Objective To explore the effect of E-Flow imaging on the radiotherapy of cervical lymph nodes metastasized from nasopharyngeal carcinoma.Methods A total of 52 nasopharyngeal carcinoma patients with 94 invasion neck lymph nodes were treated with conventional radiotherapy. Lymph node size, hemodynamic parameters, and blood supply were detected by E-Flow imaging and two-dimensional ultrasound before and after the radiotherapy. The relationship between those examinations and radiotherapy effect was analyzed.Results Of the 94 metastatic cervical lymph nodes from nasopharyngeal carcinoma before the radiotherapy, 40 disappeared, 52 reduced, and 2 maintained the original size after the radiotherapy. Blood flow in all residual lymph nodes decreased or disappearaed. Artery flow spectrum in the lymph node was changed from the high-speed high impedance to low-speed low resistance. The size of cervical lymph node and blood flow before the radiotherapy were associated with clinical efficacy (P<0.05). Conclusion E-Flow imaging plays an important role in assessing the efficacy of radiation therapy by changing the blood supply of cervical lymph node and its size before and after the radiotherapy.

Esophageal and Gastric Varices ; diagnosis ; etiology ; pathology ; Hemorrhage ; Humans ; Liver Cirrhosis ; complications ; pathology

ObjectiveTo summarize the experience of the operations of pancreaticoduodenal combined trauma.MethodsClinical data of pancreaticoduodenal combined trauma in 12 cases were analyzed retrospectively.Head of pancreas with duodenal combined trauma occurred in 9 cases,body-tail of pancreas with duodenal conbined trauma in 3 cases.Diferrent operative fashion were used.ResultsPostoperative pancreatic fistula in 2 cases( 16.7％ ),were cured by continuing lower pressure suction of all cases,11 cases were cured (91.7％ ) and 1 cases died (8.3％).ConclusionOperation in time and correct operative fashion were the key of successful treatment.Three-cavity twoBlakemore Tube had a certain value.

Objective To study the effects of atorvastatin on expression of lysyl oxidase(LOX) in myocardial tissue of rats with diabetic cardiomyopathy (DCM) and its mechanism.Methods Thirty DCM SD rats were randomly divided into 3 groups:DCM group,treatment group (atorvastain 2 mg · kg-1 · d-1 by gastric gavage) and β-aminopropionitrile group(β-aminopropionitrile 80 mg · kg-1 · d-1 by gastric gavage),10 cases in each group.Other 10 SD rats were selected as the control group.At the end of week 8,the rats were killed for extracting the myocardial tissue RNA and protein.Expression levels of LOX,MMP-2 and NF-κB mRNAs and proteins in myocardial tissue of DCM rats were measured by RT-PCR and Western blot.Results The expression levels of LOX,MMP-2 and NF-κB mRNAs and proteins in the DCM group were significantly higher than those in the control group (P＜0.01),and compared with the DCM group,the expression of BAPN LOX,MMP-2 and NF-κB mRNA and proteins in the treatment group were significantly deceased (P＜0.01).Conclusion Atorvastatin can reverse the expression of LOX in myocardial tissue of DCM rat,and then may regulate the expression of MMP-2 and NF-κB.

Objective To summarize the experience in endovascular repair of De Bakey type Ⅲ aortic dissection in recent years and summarize the prevention and management of the related perioperative complications.Methods From January 2009 to January 2011,49 cases of endovascular repair for De Bakey type Ⅲ aortic dissection were performed under general anesthesia in our department.There were 45 male and 4 female.The follow-up was performed in the outpatient department or by telephone.Results There was no inhospital death and no paraplegia events.Severe complication included:coma,2 cases ( 4.1％ ) ; endoleak,2 cases (4.1％ ) ; upper limb ischemia,2 cases (4.1％ ).Recurrent proximal aortic dissection,1 case.Fever was occurred in most of those cases.Conclusion Endovascular repair of aortic dissection improves the outcome of aortic dissection patients.But more attention should be pay to prevent the severe complications,It will help to improve the prognosis and life quality by reducing the risk of retrograde dissection,acute brain ischemia and endoleak.

Objective To discuss MRI characteristics and differential diagnosis of fourth ventricular masses. Methods We retrospectively analyzed 90 cases' MRI findings of fourth ventricular masses that were proved by the surgery (n=83) or were diagnosed by more than three professors and assistant professors in the neuroradiology field (n=7). Results These masses in our study included the medulloblastomas (n=27),the ependmomas (n=18),the choroid plexus papillomas (n=11),the metastases (n=7),astrocytoma (n=6),astrocytomas and glioma (undifferentiated and mixed patten are 5cases),epidermoid cysts (n=5),cerebral cysticercosis (n=4),cavernous hemangiomas (n=4),venous malformation (n=3). Their shapes were spheroridal or irregular,and some masses could become cystic changes in the masses. Most masses could be enhanced or a few couldn't be enhanced with DPTA on MRI. Conclusion The demonstration of fourth ventricular depends on MR findings. It is important to differentiate these masses between within and without fourth ventricular for the differential diagnosis.

Objective To employ intraoperative discography to determine the injured intervertebral disc segments that can not be identified on the preoperative MRI in patients with cervical spinal cord injury without fracture and dislocation for confirming the responsible segments needing surgical decompression and fusion.Methods The study involved 85 patients with cervical spinal cord injury without fracture and dislocation treated from January 2007 to December 2011,among which sixteen patients had not been identified with the responsible segments by preoperative MRI.The average preoperative Japanese Orthopedic Association (JOA) score was (9.1 ± 1.8) points.There was no obvious fracture or dislocation of the cervical spine on preoperative X-ray film,CT and MRI,but all patients displayed high intense signal in cervical spinal cord on MRI T2 weighted imaging.Besides,MRI revealed hemorrhagic swelling of anterior cervical soft tissue in nine patients and cervical intervertebral disk hernia in all patients.Annulus fibrosus rupture of cervical intervertebral disc with contrast leakage in intraoperative discography of suspected injury segments in all patients under direction of C-arm X-ray machine was set as the injury criterion.The patients with pure ruptured discs received cervical discectomy,interbody fusion and titanium plate fixation.The patients associated with multilevel cervical intervertebral disc hernia or ossification of posterior longitudinal ligament underwent anterior cervical corpectomy,bone graft with titanium cageand titanium plate fixation of ruptured discs.Results Nineteen injured discs were identified eventually by discography,including 2 discs at C3/4,4 at C4/5,8 at C5/6 and 5 at C6/7.Moreover,anterior annulus fibrosus rupture with intact anterior longitudinal ligament was found in 11 patients.The follow-up lasted for (24.4 ± 10.0) months.JOA scores were (13.3 ± 1.5) points and (14.5 ± 1.6) points at two weeks and three months after operation,and (15.1 ± 1.5) points at the last follow-up,indicating a relevant improvement rate of 53％,68％ and 76％ respectively.Mean operation time was 110 minutes and blood loss was 120 ml.Three patients had pain on shoulder and back and one patient had hoarse voice,but all the patients were relieved in two weeks after conservative treatments.No serious complications,such as deep infection,deterioration of neurological dysfunction,vertebral artery injury or internal fixation failure were noticed intra-or post-operatively.Conclusion For the intradiscal rupture that is hard to be determined by the conventional imaging methods,intraoperative discography can be used as an auxiliary method of imaging diagnosis in early surgical determination of responsible segments for cervical spinal cord injury without fracture and dislocation.

BACKGROUND: Clinical observation demonstrates that accelerated fracture healing or lower limb heterotopic ossifications always occur in patients with paraplegia. It indicates that peripheral nervous system may play an important role in fracture healing process.OBJECTIVE: To observe bone histomorphometery parameter, callus formation and biochemical change during the process of fracture healing of unilateral lower limb denervated tibia.DESIGN: Self-control animal experiment.SETTING: Tianjin Hospital.MATERIALS: Totally 36 six-month-old healthy male Wistar rats, with mean body mass of 210 g, were used in this experiment.METHODS: This experiment was carried out at Animal Experimental Center of Tianjin Hospital from March 2001 to March 2004. Denervated tibia fracture model and innervated tibia fracture model were made in the same rat. Animals were executed under anaesthetic status at week 2 and week 4 after fracture. Bilateral tibias were chosen to take radiografts.Biomachamical strength was measured and non-decalcification sections were prepared to perform bone histomorphometery observation.MAIN OUTCOME MEASURES: ① Comparison of wet weight of bilateral tibias and callus of rats between two groups after fracture. ②X-ray plain film scoring. ③ Biomechanical testing of tibial samples. ④ Histomorphological observation of fracture healing RESULTS: ① Wet weight of bilateral tibia and callus of rats in denervated group was much higher than that in innervated group at weeks 2 and 4 after fracture [(0.94±0.15) vs (0.76±0.14) g, (1.06±0.26)vs (0.81±0.10) g,P ＜ 0.05]. ②In X-ray plain film scoring, callus formation was significantly increased in denervated group (P ＜ 0.01). ③In biomechanical testing of three-point bending of tibial sample, callus intensity was significantly lower at weeks 2 and 4 after fracture in denervated group than in innervated group[ (9.88±8.49)vs ( 16.62±13.38 ) N, ( 12.77±7.55 )vs (20.19±10.60) N,P ＜ 0.05]. ④Bone histomorphometery showed that compared with innervated group, mineralized bone trabecula width of denervated group was significantly reduced (P ＜ 0.05), osteoid width was increased , osteoclast index and bone absorption area were significantly increased (P ＜ 0.05), and there were no significant difference of fibroblast index and bone formation area between two groups; Compared with innervated group, mineralized deposition rate in the denervated group was significantly reduced (P ＜ 0.05), the mature time of osteoid was elongated (P ＜ 0.05).CONCLUSION: Peripheral nervous system may play an important role during early and middle period of fracture healing. Intact innervation is essential for normal fracture healing.

BACKGROUND:Several studies have demonstrated that stem cells can differentiate into vascular endothelial cells, and then further differentiate and form blood capillary. Based on this principle, autologous bone marrow mesenchyrnal stem cell (BMSC) transplantation promotes angiogenesis to treat ischemia in lower limb.OBJECTIVE: To evaluate the angiogenesis in rabbit ischemic limbs following autologous BMSC transplantation using high-frequency two-dimensional ultrasound detection in conjunction with Doppler color-flow imaging examination. DESIGN, TIME AND SEI-FING: A randomized, controlled, animal experiment was performed in the Third People's Hospital of Wuxi between March 2007 and April 2008.MATERIALS: Twenty-four New Zealand rabbits were randomized to a control group and a cell transplantation group, with 12 rabbits in each.METHODS: Ischemia in lower limbs was induced in all rabbits. One week following ischemia induction, the cell transplantation group was injected with 0.5 mL cell suspension, comprising 2×106 BrdU-labeled autologous BMSCs cultured in vitro, through multiple sites in the region of gastrocnemius muscle. Simultaneously, the control group received the same amount of physical saline in the same region.MAIN OUTCOME MEASURES: The initial segment of rabbit femoral artery and superficial femoral artery was subjected to high-frequency two-dimensional ultrasound and Doppler color-flow imaging examinations to measure femoral artery vascular internal diameter, blood flow peak velocity, and blood flow acceleration time. Ischemic muscular tissue was taken for immunohistochemical staining to detect transplanted cell distribution and for pathological examination of angiogenesis. RESULTS: Two weeks following autologous BMSC transplantation, high-frequency ultrasound results revealed that femoral artery internal diameter and blood flow peak velocity were greater, but blood flow acceleration time was shorter, in the cell transplantation group than in the control group (P<0.01). Immunohistochemical staining results demonstrated the presence of BrdU-positive cells. Pathological sections displayed that vascular density was significantly higher in the cell transplantation group than ih the control group. CONCLUSION: Autologous BMSC transplantation is a promising, simple, and effective method of treating ischemia in lower limbs owing to its promotion of angiogenesis. Meanwhile, high-frequency ultrasound detection of femoral artery is an effective, practical method to evaluate the clinical outcomes of autologous BMSC transplantation.

The problem of over-treatment of percutaneous coronary intervention is expounded in the paper.From the prospective of ethics,several factors such as doctor,patient and even society,all of which can affect the excessive implement of percutaneous coronary intervention,are analyzed in the article.Effective counter-measures to help the development of the technique are also discussed.