Objective To evaluate the clinical value of stereotactic radiotherapy for the treatment of metastatic hepatic carcino-ma .Methods 42 patients with metastatic hepatic carcinoma (metastases≤3 ,maximum tumor diameter≤5 cm)were treated with Co60 stereotactic radiotherapy alone .The prescription isodose of PTV was 3 .5-4 .5 Gy ,total 10 times ,the median survival time ,lo-cal control ,complication and RILD(radiation-induced liver disease) of the patients were assessed .Results The median survival date was 7 .9 months ,2 cases were complete remission ,the local control rates was 69% ,27 cases were partial remission ,and there was no serious adverse side effect ,such as severe radiation-induced hepatic injury .Conclusion The stereotactic radiotherqpy was a good choice for inoperable metastatic hepatic carcinoma .

Objective To study the inhibitory effect of mycophenolate mofetil (MMF) on expression of TGF-? in pulmonary fibroblasts (WI26 cells) and its application value.Methods Pulmonary fibroblasts were divided into control group,MMF group,TGF-? group,and MMF+TGF-? group,after routine culture.Expression of TGF-?-induced COL1A1 was detected by reverse transcriptase-polymerase chain reaction (RT-PCR).Expression of COL1 proteins was detected by Western blot analysis and chloramphenicol acetyl transferase assay,respectively.Difference in contractility of collagen fibers and migration of cells was observed in collagen matrix contraction test and cell scratch test.Results The expression level of COL1A1 mRNA was higher in MMF group than in control group 24 and 48 h after treatment with MMF (77.0%?2.9% vs 38.0%?3.7%),and was lower in MMF group than in control group 24 and 48 h after treatment with TGF-? and MMF+ TGF-? (134.0%?3.1% vs 189.0%?2.4%,and 95.0%?2.7% vs 71.0%?3.3%,P

Objective To evaluate diagnostic value of pit pattern analysis on detection of early colorectal carcinoma. Methods 4176 patients were examined with colonoscopy and had the mucosal lesions stained with 0.4% indigo carmine, and part of them observed with magnifying endoscope and stereomicroscope, then compared the mucosal crypt patterns (the pit patterns Kudo classification) with pathologic diagnosis. Results There were 955 protruded and flat lesions on the large intestine mucosa in 752 patients, and among them there are 14 early cancers, 209 advanced cancers, 76Ⅱa、Ⅱb、Ⅱc、Ⅱa+Ⅱc lesions. We also found 43 laterally spreading tumors (LST) ranging from 16 to 110 mm in diameter, 2 for pit Ⅱ,18 for pit Ⅲ L, 19 for pit Ⅳ, 1 for pit Ⅴ A, 1 for Ⅴ N. The pit pattern of the most non neoplastic lesions was type Ⅰ or Ⅱ, which is about 85.4% (303/355), and the type of the adenomas was type Ⅲ or Ⅳ, about 86.0% (504/586). All the invasive carcinomas'pit patterns were type Ⅴ and there were 8 for type Ⅴ (2 Ⅴ A, 6Ⅴ N) among 14 early carcinomas. Conclusion Pit pattern analysis is a very important tool to determine the nature of lesions, which helps to decide the kinds of later therapeutic intervention.

Objective To examine the distribution of bacterial species and antimicrobial susceptibility profile of pathogens in febrile neutropenic patients.Methods A total of 355 bacterial strains were isolated from febrile neutropenic patients in Shanghai General Hospital from January 2005 to December 2012. Antimicrobial susceptibility testing was done by Kirby-Bauer method. The susceptibility testing results were analyzed according to CLSI 2014 breakpoints.Results Gram-negative bacteria accounted for 70.4% of the 355 isolates, while gram-positive organisms accounted for 29.6%. The most common bacterial species werePseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Stenotrophomonas maltophiliaand Staphylococcus haemolyticus. Non-fermentative bacteria accounted for 53.2% of all the gram-negative bacterial isolates. All theEnterococcus and
Staphylococcus isolates were susceptible to linezolid, vancomycin and teicoplanin. All theStaphylococcus strains were resistant to methicillin.P. aeruginosa isolates were relatively more susceptible to cefoperazone-sulbactam, piperacillin-tazobactam and cefepime (>70%) than imipenem (40.8%) and meropenem (59.2%). All theK. pneumoniae isolates were susceptible to imipenem and meropenem and more than 70% of the isolates were susceptible to cefoperazone-sulbactam, amikacin. More than 80% of theA. baumannii isolates were susceptible to carbapenems, cefoperazone-sulbactam, amikacin, ciprolfoxacin and aminoglycosides. All the E. coli isolates were susceptible to carbapenems and more than 70% were susceptible to cefoperazone-sulbactam and ceftazidime. More than 90% of theS. maltophilia strains were sensitive to levolfoxacin, minocycline, cefoperazone-sulbactam and trimethoprim-sulfamethoxazole.Conclusions Our data suggest that gram-negative bacteria, especiallyEnterobacteriaceae and non-fermentative bacteria, are still the primary pathogens in febrile neutropenic patients. Antimicrobial resistant strains are prevalent. Such data of bacterial species and antimicrobial susceptibility proifle of pathogens in febrile neutropenic patients are useful for empirical antimicrobial therapy of such infections.

ObjectiveTo analyze the risk factors for false negative diagnosis of obscure gastrointestinal bleeding (OGIB) by capsule endoscopy.MethodsA total of 133 OGIB inpatients,104 in true positive group and 29 in false negativc group,were reviewed.The features of demography,diseases and capsule endoscopy were collected and then analyzed,which included 10 variables like age,sex,time of bleeding,diseases accompanied,type and location of the disease,hemoglobin concentration,transit time of CE,quality of CE pictures and type of purgative agents.All data were analyzed with t test,and all the enumeration data were analyzed with chi square test.Logistic regression was used to analyze the correlation between the factors and results of diagnosis.ResultsAge ( t =2.095,P =0.038 ),concentration of hemoglobin ( t =2.143,P=0.034),type (X2 =20.222,P ＜0.001) and location (X2 =33.732,P ＜0.001) of the diseases,image quality of the CE (X2 =9.219,P =0.002 ) and the type of purgative agents (X2 =6.999,P =0.024) were found to have statistical differences between the two groups.Chi-square and partition Chi-square test revealed the occurrence of civerticulosis and lesion location,i.e.lower ileum and ileumcecum,were of statistical difference between the two groups (X2 =22.233,P ＜ 0.001 and x2 =24.412,P ＜ 0.001 ).Univariate logistic regression showed diverticulosis ( OR =0.102,P ＜0.001 ),lower bowel diseases ( OR =0.110,P ＜0.001 ),poor quality of CE pictures ( OR =0.258,P =0.004 ) and the use of sodium phosphate agent ( OR =0.367,P =0.027) were risk factors for false negative diagnosis,while older age facilitated diagnosis ( OR =1.024,P =0.041 ).However,multivariate logistic regression showed no statistic significance in type of purgative agent ( P =0.05 ) or the concentration of hemoglobin ( P =0.394).Furthermore,elder age facilitated positive diagnosis ( OR =1.031,P =0.032),while diverticulosis ( OR =0.118,P =0.001 ),lower bowel diseases ( OR =0.145,P =0.001 ) and poor quality of CE pictures ( OR =0.245,P =0.016) were correlated with higher probability of false negative diagnosis.ConclusionAge,disease type,disease location and image quality exert great influence on CE diagnosis.Diverticulosis,lower location of the diseases and poor CE image quality are risk factors for false negative diagnosis.

OBJECTIVETo explore the correlation between pathological characteristics of target organs and excess evil syndrome in IgA nephropathy.

METHODSData were collected in multicenter cooperation. Totally 266 IgA nephropathy patients were typed into exogenous wind-heat affection syndrome (49 cases), lower energizer damp-heat syndrome (100 cases), damp-phlegm syndrome (43 cases), and blood stasis syndrome (74 cases). Meanwhile, percutaneous renal biopsy was performed in all patients for Hass classification, Oxford classification, Katafuchi integral, and Jiang's classification methods. The correlation between excess evil syndrome and pathological index was analyzed.

RESULTSFour syndrome types were correlated with their Hass levels (r = 0. 341, P <0. 01). Affection of exogenous wind-heat syndrome was correlated with segmental proliferation of endothelial cells and damaged active lesions of segmental capillary loops. Lower-energizer damp-heat syndrome was associated with Hass III level, destroying active lesions of capillary loops, segmental proliferation of endothelial cells, glomerular segmental lesions, focal interstitial infiltration of inflammatory cells, focal interstitial fibrosis and tubular atrophy. Blood stasis syndrome was associated with Hass IV level, glomerular sclerosis, segmental glomerulosclerosis (S)/adhesion, mesangial hypercellularity (M), angiohyalinosis, multi-foci interstitial infiltration of inflammatory cells, multi-foci interstitial fibrosis and tubular atrophy. Phlegm-damp syndrome had higher proportions of Hass I and III levels, but with no association with other pathological parameters.

CONCLUSIONSExcess evil syndrome was associated with partial pathological characteristics of IgA nephropathy. It could reflect pathological damage degree of target organs, activities, chronic lesions, and prognosis of IgA nephropathy to certain extent. Correlated pathological characteristics and its evolution could indicate excess evil syndrome types and their evolution rules.

Capillaries ; Fibrosis ; Glomerulonephritis, IGA ; pathology ; Glomerulosclerosis, Focal Segmental ; Humans ; Kidney Glomerulus ; Medicine, Chinese Traditional ; Prognosis ; Syndrome

OBJECTIVEDefining the margin of clinical target volume (CTV) is very important for three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT). In this study, according to the comparison between gross tumor volume (GTV) silhouetted by radiology and pathology in non-small-cell lung cancer (NSCLC), we tried to define the correlation of GTV by radiology and pathology, and assess the degree of correlation to local microscopic extension (ME) among different pathologic types of NSCLC, so as to define the margin of CTV precisely.

METHODSFrom February 2001 to February 2002, forty-three NSCLC patients after surgical resection were studied. All patients had had CT scans of the chest before surgery and routine pathology examination after surgery. The tumor size at X (lateral direction), Y (ventrodorsal direction) and Z (craniocaudal direction) axes were measured on CT. Also by pathology examination, the tumor size at X, Y, Z axes and the degree of ME at X, Y, Z axes were measured, respectively.

RESULTSWithout taking into account the value of ME, there was almost total agreement on the GTV by radiology and pathology in three dimensions. The mean value of ME was 2.18 mm for adenocarcinoma (ADC) and 1.33 mm for squamous cell carcinoma (SCC) (P = 0.001). But, taking into account 95% of the ME, a margin of 7 mm and 5 mm must be allowed for ADC and SCC, respectively.

CONCLUSIONThere exists a correlation of GTV by radiology and pathology. In the target volume defining for 3DCRT and IMRT, we could use the GTV by radiology instead of the GTV by pathology, with the ME being different for ADC and SCC. To cover 95% of the ME, the margin from GTV to CTV must be extended to 7 mm and 5 mm for ADC and SCC, respectively.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; radiotherapy ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; radiotherapy ; Male ; Microscopy, Electron ; Middle Aged ; Neoplasm Invasiveness ; Tomography, X-Ray Computed

Objective To evaluate the effect of group health education for nasopharyngeal carcinoma patients who received radiotherapy.Methods Eighty cases of previously untreated patients with nasopharyngeal carcinoma who accepted radical radiotherapy from June 2009 to June 2010 were chosen as the control group,and 80 cases with the same conditions through June 2010 to June 2011 were chosen as the experimental group.The control group and experimental group were given oral health education and group health education respectively.The incidence of radiotherapy-related complications in patients who accepted two different methods of discharge guidance were compared.Results The improvement of patient compliance to rehabilitation guidance including regular reexamination,gargling,nasopharyngeal washing,mouth opening excise and neck excise was better in the experimental group than in the control group (85％ vs 68％,97％ vs 88％,99％ vs 70％,100％ vs 72％ and 95％ vs 60％),and the differences were statistically significant (X2 =6.892,5.766,25.079,25.507,12.822,respec.tively; P ＜ 0.05).The decreases in rate of complications including difficulty in mouth opening,neck movement restriction,sinusitis,otitis media and nasal bleeding were also better in the experimental group than in the control group (1.2％ vs 15.0％,1.2％ vs 5.0％,3.8％ vs 23.0％,1.2％ vs 12.0％ and 2.5％ vs 17.0％),and the differences were statistically significant (x2 ＝ 11.568,11.568,12.333,7.907,10.000,respectively; P ＜ 0.05).Conclusions Group health education can better meet the rehabilitation needs of patients with nasopharyngeal carcinoma,strengthen their subjective awareness of persisting in rehabilitation functional exercise,improve patient' s compliance and reduce the incidence of complications,so as to promote their rehabilitation and improve their life quality.

OBJECTIVETo evaluate the relationship of chimerism status of cell subsets with engraftment, occurrence of acute graft versus host disease (aGVHD), graft rejection and disease relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSChimerism status in peripheral blood (PB) and bone marrow (BM) of 65 patients received allo-HSCT were monitored at regular intervals post-transplant. Fluorescence-activated cell sorter (FACS) was used to sort CD3(+)T lymphocytes in 65 cases, CD3(-)CD56(+)CD16(+)NK cells in 52 cases, CD15(+) granulocytes in 32 cases and CD19(+)B lymphocytes in 20 cases post transplants. The chimerism status of different lineage cells was analyzed by polymerase chain reaction amplification of short tandem repeats (PCR-STR).

RESULTSOn day +7, NK-cells donor chimerism (DC 55.5%) was higher than other cell subsets. T lymphocyte was the latest one to reach complete donor chimerism (CDC) with a median on day +21. Patients whose T lymphocytes donor chimerism was more than 70% on day +7 and more than 95% on day +14 had a high risk for acute aGVHD. In all cases except those with ALL, the decreased DC of T lymphocytes were observed before molecular or hematological relapse occurred.

CONCLUSIONSerial and quantitative T cell chimerism analysis provides a reliable and rapid screening method for the early detection of engraftment, graft rejection, disease relapse and occurrence of aGVHD, therefore, is a prognostic tool to identify patients at high risk of aGVHD and disease relapse following allo-HSCT.

Adolescent ; Adult ; Child ; Chimerism ; Female ; Graft Rejection ; immunology ; Graft vs Host Disease ; immunology ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Middle Aged ; Recurrence ; T-Lymphocytes ; immunology ; Young Adult

OBJECTIVETo study the effects of total alkaloids(TA) from rhizoma Coptis chinensis on alcohol-induced gastric lesion in rats and the possible mechanisms.

METHODThe experimental gastric damges were established by intragastric(ig) absolute ethanol, and possible protective effects of TA given orally previously were evaluated by following parameters: gastric damage indexes, gastric juice volume, acidity, and mucus quantity. The contents of NO, MDA, *OH, and SOD activity were also measured in gastric mucosa.

RESULTTA showed significantly inhibitive effects on gastric damages induced by ig ethanol in a dose dependent manner. The effects of TA (120 mg x kg(-1)) were stronger than that of both cimitidine(70 mg x kg(-1)) and berberine(100 mg x kg(-1)), the quantity of later was equal to TA as calculated with berberine. TA significantly suppressed secretion of gastric acid caused by ethanol without clear influences on gastric juice volume and mucus secretion. TA obviously blunted ethanol-induced elevation of MDA and *OH, as well as decrease of NO level and SOD activity from gastric mucosa.

CONCLUSIONIt is suggested that the TA is a potent protective agent against ethanol-induced gastric damages. The mechanism of actions may be related with inhibiting the secretion of gastric acid and blunting the increase of MDA and *OH, as well as the decrease of NO level and SOD activity from gastric mucus.

Alkaloids ; isolation & purification ; pharmacology ; Animals ; Coptis ; chemistry ; Drugs, Chinese Herbal ; isolation & purification ; pharmacology ; Ethanol ; Female ; Gastric Mucosa ; metabolism ; pathology ; Male ; Plants, Medicinal ; chemistry ; Protective Agents ; isolation & purification ; pharmacology ; Rats ; Rats, Wistar ; Rhizome ; chemistry ; Stomach Ulcer ; chemically induced ; metabolism ; pathology