Analogy is to construct the theory of traditional Chinese medicine in clinical thinking method,which the proper use of this thinking is helpful to improve the clinical thinking of Chinese medicine,contributes to the development of disease differentiation and treatment ideas.This article tried to analyze the diagnosis and treatment of kidney diseases with Professor Zhu Zongyuan on the process,to explore the analogy on disease differentiation treatment guide.

Objective To determine the toxicity, maximal dose and clinical practicality of VM26 (teniposide) plus radiotherapy for postoperative brain neurospongioma. Methods Twenty patients were alloted in phase Ⅰ trial. The total dose was 60 Gy for the field radiotherapy (30 fractions of 2 Gy over six weeks). Teniposide at three dose levels (50 mg/m2, 75 mg/m2 and 100 mg/m2) was given intravenously once a week, totally five weeks. Dose escalation was based on each level, with a minimum of five patients in cohort if severe toxicity was not observed until the maximum tolerance dose(MTD). Results The predominant form of toxicity was hematologic toxicity. Four patients developed grade 3, 4 leucopenia when a second level of MTD (75 mg/m2) was given. Conclusion Combined radiotherapy and teniposide for postoperative brain neurospongioma is well tolerated. The dose of 50 mg/m2 for phase Ⅱ clinical trial was recommended.

ABSTRACT:Objective To investigate the differential gene expression of nasopharyngeal carcinoma cell line CNE-2 and CNE-2R exposed to X-rays.Methods We used neutral comet assay to detect the intrinsic radiosensitiv-ity of tumor cells,immunofluorescence to detect the phosphorylated histone γH2AX and Rad5 1 foci formation and to assay the time-dose effects on cell radiation injury and radiation radiosensitivity change after irradiation.The dif-ferential gene expression was screened with cDNA microarray by DNA damage repair related gene chip.Differenti-ally expressed proteins screened were confirmed by Western blot.Results After 2 h of 4 Gy 9MeV-β-ray irradia-tion,CNE-2R cells had aggravated DNA damage compared to CNE-2 cells and the damage was more obvious with the prolongation of time.It suggested that cell DNA damage severity was more obvious.The immunofluorescence showed the positive rates ofγH2AX cells in CNE-2 cell line were higher than those in CNE-2R cell line.There were 37 different genes related to DNA damage repair in CNE-2 cell line compared with CNE-2R cell line,while 24 up-regulated and 13 down-regulated genes were found in SiHaR cells.In them,there were 6 genes whose ratios were 6 times higher and 3 genes whose ratios were lower than 0.1.Western blot verified the results of four differentially expressed proteins compared with CNE-2 cells,in which GADD45a and RRAD1 expression levels were significantly lowered in CNE-2R while the RAD9a and RCF2 protein significantly increased.Conclusion The radioresistance of CNE-2R cells is significantly related to DNA damage repair capacity in certain mutations at the gene level.It is possible to regulate cell radiosensitivity by regulating the related gene.

Objective To investigate the effect of terlipressin on hepatic and renal function in cirrhotic patients undergoing hepatectomy.Methods Aanlyze the clinical data of 57 patients following irregular hepatectomy for hepatocellular carcinoma with cirrhosis,according to whether use terlipressin or not after operation,which were divided into terlipressin group (A group,n =27) and control group (B group,n =30).Liver function parameters (ALT,AST,TB),ascites,urine volume and renal function parameters (Cr,BUN) preoperatively and on postoperative day(POD) 1,3,5 and 7 were compared between the two gruops.Results Compared with those of POD 1,the levels of ALT,AST and ascites on POD 3,5,7 were significantly lower in two groups (P ＜ 0.05),urine volume was significantly increased (P ＜ 0.05),Cr of POD 7 was significantly lower (P ＜0.05),but it is more remarkable in group A than group B.The levels of ALT in terlipressin group on POD 5,7 were (144.9 ±76.3) U/L,(100.5 ±61.5) U/L,which were lower than those of (267.2±91.2) U/L,(199.3 ±70.5) U/L in control group.On POD 3,5,7,the levels of AST,BUN,Cr and peritoneal fluid in terlipressin group,which were respectively(211.1 ±99.8) U/L,(80.4 ±54.6) U/L,(50.6 ±46.5) U/L,(6.6 ± 1.9) mmol/L,(6.5 ± 1.7) mmol/L,(6.3 ± 2.1) mmol/L,(74.3 ± 10.9) μmol/L,(71.5 ± 8.9) μmol/L,(58.7 ±4.1) μmol/L,(247.6±60.3) ml,(58.8±54.3) ml,(40.2±31.8) ml,were significantly lower than those in control group which were (298.7 ±131.2) U/L,(201.1 ±93.4) U/L,(114.7 ±70.3) U/L,(7.3 ± 1.9) mmol/L,(7.2±1.8) mmol/L,(7.1±1.7) mmol/L,(79.5±15.1) μmol/L,(76.9±16.2) μmol/L,(69.4±11.4) μmol/L,(275.2±88.1) ml,(191.7±71.6) ml,(93.2±50.2) ml.while urine volume of (2232.3±409.8) ml,(2270.5 ±395.8) ml,(2179.0±301.4) ml was much more than that of (1921 ± 510.4) ml,(2019.1 ±411.2) ml,(1978.7±323.7) ml in the control group,the differences in the two groups were statistically significant (P ＜ 0.05).There were 11 (36.7％) patients with hepatic and renal dysfunction and hepatorenal syndrome after operation in group B,while only 2 (7.4％) patients in group A.Conclusions The use of terlipressin after partial liver resection has a protective effect on hepatic and renal function in patients with cirrhosis,and can reduce postoperative ascites and prevent hepatorenal syndrome.

Objective To analyse the efficacy of microvascular decompression for hemifacial spasm (HFS) caused by vertebral basilar artery compression. Methods A total of 141 patients with HFS treated by microvascular decompression in our hospital were collected in this study. The improvement of the symptoms after operation was compared between patients with HFS caused by vertebral basilar artery compression (28 cases) and patients with HFS caused by non-vertebral basilar artery compression (113 cases). Results There was no significant difference in the effective rate between the two groups of HFS (96.43%vs. 98.23%,P=0.49) with mean following-up 13.81 ± 1.57 months. And there was no significant difference in the delayed cure rate after surgery between two groups (37.04%vs. 20.72%,χ2=1.38, P>0.05). Conclusion Microvascular decompression is a safe and effective method for the treatment of HFS caused by compressed vertebral basilar artery.

Objective To study the bowel-cleansing efficacy, patient security and mucosal injury of low-volume PEG plus ascorbic acid regimen. Methods Five hundred patients referred for colonoscopy were enrolled and randomly divided into two groups. Group A received low-volume PEG regimen, Group B received sodium phosphate (NaP) regimen for bowel preparation. Patients of the two groups drank solution 5 h before colonoscopies, serum creatinine and electrolyte were monitored at 5 h and 3 h before colonoscopies. The bowel-cleansing efficacy was rated during colonoscopy. All mucosal injuries observed during colonoscopy were biopsied and histopathologically reviewed. Results The patients of group A completed bowel preparation of 233 cases, completed colonoscopy 226 Cases, group B completed bowel preparation 238 cases, completed colonoscopy 210 cases. There was no significant difference in bowel cleansing between the groups (P > 0.05). Group A reported less incidence rate of the mucosal injuries than Group B. Group A reported better patient security than Group B at the same time. Conclusion Compared with sodium phosphate (NaP) regimen low-volume Polyethylene Glycol (PEG) plus ascorbic acid regimen exhibited equivalent bowel-cleansing efficacy and less incidence rate of the mucosal injuries and better patient security.

Objective To investigate the surrounding and central dosimetric distribution difference of the same activity, same number of 125I seeds. Methods 3D treatment planning system (3D-TPS) was used to separately sketch out 7 cubes with side length of 2 cm, 2.5 cm, 3 cm, 3.5 cm, 4 cm, 4.5 cm and 5 cm;simulations of different tumor sizes were established, into which 125I seeds with activity of 0.5 mCi were respectively loaded. All seeds were distributed at the periphery of the tumor (peripheral group) with the prescribed dose of 145 Gy. The dose volume histogram (DVH) was printed and the 90% of target volume absorbed dose (D90), 90% of prescription dose coverage target volume percentage (V90), the maximum dose and mean dose were determined. Then the seeds in every cube were distributed into the center (central group) and the above parameters were calculated by using the same method. Results The mean D90 of the peripheral and central group was (147.29 ±0.58) Gy and (106.08 ±9.40) Gy respectively, the difference between the two groups was statistically significant (t=-4.292, P=0.005). The mean V90 of the peripheral and central group was (95.46±0.44)% and (79.07±4.19)% respectively, the difference between the two groups was statistically significant (t=-3.831, P=0.009). The mean maximum dose of the peripheral and central group was (1 224.65 ±12.7) Gy and (1 532.48 ±48.54) Gy respectively, the difference between the two groups was statistically significant (t=6.823, P=0.000). The mean value of average dose of the peripheral and central group was (192.14 ±2.89) Gy and (179.81 ±5.40) Gy respectively, the difference between the two groups was statistically significant (t=-2.847, P=0.029). Conclusion The dose distribution is directly influenced by the distribution pattern of the 125I seeds. When the number and activity of the 125I seeds are the same, the peripheral seeds implantation has a better dose distribution.

Objective To explore the dosimetric effects of the same number and activity of radioactive 125I seeds in different plane arrangements. Methods Simulated 9 distribution modes using 9 125I seeds were designed by three- dimensional treatment planning system (3D- TPS), and the isodose curves of 60 Gy, 80Gy, 130 Gy, 145 Gy and 200 Gy were obtained. The areas enclosed by the isodose curves, the longer and shorter radius of these isodose curves and the medical cost per unit area were calculated with the professional image analysis software. Results Obvious differences in areas enclosed by the isodose curves, the longer and shorter radius of these isodose curves and the medical cost per unit area existed between each other among the nine different distribution modes of 9 125I seeds. The distribution modes that had the maximum areas enclosed by 60 Gy, 80 Gy, 130 Gy, 145 Gy and 200 Gy isodose curves were x1.5y1.5, x1y1.5, x1y1, x1y1 and x0.5y1, respectively, with the corresponding areas of 1 583.86 mm2, 1 146.03 mm2, 768.30 mm2, 621.85 mm2 and 480.97 mm2, respectively. Conclusion The peripheral dose and the therapeutic efficacy are significantly influenced by the arrangement of 125I seeds when the same number and activity of the seeds are used. The dose distributions are more homogeneous when the maximum areas enclosed by the isodose curves are obtained.

Objective To evaluate the safety and efficacy of CT-guided radioactive 125I seed implantation in treating retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy.Methods A total of 10 patients with retroperitoneal lymph node metastasis (12 lesions in total)due to recurrent cervical cancer after radiotherapy,who were treated with CT-guided 125I seed implantation during the periodfrom November 2011 to October 2015,were included in this study.The diameters,that were perpendicular to each other,of the involved lymph nodesranged from 1.7 cm×1 cm to 6.5 cm×5 cm,the diameter of 6 involved lymph nodes (50％) was ＜5.0 cm and the diameter of other 6 involved lymph nodes (50％) was ≥5.0 cm.With the help of treatment planning system for brachytherapy,the source distribution was formulated.Under CT guidance,the 125l seedswith the activity of 0.3-0.7 mCi were implanted.Postoperative validation showed that D90 (90％ minimum prescription dose received by the target volume) was 36-110 Gy (median 59 Gy).After the treatment,the changes in lesion size,pain relief and complications were recorded.Results The 10 patients were followed up for 4.3-16.1 months,the median follow-up time was 9.7 months.The 2-month local control rate and the 2-month effective rate were 100％ and 58.3％,respectively.The 2-month,6-month and 12-month survival rates were 100％,66.7％ and 58.3％,respectively.The median survival time was 12.1 months.One patient (10％) died of gastrointestinal bleeding at five months after treatment,six patients (60％) died of distant metastases,three patients (30％) survived withno evidence of local recurrence.No major complications such as massive hemorrhage,intestinal infection,bone marrow suppression or other 125I seed-related complications occurred.Conclusion For the treatment of retroperitoneal lymph node metastasis due to recurrent cervical cancer after radiotherapy,CT-guided radioactive 125I seed implantation has satisfactory short-term curative effect,and this technique is safe and feasible.

Objective:To study the effiacious based on our experience of precise anatomical hemi-hepatectomy strictly guided by the middle hepatic vein (MHV) for regional to treat intrahepatic hepatolithiasis.Methods:A retrospective analysis was conducted on the data of 47 patients with regional hepatolithiasis treated with hemihepatectomy from July 2015 to July 2019 at the Department of Hepatobiliary and Pancreatic Surgery, The University of Hong Kong-Shenzhen Hospital. The study included 15 males and 32 females, aged (42±15) years. The exposure and preservation of the MHV was included in the precision surgery group ( n=26), and failure to fully expose the MHV or damage to the MHV was included in the control group ( n=21). The operation time, intraoperative blood loss and other surgical data and postoperative complications of the two groups were compared. Results:All patients successfully completed the operation. There was no patient who developed liver failure, and no patient died 90 days after the operations. The operation time (5.2±1.8) h and intraoperative blood loss (620.5±450.8) ml of the precision surgery group were not significantly different from those of the control group (4.9±2.3) h and intraoperative blood loss (760.5±540.2) ml ( P>0.05). A total of 19 patients (40.4%) (7 in the precision surgery group and 12 in the control group) developed 36 post operative complications of various types. The postoperative complication rate in the control group was higher than that in the precision surgery group [47.6%(10/21) vs 19.2% (5/26)], the difference was significant ( P<0.05). All 47 patients were followed-up for 6 to 30 months. For postoperative long-term complications: 5 patients in the control group had residual stones, biliary tract infection, liver abscess, and biliary-enteric anastomosis stenosis with recurrence of stones, and only 2 patients in the precision surgery group were found to have residual stones and biliary-enteric anastomotic stenosis. Stone recurrence, (the incidence of long-term complication) in the control group was significantly higher than that in the precision surgery group [23.8% (5/21) vs 7.7% (2/26)], ( P<0.05). Conclusions:Precise anatomical hemi-hepatectomy strictly guided by MHV for regional hepatolithiasis could more fully remove stones and lesions, and reduced the rate of stone recurrence. It was safe and feasible with favorable efficacy.