Objective To investigate the effect and safety of Mycobacterium vaccae vaccine ( M. vaccae vaccine) on diabetes patients complicated with pulmonary tuberculosis. Methods A total of 76 diabetes patients complicated with pulmonary tuberculosis were randomized into immunotherapy group (M, n =38) and control group (C, n =38). Administration of routine anti diabetic drugs and diet treatment were conducted in both groups. In addition, patients in group M were treat with additional M. vaccae vaccine for 3 months, but those in group C were not. Results At the end of the treatment, no side effects of M. vaccae vaccine were found in group M, but immunological function of T cells was significantly improved. Compared with those in group C, CD3 and CD4 in group M were significantly higher ( P

Objective To study the sugical treatment of elderly patients with acute intestinal ob-struction caused by colorectal cancer. Methods The clinical data of 56 elderly patients of acute colonic ob-struction caused by colorectal cancer from Janury 2002 to Janury 2007 were analyzed retrospectively. There were 20 cases with right side coloniclesion,32 cases with left side coloniclesion and 4 cases with rectal lesion. All patients received emergency operation. One stage tumor resection and anastomosis was performed in 20 cases with right side coloniclesion and in 25 cases with left side coloniclesion,Hartmann operation in 4 cases,proximal colostomy in 3 cases were performed with left side coloniclesion. Dixon operation in 2 cases and proximal colostomy in 3 cases were performed with rectum cancer. Results Postoperative complications occurred in 18 cases,including wound infection,intraperitoneal sepsis and intestinal fistula. Fifty-five cases recovered,there was one perioperative death. Conclusions Positive operation should be taken when the diagnosis of acute obstructing colorectal cancer the elderly is made. The operative methods depended on the patient'conditions. The perioperative managment should be emphasized and selection of rational operation procedure is important for decreasing mortality and complications of acute obstructing colorectal cancer in the elderly.

10.3969/j.issn.1000-3606.2013.06.008

Implantation of radioactive seeds is an effective therapeutic option for the treatment of malignant tumors. With the development of imaging technique and the use of treatment planning system (TPS) it has been more and more employed in clinical settings. The technique has been widely practiced in various malignant tumors, such as prostate cancer, lung caner, pancreatic cancer, hepatocarcinoma, etc. In order to standardize the clinical application of this technology, the authors propose some suggestions concerning the management of radioactive seeds, the indications and contraindications as well as the method of operation as a technical guidance.

Objective To investigate the safety and clinical efficacy of CT-guided radioactive ~(125)I seed implantation treatment for advanced lung cancer. Methods The clinical data of thirty cases with lung cancer, which was proved by puncture biopsy, histology or cytology, were retrospectively analyzed. The pathologic diagnoses included squamous cell carcinoma (n= 13), adenocarcinoma (n= 8) and metastatic lung cancer (n= 9). Using treatment planning system (TPS) 3D images of the tumor were reconstructed, the number and the dose rate distribution of ~(125)I seeds were calculated. The matched peripheral dose (MPD) of ~(125)I seed implantation was 80-130 Gy. The median amount of implanted ~(125)I seeds was 35 (8-83) in number. Results Follow-up observation was made at 1, 3, 6 and 12 months after the treatment in all patients. The median survival time was 12 months (7-18 months). The cumulative survival rate at 6, 9 and 12 months was 100.0%, 80.0% and 23.3%, respectively. Follow-up CT images 12 months after the therapy showed that complete relief (CR) was seen in 9 cases, partial relief (PR) in 14 cases, no change (NC) in 4 cases and progression (PD) in 3 cases. The overall effective rate (CR + PR) of 1-month, 3-month, 6-month and 12-month was 83%, 80%, 80% and 77%, respectively. During following-up period, pneumothorax occurred in 3 cases and bloody sputum occurred in 7 cases. Conclusion CT-guided radioactive ~(125)I seed implantation treatment is a safe, effective and minimally-invasive treatment for lung cancer.

Objective To discuss the clinical efficacy of CT-guided radioactive ~(125)I seed implantation treatment for unresectable pancreatic cancer. Methods Forty patients with inoperable pancreatic cancer were enrolled in this study, including 25 males and 15 females with an median age of 69 years (38-89 years). Treatment planning system (TPS) was used to reconstruct 3-dimensional images of pancreatic tumor and to define the quantity and distribution of ~(125)I seeds. The radioactivity of ~(125)I seeds was 0.5-0.8 mCi/seed. The seeds were implanted into pancreatic tumor under CT guidance at intervals of 1 cm and were kept away from vessels, pancreatic duct and other adjacent important organs. The tumor matched peripheral dose (MPD) was 60-140 Gy. The median amount of implanted ~(125)I seeds was 36 (18-68) in number. CT scan was performed immediately after the procedure to check the quality of the seeds. In addition, 10 patients received concurrent chemotherapy with arterial infusion of gemcitabin and 5-fluororacil (5-Fu) for 3 to 4 therapeutic courses. Results The median diameter of the tumors was 4.9 cm. The follow-up period was 2 to 28 months. After the treatment the refractory pain was significantly relieved (P < 0.05), and Karnofsky score was dramatically increased (P < 0.05). Most patients experienced relief of pain within 2-5 days after implantation. Two months after treatment, on CT scans the tumors showed completed relief (CR) in 3 cases, partial relief (PR) in 20 cases, no change (NC) in 14 cases and progression (PD) in 3 cases. The overall effective rate (CR+PR) was 57.5%. The median survival time for all patients was 10.2 months, while it was 14.7 months, 10.9 months and 7.1 months for patients in stage Ⅱ, stage Ⅲ and stage IV respectively. For patients in stage Ⅱ, stage Ⅲ and stage Ⅳ, the 6-month cumulative survival rate was 100%, 88% and 62% respectively, while the 12-month cumulative survival rate was 70% , 41% and 0% respectively. After the therapy, liver metastasis occurred in 5 cases and chemoembolization was employed. In three patients, immigration of four radioactive seeds to the liver was found. No serious complications, such as upper GI bleeding, pancreatitis, pancreatic fistula formation and radiation colitis, occurred during the follow-up period. Conclusion CT-guided radioactive ~(125)I seed implantation is a safe, effective and minimally-invasive brachytherapy for unresectable pancreatic cancer with reliable short-term efficacy. It has an excellent anti-pain effect. The curative results can be further improved when chemotherapy is employed together. However, its long-term efficacy needs to be observed.

Objective To investigate the therapeutic effect of VSD combined with external fixator in the treatment of open tibial and fibular fractures in Tibet plateau. Methods From August 2014 to August 2015, totally 16 cases of open tibial and fibular fractures were treated in our department, including 12 males and 4 females with an average 39. 4 years-old. There were 4 cases of proximal and mid tibial fractures while 12 cases were distal fractures. Debridement, vacuum sealing drainage combined with external fixator for stabilization of fractures was performed in all patients after general condition was improved. A vacuum sealing drainage change or second stage wound closure or soft tissue coverage was undergone after 7 days. Bone union time by X-ray and complications were recorded. Results All wounds were healed by second stage. Twelve patients months were followed up ( by calling back to the hospital ) for an average 18 months ( 12 to 24 months ) , 4 cases were lost to follow-up. X-ray demonstrated that bone union was obtained at a mean 5. 5th month (3 to 7 months). There were 9 cases (75%) obtained a first phase of fracture healing, while 3 cases ( 25%) of delayed healing. Pin-track infection was occurred in two patients and was cured by conservative treatment. No complications of deep infection, graft skin or flap necrosis, malunion, nonunion or osteomyelitis was seen during follow-up. Conclusions Vacuum sealing drainage combined with external fixator for treatment of open tibial and fibular fracture in Tibet can rapidly and effectively stabilize the fracture, and simultaneously safely and effectively seal the wound, reduce the wound healing time, promote fracture healing and lower the complication rates.

Objective To investigate the effects of mefformin on the differentiation of osteoclastas well as relative mechanism.Methods Raw264.7 cells from the murine macrophage cell line was used.Receptor activator of NF-κB ligand (RANKL) was used to stimulate osteoclast differentiation from Raw264.7 cells.Osteoclast differentiation was assessed by tartrate-resistant acid phosphatase (TRAP) and actin fluorescence staining and counting the TRAP-positive cells after exposure to different concentrations of mefformin (0 μmol/L,400 μmol/L,800 μmol/L and 1000 μmol/L) or rapamicin (100 nmol/L) in the presence of 50 ng/ml RANKL for 5 days.Bone-resorbing activity was evaluated by BD BioCoatTM OsteologicTM Bone Cell Culture System.The expression of osteoclast-specific genes like TRAP,capthesin K,calcitonin receptor (CTR) and matrix metalloproteinase (MMP-9) was evaluated by RT-PCR.The expression of tumor necrosis factor-α(TNF-ct) S6K1Thr389,S6 Ser235/236,4E-BP1Thr37/46 and c-Fos protein was evaluated by ELISA kit and Western blot analysis,respectively.Results Mefformin dose-dependently inhibited RANKL-stimulated osteoclasts differentiation in Raw264.7 cell culture,as manifested by decrease of TRAP-positive multinucleated cells and pit erosion area,down-regulation of TRAP,cathepsin K,CTR and MMP-9 mRNA and reduction of TNF-α and c-Fos protein expression.Further study revealed that RANKL activated mTOR complex 1(mTORC1) signaling,while mefformin impaired RANKL-stimulated mTORC1 signaling.Rapamycin,an mTORCl-specific inhibitor and immunosuppressive macrolides could also prevent RANKL-induced osteoclast differentiation and bone resorption in vitro.Conclusion Mefformin inhibits osteoclastogenesis in vitro,which may due to reduction of TNF-α and c-Fos protein expression,and mTORC1 signaling is involved in this process.

Objective To investigate the feasibility and safety of portal 125I seed stent implantation combined with doxorubicin-eluting beads transcatheter arterial chemoembolization (DEB-TACE) for the treatment of hepatocellular carcinoma (HCC) associated with main portal vein tumor thrombus (MPVTF).Methods Prospective single-arm study was designed.Seven HCC patients with MPVTT were sequentially enrolled in this study to receive treatment.Portal pressure before and after portal vein stent implantation were determined,the liver function were tested before and 1-3 days,4 days,5-7 days after portal vein stent implantation,the results and the postoperative complications were analyzed.Results All 7 patients were in BCLC-C stage,with Child-Pugh classification being A-B level.All patients were diagnosed as massive type HCC complicated by portal vein tumor thrombus.The lesions were located in hepatic left lobe (n=l) and hepatic right lobe (n=6),tumor thrombus in left branch of portal vein was seen in one patient and tumor thrombus in right branch of portal vein was found in 6 patients,MPVTT was observed in all 7 patients.Portal 125I seed stent implantation plus DEB-TACE was successfully accomplished in all 7 patients.The portal pressure before and after stent implantation was 15.3 cmH2O and 10.2 cmH2O respectively,the postoperative pressure showed an obvious reduction.After stent implantation,a transient elevation of the serum total bilirubin (TB),alanine aminotransferase (ALT) and aspartate aminotransferase (AST) could be observed,which gradually decreased in 3-4 days;the recovery of TB level was slower than that of ALT and AST levels.Two patients had concomitant myocardial damage,which was gradually recovered in 2-3 days.Conclusion For the treatment of HCC associated with MPVTT,portal 125I seed stent implantation plus DEB-TACE is safe and feasible,although its long-term curative effect needs to be further clarified.

The pathogenesis of liver failure is extremely complex. In recent years, the role of chemokines in viral hepatitis has been widely concerned. A large number of studies have confirmed that the abnormal expression of chemokines is closely related to the process of viral hepatitis and other types of hepatitis. Interferon-inducible protein-10 (IP-10) is a good indicator of the specificity and sensitivity of inflammatory liver injury. In this paper, IP-10 in different types of liver injury in the pathogenesis of research progress were reviewed to provide valuable indicators for clinical diagnosis, treatment strategy and prognosis evaluation of liver injury.