therapy group had no significant difference [90.2％(83/92) vs.90.9％(60/66),9.8％(9/92) vs.9.1％ (6/66)] (x2 =0.298,P ＞ 0.05).The preoperative Hunt-Hess classification and CT Fisher classification between two groups had no significant difference (P ＞ 0.05).Six months after discharge,mRS score was used to evaluate the curative effect,the defective rates in same level patients between two kinds of treatment methods had no significantdifference (P ＞ 0.05).The treatment time,hospital stay in surgical clipping group were significantly longer than those in intravascular interventional therapy group [(4.03 ± 1.01) h vs.(1.61 ± 0.98) h,(15.90 ± 2.03) dvs.(13.20 ± 1.95) d],hospital expenses was significantly lower than that in intravascular intervention therapy group [61 829.4 ±320.6) yuan vs.(99 876.2 ±371.5) yuan] (P ＜0.05).The postoperative complications rate between two groups had no significant difference (P ＞ 0.05).Followed up for 31.3 (10-46) months,the recurrence rate in surgical clipping group was significantly lower than that in intravascular intervention therapy group [1.1％ (1/94) vs.8.8％ (6/68)] (P ＜ 0.05).Conclusion Surgical clipping and intravascular interventional therapy in treatment of intracranial wide-necked aneurysm has their own different characteristics,so patients' treatment methods should be based on their preoperative status (especially preoperative Hunt-Hess and Fisher classification) and patients' economic conditions.

Objective:To explore the relationship between the accelerated repopulation of tumor cells in the afterloading fractionated radiation therapy and the radiation dose,Ki67 antigen,PcNA & mutation p53 antigen expression were analyzed by continual biopsy on the same patients of cervical carcinoma two weeks (10 Gy)and four weeks(20 Gy).Methods:Ki67 antigen expression and cell cycle analysis (SPF,PI,DEN) were checked by flow cytometry,PCEA & mutation p53 antigen expression were checked by means of immunohistochemical technique and computerized image cytometry.All these indexes were viewed on their relationship with the irradiation dose.Rusults:Ki67 antigen expression and DEN were increased as radiation dose increased.The difference of Ki67,PCNA and mtP53 antigen expression at the dose of 10 Gy had statistical significance compared with before brachytherapy,but it had no statistical significance compared with at the dose of 20 Gy.Conclusion:It may be concluded that the tumor cell repopulation had occurred at the dose of 10 Gy (two weeks after brachytherapy).But these markers were not obviously changed compared with at the dose of 20 Gy,so it leads to a conclusion that tumor cell repopulation was stable.It also offers the theory basis to select the opportunity of accelerated brachytherapy of cervical carcinoma.

Objective To establish the co-culture model in vitro and induce bone marrow mesenchymal stem cells (MSCs) to differentiate into lung alveolar epithelial cells. Methods Each group had 6 samples, control group was MSCs alone; Group A was the MSCs cultured with the cells from normal lung; and Group B was the MSCs with the cells from injuried lung. Each group was cultured for 8 days and the two markers of lung alveolar epithelial cells including AQP5 and SP-C were tested by laser confocal microscopy and RT-PCR. Results Only AQP5 was detected in the control group and Group A, both AQP5 and SP-C were detected in Group B, the AQP5 mRNA expression in Group B was significantly increased compared with that in the control group(P<0.01). The AQP5 mRNA expression in Group B was also significantly increased compared with that in Group A (P<0.01). But there was no significant difference in AQP5 mRNA expression between Group A and control group. Conclusion We have successfully established the co-culture model in vitro to induce bone marrow mesenchymal stem cells to differentiate into lung epithelial cells.

Objective To explore the diagnostic value of 18F-FDG PET/CT in primary peritoneal papillary serous carcinoma (PPPSC).Methods Ten postmenopausal female cases of pathologically diagnosed PPPSC from March 2009 to October 2011 were retrospectively reviewed (age range:61-81 years,mean:(69.4±6.2) years).All cases underwent 18F-FDG PET/CT.The CT characteristics and SUVmax of lesions on PET images were analyzed.Serum CA125 levels were measured before or after PET/CT within one week.The patterns of PPPSC on PET/CT were compared with histopathological results.Linear correlation analysis was used to evaluate the correlation between the CA125 and the maximum SUVmax of lesions presented in parietal peritoneum,greater omentum or mesentery.Results The PET/CT uptake pattern of the 10 PPPSC cases was described as floccus,multi-nodular or cake-like in greater omentum (SUVmax =6.32±2.87),and as diffuse or localized nodules,or non-uniform strip-like thickening in 9 parietal peritoneum and 8 mesentery cases (SUVmax =5.96±2.14 and 5.70± 1.69,respectively).The most commonly involved sites were pelvic wall of peritoneum and mesentery of small intestine.All 10 cases had different degrees of ascites,mainly intrapelvic and perihepatic.Hypermetabolic ovarian enlargement (all ＜5 cm) was bilateral in 2 patients and right-sided in 1 patient.Four patients had retroperitoneal lymph node metastasis and others were found with punctate calcifications in metastatic lymph nodes,small pleural effusions,liver metastasis,as well as portal node metastasis.CA125 concentration was elevated in all cases ((51.25±26.40) ×104 U/L),but there was no significant correlation between CA125 and the maximum SUVmax of lesions found in parietal peritoneum,greater omentum or mesentery (r=0.05,P＞0.05).Conclusion 18F-FDG PET/CT could show the positions and metabolic status of PPPSC lesions.It may be an effective imaging modality in the diagnosis and assessment of PPPSC.

Objective To evaluate the clinical effect of continuous blood purification (CBP) in treatment of children with severe sepsis,and analyze the changes of severity of illness and inflammatory factors,which can provide the proof for treatment of children with severe sepsis.Methods Twenty cases with severe sepsis admitted to pediatric intensive care unit of Bayi Children's Hosptial Affiliated to General Hospital of Beijing Military Commond from Aug 2008 to May 2011 were treated with CBP.The mean arterial blood pressure,boost dosages,urine output,arterial blood gases,and oxygenation index were collected before CBP and 12,24,48 hours after CBP treatment.The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α were determined by enzyme-linked immunosorbent assay.Pediatric critical illness scores were assessed before and 48 h after CBP treatment.Results After the treatment of CBP,16 children were clinical improvement,2 died,2 abandoned the treatment.CBP was effective in the treatment by rising the mean arterial blood pressure (P ＜ 0.01),decreasing the dosages of dopamine and epinephrine (P ＜ 0.01),increasing urine output(P ＜ 0.01).The value of pH and base excess returned to normal basically.The levels of IL-6 and TNF-α were(706.90 ± 275.95) ng/L,(989.67 ± 386.33) ng/L before the CBP.The levels of IL-6 and TNF-α decreased to (162.59 ± 63.47) ng/L,(439.08 ± 159.37) ng/L at 48 h after CBP treatment (P ＜0.01).The pediatric critical illness scores were 67.59 ± 25.02 and 87.05 ± 32.81 before CBP and at 48 h after CBP,which showed significant difference (P ＜ 0.01).Conclusion The treatment of CBP can remove inflammatory factors in children with severe sepsis and improve the severity of illness.

Objective To analyze the relationship between the radiation doses to mediastinal lymph nodes regions and the regional failure patterns when involved field radiation therapy (IFRT) was used for limited-stage small cell lung cancer (SCLC).Methods The mediastinal lymph node regions (group 1 to 10) of the iimited-stage SCLC patients received definitive radiotherapy were contoured in treatment planning system.The intentional or incidental radiation doses to each lymph node regions were recorded.In-field recurrence,marginal recurrence and out-of-field recurrence were respectively defined as the volume of failed lymph nodes located within the 80％ iso-dose lines,in the 80％-20％ iso-dose lines and beyond the 20％ iso-dose lines of prescribed doses.Results A total of 1 216 lymph node regions in 76 patients were contoured.The median follow-up time was 17.4 months.At diagnosis,lymph node regions with metastatic rates ＞50％ were 4R (68.7％),4L (57.9％),10R (57.9％),2R (56.6％) and 7 (51.3％).The positive lymph node regions were all subjected to prescribed doses.The lymph node regions that received incidental radiation doses of more than 3 000 cGy were:3P,4L,7,6,4R,5,2L.The median lymph node failure-free time was 9.8 months.In this study,only 1 patient developed out-of-field mediastinal lymph nodes failure.The rest of out-of-field recurrences and marginal recurrences were developed in the supraclavicular regions or contralateral hila.Conclusions When IFRT is used to treat mediastinal lymph node regions for patients with SCLC,negative mediastinal regions can be subjected to considerable incidental radiation doses.Out-of-field recurrences of the mediastinal lymph node regions are rare.This is contributed by the incidental radiation dose to these regions.

Objective To discuss the clinical effects of using CT positioning keyhole approach to treat hy-pertensive intracerebral hemorrhage (HICH).Methods 85 cases of patients with hypertensive intracerebral hemor-rhage(HICH) were chosen and divided into two groups according to the operation methods:the observation group had 55 cases given CT positioning keyhole approach ,while the control group had 30 cases treated with traditional cranioto-my hematoma removal operation .All patients were supplemented by postoperative blood pressure control and nutrition -al support treatment .The average operation time ,hematoma disappearing time ,the length of hospital stay and re-bleed-ing rates and postoperative ability of daily life ( ADL) scores of the two groups were all carefully recorded and com-pared.Results The average operation time,hematoma disappearing time and hospital stay of the observation group were (66.5 ±12.8)min,(3.4 ±1.3)d,and (9.3 ±1.7)day which were all significantly lower than those of the con-trol group(193.5 ±23.7)min,(5.8 ±2.1)d and (15.2 ±3.8)d;T-test values of the two groups were 2.874,3.125 and 3.433 separately(P<0.05);there were 2 cases(3.6%) of postoperative hemorrhage in the observation group of while 6 cases(20.0%) in the control group,whose difference was statistically significant (χ2 =6.097,P<0.05);In the observation group 4 cases(7.3%) died after operation and also 4 cases(13.3%) died in the control group ,and the mortality of the two groups had no statistical significance (χ2 =0.836,P>0.05).6 months′follow-up after opera-tion,in the control group 2 cases were lost to follow-up while in the observation group 3 cases were lost to follow-up;Using ADL to evaluate the two groups of patients with survival and continuous follow-up,we found that the observation group′s postoperative quality of life was better than that of the control group′s(μ=3.325,P<0.05).Conclusion Using CT positioning keyhole approach has smaller trauma , shorter operation time and faster postoperative recovery and other characteristics,which is an effective method for the treatment of hypertensive intracerebral hemorrhage(HICH).

Objective To investigate toe-brachial index ( TBI) in the diagnosis of peripheral artery disease ( PAD) and its risk factors in the patients with type 2 diabetes.Methods TBI was examined in the 238 patients with type 2 diabetes.The patients were divided into the group with low TBI ( TBI≤0.7 ) and the group with normal ABI ( TBI>0.7 ) .The two groups were compared for clinical parameters.Results Thirty two patients (13.4%)with abnormal ABI (TBI≤0.7) showed older age [(63.8 ±9.9) yrs vs (54.9 ±10.8) yrs, P =0.000] , lower diastolic blood pressure [(70.5 ±6.9) mmHg vs (74.9 ±9.1) mmHg, P =0.003], more frequency of hypertension (56.3%vs 38.3%, P =0.043), coronary artery heart disease (28.7%vs 10.7%, P =0.020) and cere-bral vascular disease (15.6%vs 4.4%, P =0.025).Step-wise analysis screened that age and diastolic blood pressure were the inde-pendent risk factors for TBI .Conclusions Aging and hypertension were the risk factors in the patients with abnormal TBI in type 2 di-abetes.TBI was an easy and economical method for diagnosing PAD in patients with type 2 diabetes.

OBJECTIVETo summarize the experiences of using cardiopulmonary bypass for patients with serious airway obstructive lesions.METHODS From Sept. 2013 to Jan. 2015, 3 cases with serious airway obstructive lesions underwent operation safely with the assistance of cardiopulmonary bypass.RESULTSAll of 3 cases were successfully managed by tracheotomy under cardiopulmonary bypass without hemodynamic disturbance and coagulation dysfunction.CONCLUSIONSevere airway obstructive lesion could be relieved successfully under the cardiopulmonary bypass. Complications can be avoided effectively by shortening the time of cardiopulmonary bypass.

ObjectiveThe study is to investigate the predictive values of dosimetric parameters and patient related factors in severe acute radiation pneumonitis (SARP) after concurrent chemoradiotherapy in non-small cell lung cancer (NSCLC).Methods In all,147 NSCLC patients treated with concurrent chemotherapy and 3DCRT between 2006 and 2010 was collected.Independent sample t test was used to compare parameter values between patients with SARP and those without SARP.Logistic regression was used to identify significant determined factor.Predictive value of each parameter was tested by ROC analysis.Pearson correlation was used to analyze correlations between parameters.Represent factors were identified by factor analysis.ResultsThe incidence of SARP was 9.5％ ( 14/147 ).The means lung dose (MLD),V20,V30,V40,and V50 ( x2 =4.87 -6.84,P =0.009 -0.025,respectively ) were determining factors for SARP.Our datasets shows that for SARP ＜5％,MLD,V20,V30,V40 and V50 should be ≤16.77 Gy,V20≤34.15％,.V30 ≤23.62％,.V40 ≤ 18.57％,V50 ≤ 13.02％.ROC analysis show that areas under MLD,V20,V30,V40 and V50 curves was corresponding to 0.678,0.661,0.667,0.677,and 0.651,respectively.In addition,the sensitivity and specificity of each parameter at cutoff values are:78.0％ and 48.1％ for MLD;42.9％ and 82.0％ for V2o ;78.6％ and 52.9％ for V30 ;71.4％ and 61.7％ for V40,and 57.1％ and 67.7％ for V50.Factor analysis suggest that we can choose 1 or 2 parameters from MLD,V20,or V30,and another from V40 or V50 for predicting.The incidence of SARP was greater in patients with tumorsin right lower lung than other locations ( 22.2％ vs 6.7％,x2 =6.19,P =0.0 2 3 ).Conclusions The MLD,V20,V30,V40 and V50 are determining factors for SARP.As predictive value of each parameter alone is relatively week,using two or more parameters to predict SARP is recommended.