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.

Objective To study the value of ultrasound-guided fine needle aspiration (FNA) in the diagnosis of axillary lymph node metastasis in breast cancer,and to compared with conventional ultrasound in the diagnosis of metastatic lymph nodes of breast cancer.Methods Five hundred patients were enrolled into study prospectively from our hospital.The set of standard for patients into study:patients were diagnosed by BI-RADS and classified into class 4 or class 5 preoperative,the maximum diameter of the tumor was less than 2 cm,and there was no case of distant metastasis.Ultrasound guided FNA was performed in each case,and the results were compared with conventional ultrasound diagnosis results,using pathological findings as gold standard.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy in the diagnosis of axillary lymph node by conventional ultrasound were 60.6%,67.6%,77.2%,48.7%,and 63.1%,respectively,and by ultrasound-guided FNA were 78%,100%,100%,71.6%,and 85.6%,respectively.There were significant differences between the two diagnostic methods statistically(χ2=113.2,P<0.001).Conclusions Ultrasound-guided FNA can effectively reduce the number of sentinel lymph node biopsy,which displays a certain clinical value.

Angiotensin II ; pharmacology ; Calcium ; metabolism ; Cell Hypoxia ; drug effects ; physiology ; Cells, Cultured ; Endothelial Cells ; drug effects ; metabolism ; physiology ; Humans ; Membrane Potential, Mitochondrial ; drug effects ; physiology ; Oxygen ; metabolism

Objective To investigate the effect of liraglutide on the expression of NF-kappa B (NF-κB), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in renal tissue of insulin resistance rats. Method The rats were divided into 4 groups, control group ,high fat group ,liraglutide low dose group [100 μg/(kg· d)], liraglutide high dose group[100 μg/(kg·d)]. Detection of serum creatinine and urea nitrogen by automatic biochemical analyzer, and 24 h urine micro albumin was determined by immunoassay. The protein concentration of serum NF-κB,TNF-α and IL-6 was measured by ELISA. The expression of NF-κB,TNF-α and IL-6 mRNA in renal tissues was determined by RT-PCR. Results Compared with the control group, the serum creatinine, blood urea nitrogen,urinary protein, and the expression of NF-κB, TNF-α and IL-6 were significantly higher in high fat group, respectively (P < 0.05). The glomerular basement membrance thickening and foot process fusion were seen under electron microscope. Liraglutide high dose intervention can significantly reduce these changes. Conclusions Liraglutide can inhibit the expression of NF-κB,TNF-α and IL-6 in renal tissues of high fat induced insulin resistance rats,in a concentration dependent manner, which possibly improve renal function.

Objective To investigate the progress of pathology of the perihematomal tissue, and to study the relationship between the pathology and the changes of regional cerebral blood flow after intracerebral hemorrhage(ICH) in rats. Methods ICH was produced by microinjection of fresh autologous blood into the right caudatum in rats. CT perfusion imaging and computer-aided mapping in measurements of regional cerebral blood flow adjacent to the hematomas were performed in seventy SD rats at 1h, 3h, 6h, 12h, 24h, 48h and 72h respectively after the ICH. The parameters of regional cerebral blood flow(rCBF), regional cerebral blood volume(rCBV) and mean transit time(MTT) were calculated respectively. After the CT examination, the histopathological examination of TTC, HE and ultrastructure staining were carried out. Results The gradient of perihematomal hypoperfusion was revealed on CT perfusion maps. The rCBF and rCBV around the hematomas reduced pronouncedly, and the MTT delayed. TTC staining did not show infarction around the hematoma. Histopathological study demonstrated the astrocytic swelling and neuronal degeneration in the peri-ICH regions. The inflammory cell infiltration and capillaries hyperplasia were also observed around the ICH. Under the electronic microscope, the pathological changes of ultrastructure were revealed. In the early stage of ICH, there existed swelling of astrocytes, loosing of myelin sheath lamina, but no clear changes occurred in neurons. With the delay of ICH, the cellular injury around hematomas exacerbated progressively, more swelling of astrocytes, slight degeneration of neurons and local fragmentation of myelin sheath lamina were observed.Conclusion The perihemorrhagic and distant ischemic injury can be induced by the pronounced reduction of cerebral blood flow in the early stage of ICH. The cellular injury around hematomas exacerbates progressively in the acute stage of ICH. There is a perihematomal penumbra affecting multiple mechanisms of cellular injury.

AIM: To investigate the relationship between morphologic changes in neuron or neuroglial cells and expression of tumor necrosis factor ? (TNF-?) and c-Myc in cortex after focal cerebral ischemia/reperfusion in MCAO rats. METHODS: The focal cerebral ischemia/reperfusion model was established by intraluminal thread occlusion of the middle cerebral artery (MCAO). The middle cerebral arteries of rats were occluded for 2 hours and reperfused for 1, 3 and 7 days. Using the techniques of immunohistochemical staining and optical microscopy, the morphologic changes in neuron or neuroglial cells were observed in the cortex of frontal or parietal lobe; the cell types which dynamicaly expressed TNF-?, c-Myc in the different period were also observed. RESULTS: The degeneration or necrosis of neuron or neuroglial cells were observed at the center of infarction, it was very serious at 3 d after reperfussion. Astrocyte and microglial cell proliferation were observed at the broder of infarction. TNF-? and c-Myc positive cells, most of which were astrocytes and microglial cells, increased significantly at 3 d after reperfusion. CONCLUSION: TNF-? and c-Myc may play an important role in the regulation of neuron or neuroglial cells after focal cerebral ischemia with reperfusion. [

Objective To investigate the efficacy and safety of the combined therapy of cyclophosphamide and thalidomide in the treatment of refractory Crohn's disease (CD).Methods This study was a prospective and open study.A total of 15 patients with refractory CD were enrolled.All patients received intravenous cyclophosphamide 200 mg every other day for two weeks,then followed by intravenous 400 mg once a week until the cumulative dose reached 6 to 8 g.when the cyclophosphamide treatment started,at the same time thalidomide was taken 25 to 75 mg every night according to the tolerance of patients.Before the treatment,two weeks' after the treatment and at the time when the cumulative dose of cyclophosphamide reached 6 to 8 g,Crohn's disease activity index (CDAI),hemoglobin (Hb),white blood cell (WBC) count,erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hs-CRP) were recorded.Endoscopy examination was conducted before the treatment and at the time when the cumulative dose of cyclophosphamide reached 6 to 8 g.The condition of mucosa healing was observed and scored by simple endoscopic score for crohn's disease (SES-CD).Adverse effects of all patients were monitored.Paired t test was performed for statistical analysis.Results Before the treatment,the CDAI of 15 patients with refractory CD was 235.87±59.87,two weeks after the treatment the CDAI declined to 135.33 ± 29.23,and the difference was statistically significant (t=7.50,P＜0.01).Before the treatment,ESR and hs-CRP was (42.13±22.80) mm/1 h and (13.73± 2.18) mg/L.Two weeks after treatment they declined to (23.80±16.63) mm/1 h and (5.77±4.77) mg/L,and the differences were statistically significant (t=2.43 and 6.17,both P＜0.05).After two-week treatment,10 patients achieved clinical remission.After the cumulative dose of cyclophosphamide reached 6 to 8 g combined therapy,CDAI of patients was 108.14 ± 47.10,which decreased significantly compared with that before treatment (t=6.30,P＜0.01).ESR,hs-CRP and WBC count was (19.35± 19.18) mm/1 h,(6.16± 5.02) mg/L and (6.28 ± 3.42) × 109/L,respectively,which decreased compared with those before treatment,and the differences were statistically significant (t=5.90,5.40 and 3.71,all P＜0.01).Twelve patients achieved clinical remission.And the lesions of 12 patients improved under endoscope,furthermore,the mucosa of four patients healed.Before the treatment,SES-CD was 9.14 ± 5.39,which declined to 5.07 ± 4.58 after the treatment,and the difference was statistically significant (t =3.14,P ＜ 0.01).During the treatment,five patients had adverse effects.Alanine aminotransferases (ALT) increased in three patients,WBC count decreased in one patient and one patient got a severe urinary infection.Conclusions Patients with refractory CD could achieve clinical remission,mucosa healing under endoscopy and better efficacy with the combined therapy of cyclophosphamide and thalidomide.However,adverse effects should be monitored during the treatment.

Objective To evaluate the effect of triamcinolone orbital injection combined with dexamethasone in treatment of the patients with the grade Ⅳ of thyriod associated ophthalmopathy. Methods NOSPEVS Ⅳ grade of 90 patients were randomly divided into three groups,Group A,orbital injection of triamcinolone combind with dexamethasone, Croup B,simple injection of triamcinolone,Group C,oral prednisone therapy for half a year. To review each record of visual acuity intraocular pressure palpebral fissure size, upper eyelid drop late exophthalmos eye movement and so on every 4 weeks and follow-up for one year. Results Group A and group B of exophthalmos and eye movement improved obviously,however,Group C with poor efficacy and more side effects,and Group A in 3 groups was the fastest with least number of injections and which improved eye symptons significantly with fewer complications. Conclusion Orbital injection of triamcinolone combined with dexamethasone could be more rapid and effective than a simple injection of triamcinolone or oral prednisone to improve symptoms and signs in thyroid ophthalmopathy.

Objective To validate the effect of anti-infective reconstituted bone xenograft (ARBX) in treating posttraumatic osteomyelitis by one-stage grafting in the adults.Methods With clinical application approval of Medical Command,Logistics Ministry of PLA,ARBX was used to treat 27 adult patients (29 lesions) with posttraumatic osteomyelitis by one-stage grafting after debridement since September 2001.The study analyzed 27 patients (29 grafts) who were followed up for average 26 months (12-63 months).Results The follow-up for average 26 months (12-63 months) in 27 patients showed that infection of 22 patients (24 lesions) was controlled and cured,except for three with failure to control the infection or with recurrence of infection,two with controlled infection but with postoperative nonunion.The infection control rate was 89.7% (26/29) and the cure rate was 82.8% (24/29) ,which were better than the results of traditional therapy.Conclusions ARBX has high osteoinductive activity and enhanced anti-infective capability,which enables it to be used as one-stage grafting to treat posttraumatic osteomyelitis in the adults.