Objective To evaluate the application of three dimensional conformal radiotherapy (3D-CRT) for non-small cell lung carcinoma (NSCLC) based on CT simulation in different respiratory phases in patients gaed≥70 years. Methods A total of 51 patients gaed≥70 years (range 70-88 years, mean age 73.5 years) with NSCLC were treated by 3D-CRT alone, using CT images of different respiratory phases. The case numbers at Ⅰb, Ⅱb, Ⅲa, Ⅲb and Ⅳstage were 3, 7, 19, 17 and 5, respectively. Both gross tumor volumes (GTV) at the end of inspiration and expiration were fused to a total GTV which was close to motorial range of tumor in respiration, and the expansion of clinical target volume/ planning target volume (CTV/PTV) need not include respiratory motion moreover. Compared with plans of classic 3D-CRT, the efficacy, prognostic factors and side effect of this treatment were evaluated. Results Compared with the traditional expansion of CTV/PTV, the volumes of PTV in this scheme were averagely 19.3% lower (median, 17.5%),and the volumes of lung that received equal dose to tumor were averagely 21.8% lower (median, 19.9%). The 1-, 2-and 3-years total survival rates were 70. 6%, 54.9% and 29.4% with a overall tumor response rate of 78.4%. KPS scores and node stages were independent prognostic factors, age was not. Conclusions CT simulations in different respiratory phases can effectively reduce PTV and improve the life quality without affecting the therapeutic effect in senile patients with NSCLC, and can be well tolerated.

BACKGROUND: The repair and functional reconstruction of peripheral traumatic nerves depend, on posttraumatic operation time and operative techniques which have certain referential value.OBJECTIVE: To explore the effects of related factors on the repair and functional reconstruction of common peroneal nerve (CPN) after injuries.DESIGN: A case analysis.SETTING: Department of Orthopaedics, Fourth Hospital Affiliated to China Medical University.PARTICIPANTS: Eighteen patients diagnosed with simple CPN injury received treatment in the Department of Orthopedic Surgery of the Fourth Affiliated Hospital, Chinese Medical University, between January 1991 and January 2001. There were 15 males and 3 females aged 12-61 years old with the mean age of 26.5 years; there were 9 cases of complete transection, 3 cases of incomplete transection, 1 case of compression, 4 cases of contusion, and 1 case of irreversible injury. Posttraumatic treatment at hospital was obtained 0.5 hour to 6 months after injury.METHODS: All patients were subjected to CPN explorative operation;neuroanastomosis was performed on 12 cases, neurolysis on 2 cases, tendon graft on 1 case and conservative treatment on 3 cases. Antibiotics were administered after operation together with blood activating medicine and neurotrophic medicine. Moreover, the patients were required to do passive functional exercise in order to avoid arkylosis and myoatrophy.MAIN OUTCOME MEASURES: Functional recovery of CPN was assessed at postoperative 6 months based on the myodynamia of the same side anterior tibia muscles (excellent: above grade 4; good: grade 3; passable: grade 2; poor: grade 1 or grade 0).RESULTS: All the 18 patients entered the results analysis; their outcomes were assessed as excellent in 10 cases, good in 6 cases, and passable in 2cases, with the excellent rate being 89% (16/18).CONCLUSION: Patients diagnosed with CPN injury should be treated with primary repair of traumatic nerves as early as possible, which will benefit the functional recovery of limbs.

To compare the measurements of axial length by A-scan ultrasound and IOLMaster.For a total of 138 eyes,axial length was measured with IOLMaster followed by contact A-scan ultrasound.Though a great correlation existed between two measurements,the axial length was a little longer with IOLMaster than with A-scan ultrasound.And the difference was statistically significant (P ＜ 0.01).The mean difference of two methods was (-0.198 ± 0.146) mm.With the elongation of axial length,the difference of two methods also increased.For cataract patients with axial length ＞ 28 mm,the control range of crror from IOLMaster for axial length was much lower than that from A-scan.Thus IOLMaster is a simple,fast,reliable and non-contact measurement method of axial length.

For understanding the effect of MDG-1, a water-soluble β-D-fructan polysaccharide from Ophiopogon japonicas, on intestinal microecological balance, especially on the changes of lactobacillus, sixty 8-week-old male C57BL/6J mice were given a high-fat diet for six weeks and were also gavaged with saline once a day simultaneously. Then the mice which is below 30 grams or dropped more than 10% through lavage were eliminated and the rest were randomly divided into four groups: diet-induced obese (DIO) model group (n = 12, gavaged with saline), low-dose MDG-1 group (n = 12, gavaged with MDG-1, 75 mg · kg(-1)) , medial-dose MDG- 1 group (n = 12, gavaged with 150 mg · kg(-1)), and high-dose MDG-1 group (n = 12, gavaged with 300 mg · kg(-1)) according to the weight and blood glucose; the model group and MDG-1 group were placed on a high-fat diet while the normal control group (n = 12, gavaged with saline) were kept on a low-fat diet through the experiment. After 12-weeks of treatment, feces samples were collected and cultured for intestinal microecological balance analysis. Then the intestinal probiotics were cultured through traditional methods combined with modified gradient gel electrophoresis (DGGE) method. The changes of lactobacillus in each treatment group were also detected by a statistical analysis of the total number of the intestinal flora. We have established the phylogenetic tree by 16S rDNA sequencing and use some molecular identification methods such as PCR-DGGE to analyse the changes of the dominant bacteria floras, and also get the pure culture. In conclusion, different concentrations of MDG-1 can increase the number of the intestinal probiotics, especially Taiwan lactobacillus and Lactobacillus murinus, and improve their diversity and promote proliferation in a dose-dependent way.
Animals ; Biodiversity ; Diet, High-Fat ; adverse effects ; Dietary Carbohydrates ; administration & dosage ; analysis ; Humans ; Intestines ; drug effects ; metabolism ; microbiology ; Lactobacillus ; classification ; drug effects ; genetics ; growth & development ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Obese ; Molecular Structure ; Obesity ; drug therapy ; metabolism ; microbiology ; Ophiopogon ; chemistry ; Phylogeny ; Plant Extracts ; administration & dosage ; chemistry ; Polysaccharides ; administration & dosage ; chemistry

Objective To explore the reason for remedy radical operation after endoscopic submucosal dissection (ESD) for early gastric cancer.Methods The clinical data of 26 early gastric cancer cases who received remedy radical gastrectomy after ESD between January 2012 to March 2015 in Nanjing Drum Tower Hospital were analyzed retrospectively.Results All cases were followed up and mid follow-up was 25 months.There was no death nor tumor reccurence cases during the follow-up.Three cases suffered from complications in radical surgery for gastric cancer including afferent jejunal loop obstruction,adhesive intestinal obstruction,stomach paralysis respectively,all were cured by conservative therapy.Postoperative pathology found lymph node metastasis in 3 cases.Conclusions En bloc resection and negative resection margin,as well as free lymphatic metastasis are two important factors determing the survival of early gastric cancer patients undergoing ESD treatment.

Objective To investigate the value of functional MRI in the diagnosis and differential diagnosis of breast diseases.Methods Sixty-five patients with 68 lesions were enrolled in this study. Conventional T_1 WI and T_2 WI scan,dynamic contrast enhanced MRI,diffusion weighted imaging and ~1H single voxel MR spectroscopy were performed consequently.All lesions were verified by pathology,including 4 cases of breast adenosis,22 fibroadenomas,2 chronic inflammations,3 cysts,33 infitrating ductal carcinomas,1 intraductal carcinoma and 3 cystosarcoma phyllodes tumors.Morphological features,maximum enhancement ratio,time-intensity curve,apparent diffusion coefficient and Choline peak were analyzed. Results The detection rates of T_1 WI and T_2 WI were 14.7%(n=10)and 51.5%(n=35).The sensitivity,specificity,accuracy of dynamic contrast.enhanced MRI for the malignant tumor were 94.6%, 71.4% and 76.5% respectively.Retrospective study showed that diffusion weighted imaging,with the b value from 800 s/mm~2 to 1000 s/mm~2,could be used to differentiate various types of breast lesions.~1H signal voxel spectroscopy had a sensitivity of 51.4%,specificity of 82.6%,and accuracy of 67.6% for the malignent.The sensitivity,specificity and accuracy could reach 97.3%,90.0% and 92.6% respectively by combining conventional scan,dynamic contrast enhanced MRI and MR spectroscopy.Conclusion Functional MRI,with high sensitivity,specificity and accuracy,can be used widely in the diagnosis of malignant breast lesions.

Objecive To investigate the prevalence of NDM-type carbapenemases in the carbapenem-resistant Escherichia coli strains collected from Ruijin Hospital, Shanghai Jiaotong University School of Medicine. The epidemiological characteristics of NDM-type carbapenemase-producing isolates were analyzed.Methods Eighteen strains were collected from November 2013 to January 2015 in the clinical microbiology laboratory of Ruijin Hospital. All of them were resistant to imipenem or meropenem (inhibition zone diameter≤19 mm). The blaNDM gene was detected by PCR. The amplified products were subjected to sequencing analysis. Conjugation experiment was carried out to verify the transferability of plasmids. Multilocus sequence typing (MLST) and pulsed field gel electrophoresis (PFGE) were performed to analyze the molecular epidemiology.Results The blaNDM gene was identified in 6 strains, 4 of which had blaNDM-1-type and 2 had blaNDM-5-type carbapenemase gene. Three strains were positive in the conjugation experiment. MLST analysis showed that 6 NDM carbapenemase-producing isolates belonged to ifve sequence types, corresponding to five PFGE-DNA patterns (A-E). Two of these isolates shared the identical sequence type (ST5018) and nearly the same PFGE-DNA patterns (A1, A2).Conclusions NDM-type carbapenemase-producing E. coli is identified in this study. Most blaNDM-positive cases were sporadic. Plasmid might play an important role in the spread of blaNDM inE. coli. The blaNDM-5 type carbapenemase gene was first identified in Shanghai, to which more attention should be paid.

Objective To assess the value of chest computer tomography (CT) and serum tumor marker in lung cancer screening among health check-up populations.Methods A total of 88 596 adults who had a medical check-up (including chest CT,chest DR,and tumor biomarkers test) in our center were enrolled in this investigation.Clinical diagnosis of lung cancer was confirmed by three professional doctors.Receiver operating characteristic (ROC) curve was used to assess the relationship between serum level of tumor biomarkers and lung cancer.Results The average detection rate of lung cancer was 59.8/100 000 in our center during 2007 and 2011 (men 42.9/100 000,women 92.2/100 000).Rate of positive results of chest CT was 94.3％,which was approximately 2 times of chest DR.Moreover,carcinoembryonic antigen (CEA) testing was effective in early diagnosis of lung cancer with higher sensitivity (73.6％) and specificity (57.1％).Conclusion This study suggests that health checkup centers should pay more attention to lung cancer screening in high risk populations,and new technologies might be used to facilitate the early diagnosis of lung cancer.

Objective To report the clinical and pathological features of chronic graft-versus-host disease-related polymyositis by summarizing the clinical data of the patient with chronic graft-versus-host disease-related polymyositis. Methods One patient with chronic graft-versus-host disease-related polymyositis was hospitalized in our hospital on December 29,2010.The patient,40 years old,female,underwent allogeneic haematopoietic stem cell transplantation because of acute granulocytic-monocytic leukemia.Fourteen months later she manifested as slowly progressive muscle weakness and myalgia in all limbs.Serum creatine kinase level was between 426-1948 U/L. Myositis antibody EJ was strongly positive.Electromyogram showed a neurogenic impairment and slow peripheral nerve conduction speed.Muscle biopsies were carried out in the left biceps brechii.In addition of standard histological and enzyme histochemical staining for the muscle sections,immunohistochemical workup was performed with mouse antiCDs,anti-CD20,anti-CD68 and anti major histocompatibility complex- Ⅰ ( MHC- Ⅰ ) monoclonal antibodies as first antibodies.Results The muscle biopsy showed large variation of fiber size,with muscle fiber necrosis,regeneration.Some angular fibers distributed in small cluster.The inflammatory cells infiltrated around the small vessel or in the endomysium,mainly CD8+ T-lymphocytes and CD6+8 macrophages.The most muscle fibers were MHC-Ⅰ positive. Conclusion The graft-versus-host disease-related polymyositis manifests as chronic myositis process with neurogenic lesions.

BACKGROUND:Nano-hydroxyapatite/bacterial celulose (nHA/BC) composite scaffolds prepared by nano-bionics method exhibit a structure and performance similar to natural bone. OBJECTIVE:To study the cytotoxicity and biocompatibility of nHA/BC composite scaffolds. METHODS:(1) Acute systemic toxicity test: nHA/BC leach liquor and normal saline were respectively injected intraperitonealy into Kunming mice. After 24, 48, 72 hours, the body mass of mice was recorded. (2) Sensitization test: nHA/BC leach liquor and normal saline were respectively injected subcutaneously into the back of Japanese white rabbits. With 72 hours of injection, edema and erythema were observed, and the experiment was done again at an interval of 14 days. (3) Pyrogen test: nHA/BC leach liquor and normal saline were respectively injected into the ear vein of Japanese white rabbits, and after injection, the body temperature of rabbits were determined. (4) Hemolysis test: Diluted rabbit anti-coagulant was added into nHA/BC leach liquor, normal saline and distiled water, respectively. (5) Passage 3 bone marrow mesenchymal stem cels from rabbits were co-cultured with nHA/BC materials, and then, cel proliferation, growth and adhesion on the material surface were observed. RESULTS AND CONCLUSION: nHA/BC composite scaffold was of no acute systemic toxicity, non-alergenic, no pyrogenic and hemolytic reactions; nHA/BC had a three-dimensional porous structure that was better for growth, proliferation and adhesion of rabbit bone marrow mesenchymal stem cels. These findings indicate that the nHA/BC composite scaffold has good biocompatibility and cytocompatibility.