Objective Extramedullary plagmocytoma at diagnose or during the course of multiple myeloma is rare.In order to know this entity better and explore new therapy for it,by combining with literature review,we conducted a retrospective study to describe the clinical and laboratory features of this entity and the outcome of these manirestation.Methods From January 2001 to July 2007,123 multiple myeloma patients were treated in our hospital.We analysed the clinical features of patients with extramedullary plagmocytoma at diagnose or during the course of multiple myeloma.The response to therapy was evaluated according to the EBMT criteria.Results 9 eligible patients out of 123 with MM were retrieved from the hematology department of Beijing Chaoyang hospital.The median age was 55(range:48～66)with a female/male ratio of 1/8.One patients was found to have Extramedullary and extraosseous tumor at the time of MM diagnose,and eight patients developed Extramedullary tumor during the course of the disease.Multiple sites were usually involved.Resistance to traditional chemotherapy wag frequent.With a median follow-up of 19 months(range:3～47),2 patients are alive.Median time from progression of disease to diagnose of Extramedullary disease was 4 and a half months.The median interval from diagnosis of Extramedullary disease to death was 2 months and OS was 23 months.Conclusion Extramedullary plasmocytoma is a rare manifestation of MM,with a cumulative incidence of 7.3% of MM in our department.Multiple sites are usually involved.The resistance to the traditional chemotherapy is frequent and the prognosis is very poor.The new therapy is necessarily explored.

Objective To investigate the effects of right or left transaction of cervical sympathetic trunk (TCST) on left ventricalar remodeling (LVRM) after acute myocardial infarction in rats and the mechanism. Methods Sixty-four adult mule pathogen-free SD rats (230-250 g) were randomly divided into 4 groups (n=16 each): group Ⅰsham operation (group S) ; group Ⅱ LVRM; group Ⅲ left TCST and group Ⅳ right TCST. Myocardial infarct was induced by ligation of left anterior descending branch (LAD) of coronary artery in group Ⅱ, Ⅲ and Ⅳ. Left and right TCST were performed immediately after myocardial infarct was successfully induced in group Ⅲ and Ⅳ respectively. In group S LAD and cervical sympathetic trunk were exposed but not ligated and transected. The animals were killed at 4 weeks after ligation of LAD and TCST. The weight of left ventricle was measured and left ventricle weight index calculated, Left veatricular myocardial tissue volume (V_t), the volume density of myocardial cells (V_v) and myocardial cell volmne (V_c) were quantitatively analyzed by stereological method. The c-fos mRNA expression in myocardium was determined by RT-PCR. Results The left ventricle weight index, V_t, V_c and c-fos mRNA expression were significantly increased in group LVRM (Ⅱ), left and right TCST (Ⅲ, Ⅳ) as compared with group S. Left ventricle weight index, V_v, V_t, V_c and c-fos mRNA expression were all significantly decreased in fight TCST group (Ⅳ), while left ventricle weight index, V_t, V_c and c-fos mRNA expression were significantly increased in left TCST group (Ⅲ) as compared with LVRM group (Ⅱ). Conclusion Right TCST down-regulates the increase in c-fos mRNA expression after acute myocardial infarction and inhibits the left ventricular remodeling while left TCST up-regulates the c-fos mRNA expression and promotes the development of left ventricular remodeling.

Objective:To investigate the relationship of family history , psychosocial factors of PD (Parkinson's Disease) in a rural population in north China. Methods: A case control study was conducted in rural population in China. Cases (n=77) have been diagnosed by a two-phase screening by neurologists and interviewers in May, 2000. Controls (n=154), randomly selected from the same cohort, who were matched with patients (control/cases ra-tio=2) for sex, age (?5 years). Information of participants' characteristics came from the interview in 2001. Data was analyzed by using conditional logistic regression by SAS 6.12. Results: Family history (OR=13.54) .negative life events (OR=3.02), interpersonal communication (OR=2.10) were associated with a significantly elevated risk for the onset of PD. Conclusion: These results indicate that family history, psychosocial factors were risk factors of PD.

OBJECTIVE:To find out a cost-efficient antibiotic prophylaxis of p ul monary and esophageal surgery by way of pharmacoeconomic analysis METHODS:To c ompare the efficacy and cost between short-term and long-term of prophylactic uses of ceftriaxone in pulmonary and esophageal surgery by randomized controlled study and cost-effectiveness analysis RESULTS:Single-dose ceftriaxone regim en and four-dose ceftriaxone regimen were equally effective in preventing posto perative infections in pulmonary and esophageal surgery,the average cost per pa tients for single-dose ceftriaxone regimen(1 257 84?769 67)yuans was signi ficantly lower than that for four-dose ceftriaxone regimen(1 786 69?652 83 ) yuans,P

Objective To observe vasculogenic mimicry (VM) of human choroidal melanoma cell line OCM-1 cultured in vitro and the expression of PI3K and EphA2 protein,as well as to explore the possible mechanisms.Methods OCM-1 cells were cultured in vitro and stained with periodic acid Schiff (PAS) on days 7,which aimed to observe the formation of PAS-positive cyclic structures,that is,VM formation.Then immunohistochemical staining was performed to detect PI3K and EphA2 on day 1,4,7 and the results were observed.Ressults On day 4 of 3-demintional culture,most of OCM-1 cells were polygonal and the cytoplasm was abundant;the nuclei were round and the nucleoli were visible.A small part of the tumor cells were long spindle.It was found that several long spindle cells were connected to each other to form hemicyclic structure.After 7 days,a large number of tumor cells became long spindle,growing along the collagen scaffold,and long protrusions appeared,forming a ring structure.PAS staining showed that the tumor cells were mostly arranged in a row,and tumor cells imitated the formation of body blood vessels,resulting in cell band and pipeline-like cell layers,with one layer of extracellular matrix (PAS-positive substance) making up the ring structure.Moreover,the expression levels of PI3K and EphA2 on day 4 and 7 were significantly higher than those on day 1 (all P ＜ 0.05),and their expression levels on day 7 were higher than those on day 4 (all P ＜ 0.05).Conclusion EphA2 and PI3K may play an important role in the VM formation in 3-dimentional culture of human choroidal melanoma cell line OCM-1.

Objective This thesis observes the effect of integrated traditional Chinese and western medical nursing on the therapeutic effects of chronic sinusitis with nasal endoscopic surgery.Methods 106 patients with chronic sinusitis were randomly recruited into an observation group and a control group.The observation group was treated with traditional Chinese medicinal syndrome differentiation care besides conventional western medical care to observe the effectiveness.Resulls The therapeutic effectiveness and the degree of satisfaction about health education in the observation group was significant better than the control group(P＜0.05).Conclusion Integrated traditional Chinese and western medical care could improve the degree of satisfaction on patients with Chronic sinusitis and promote patients recovery from illness.

Objective:To explore the clinical effect of negative pressure wound therapy and to discuss the ethi-cal issues in this therapy and seek a solution. Methods:Sixty patients with negative pressure wound therapy in our hospital were invited to participate in this study. Patients were all with deep pressure ulcers or diabetic foot, of which the Wagner Scores were graded as three or four. They were divided into two groups randomly. The subjects in control group received standard treatment, while those in experimental group were treated by self -designed closed negative pressure drainage settings. The wound healing time, the cost of the treatment and comfort were compared between the two groups. Results:The cost of wound care in the experimental group was less than those in the control group (P<0. 001). There was no significant difference in comfort between two groups (P>0. 05). But the wound healing time was longer in the experimental group than those in the control group. Conclusion:Self-designed closed negative pressure settings can decrease the cost of patient care with the equal patient comfort and acceptance as the standard negative pressure, however, the wound healing time has been extended. So before using negative pressure technique, the medical staff should comprehensively analyze, be guided by medical ethics and choose the appropriate treatment for different patients.

Objective To evaluate the role of CT imaging in staging of hypopharyngeal and laryngeal carcinoma.Methods 85 patients with hypopharyngeal or laryngeal carcinoma proved by operation were examined contrast-enhanced CT scan.The CT images were analysed by two experienced radiologists who were unknown pathologic results,in combination with the clinical data,the TNM staging of tumors were evaluated,then the results were compared with that of pathology,and Wilcoxon rank sum test was used for statistical analysis.P value less than 0.05 was considered statistically significant.Results The accuracy of the staging of lesions was 70.1% based on clinical data alone,while the clinical informations in combination with CT,the accuracy reached 87.1%,that was of significant statistically(P=0.001).Conclusion CT imaging is useful in staging of hypopharyngeal and laryngeal carcinoma,especially when it is combined with clinical data.

Objective To investigate incidence,diagnosis and treatment strategy of delayed esophageal complications after anterior cervical spine surgery.Methods The clinical data of 2316 patients who had undergone anterior cervical spine surgery from January 2001 to December 2011 were analyzed.The delayed esophageal complications were defined as esophageal perforation,esophago-tracheal fistula,esophago-cutaneous fistula,diverticulum of esophagus,esophagopleural fistula and esophageal stenosis that occurred 2 weeks after spine surgery.Results Delayed esophageal complications occurred in 4 patients,and the incidence was 0.17％.Esophageal perforation occurred in 2 patients; the incidence was 0.09％.Case 1 was a 31-year-old man who was found to have esophageal diverticulum and perforation 7 years after anterior cervical spine surgery.Then he underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 2 was a 46-year-old man who was found to have esophageal diverticulum 3 years after cervical spine surgery.He also underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 3 was a 58-year-old woman who was found to have esophageal diverticulum 5 years after cervical spine surgery.She underwent removal of implant,excision of diverticulum,and repair of esophagus with sternocleidomastoid muscle flap.Case 4 was a 56-year-old woman who was found to have esophageal perforation 3 years after cervical spine surgery.She underwent removal of implant and repair of esophagus with sternocleidomastoid muscle flap.All 4 patients recovered after operation.Conclusion The incidence of delayed esophageal complications after anterior cervical spine surgery is low,and the diagnosis is difficult.X-ray,digestive tract radiography,and gastrointestinal endoscopy are the main diagnostic tools.Surgical treatment is the main and effective management.

OBJECTIVE:TO summarize the treatment of complicated proximal humeral fracture with artificial shoulder replacement.METHODS:A computer-based online search of VIP was performed for related articles published between January 1998 and October 2009 with the key words"shoulder joint,prosthesis replacement,proximal humeral fracture".Articles with high correlation were included.and repetitive studies were excluded.The data were firstly collected,the references of each article were reviewed.RESULTS:A total of 18 articles were included The treatment of complicated proximal humeral fracture remains controversial.Early semi-shoulder ioint replacement is an appropriate method.Shoulder replacement includes humeral head replacement and total shoulder replacement.Neer and Biligani type are typical artificial humeral head.The fixation patterns of humeral head prosthesis shaft include cemented and cementless.Bone cement includes total bone cement and proximal cement fixation,and cementless includes pressure fixation and compaction bone grafting.Complications following shoulder replacement involve prosthesis instability,nodule heterotopia,heterotopic ossification,prosthesis loosening,periprosthetic fracture,infection and nerve injury.CONCLUSION:Majority of complications can be prevented by appropriate location of prosthesis,reconstruction of greater and lesser tubercle.and in combination with postoperative rehabilitation treatment.