Objective To evaluate the method and curative effect of reconstruction with vascularized or nonvascularized autogenous fibular transplantation of radiocarpal joint after en bloc excision of giant cell tumor of distal radius.Methods Seventeen cases with giant cell tumor of distal radius bone were treated by en bloc resection and reconstruction of wrist joint with vascularized or non-vascularized autogenous fibular transplantation.Postoperative wrist joint function and radiographic outcomes were evaluated.Results Seventeen cases were followed up from 2.0 to 5.5 years (average 3.6 years).Three cases were treated by peroneal artery anastomosis and other 3 cases by inferior lateral genicular artery anastomosis.All cases achieved primary healing of incision and the radial average length that was en bloc excised was 7.6 cm.All of the transplanted fibulas were healed well.The bone healing average time of the vascularized fibular graft was 3.7 months,while that of the non-vascularized fibular graft was 7.9 months.No tumor recurrence or lung metastases was observed during the follow-up,but 1 wrist joint was narrowed and another had degeneration of the wrist.After 2 years of surgery,the average range of motion of the wrist joint was as follows:dorsiflexion 47°,flexion 30°,ulnar deviation 23°,radial deviation 14°,pronation 55°,supination 62°.The grip force was from 40％ to 80％ of the contralateral upper limb.The MSTS score averaged 87.6 ％ with 6 excellent,eight good and 3 satisfactory results.Disabilities of the Arm,Shoulder,and Hand (DASH) questionnaire score averaged 3.48.Conclusion The method of autogenous fibular transplantation and reconstruction of radiocarpal joint after en bloc excision of giant cell tumor of distal radius can save the wrist joint function in a certain extent.It is an effective method of the wrist joint function reconstruction and beneficial to bone healing with vascularized transplantation which has less complications.

Background:Gastric cancer is one of the malignant tumors with highest morbidity and mortality,and the early change of molecular marker in gastric mucosal lesion is the hot spot of gastric cancer study. Aims:To investigate the expressions and clinical significance of trefoil factor 2(TFF2),claudin 18(CLDN18),mucin 5AC(MUC5AC)in gastric mucosal lesions. Methods:Gastroscopy biopsies and surgery specimens from Dec. 2008 to May 2009 at Inner Mongolia People’s Hospital were collected,including 20 normal gastric mucosal tissues,20 intestinal metaplasia tissues,11 dysplasia tissues and 20 gastric cancer tissues. The protein expressions of TFF2, CLDN18, MUC5AC were determined by immunohistochemical SP method. Results:The positive expression rates of TFF2,CLDN18 and MUC5AC in normal gastric mucosal tissues were all 100% ,and were gradually decreased in the order of intestinal metaplasia,dysplasia and gastric cancer tissue,the differences were statistically significant(P < 0. 01). Conclusions:Expressions of TFF2,CLDN18 and MUC5AC protein are closely related to the degree of malignancy of gastric mucosal lesions,and can be considered as a potential biological marker for predicting the development and prognosis of gastric cancer.

Objective To study the efficacy of CPT-11 TACE in the treatment of unresectable HCC.Methods A retrospective review was undertaken on unresectable HCC patients receiving doxorubicin transarterial chemoembolization (59 cases) and irinotecan(CPT-11) in 24 cases from May 2003 to November 2011.Survival analysis was performed with Kaplan-Meier statistics.Differences in survival between the two groups were assessed for statistical significance with the log-rank test.Results Overall survival time was significantly longer in patients treated with CPT-11 compared with doxorubicin treated group (21.7 vs 14.5 months,P =0.042).There was no significant difference in time to progression between the two groups,but time to progression was longer in CPT-11 group than doxorubicin treated group (11.42 vs 9.46 months,P =0.091).Subgroup analysis showed that for intermediate-stage HCC,CPT-11 resulted in a significantly longer time to progression and overall survival compared with doxorubicin treated group (P =0.029 and P =0.014,respectively).There were no significant differences in adverse events among the two groups (P ＞ 0.05).Conclusions Chemotherapeutic agent CPT-11 in the form of TACE significantly improved overall survival when compared with doxorubicin for the treatment of unresectable HCC.

Objective To evaluate the efficacy of chemoradiotherapy in patients with unresectable pancreatic cancer who were previously treated with PTCD.Methods From September 2005 to December 2012,47 unresectable pancreatic cancer patients with obstructive jaundice were enrolled in this study.They were divided into two groups.21 patients received after PTCD chemotherapy or radiation,or chemoradiotherapy.26 patients in support care group received only nutrition,analgesia and other related support treatment.Survival analysis was performed with Kaplan-Meier statistics.Differences in survival between the groups were assessed for statistical significance with the log-rank test.Results The median overall survival time of patients after PTCD was 7.19 months.The median overall survival time of chemoradiation group was 9.07 months,which was higher than that of support care group (5.52 months),P=0.017.12 patients received single therapy (either chemo or radiation),and 9 patients received chemoradiotherapy.The median overall survival times were 8.31 months and 11.15 months,respectively (P =0.325).Conclusions Post PTCD chemoradiotherapy helps prolong the survival time in unresectable pancreatic cancer patients.

Objective To study the efficacy and the safe dosage of high intensity focused ultrasound (HIFU) ablation in pancreatic cancer.Methods From November 2010 to May 2013,21 patients with advanced pancreatic cancer were treated by HIFU at the First Affiliated Hospital of Zhengzhou University.These patients who were randomly divided into two groups (10 and 11 patients respectively),were given a low-power (100～249 W) treatment and a high power (250 ～350 W) treatment.These two groups of 21 patients received a total of 25 times of HIFU treatment (3 patients received twice of low-power treatment,while 1 patient received twice of high-power treatment).The two groups were compared by analyzing the treatment parameters (average power,total treatment time,treatment total energy,treatment volume,etc.) and volume of tumour response as shown on postoperative imaging (CT or MRI) examinations.Also,the complications,degree of pain relief and survival were compared.The energy efficiency factor (EEF) and the ablation ratio were calculated.A preliminary study was conducted on the relationship of the ultrasound dose and the ablation effect of HIFU treatment for pancreatic cancer.Results (1) The EEF of the high-power group (≥250 W) and the low-power group (＜ 250 W) were (10.39 ± 5.71) J/mm3 and (21.62 ± 9.81) J/mm3,the former group was significantly lower than the latter group (P ＜0.05) ; the ablation ratio of the high-power group was higher than the low-power group,(91.52 ± 4.18)％ versus (51.59 ± 7.66)％ respectively,the difference was statistically significant (P ＜ 0.001).(2) The efficiency factor and the ablation volume for the HIFU treatment showed a linear trend,and both were negatively correlated (Pearson correlation coefficient r =-0.485,P ＜ 0.05).(3) There was no serious complication after the HIFU treatment.In the low-power group,six of ten patients were alleviated of his pain (60％) ; the CA19-9 decreased in four of ten patients after HIFU treatment (40％).In the high-power group,nine of eleven patients were significantly relieved of pain after treatment (82％),the CA19-9 decreased in five of nine patients after HIFU treatment (56％).(4) On Kaplan-Meier survival analysis,HIFU treatment of patients with pancreatic cancer,the median survival was 8 months and 9 months in the low-power group and high power group,respectively (Log-rank test x2 =0.05,P =0.944).Conclusion During HIFU treatment of patients with pancreatic cancer,if the ultrasound power was between 250 W and 350 W,there was a higher proportion of tumor ablation,but with no serious complications.Thus,this dose was safe.

Objective To investigate MRI manifestations of lumbar and proximal femoral bone marrow changes before and after recombinant human granulocyte colony stimulating factor (rhG-CSF) was subcutaneous injected for healthy adults.Methods Twenty healthy blood stem cell donors without hematologic disease were enrolled in this study. All of them underwent lumbar sagittal and proximal femur coronal MRI examination with spin echo T1 WI and fat-suppressed T2WI.The first examination were performed before subcutaneous injection of rhG-CSF for comparison. In 4-7 days and 30-60 days after injection, the other two examinations were performed. The signal changes of lumbar and proximal femoral bone marrow were investigated by reading pictures and calculating the contrasted noise ratio (CNR).ResultsBefore rhG-CSF injection, all patients presented normal signal intensity of hone marrow. In 4-7 days after injection, all the 20 cases presented homogeneous signal decrease in lumbar vertebral bodys on T1 WI, accompanied by reduced fatty signal. In proximal femur, patchy or stripped hypointensity areas were found in intertrochanteric and subtrochanteric areas on T1 WI. On fat-suppressed T2 WI images, the signal of lumbar and proximal femoral bone marrow changed to equal or slightly-high signal intensity. In all cases,abnormal signal areas presented in lumbar and proximal femoral bone marrow occurred simultaneously in the same case.In the 10 cases received the third MRI during 30-60 days after rhG-CSF injection, signal intensity of lumbar bone marrow turned to normal in all sequence, but abnormal signal intensity areas were still existed and extended to distal part in femoral bone marrow, which appeared as symmetric stripped or patchy equal or slightly-low signal intensity on T1 WI and equal or slightly-high signal intensity on T2 WI. The CNR of lumbar bone marrow to subcutaneous fat before rhG-CSF injection, in 4-7 days and 30-60 days after rhG-CSF injection were 114. 11 ± 15. 11,71.04 ± 12. 25 and 91.64 ± 1 I. 68, respectively. Significant difference was found between before rhG-CSF injection and 4-7 days after injection ( P ＜ 0. 05 ) , but no significant difference between the others( P ＞ 0. 05 ). Conclusion After injection of rhG-CSF, the short-term changes of hematopoietic cells and fat content in bone marrow can be displayed on MRI, which provided non-invasive information for bone marrow transplantation.

ObjectiveTo assess the cause of tadalafil failure and the feasibility of successfully rechallenging nonresponding patients.Methods A total of 80 consecutive erectile dysfunction ( ED ) patients who claimed poor response to tadalafil were enrolled into the study.A self-administered tadalafil-use questionnaire composed of eight questions was applied to assess how they had used tadalafil.Subjects were given thorough instruction based on individual answers and four doses of tadalafil 20mg.After a 2-week follow-up,end point efficacy of rechallenge was evaluated using the sexual encounter profile (SEP),which was recommended by international advisory panel in 2004.ResultsA total of 45 subjects had one or more areas of major suboptimal use of tadalafil:21.2％ did not know that sexual stimulation was necessary for tadalafil to work,87.5％ attempted to use tadalafil less than four times,57.5％ took a maximal dose less than 20 mg,and 84％ felt nervous or anxious.Of the 65 patients undergoing tadalafil rechallenge,30 patients answered “yes” to SEP2 and SEP3.The response rate to rechallenge was 46.2％ ( 30/65 ).ConclusionsInappropriate use of tadalafil was major cause of tadalafil non-pesponse.The efficacy of tadalafil could be improved to a better extent by education of patients.

Objective To explore the relationship between the endovascular aortic repair (EVAR)in patients with abdominal aortic aneurysm (AAA) and postoperative systemic inflammatory response syndrome (SIRS).Methods In this study,93 AAA patients undergoing EVAR were enrolled.Analysis was performed to evaluate the incidence of SIRS during peri-operation period.Logistic multiple regression analysis was performed to determine the parameters predicting SIRS.Results The incidence of SIRS was 58.1％.Aneurysm size,mural thrombus,iliac artery lesion,number of stent,operating time,volume of contrast agent,blood loss and length of stay were all significantly correlated with SIRS (P ＜ 0.05).In a logistic regression model,history of kidney disease or operation,aneurysm size,ruptured aneurysm and number of stents were strongly and independently associated with SIRS.Conclusions SIRS is common in AAA patients after EVAR.Optimizing treatment strategies avoiding risk factors for SIRS benefits AAA patients.

Objective To investigate the association between the genetic polymorphisms in GSTA1 and the clinical outcome of breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy. Methods A total of 137 breast cancer patients receiving cyclophosphamide-based adjuvant chemotherapy were recruited ( 124 cases with infiltrative ductal carcinoma, 5 cases with infiltrative lobular carcinoma and 8 cases with other histological types). PCR-LDR method was used to detect the genotypes of GSTA1. Survival curves were generated by the Kaplan-Meier method, and verified by the log-rank test. Cox proportional hazards regression analysis was used to estimate the prognostic factors in multivariate analysis. Results Of the 137 breast cancer patients, the genotypic frequencies of the GSTA1 * A/* A,* A/* B and * B/* B were 67.2% ( 92/137 ), 31.4% ( 43/137 ) and 1.5% ( 2/137 ), respectively. No significant differences were found between the genotypic frequencies and groups categorization according to age, stage, lymph node metastasis, ER or PR status (x2 = 0. 722,1. 967, 3. 303, 0. 226 and 0. 709, all P ＞0. 05 ) ;through Fisher exact test, also no significant differences were found between the genotypic frequencies and group categorization according to tumor size, histological types and grading ( all P ＞ 0. 05 ) . The recurrence rates in patients with GSTA1 * A/* A and * A/* B or * B/* B genotypes were 47. 8% (44/92) and 31.1% ( 14/45 ), respectively, and the mortality rates were 22. 8% ( 21/92 ) and 17. 8% ( 8/45 ),respectively. Patients with GSTA1 * A/* B and * B/* B genotypes were significantly associated with reduced hazard of relapse (x2 =18.723, P＜0. 01)and mortality (x2 =7.352, P＜0.01), compared to cases with the common * A/* A genotypes, according to Kaplan-Meier survival analysis and log-rank test. Moreover,Cox multivariate analysis showed that GSTA1 polymorphisms appeared to be an independent risk factor for recurrence-free survival ( OR =0. 222, 95% CI:0. 108-0. 458, P ＜0. 01 ) and overall survival ( OR =0. 362,95% CI:0. 145-0. 902, P ＜ 0. 05 ). Conclusion These data indicate that GSTA1 polymorphism may be a potential prognostic factor for recurrence-free survival and overall survival in breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy.

Objective To assess the causes of sildenafil failure and the feasibility of successfully rechallenging non-responding patients. Methods A total of 126 consecutive erectile dysfunction (ED) patients from Jan 2009 to Dec 2009 who claimed poor response to sildenafil (sildenafil 100 mg on demand, at lease 4 epiodes) were enrolled into the study. All patients received sexual reeducation and were treated with sildenafil, taken on a daily dose of 50 mg for 4 weeks. The International Index of Erectile Function-5 (IIEF-5), Rigiscan, serum testosterone or penile Doppler were used to evaluate ED and the cause of on-demand sildenafil failure. End point efficacy of rechallenging was evaluated using the IIEF-5 and the sexual encounter profile (SEP) 'Were you able to insert your penis into your partner's vagina?' and 'Did your erection last long enough to achieve successful intercourse?'. Results The recruited patients comprised of 41 cases with psychological ED, 39 cases with hypogonadism ED, 28 cases with diabetes mellitus ED and 18 cases with vascular ED. Compared with pretreatment and on-demand sildenafil baseline, daily administration of sildenafil significantly enhanced all efficacy outcome variables. The IIEF-5 was significantly improved after daily sildenafil (12.3 ± 2.9 vs18. 8±4.4, P＜0.01), 78 patients responded to daily sildenafil. The overall salvage rate was 61.9%(78/126). Conclusions Sexual reeducation and daily administration of sildenafil may be able to salvage many patients with ED who were sildenafil non-responders.