Objective To investigate the efficacy and toxicity of bortezomib in combination with dexamethasone for the treatment of patients with multiple myeloma(MM).Methods Fourteen patients(11 males,3 females,mean age 65.1 yrs)with MM,who were hospitalized in the First Affiliated Hospital of Wenzhou Medical College from June 2005 to July 2007,were treated with bortezomib(1.3 mg/m2)by intravenous bolus twice a week for 2 weeks in a 21-day cycle,followed by an intravenous injection of dexamethasone 20～40 mg.The patients received one to eight courses.Response to bortezomib was evaluated according to the criteria of the European Group for Blood and Marrow Transplantation(EBMT)before initiation of each bortezomib chemotherapy course.Adverse effects were graded according to the National Cancer Institute Common Toxicity Criteria,version 3.0.Results The median follow-up duration from the begining of bortezomib treatment was 3.5 months.Clinical reponse was observed in 12 patients(86%),including complete response in 2,nearly complete response in 6,partial response in 3,minimal response in 1 and progressive disease in 2.The most common adverse effects were fatigue(10 patients),peripheral neuropathy(7 patients),gastrocnemius myalgia(2 patients),gastrointestinal symptoms(4 patients),thrombocytopenia(5 patients),disseminated herpes zoster(1 patient)and refractory hyponatremia(1 patient).The adverse effects were subsided on routine supportive care.Conclusion Bortezomib in combination with dexamethasone is an effective therapy with a high response rate for MM patients.All the adverse effects are more than common but are manageable with symptomatic therapy and(or)dose modification.

Objective: To study the application of CT and MRI fusion technique in the diagnosis and treatment of intraocular and orbital tumors. Methods: 2D-images of 13 patients with intraocular and orbital tumors were fused by special-point registration and Iterative Local Closest Point(ILCP) method; 3D-fusion images were reconstructed by Ray Tracing method. Results: A 3D-CT-MRI fusion images of intraocular and orbital tumors were reconstructed and displayed. The CT and MRI data of intraocular and orbital tumors were displayed on the same image as a comprehensive whole,which provided a stereogram of 3D-structure of the normal and abnormal orbital tissues. Anatomical structure of the orbit was clearly visualized by 3D-CT-MRI image. Conclusion: The multi-modality fusion technique can provide more accurate and comprehensive information for clinical diagnosis of intraocular and orbital tumors, which is helpful for doctors' planning of surgical operations,clinical education and doctor-patient communication.

Objective To evaluate the efficacy and adverse effects of the three dimensional conformal radia- tion therapy(3D-CRT) concurrently combined with chemotherapy for limited stage small cell lung cancer(LSCLC). Methods 33 patients with LSCLC received 6 cycles EP(cisplatin,etoposide) chemotherapy and 3 weeks was a cy- cle. The conventional radiotherapy was given after the first cycle chemotherapy or the third cycle chemotherapy, then the 3D-CRT and the total dose of the primary tumor was 45Gy per 3 weeks,1.5Gy for once,twice for a day. Results Toxicity was durable in 33 patients received 3D-CRT concurrently combined with chemotherapy. The total re- sponse was 97 %. Median time was 21.9 months, and the 1-,2-, 3-year survival rates was 69.7 % ,51.5 %, 30.3 %. The 1-,2-, 3-year local progress ion-freely survival rates were 66.7 %, 45.5 %, 30.3 %, respectively, with the median local progression-freely survival time of 18.5 months. Respectively during three year follow-up visit. Conclusion The 3D-CRT concurrently combined with chemotherapy for patients with limited stage small cell lung cancer could be more effectively, and the patients could tolerate the side effects, this therapy method was secure and received.

Objective To determine the relationship between serum interferon-inducible T cell alpha chemoattractant(I-TAC)levels and disease activity in patients with systemic lupus erythematosus(SLE).Methods Serum level of I-TAC was measured by sandwich ELISA.Results①Serum level of I-TAC was significantly increased in patients with SLE as compared with controls,and significantly higher in patients with active SLE than those of the inactive.Serum level of I-TAC showed significant positive correlation with disease activity,erythrocyte sedimetation rate(ESR),logarithm of serum ANA titer,and negative correlation with serum C3levels.②Serum level of I-TAC was significantly higher in patients with renal involvement than those without renal diseases.Conclusions These results suggest that I-TAC might be involved in the pathogenesis of SLE,and its serum level might be used as a good indicator for the disease activity of SLE and renal involvement.

Objective To explore the effects of radiofrequency ablation ( RFA) combined with percutaneous vertebroplasty ( PVP) by the injection of artificial bone for metastatic spinal tumor. Methods Fifty-eight patients with metastatic spinal tumors were divided into bone cement group 1 (n=12),bone cement group 2 (n=16), artificial bone group 1 (n=16), artificial bone group 2 (n=14). The patients in bone cement group were arranged RFA combined with PVP by injection of bone cement,and the artificial bone group were treated with RFA combined with PVP by injection of artificial bone. The vertebral body modality,fractures, and visual analogue scale ( VAS) ,spinal ODI score were compared before operation,1 week,1,3,6,9,12 months of after operation. Results There were 12 patients (42. 9%) with vertebral body deformation in bone cement group,which was more than those in artificial group (6. 7%) (χ2 =8. 4768,P=0. 0036). The VAS or DOI score decreased after operation than those pre-operation in the 4 groups (P<0. 01),but increased in bone cement group after operation of 6, 9 and 12 months than those in artificial group (P<0. 05). Conclusion The combination of RFA and PVP by injection of bone cement or artificial bone is effective to metastatic spinal tumors. The effects of PVP injection with artificial bone maintains longer duration compared to bone cement.

Objective To explore whether the Chinese medicine Guben Yiliu III can improve the effect of gemcit -abine on human pancreatic cancer xenograft in nude mice . Methods Nude mice with transplanted human pancreatic cancer were divided randomly into 4 groups: control group, gemcitabine treatment group , combined ( Guben Yiliu III +gemcitabine) group, and Guben Yiliu III group, 10 mice in each group.The gemcitabine group and combined group were treated with gemcitabine from the 8th day after transplantation in a dose of 100 mg/kg by i.p.injection, twice a week. Guben Yiliu III and combined groups were given the aqueous solution of Guben Yiliu III granules p .o.since the 8th day af-ter transplantation .Result The inhibition rate of transplanted tumor in the three treatment groups were 48.9% in the gemcitabine group , 68.9%in the combined group , and 28.0%in the Guben Yiliu III group .The combined group showed a significantly higher inhibition rate than the gemcitabine group (P<0.05).The gemcitabine group, combined group and Guben Yiliu III group showed a significantly slower growth rate than the control group .However, the combined treatment group showed a pronounced side effect and body weight loss than the other 3 groups .Conclusions The Chinese medicine Guben Yiliu III can improve the inhibitory effect of gemcitabine on nude mice with human pancreatic cancer xenograft in the auxilla of nude mice .

Objective To review the indications,surgical methods,and matters which need attention in partial right diaphragmatic resection,and to summarize our experience of surgical therapy for hepatocellular carcinoma with right diaphragmatic invasion.Methods The clinical data of 27 patients with hepatocellular carcinoma which had invaded the diaphragm and had received partial right diaphragmatic resection and partial hepatectomy in our hospital from September 2008 to September 2012 were retrospectively analyzed.Results The operations were all performed successfully.The tumor diameter ranged from 5.0 to 15.0 cm (average 8.5 cm).The area of right diaphragm which was resected ranged from 9.0 to 50.0 cm2 (average 28.5 cm2).The operation time was 110～250 min (average 165 min),and blood loss was 450～2600 ml (average 870 ml).Diaphragmatic invasion was confirmed by postoperative histopathology in 9 patients (33.3％).A small quantity of right thoracic effusion was detected in all the cases postoperatively.Other complications included hepatic insufficiency in 4 patients and early postoperative bleeding,upper gastrointestinal bleeding,biliary fistula,and infection under the diaphragm in 1 case each.All patients recovered after conservative treatment.There was no perioperative death.19 patients received other postoperative adjuvant treatment while 6 patients refused further treatment and 2 patients were lost to follow-up.The 0.5-,1-,2,and 3 year survival rates after operation were 92.6％,81.5％,51.9％ and 33.3％ respectively.Conclusions Right diaphragmatic invasion is not a contraindication to surgery.Right diaphragmatic resection was safe and feasible,and postoperative long-term survival was satisfactory.

Objective To apply the real-time gray scale contrast-enhanced ultrasonography(CEUS) with quantitative analysis technique to monitor the change of the renal cortex blood perfusion before and after Salvia miltiorrhiza treatment of rabbit renal is-chemia-reperfusion injury and to investigate the application value of the ultrasound contrast for evaluating the effect of medication in the treatment of rabbit renal ischemia-reperfusion injury (IRI) .Methods The rabbit right kidney was resected and the left renal pedicle was occluded for 60 min ischemia ,then the perfusion was recovered for establishing the IRI model .Salvia miltiorrhiza injec-tion was given for observing the pathological changes of the left kidney and the renal cortex blood prefusion under the contrast-en-hanced ultrasonography .The parameters of renal cortex blood perfusion were quantitatively analyzed by the time-intension curves . Results After IRI occurrence ,the time-intensity curve (TIC) of the rabbit renal cortex was slowly ascended .The time to peak (TTP) was extened and the rising slope(Grad) of the curve ascending branch was declined (P< 0 .05);after Salvia miltiorrhiza treatment ,TTP decreased and Grad increased obviously(P<0 .05) .Conclusion CEUS combined with quantitative analysis can re-flect the renal blood perfusion abnormity caused by ischemia-reperfusion and discover the change of the renal blood perfusion after medication treatment .

【Objective】To observe the expression of PI3-K phosphorylated products and elucidate the correlation between PI3-K phosphorylated products and Th2 cytokine in peripheral blood mononuclear cell (PBMC).【Methods】14 patients with active lupus nephritis and 12 controls were selected,PI3-K phosphorylated products were detected by immunoprecipitation and Western blotting,RT-PCR was used to observe interleukin-6 mRNA and interleukin-10 mRNA expression.【Results】In either spontaneous condition or stimulated by anti-CD3 antibody,the expression of PI3-K phosphorylated products in patients with active lupus nephritis were higher than those of the controls(1.14±0.23 vs 0.46±(0.12，P=0.023;2.09±0.63 vs 0.65±0.14，P=0.016).The expression of PI3-K phosphorylated products in active lupus nephritis showed a positive correlation with interleukin-6 mRNA and interleukin-10 mRNA (r=0.652,P=0.008;r=0.718,P=0.007).PY294002,one of specific inhibitor of PI3-K,inhibited significantly the expression of interleukin-6 mRNA(2.32±0.51 vs 0.57±0.15,P=0.009) and interleukin-10 mRNA (1.71±0.33 vs 0.67±0.11,P=0.006) in stimulated PBMC in active lupus nephritis.【Conclusion】PI3-K can involve in the pathogenesis of lupus nephritis by inducing the overexpression of interleukin-6 and interleukin-10.

Objective To investigate the diffusion changes in ipsilateral substantia nigra after a chronic striatum infarction with diffusion tensor imaging ( DTI ) and its connotation for clinical lecture.Methods Participators underwent a DTI scan and were divided into three groups. The striatum infarction (SI) group consisted of twenty patients with chronic basal ganglia infarction with striatum involved, while the non striatum infarction (NSI) group consisted of another twenty patients with chronic basal ganglia infarctions without striatum involved. The control group consisted of twenty healthy volunteers. Before the DTI scan all patients underwent a clinical evaluation with Modified Rankin Scale (mRS) and Barthol Index,and the four patients of SI group with symptoms like Parkinson disease underwent an additional evaluation with the third subscale of Unified Parkinson' s Disease Rating Scale ( UPDRS Ⅲ ). Results Compared with NSI and control groups, the infarct side substantia nigra MD of SI group increased by 30. 86 percent (t =40.07,P=0.000) and 31.42 percent (t =42. 64,P =0.000). The FA values from the three groups were not different. There were four patients with some symptoms like Parkinson disease in SI group. Compared with those patients without symptom like Parkinson disease in SI group, the infarct side substantia nigra MD of these four patients increased by 22 percent(t = 18.03, P =0. 01 ). Moreover, the infarct side substantia nigra MD of these four patients was correlated with their UPDRS Ⅲ positively ( r = 0. 97, P = 0. 03 ).Conclusions The secondary degeneration in the ipsilateral side substantia nigra after striatum infarction could be detested quantitatively with diffusion tensor imaging. The secondary degeneration in substantia nigra may be responsible for the symptoms like Parkinson disease in striatum infarction patients.