OBJECTIVE:To explore security of interstitial chemotherapy by implanting 5-fluorouracil sustained-release reagent into interstitial tissues of oesophageal tumor tissue and tumor peripheral tissue under orthoptic endoscope. METHODS:Relative articles were retrieved from Pubmed database from January 1988 to December 2008 and CNKI database from January 2000 to December 2008. Inclusion criteria:articles which were related to 5-fluorouracil sustained-release reagent for the treatment of esophageal carcinoma were included;Exclusion criteria:Duplicated articles were excluded. A total of 29 patients with grade Ⅲ-Ⅳ esophageal carcinoma who received implantation of 5-fluorouracil sustained-release reagent under orthoptic endoscope were collected from Department of Oncology,Shenyang Red Cross Hospital from March 2001 to December 2007. There were 22 males and 7 females,aging 51-82 years and mean age of 60.2 years. 5-fluorouracil sustained-release particles were implanted into tumor interstitial tissue under orthoptic endoscope. 800 mg 5-fluorouracil sustained-release particles were gradually implanted for 3-5 particles each time. RESULTS:Implantation of 5-fluorouracil sustained-release reagent has been reported to safely and effectively treat esophageal carcinoma. Clinical results indicated complete remission(n=3) ,partial remission(n=16) ,stable pathogenetic condition(n=6) ,and no remission(n=4) . Body mass increased in 21 patients(72.4%) ,and average effectiveness level was 70.9%. Symptoms including hemorrhage,light descent of leukocyte,light malignancy,diarrhea but excluding functional disorder of liver and kidney were found. Easement of pain in 22 patients was 75.8%,and discontinuing analgesics accounted for 50%(P

Currently,tracheal stents used in clinic include silicone,dynamic and metal types.The metal stents contain Ni-Ti memory alloy,stainless steel,and coating stents,which are cylinder and network structured.These stents are more expensive than silicone stents.The internal stents,mainly metal stents,have been used recently in clinic to treat tracheal stenosis.Tracheal stenting methods are divided into bronchofibroscope and hard lens implantation.Both tracheal and esophageal stent implantations are invasive treatment.However,tracheal stent implantation is different from esophageal stent implantation.As patients with airway obstruction are always complicated by dyspnea and hypoxemia,even respiratory failure,which increases risk and difficulty of stent implantation.During tracheal stent implantation,the bronchofibroscope or stent entering the stenosis site may lead to complete tracheal obstruction-induced asphyxia.Corrosion of metal wire of stent to airway mucosa and vessels may result in hemorrhea,leading to postoperative hemoptysis.Stent dislocation is mainly caused by inappropriate selection of stent,inappropriate implantation position or severe cough.Carcinoma tissue growing along stent lumens can induce re-obstruction in stent,resulting in atelectasis relapse.Although there are many unsolved problems and the incidence of complication is 10%-20%,tracheal stent is still a safe,effective and simple therapy for tracheal stenosis.Prevention and treatment of tracheal stenosis following stent implantation and development of novel stents with better effect and fewer side effects is future study focus.

BACKGROUND:The therapeutic effect of traditional Chinese drug on myocardial ischemia and reperfusion has been increasingly attached importance to. The tongxinluo, a Chinese paten drug taking insect medicine as its major gradients, has been achieved satisfactory effect in anti-myocardial ischemia clinicallyOBJECTIVE: To investigate the effect of tongxinluo on myocardial apoptosis induced by ischemic reperfusion.DESIGN:A randomized controlled trialSETTING: Department of Traditional Chinese Medicine (TCM) of the First Affiliated Hospital, Sun Yat-sen UniversityMATERIALS:The experiment was conducted from November to December 2002 at the Molecular Medicine Research Center of Sun Yat-sen University.METHODS:Totally 72 Kunming mice were at random divided into 6groups with 12 in each group: 2 g/kg tongxinluo, 1.5 g/kg tongxinluo, 1.0g/kg tongxinluo group (The mice were administrated by gavage, once a day, on the day 5, one hour after administration, pituitrin and nitroglycerin were in combination used for building the myocardial ischemic reperfusion model), isosorbide dinitrade group (The dose was 3.9 g/kg, and the rest treatment was the same as the above), model group and blank control group(Normal saline was taken as substitute for the drug). At the end of trial the myocardia of the mice were taken for investigating the levels of superoxide dismutase (SOD) and malondialdehyde (MDA) of myocardia in mice with ischemic reperfusion, analyzing the myocardial apoptosis index, and determining the expression levels of apoptosis-relevant proteins bcl-2 and bax.MAIN OUTCOME MEASURES: [1] Comparison of SOD activity and MDA level in mice of each group. [2] Comparison of myocardial apoptosis and apoptosis relevant proteins.RESULTS:Totally 72 mice involved were good for the trial and no one died. [1] SOD activity and MDA level: Compared with the model and isosorbide dinitrade groups, SOD activity in 2 g/kg tongxinluo, 1.5 g/kg tongxinluo, 1.0 g/kg tongxinluo group was increased [( 1379.28±140.03 ),(1223.91 ±109.02), (1789.19 ±155.20), (2267.79 ±216.04), (2387.55±229.71 )nkat/L]; MDA level was decreased [(16.58±2.59), (20.40±2.66),(12.73±1.98), (9.65±2.03), (7.56±1.67)nmol/L], and the effect was increased as the dose was raised [2] myocardial apoptosis and apoptosis relevant proteins: Compared with the model and isosorbide dinitrade groups, the myocardial apoptosis index and Bax expression index in 2 g/kg tongxinluo,1.5 g/kg tongxinluo, 1.0 g/kg tongxinluo group were obviously decreased[(13.84±1.97)%, (11.56±1.43 )%, ( 334±0.96)%, (0.82±0.12 )%, (0.42±0.06)%;(17.44±6.18)%, (15.45±3.72)%, (10.85±2.73)%, (6.46±1.88)%, (5.57±1.49)% ]; Bcl-2 expression index was obviously increased [(6.22±0.50)%, (8.73 ±0.63)%, (11.38 ±1.38)%, (16.22 ±2.36)%, (19.45±2.92)%], and with a dose-effect relationship.CONCLUSION:Tangible capsule had the effects of. resisting oxygen free radical injury, anti-myocardial apoptosis and protecting ischemic reperfusion myocardial cells, and with a dose dependence.

BACKGROUND: In the evaluation on the effects of intervention on the patients with angina pectoris,whether the quality of life is improved or not is a very important factor while the symptoms and physical signs are benefited.OBJECTIVE: To probe into the intervention effects of sini tang,the classic formula,on angina pectoris of coronary heart disease and compare the effects of simple Chinese herbs,western medicine and integrated traditional Chinese and western medicine on quality of life.DESIGN:Prospective observation and control study in which the patients with angina pectoris of coronary heart disease were taken as the objects.SETTING: Department of Traditional Chinese Medicine of a Hospital Affiliated to a University.PARTICIPANIT : The 88 cases in total were the patients with angina pectoris of coronary heart disease in the clinic of Department of Traditional Chinese Medicine of First Hospital Affiliated to Sun Yat-sen University from February to August 2003. Inclusion criteria: those compiled with "Guide Principles of Pharmaceutical Clinical Study in Cardiac Vascular System" and "Standards on Differentiation of Coronary Heart Disease with Chinese Medicine". Exclusion criteria: those complicated with various severe diseases. All the patients were randomized into sini tang group,isosrbide dinitrate group and allied medication group of 29,30 and 29 cases successively.METHODS: In sini tang group,isosrbide dinitrate group and allied medication group,sini tang,isosrbide dinitrate and sini tang allied with isosrbide dinitrate were prescribed successively. At the beginning and the end of treatment, it was to observe the attack frequency,condition, severity and persistent duration of angina pectoris and to record electrocardiogram (ECG).The evaluation on quality of life was carried on before and two weeks after medication with the unified inventory and determination device.MAIN OUTCOME MEASURES: Comparisons of therapeutic effect on angina pectoris control,ECG and evaluation on life quality in every group.RESULTS: Both isosrbide dinitrate and sini tang relieved remarkably angina pectoris, improved ECG and quality of life in physical symptoms, health pleasure and depression level(P<0.01) . The result of sini tang on improving the quality of life in above-mentioned three aspects was better than that of isosrbide dinitrate(P<0.01) . But the allied medication improved clinical therapeutic effects and quality of life (health pleasure and depression level) best(P<0.01).CONCLUSION: Sini tang benefits the improvement of quality of life of patients with angina pectoris. But during clinical medical intervention,the advantages of integrated traditional Chinese and western medicine should be adopted.

Objective To investigate the anti-inflammatory effects of low-dose and sustained release oral theophylline on the chronic obstructive pulmonary disease (COPD) patients.Methods Thirty four patients with stable COPD were randomly divided into two groups:theophylline group (n =18) was treated with slow-release theophylline (100 mg,twice daily),and placebo group (n =16) was given with placebo.Healthy non-smokers (n =12) were taken as control.The course of treatment was 12 weeks both of theophylline group and placebo group.The percentages of Neu/Leu and Mφ/Leu in sputum were detected before and after treatment and the concentrations of interleukin (IL)-17,IL-8,and tumor necrosis factor-α (TNF-et) were detected with enzyme linked immunosobent assay (ELISA).Results (1) Compared to pretreatment with theophylline group,the Neu/Leu was increased [(89 ±4.14)％ vs (83.4 ±6.98)％,P ＜0.05] and the Mφ/Leu was decreased [(6.4 ± 4.11) ％ vs (12.3 ± 6.96) ％,P ＜ 0.05] in the post-treated theophylline group.No significant changes in both Neu/Leu and Mφ/Leu were observed before and after placebo-treatment (P ＞ 0.05).(2) Compared to the control group,the concentrations of TNF-α,IL-8,and IL-17 in the sputum supernatant were significantly increased in both pretreatment and posttreatment with the theophylline or the placebo.Sputum TNF-α,IL-8,and IL-17 levels were significantly decreased in COPD patients who were given theophylline.Compared to pre-treatment with placebo group,the IL-8 and IL-17 levels were significantly increased in the post-treated placebo group (P ＜0.01).There was no significant change in TNF~ level between before and after treatment with the placebo.(3) The concentrations of IL-17,IL-8,and TNF-α in the sputum supernatant were positively correlated with the Neu/Leu counts (r =0.471,0.652,0.466,respectively,all P ＜0.01),negatively correlated with the forced expiratory volume in one second (FEV1 ％) (r =-0.516,-0.652,-0.496,respectively,all P ＜ 0.01).Conclusions Low-dose and sustained-release oral theophylline was efficient in improving airway inflammatory cells and inflammatory mediators,which plays an anti-inflammatory effect.

Objective To investigate the effects of low-dose,sustained release oral theophylline on the chronic obstructive pulmonary disease (COPD) patient.Methods Fifty-six patients with stable COPD were randomly divided into two group:theophylline group (n =35) that was treated with slow-release theophylline(100 mg,twice daily),and control group (n =21) that was given with placebo.A series of parameters including lung function,quality of life scores,body mass index,airflow obstruction,dyspnea,and exercise capacity index (BODE) score,exercise tolerance,exacerbations,satisfaction with treatments and adverse effects were tested before and 12 weeks after the treatments.Results Forty two patients completed the study,25 cases in the slow-release theophylline group,and 17 cases in the placebo group.The differences of two groups before the treatment were not prominent except the age (P ＞ 0.05).After treated with slow-release theophylline,the forced expiratory volume in one second (FEV1),forced vital capacity (FVC) and the symptom score were slightly increased,but there were no statistically significant differences (P ＞0.05).After theophylline therapy,the quality of life score,including activity ability score,disease activity score and total score,and BODE index score were significantly decreased(P ＜0.05),but 6 minutes walk test (6 MWT) differences were no significant (P ＞0.05).The differences in pulmonary function test,the quality of life score,BODE index score and 6 minutes walk test were no significant between before and after the treatment with the placebo (P ＞ 0.05).Compared to the cases who treated with the placebo group,the patients in slow-release theophylline group reduced the frequencies of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (3/25 vs 7/17,x2 =4.748,P ＜0.05),and increased the efficacy satisfaction (Z =-2.579,P ＜ 0.05).Slightly adverse reaction was observed in 3 cases in slow-release theophylline group,but it could relieve by oneself,and not affect the common treatment.There was no adverse reaction in the placebo group.Conclusions Low dose,sustained release oral theophylline was efficient in improvement of the quality of life scores and BODE index score.

Objective To studythe cephalocaudal relationship ofabdominal aortic bifurcation relative toumbilicus and iliac crest vertex and their correlations with abdominal adipose tissue thickness and age. Methods The vertical distances,cephalocaudal relationship and other related anatomic parameters of aortic bifurcation relative to umbilicus and iliac crest vertex in 108 patientswere measured by consecutive abdominal CT scanning. The correlations of the acquired data with abdominal adipose tissue thickness and age were analyzed using Pearson correlation coefficient. Results Umbilicus was located at cephalad to aortic bifurcation in 67 patients(62.0%), caudal in 34(31.4%)andthe same level in 7(6.5%),with the vertical distance of(4.53 ± 17.51)mm to the aortic bifurcation. No statistically significant relationship was found between abdominal adipose tissue thickness(P>0.05) or age(P>0.05). Iliac crest vertex relative to aortic bifurcationwas located at cephalad,caudal and the same level in 31,71 and 6 patients,taking up 28.7%,65.7%and 5.6%,respectively. Its vertical distance to the bifurcation was(-6.34 ± 14.49)mm,nonrelated with abdominal adipose tissue thickness(P>0.05),but positively correlated with age(P<0.01). The difference in the cephalocaudal relationship of aortic bifurcation relative to umbilicus and iliac crest vertex was statistically significant(P<0.01). Conclusion Compared with iliac crest vertex,umbilicus is an important landmark of locating abdominal aortic terminal occlusion position in vitro because it mostly lies cephalad to aortic bifurcation in the front of the body,not easy to vary with abdominal adipose tissue thickness and age.

Objective To evaluate a model for axillary lymph node involvement combining CK19 mRNA with contrast enhanced ultrasound sonography (CEUS) score in operable breast cancer.Methods Operable breast cancer patients planned for sentinel lymph node (SLN) biopsy were enrolled.Preoperative CK19mRNA expressions in peripheral blood and CEUS score of axillary lymph nodes were tested before surgery.In the training set,postoperative sentinel lymph node (SLN) and non-sentinel lymph node (nSLN) pathological results were taken as the gold standard,effective modeling variables were screened,logistic regression was used to establish the prediction model.Parallel control studies were conducted between the validation set and the MSKCC model to evaluate the prediction accuracy and prediction efficiency.Results From Oct 2015 to Nov 2016,359 cases (training set) were enrolled and mathematical formulas for predicting SLN and nSLN were established,respectively.The sensitivity,specificity and AUC of predicting SLN involvement were 91.36％,94.92％ and 0.979 respectively.The sensitivity,specificity and AUC of predicting nSLN metastasis were 91.04％,90.53％ and 0.932 respectively.From Dec 2016 to Jul 2017,219 cases (verification set) were included.The sensitivity of SLN metastasis predicted by the model was 91.84％,the specificity was 96.69％,and the AUC was 0.979,significantly superior to the MSKCC model (0.739).The sensitivity,specificity and AUC of predicting nSLN metastasis were 95.35％,92.73％ and 0.945 respectively,significantly superior to the MSKCC model (0.873).Concolusions Combined with peripheral blood CK19 mRNA and CEUS score,the prediction model for axillary lymph node involvement for operable breast cancer,SLN/nSLN involvement probability can be calculated and qualitative judgment can be made.The overall accuracy and AUC of this model are better than the prediction model of MSKCC.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.