Purpose:To observe the curative effect and the clinical-benefit-response of patients with advanced pancreatic cancer who used a combine of Gemcitabine,5-FU and PDD.Methods:The treatment with Gemcitabine (800 mg/m 2) was followed by 5-FU(600 mg/m 2) and DDP (30 mg/m 2),administered on days 1,8 and 15 of 28-day schedule. The curative effect was estimated according to the standard of WHO and the clinical benefit response was evaluated at the same time. The standard of CBR included pain,physical states and body weight. Results:Twenty-five (25/29) patients received over two cycles chemotherapy. 6(24%) partial response (PR), 12 (48%) stable disease and 7(28%) progressive disease were observed. According to the standard of CBR, 18(62.1%) patients achieved the clinical-benefit-response level. Therapy was well tolerated. The main toxicities included that the alimentary tract reactions and the marrow depression. Grade 3-4 thrombocytopenia was reported in 8 (27.6%) patients. Conclusions:The combination of GEM, 5-FU and DDP is a moderatedly active treatment with tolerable side-effects. It has definite response rate and high CBR rate in pancreatic cancer.

AIM:To observe the expression of Toll like receptor 4 (TLR4) in the left ventricle of Goldblatt rats and to explore the role and mechanism of TLR4 in left ventricular remodeling of hypertension.METHODS:Goldblatt model of Two-kidney,one-clip (2K1 C) renovascular hypertension was induced in twenty-five rats(H group),and twenty rats served the sham-operated group(sham group).The tail cuff blood pressure was detected every week and echocardiogram was observed every other week.After eight weeks of operation,the rats were killed and the samples of the left ventricle were collected.The concentration of Ang Ⅱ in left ventricle was assessed by tadioimmunoassay.Western blotting and RT-PCR were used to exam the mRNA and protein expression of TLR4 in the left ventricle.Immunohistochemistry was adopted to exam the location of TLR4 in the myocardium.RESULTS:TLR4 mRNA and protein expression were consistently upregulated in the left ventricle of H group compared with sham group.In H group, predominantly sarcolemmal staining was observed,especially focal areas of intense TLR4 staining were found in juxtaposed regions of two or more adjacent myocytes;However,in sham group,TLR4 expression was diffuse and presumably cytoplasmic.Considerable correlation was found between blood pressure,MESS,LVMI,RWT,the concentration of Ang Ⅱ in left ventricle and the protein expression of TLR4 in myoeytes.CONCLUSION:During the development of left ventricular remodeling of Goldblatt rats,expression of TLR4 increases significantly.Enhanced expression of TLR4 locates in the sarcolemma,especially in juxtaposed regions of two or more adjacent myocytes.These indicate that TLR4 transmembrane receptor which is closely relative with inflammation and immunity probably contributes to the development of ventricular remodeling.[KEY WORDS]Hypertension;Ventricular remodeling;Receptors,Toll-like;Goldblatt rats

Objective To investigate the clinical results in the treatment of developmental dysplasia of the hip (DDH) with one stage open reduction and Salter or Dega osteotomy for “walking age”children .Methods We retrospectively reviewed 16 patients(16 hips)with unilateral hip dislocation who had undergone one‐stage open reduction and Salter or Dega innominate osteotomy in the the“walking age”children .the results were evaluated clinically by McKay′s classification and radiologically by the modified Severin′s classification .Early signs of osteonecrosis were identified by neck widening ,epiphysis fragmentation ,and presence of a metaphyseal growth disturbance line in the first year after the operation .Results After a follow‐up of one year on average ,good clinical and ra‐diographic results were noted in 87 .5% and 81 .25% of the patients ,respectively .Osteonecrosis occurred in 3 hips(18 .75% ) .Con‐clusion One‐stage open reduction and Salter or Dega osteotomy is an effective treatment for developmental dysplasia of the hip in walking age .

Objective To investigate the clinical features of anterior pituitary hypofunction.Methods A retrospective analysis was carried out on the data of 117 patients with anterior pituitary hypofunction during 1994-2010.Results There were 60.68％ male and 39.32％ female patients respectively.The onset age was from 13 to 79 years,with 79.12％ of the patients more than 40 years old.There were 57 cases with sellar tumors ( 40.17％ ),in which 55 cases( 96.49％ )were operated and (or) treated with radiotherapy.35 cases were operated via the frontal approaches( 66.04％ ) and 18 cases underwent transsphenoidal surgery ( 33.96％ ).There were 108 cases with hyponatremia with the first symptoms of weakness,anorexia,nausea,and vomiting induced by ACTH deficiency (92.31％ ).There were 23 cases accompanied with central diabetes insipidus( 19.66％ )and 82 cases with coronary heart disease( 70.09％ ).Conclusion Owing to the difference in etiological factors,the incidence,early symptoms,and the hormones involved are greatly different.The main cause is pituitary tumor,which occured more in aged person,more in males than females.

Animals ; Cells, Cultured ; Ethanol ; toxicity ; Hepatocytes ; drug effects ; metabolism ; pathology ; Male ; Mice ; Mice, Inbred Strains ; Transcription Factor RelA ; metabolism

OBJECTIVE: To observe the cardiac adverse events associated with antithymocyte globulin (ATG) in the treatment of severe aplastic anemia (SAA), and analyze its possible pathogenetic mechanisms and prophylactic measures.

Objective To investigate MRI manifestations of temporomandibular joint trauma,emphasized on the displacement and deformation of the meniscus.Methods Thirteen patients with TMJ trauma were examined by MRI with 3-inch dual surface coils.T1WI and T2WI images in oblique sagittal and coronal plane were acquired in both closed-and open-mouth positions.Results Twenty(20/26,76.9%) joints had condylar fractures.Nineteen(19/20,95%) discs in 12 patients displaced anteromedially with the condylar fragments,six(6/20,30%) discs showed distortion and deformation.The other one patient had unilateral condylar fracture companied with avulsion and lateral dislocation of ipsilateral disc(1/20,5%),and the opposite disc also showed slight anterior displacement.Effusion was observed in 12(12/20,60%) joints with condylar fractures.The location of the discs didn't show obvious change between closed-and open-mouth positions.Conclusion MRI is an effective method for demonstrating TMJ injuries,and is useful for detecting the changes of morphology and position of the discs.

It is necessary to medical student to take the elective course of pharmacy.This paper put forward several viewpoints and concrete methods about teaching methods,means and contents of elective course of pharmacy.

Objective To evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) guided with endoscopic ultrasonography (EUS) for rectal neuroendocrine neoplasms(NENs).Methods A retrospective analysis was performed on 58 patients with rectal ENEs who underwent ESD from January 2011 to December 2015 in JiangSu Province Hospital.Manifestations of EUS, clinicopathological characteristics, proliferation activity grade, complete resection rate, complications and follow-up results of lesion were studied.Results Those treated by ESD included 58 patients with 64 lesions of rectal NENs.EUS results showed that 3 lesions originated from mucosa, 3 from muscularis mucosa and 58 from submucosa.A total of 34 lesions located within 5 cm from anus, 26 in 6-10 cm from anus and 4 more than 10 cm from anus.All 64 lesions were successfully treated by ESD.The mean maximum diameter of the lesions was 0.8 cm(0.2-3.5 cm), and the mean procedure time was 31 min(10-60 min).The complete resection rate was 93.8% (60/64).There were 4 patients with positive basal surgical margin, and two of them underwent additional surgery and two others were treated with argon plasma coagulation after rejecting surgery and ESD.Histological examination determined that 59 lesions were pathologic grade 1(G1) and 5 were pathologic grade 2(G2).Delayed bleeding occurred in 4 cases after ESD,which was managed by medicine in 1 case and endoscopic treatment in 3 cases.No perforation occurred after ESD.During a mean follow-up period of 22.9 months(3-48 months), no lymph node metastasis or distant metastasis was observed.Conclusion EUS is able to distinguish the origin of rectal NENs and aid determining the range and depth of ESD.ESD appears to be a safe, feasible and effective procedure for providing accurate histopathologica1 evaluations as well as curative treatments for rectal NENs limited to submucosa.

OBJECTIVETo explore the clinical efficacy of self-made Kirschner wire hook in the treatment of severely displaced proximal humerus fractures in children.

METHODSFrom January 2007 to February 2012,35 children with severely displaced proximal humerus fractures were treated with self-made Kirschner wire hook fixation,including 25 boys and 10 girls with an average age of 13.2 years old ranging from 5 to 17. The duration from injury to operation was 1 to 10 days with an average of 4.5 days. Preoperative diagnoses were confirmed by X-ray films as type III in 26 cases and type IV in 9 according to the Neer-Horwitz classification of the proximal humerus fractures. All fractures were close fracture without nerve or vascular injuries. Anatomical reduction was achieved by open reduction and the fractures were fixed by self-made Kirschner wire hook. Intra-operative and postoperative complications, postoperative radiographic examination, upper extremity length and range of shoulder motion were observed and recorded. Neer score system was used to evaluate shoulder function.

RESULTSAll patients were followed up from 6 to 18 months with an average of 12.1 months. The mean Neer score of the injured side was 94.2 +/- 4.8 (ranged, 84 to 99), 30 patients got an excellent result and 5 good according to the Neer scores. The X-ray showed all the fractures healed without shortening deformity or epiphyseal arrest at early stage. There were no complications related to the implant including loosening or breakage of the self-made Kirschner wire hook. The range of shoulder motion in the injuried side was similar to the normal side, except in abductor lift. All the patients could participate in normal physical activities.

CONCLUSIONThe method of open reduction and fixed with self-made Kirschner wire hook is a safe,effective,convenient treatment for severely displaced proximal humeral fractures in children.

Adolescent ; Bone Wires ; Child ; Child, Preschool ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; physiopathology ; surgery ; Male ; Range of Motion, Articular