Antigens, CD34 ; metabolism ; Hemangioendothelioma, Epithelioid ; metabolism ; pathology ; surgery ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; metabolism ; pathology ; surgery ; Male ; Middle Aged ; Vascular Endothelial Growth Factor A ; metabolism ; von Willebrand Factor ; metabolism

Objective To determine the cause, prevention and management of failed spinal deformity surgery, and evaluate the indication of spinal revision. Methods Thirty-one cases of failed spinal deformity surgery were treated surgically. There were 18 males and 13 females with an average age of 14.7 years(ranged from 4 to 35 years) at the present procedures. The average number of previous surgeries for this group of patients was 1.5 times. The duration between the first surgery and revision was 13-114 months, with an average of 47.9 months. There were 16 patients with consistent back pain which became worse after movement, 5 patients with implant complication (broken, loosing, explosing), 21 patients with failure of instrumentation and deterioration of deformity, 5 patients with decreased sensory and motor function. The average preoperative angel of deformity was 75.3 degrees for scoliosis and 76 degrees for kyphosis and the flexibility was 9.8% and 25.2%, respectively. All patients underwent reconstructive surgery with segmental vertebral osteotomy and trans-pedicular fixation and fusion in one or two stages according to the location and degree of the deformity. Results The average follow-up period for this group of patients was 31.8 months in 20 cases. The postoperative correction rate for scoliosis and kyphosis was 55.2% and 67.5%, respectively. There were 4 cases (12.9%) developed temporary neural dysfunction postoperatively and were recovered within 1-3 weeks after appropriate treatment. Instrumentation failure was occurred in two cases and there was no other complication in this group. Conclusion It is might be benefit to follow the principle of spinal deformity correction, fuse with adequate bone grafting and combine with proper pedicle fixation, especially for the congenital scoliosis patients, which are the efficial methods to prevent the failure of spinal deformation surgery. The management for the patients suffered from long-time back pain, spinal pseudarthrosis or progressive aggravated deformity postoperatively should be individuated depending on the degree of deformity, flexibility of the spine and the age of patients.

Objective To evaluate the clinical characteristics,efficacy and toxicity of three dimensional conformal radiotherapy(3D-CRT)for elderly patients suffering from advanced stage of non-small cell lung cancer(NSCLC).Methods From September 1999 to October 2006,with the use of Leibinger planning system,the authors performed 3-dimensional conformal radiotherapy(3D-CRT)for 108 elderly patients suffering from advanced stage of non-small cell lung cancer who had not received operation because of medical contraindications such as cardiac insufficiency,impaired pulmonary function,etc.For the patients with positive lymph metastasis,the primary tumor was treated with high dosages.Conventional radiotherapy was delivered,and the tumor site and draining lymphatic areas received 40~45Gy of radiation,followed by 3D-CRT.Results All patients received whole course of radiotherapy,and the total survival rate for 1,2,3 years was 65%,33% and 28%,respectively.Meanwhile,the radioreaction did not exceed grade 2 in all 108 cases.Conclusions 3-dimensional conformal radiotherapy was relatively an effective treatment for non-small cell lung cancer in elderly patients who could not withstand operations because of medical contraindications or other problems.The treatment was proved to improve total survival rate and life quality,relieve complications such as radiation pneumonia and radiation esophagitis.Therefore,3-dimensional conformal radiotherapy was recommended for elderly patients with advanced stage of lnon-small cell lung cancer.

Objective To evaluate the short-term therapeutic effects for patients with primary liver cancer using three-dimensional stereotactic conformal radiotherapy(3D-CRT).Methods Twenty-eight patients with primary hepatic cancer were treated with 3D-CRT(the average overall dose was 38Gy,localized by Elscint twin flash slice CT,radiotherapy plan was designed by Leibinger three-dimensional radiotherapy planning system and operated on Varian 600C/D liner accelerator).The average follow-up time was 12 months(5-17mon.).Tumor volume response rate,rate of free from tumor progression and survival rate were analyzed.The adverse effects were studied simultaneously.Results According to follow-up CT results 3 months after radiotherapy,2 cases had full responses with disappearance of the tumors,while partial responses with decreased tumors mass were seen in 22 cases,and no response in 4 cases.Tumor volume response rate was 85.7%.The last follow-up CT results showed that in 5 patients there was tumor progression in planning target volume(PTV),in 10 cases there was intrahepatic progression but not in PTV,and in 4 cases extrahepatic tumor growth.Intrahepatic tumor free rates 6 months and 12 months after radiotherapy were 66.5% and 38.4%,respectively.6-month survival rate after radiotherapy was 88.6%,12-month survival rate was 70.5% after radiotherapy.During 3 months of radiotherapy,manifestations of subacute radiation injuries occurred in six patients:gastrointestinal hemorrhage in 2 cases,jaundice in 3 cases and subacute radiation hepatitis in 1 patient.No survivors suffered from long-term liver injury.Conclusions With little adverse effect,3D-CRT could raise the control rate of the hepatic tumor,and also short-term survival rate.There fore,3D-CRT is a valuable treatment for patients with primary liver cancer.

Objective To evaluate the therapeutic effects and adverse effects of three-dimensional conformal radiotherapy(3D-CRT) for elderly patients with non-small cell lung cancer(NSCLC).Methods From August 2001 to October 2006,36 patients over 70 years old with NSCLC were treated with 3D-CRT.Leibinger treatment planning system was used for drafting radiotherapy plan,the prescription dose was 40-80Gy(median,60Gy).Twenty-four patients received hypofractionated radiation every two days in 8-12 fractions at a dose of 5-8Gy per fraction;12 patients accepted conventional fractionated radiation with 30-40 fractions during 6 to 7 weeks.With median follow-up time of 11 months(range,5-54 mon.),tumor volume response rate,1-year and 2-year survival rate were investigated,adverse effects of the treatment were also recorded in present research.Results Of the 36 patients,clinical symptoms were improved in 33 cases,while no changes were observed in 3 cases.According to follow-up CT results 2-3 months after radiotherapy,8 patients showed complete response(CR),22 cases with partial response(PR),with the overall tumor response rate of 83.33%(30/36).In this group,1-year and 2-year survival rate was 66.67% and 36.11% with median survival time of 8 months(range,2-53 months).No patients suffered from serious adverse effects.Conclusions 3D-CRT was an effective and safe treatment for elderly patients with NSCLC,which could raise the survival rate and improve the quality of life with little adverse effects.

Objective To evaluate the therapeutic effects of three-dimensional conformal radiotherapy(3D-CRT) for malignant tumors.Methods From July 1999 to October 2006,830 patients with malignant tumors received non-coplanarity multifield 3D-CRT by using Leibinger three-dimensional stereotactic conformal radiotherapy machine,Varian 600C/D 6MeV X liner accelerator and multileaf collimator.Single dose was 4-8Gy per fraction,once every two days and total dose was 50-82Gy.Results All 830 cases underwent 3D-CRT.According to the WHO evaluation standard for therapeutic effects,CT results showed that complete response(CR),partial response(PR),no change(NC),and progression(PD) rates were 20.7%(172/830),68.7%(570/830),10.2%(85/830),and 0.3%(3/830),respectively.Overall response rate(CR+PR) was 89.4%(742/830).No patients suffered from serious adverse effects.The incidence of radiation penumonia was 9%.Conclusions For patients with malignant tumors who could not endure operations due to existing contraindications or other conditions,3D-RCT was a relatively effective treatment because the method could deliver an increased therapeutic dose to tumors,enhance survival rate,improve life quality,decrease injuries to adjacent normal tissue,and reduce the incidence of complications.

OBJECTIVE: In order to evaluate the potential of matrix metalloproteinase 2(MMP-2) as a prognostic factor for human laryngeal squamous cell carcinoma (HLSCC). METHOD: Seventy-three surgical specimens from patients with HLSCC were reviewed retrospectively regarding MMP-2 expression via immunohistochemistry. Immunostaining was performed using a streptavidin-biotin peroxidase complex technique. The patients were followed-up till June 2014 and the relationship between MMP-2 and clinical data including age, gender, metastasis, clinical type, pathological type, lymph node metastasis and prognosis were analyzed using SPSS 19.0. RESULT: The positive expression rate of MMP-2 in 73 patients was 57.53% (42/73). Kaplan-Meier analysis demonstrated statistically significant difference for 5-year overall survival rate between the group with positive and negative MMP-2 expression,the 5-year overall survival rate were 76.0% and 57.5% respectively in the group with negative and positive MMP-2 expression. The site of the primary tumor, clinical stage, lymph node metastasis and T grade were related to the prognosis of HLSCC (P were 0.002, 0.009, 0.034 and 0.001 respectively), and there was no significant correlation between age, sex, pathological differentiation and prognosis of HLSCC. CONCLUSION MMP-2 was related with worse overall disease survival and could be considered as a potential marker of poor prognosis.
Carcinoma, Squamous Cell ; diagnosis ; metabolism ; Head and Neck Neoplasms ; diagnosis ; metabolism ; Humans ; Immunohistochemistry ; Laryngeal Neoplasms ; diagnosis ; metabolism ; Lymphatic Metastasis ; Matrix Metalloproteinase 2 ; metabolism ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Squamous Cell Carcinoma of Head and Neck ; Survival Rate

Logistics supplies are essential for normal operations of hospitals,while effective management of hospital suppliers is key to optimizing the materials supplies.An evaluation system is built for both key suppliers and standby suppliers respectively.Based on such a system,a dynamic management mechanism is built to provide long-lasting supplier incentives,for competitive selection and elimination of the suppliers.These efforts enable the hospitals to pick the best suppliers by means of systems and regulations.

BACKGROUND: The establishment of animal models is of important significance for understanding the pathogenesis, prevention, and treatment of intervertebral disc degeneration. OBJECTIVE: To develop rabbit models of intervertebral disc degeneration by acupuncture and to analyze the effects of acupuncture on intervertebral disc height and degeneration by X-ray and MRI examinations. DESIGN: A randomized and controlled observation. SETTING: Department of Orthopaedics, Changhai Hospital, Second Military Medical University of Chinese PLA. MATERIALS: This study was performed at the Animal Cener, Changhai Hospital, Second Military Medical University of Chonese PLA between June 2005 and April 2006. Six healthy New Zealand white rabbits of either gender, averaging 6 months old, weighing 2.5 kg on average, were provided by Animal Cener, Changhai Hospital, Second Military Medical University of Chinese PLA [permission No. SCXK (hu) 2002-0006], and recruited for this study. The protocol was performed in accordance with ethical guidelines for the use and care of animals.METHODS: ① Operation was made in experimental rabbits via the anterior retroperitoneal approach. The management for the intervertebral discs was as follows: L3-4 was the control disc without exposure or needle stab; L4-5 was subjected to sham-operation with only exposure; L5-6 was the experimental disc with three times of anterior-lateral needle stab after exposure. Lumbar lateral X-ray film was respectively taken with a CR machine (Simens Company) prior to and 4 weeks after surgery for measuring L3-4, L4-5, and L5-6 intervertebral disc height and calculating the ratio with intervertebral disc height prior to surgery. Each segmental lumbar intervertebral disc T2-weighted signal was measured with a 1.5 T medical superconductive magnetic resonance scanner (Simens Avanto). According to signal intensity, intervertebral disc degeneration was graded: a score of 4 indicated normal intervertebral disc without apparent degeneration but with bright signal, a score of 3 indicated slight degeneration with a little decrease in T2-weighted signal, a score of 2 indicated moderate degeneration with apparent decrease in T2-weighted signal, and a score of 1 indicated severe degeneration with apparent decrease in both T2-weighted signal and intervertebral disc height. MAIN OUTCOME MEASURES: Intervertebral disc height change revealed by lumbar lateral X-ray film; Intervertebral disc degeneration degree analyzed through magnetic resonance imaging (MRI) examination. RESULTS: All 6 experimental rabbits were included in the final analysis. The postsurgery-to-presurgery ratio of intervertebral disc height was 0.982 5±0.017 08 and 0.972 5±0.017 08 for L3-4 and L4-5 respectively, which was higher compared to that for L5-6 (0.550 0±0.02 582). Significant statistical difference existed (P ＜ 0.01). T2-weighted singal score was (4.00±0.0) and (3.75±0.5) for L3-4 and L4-5 intervertebral disc, respectively, which was higher compared to that for L5-6 intervertebral disc. Significant statistical difference existed (P ＜ 0.01). CONCLUSION: After 4 weeks of acupuncture, intervertebral disc height is decreased and interterbral disc degeneration obviously appears.

AIM:In human being,the exposure of lumbar Intervertebral discs usually requires the anterior transperitoneal or lateral retroperitoneal approaches. To study the feasibility of retropedtoneal approach to the lumbar spine in the New Zealand white rabbits.METHODS: The experiment was carried out between April 2005 and April 2006 in the Animal Center of Changhai Hospital.Second Military Medical University of Chinese PLA.Thirty New Zealand white rabbits,aged 6 months old, of either gender, weighing 2.5 kg,provided by the Animal Center of Changhai Hospital,Second Military Medical University of Chinese PLA [permission No.SCXK (hu) 2002-0006],were used in this study.During the experiment,the management of animals corresponded to Animal Ethical Standard.This study was approved by the Experimental Animal Ethics Committee,Changhai Hospital,Second Military Medical University of Chinese PLA.Transperitoneal approach was used to exposure the lumbar spine of experimental rabbits. The skin was disassociated, and a blunt dissection was made backwardly along the juncture of the maximum back muscle and external oblique muscle of abdomen,and lumbar intervertebral disc was exposed gradually.Observation index:①Operative effect of exposure.②Postoperative general condition (food intake,urination and defecation,activity,incision healing and death or not).RESULTS: Thirty experimental rabbits were involved in the final analysis.①The operative effect of exposure:The dght retroperitoneal approach was chosen,with satisfactory anesthesia and excellent exposure of rabbit lateral lumbar spine. And the exposure was usually accomplished within 15 minutes, with Less bleeding and no retroperitoneal rupture. ②Postoperative general condition: All animals recovered their consciousnesses within about 1 hour. They were intravenously injected continuously for supplementing blood volume,and after that,they were raised in the separate cases and were allowed to move freeLy.On the day of operation.they were fasted and forbidden to access to water.Their appetites began to decrease on the postoperative 1 day.restored from the 3rd day postoperatively and restored to normal on the 40th day postoperatively.All animals survived until after 4 weeks.They could move freely,without paralysis occurred or incontinence. There was one experimental animal whose surgical Incision broke.Debridement and resuture were given, and its wound healed. In all the other animals, the surgical incision healed well.CONCLUSION: Retroperitoneal approach can give an excellent access to the lumbar spine with easy operation and less complications.