Stereotactic radiotherapy is a rapidly growing treatment strategy for tumor due to the advances in target definition,radiation dose delivery,and image guidance of radiation.We reviewed the clinical application of stereotactic radiotherapy in the management of early stage non-small cell lung cancer including the technique,the workflow of the technique established,the outcome and relative radiation toxicity.

Objective: To summarize surgery experience and efficiency of laparoscopic excision of choledochal cyst and reconstruction of biliary tract and to analyze the treatments administered during intra and post-operation of the biliary reconstruction. Methods: We enrolled 48 cases of video-guided laparoscopic intraoperative cholangiography, cholecystectomy, choledochocele resection, Roux-en-Y hepaticojejunostomy with an anti-reflux valve from August, 2001 to October, 2003.Their operative procedures and aims were retrospectively analyzed. Results: Forty-four out of 48 patients successfully underwent laparoscopy and recovered soon. Only 4 cases were transformed to open operation. The post-operation complications were found in 4 cases. Conclusion: Video-guided laparoscopic excision of choledochal cyst, biliary tract reconstruction and Roux-en-Y hepaticojejunostomy are an effective method of treatment with advantages of minimal injury, less bleeding, and sooner recovery.

Objective To explore the value of two-dimensional strain echocardiography for quantitative assessing the change of regional left ventricular myocardial function in rats following acute myocardial infarction. Methods Sixty Wistar rats were randomly divided into two groups. The study group consisted of 50 rats with occlusion of LAD for 30-45 minutes and the sham-operated group consisted of 10 rats without occlusion of LAD. Echocardiography were performed before operation, which was defined as baseline, and 1 week, 4 weeks and 8 weeks after operation. Left ventricular internal diameter at diastole ( LVIDd) and systole < LVIDs), fractional shortening( FS), ejection fraction (EF) and left ventricular mass(LVM) were measured by anatomical M-model echocardiography. High frame rate two-dimensional images were recorded in the left ventricular short-axis views at the papillary muscle level. Peak systolic radial strain(PRS) and circumferential strain(PCS) of each segment were measured using 2-dimensional strain software. The rats were sacrificed and the infarcted size of each segment was measured using triphenyl tetrazolium chloride (TTC) after echocardiography was performed. Fibrosis of left ventricular myocardium was displayed using Van Gieson stain in 1 weeks after infarction. Results Based on the TTC findings,the left ventricle of the study group was divided into three regions:infarcted,peri-infarct and remote myocardial regions. Van Gieson stain showed fibrosis existed in all the three regions. Compared with baseline and sham-operated group, PRS and PCS of infarcted, peri-infarct and remote myocardial regions of the study group significantly decreased within 1 week after operation ( P <0. 01) and persisted for 8 weeks. PCS and PRS of infarcted, peri-infarct and remote myocardial regions of the study group in 4 weeks and 8 weeks after operation showed no significant difference when compared with those in 1 week after operation ( P >0. 01). Compared with baseline and sham-operated group,LVIDd,LVIDs and LVM of study group all increased significantly ( P <0. 05) in 4 weeks and 8 weeks after operation,and FS and EF reduced significantly ( P <0. 05). Two-dimensional strain obtained in interobserver and intraobserver both showed high agreement. Conclusions Two-dimensional strain echocardiography can assess regional function of myocardium with different perfusion in rats following acute myocardial infarction, and provides a sensitive and reliable method to follow up the process of left ventricular remodeling after myocardial infarction.

This study evaluated the change in regional left ventricular myocardial function in rats following acute occlusion of the left anterior descending coronary artery (LAD) by using two-dimensional speckle tracking imaging (2D-STI). Sixty Wistar rats were randomly divided into two groups, a myocardial infarction (MI) group, in which 50 rats were subjected to LAD occlusion for 30-45 min, and a sham-operated (SHAM) group that contained 10 rats serving as control. Echocardiography was performed at baseline and 1, 4 and 8 week(s) after the operation. High frequency two-dimensional images of left ventricular short axis at papillary muscle level were recorded. Peak systolic radial strain (PRS) and circumferential strain (PCS) were measured in the mid-ventricle in short-axis view by using EchoPAC workstation. Left ventricular internal diameter at diastole (LVIDd) and systole (LVIDs), fractional shortening (FS), ejection fraction (EF) and left ventricular mass (LVM) were measured by anatomical M-model echocardiography. Infarct size was measured using triphenyl tetrazolium chloride (TTC) staining 1 week and 8 weeks after the operation. Fibrosis of left ventricular myocardium was displayed using Van Gieson staining 1 week after the infarction. In terms of the TTC staining results, the left ventricle fell into three categories: infarcted, peri-infarcted and remote myocardial regions. Compared with those at baseline and in the SHAM group, (1) PRS and PCS in the infarcted, peri-infarcted and remote myocardial regions were significantly decreased in the MI group within 1 week after the operation (P<0.05) and the low levels lasted 8 weeks; (2) Compared with those at baseline, LVIDd, LVIDs, FS, EF and LVM in the MI group showed no significant difference 1 week after the operation (P>0.05). However, LVIDd, LVIDs and LVM were increased significantly 4 and 8 weeks after the operation (P<0.05), and FS and EF were decreased substantially (P<0.05). Van Gieson staining showed that fibrosis developed in all the three myocardial regions to varying degrees. It is concluded that 2D-STI is non-invasive and can be used to assess regional function of myocardium with different blood supply in rats following acute occlusion of the LAD, and can be used as a sensitive and reliable means to follow up the process of left ventricular remodeling.

Objective To explore the relation of newly genome-wide association study (GWAS) identified lipid-associated genes by euramerican white and coronary heart disease ( CHD ) susceptibility in Chinese Han population. Methods One thousand patients with CHD were enrolled according to WHO criteria. 1000 age-and sex-matched controls were included. Single-nucleotide polymorphisms (SNPs) were detected by Taqman technique. Results Two novel SNPs (rs599839 in SORT1 region and rs16996148 in NCAN region) were significantly associated with CHD risk in Chinese Han population. Compared to AA genotype of rs599839, subjects with AG genotype of rs599839 (OR=0.64, 95%CI=0.48~0.85, P=0.002 and OR=0.67, 95%CI=0.52~0.91, P=0.008, respectively). Compared to GG genotype of rs16996148, subjects with GT genotype were associated with significantly decreased risk of CHD(OR=0.67, 95%CI=0.52~0.91, P=0.008). Two another SNPs (rs12695382 in B4GALT4 region and rs2254287 in B3GALT4 region) were not significantly associated with CHD in Chinese Han population. Conclusions Two novel SNPs (rs599839 and rs16996148) at newly identified lipid-associated loci were significantly associated with CHD susceptibility in Chinese Han population.

Objective To explore the treatment using two different ventilation tubes insertion for secretory o-titis media ,and to determine which factors are associated with the tympanic membrane perforation after a extrusion or surgical removal of a ventilation tube(VT) .Methods A retrospective analysis of 121 cases (210 ears) with re-fractory secretory otitis media from 1998 June to 2013 March was carried out .There were 58 cases (105 ears ) and 63 cases (105 ears) in patients and control group ,respectively .All subjects had more than 2 years of history ,and were treated by two types of ventilation tube (Goode -T and Shepard tube) .Various factors were analyzed to deter-mine the factors associated with persistence of a tympanic membrane perforation after VT extrusion or removal ,in-cluding gender ,age ,medical history ,ventilation tube pattern ,location ,history of previous VT insertions ,intuba-tion period reason for VT insertion ,condition of the TM ,nature of the tympanic cavity effusion and previous ade-noidectomy ,et .Results Analysis factors of perforation group (105 ears) and the control group (without perfora-tion ,105 ears) ,were statistically significant in ventilation tube pattern (χ2 =6 .916 ,P<0 .01) ,history of previous VT insertions(χ2 =7 .325 ,P<0 .01) ,frequency of previous VT insertions (χ2 =13 .01 ,P<0 .01)and the nature of the tympanic cavity effusion(χ2 =7 .04 ,P<0 .01) .The proportion of perforation group about Goode - T ventilation tube ,history of previous VT insertions ,the frequency of tube (more than 3 times) ,mucus of the middle ear cavity were 58 .4% ,57 .3% ,66 .7% and 57 .9% respectively ,others had no significant difference between the two groups . The multivariate analysis showed that ,regardless of the ventilation tube ,the frequency of tube was the tympanic membrane perforation risk factor ;Goode-T tube increased the risk of perforation of tympanic membrane was 1 .637 times than Shepard tube(OR=1 .637 ,P<0 .01) .Conclusion Using the Goode - T type ventilation tube ,history of previous VT insertions ,the frequency of tube (more than 3 times) ,mucus of the middle ear cavity were four risk factors for persistence of a tympanic membrane perforation after VT insertion for secretory otitis media .

To observe the effect of Ligusticum wallichii-containing serum on the expressions of Toll-like receptor 4 and myeloid differentiation factor 88 in hepatic stellate cells. Clean-grade SD rats were randomly divided into 5 groups and orally given L. wallichii decoction, colchicine and normal saline for 7 d to prepare L. wallichii-containing serums. Except for the blank group, all of the remaining groups were stimulated with LPS 1 mg x L(-1) for 24 h. After being intervened, the L. wallichii-containing serums were cultured in 5% CO2 incubator at 37 degrees C for 24 hours. The expression of TLR4 and MyD88 were detected by RT-PCR and Western blot. After HSC was stimulated with LPS, TLR4 and MyD88 mRNA and protein expressions were significantly higher than the blank control group (P < 0.01). After being intervened with L. wallichii-containing serum, TLR4 and MyD88 mRNA and protein expressions were notably lower than the model group (P < 0.05 or P < 0.01). In conclusion, L. wallichii-containing serum could regulate the TLR4 signaling pathway and show the anti-fibrosis effect by inhibiting the expression of TLR4 and MyD88 in LPS-induced HSCs.
Animals ; Female ; Hepatic Stellate Cells ; drug effects ; metabolism ; Ligusticum ; Lipopolysaccharides ; pharmacology ; Liver Cirrhosis, Experimental ; drug therapy ; Myeloid Differentiation Factor 88 ; genetics ; physiology ; Phytotherapy ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Toll-Like Receptor 4 ; genetics ; physiology

Objective To discuss the clinical effects of hemiarthroplasty for the treatment of intertrochanteric comminuted fracture in aged patients.Methods From June 2006 to June 2010,91 cases with intertrochanteric comminuted fractures were treated by hemiarthroplasty using Zweymtüller long-stem cementless implant.There were 35 males and 56 females,with an average age of 81.2 years (range,75-94 years).There were fresh fractures in 75 cases and old fractures in 16 cases.According to classification of Evans-Jensen,there were 36 cases with type Ⅲ fracture and 55 with type Ⅳ.Osteoporosis was graded by Singh index,and there were 51 cases with level Ⅲ and 40 with level Ⅱ.The interval between injury and operation was 2-10 d (average,3.5 d).Results The surgery lasted 30-50 min (average,39 min).The blood loss was 320-610 ml (average,405 ml).The hospital stay was 14-21 d (average,16.5 d).Two cases who experienced with the infection of the respiratory system after operation,recovered through routine treatment.Thirty-seven cases were followed up for 15 to 38 months (average,24.5 months).According to the Harris score,the overall rate of excellent or good result was 83.8％ (31/37).Conclusion Hemiarthroplasty using Zweymüller long-stem cementless prosthesis is reliable option for intertrochanteric comminuted fracture in the aged patients.

Objective To compare the accuracy and feasibility among CT, MR, and CT-MR image fusion technology in the delineation of gross target volume (GTV) for nasopharyngeal carcinoma (NPC). Methods Thirty-six consecutive patients with newly diagnosed or recurrent NPC were enrolled. Each pa-tient underwent both CT and MR scanning in the same treatment position. Several lead marks were made at the exactly same locations of the body surface before CT and MR scanning. The two sets of images were then transferred to the Tomcon workstation for image fusion. CT-MR image registration was performed using Land-Mark methods. GTV of each patient was contoured on CT (GTV_(CT)), MR (GTV_(MR)) and CT-MR (GTV_(CT-MR)) images. Results The mean GTV_(CT), GTV_(MR) and GTV_(CT-MR) were 27.60 cm~3, 30.99 cm~3 and 31.71 cm~3, respectively (F = 7.48, P = 0.001). Significant difference was found between GTV_(CT) and GTV_(MR) (q =2.54,P=0.016), GTV_(CT) and GTV_(CT-MR) (q =3.10,P =0.004), but not GTV_(MR) and GTV_(CT-MR) (q = 1.31 ,P = 0. 199). Significant difference among GTV_(CT), GTV_(MR) and GTV_(CT-MR) was found in patients with skull base invasion (35.65, 42.70 and 44.22 cm~3 ; F = 14. 13, P = 0. 000), but not in those without skull base invasion (20.79 cm~3, 20.46 cm~3 and 21.18 cm~3 ; F = 0.18, P = 0.832). Significant difference between GTV_(CT) and GTV_(CT-MR) was found in patients with T_3 and T_4 tumor (t = -2.17,P =0. 036), but not in those with T_1 and T_2 (t = -0.66 ,P = 0.514). Conclusions CT-MR image fusion is helpful in GTV de-lineation for NPC, particularly for patients with skull base invasion.

OBJECTIVEWith functional magnetic resonance imaging (fMRI), cerebral function imaging of acupuncture and sham acupuncture at Taichong (LR 3) in patients with essential hypertension (EH) was observed to analyze central mechanism of Taichong (LR 3) to treat EH.

METHODSEighteen EH patients were divided into a twisting acupuncture group (10 cases) and a sham acupuncture group (8 cases), which were treated with twisting manipulation and sham acu- puncture at right Taichong (LR 3), respectively. The treatments were both given with 30-second manipulation and 30- second interval for totally 5 min. During the acupuncture, fMRI was adopted to scan the cerebral function imaging of EH patients on resting state, and the acquired data were analyzed with SPM2 module in Matlab software.

RESULTSAcupunc- ture at Taichong (LR 3) in EH patients mainly increased opposite-side oxygen consumption, which generally activated left anterior cingulated gyrus (BA 32), left inferior parietal lobule (BA 40), left inferior temporal gyrus (BA 19), left middle temporal gyrus (BA 37) and right anterior central gyrus (BA 6). The activated areas were related to motor, vision and cognition of emotion. Stimulation region of sham acupuncture mainly included right anterior cingulated gyrus (BA 24), left inferior parietal lobule (BA 40) and left inferior frontal gyrus (BA 7).

CONCLUSIONThe central mechanism of Tai- chong (LR 3) on antihypertensive effect and symptom improvement is not in thalamus and medulla that are traditionally believed to control blood pressure. Taichong (LR 3) could activate anterior cingulated gyrus to regulate parasympathetic nerve and lower blood pressure, and through anterior cingulated gyrus, the connection with the surrounding areas is strengthened to improve the cognitive impairment caused by long-term hypertension.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Brain ; diagnostic imaging ; Cognition ; Essential Hypertension ; Female ; Humans ; Hypertension ; diagnostic imaging ; psychology ; therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography