OBJECTIVE:To observe the influence of capecitabine combined with radiotherapy on postoperative survival rate, relapse rate and survival quality of elderly patients with rectal cancer at Ⅱ-Ⅲ stage. METHODS:110 patients with rectal cancer atⅡ-Ⅲ stage were selected and randomly divided into control group and observation group with 55 cases in each group. Both group received radical resection of rectal carcinoma. Control group was given three dimensional conformal radiation therapy(3DCRT)af-ter operation;observation group was additionally given capecitabine 1 500 mg/m2,d1-14,qd,on the basis of control group. A treatment course lasted for 21 d,and both groups received 2 courses of treatment and followed up for 3 years. The survival rate and metastasis and recurrence rate of 2 groups were compared as well as KPS score before and after treatment. Toxic reaction of 2 groups was also observed. RESULTS:The follow-up total survival rate and disease-free survival rate of observation group were 89.09%and 76.36%,which were significantly higher than 74.55%and 54.55%of control group;the distant metastasis rate and lo-cal recurrence rate were 12.73% and 5.45%,which were significantly lower than 30.91% and 21.82%,with statistical significance (P<0.05). KPS score of 2 groups were increased significantly,between 2 groups before and after treatment ,with statistical signifi-cance(P<0.05);Comparison between groups(P>0.05). There was no statistical significance in the incidence of nausea and vom-iting,diarrhea and urinary tract reaction between 2 groups (P>0.05);but the incidence of bone marrow arrest in observation group was significantly higher than control group(P<0.05). CONCLUSIONS:Capecitabine combined with 3DCRT can effectively improve postoperative distant survival rate of patients with rectal cancer at Ⅱ-Ⅲ stage,and reduce the metastasis and recurrence risk;do not lower life quality and induce serious adverse reactions.

Objective To investigate the high risk factors of chlamydia (CT) infection in female.Methods Enzyme linked immunosorbent assay was used to detect 120 cases of gynecological clinic,including 60 cases asymptomatic patients before abortion and 60 cases patients with symptoms of mild genital itching,vaginal secretions slight increased.CT antigen in uterine cervix were detected,and the relationship between its symptoms,age,birth time,contraception,cervical condition,the number of sexual partners,mycoplasma and CT infection were analyzed.Results Among 120 cases,there were 28 cases of CT positive,positive rate was 23.3％ (28/120).CT infection rate of symptomatic and asymptomatic patients was 16.7％,30.0％ respectively,the difference was not significant(P＞0.05).The CT infection rate of patients' age younger than 30 years was 27.8％,higher than older than 30 years (10.0％),the difference was significant(x2=3.975,P＞0.05).The CT infection rate of patients had multiple sexual partners in nearly lyear was 62.5％,higher than that had one sexual partner(9.0％),the difference was significant(x2=37.42,P＞0.05).The CT infection rate of patients didn't use contraceptive tools was 29.1％,higher than that used contraceptive tools(12.2％),the difference was significant(x2=4.319,P＜0.05).Conclusion The symptoms of CT infection are no specificity,should be targeted at screening for patients have high-risk factors,such as age less than 30 years old,have multiple sexual partners nearly 1 year and don' t use contraceptive tools.

Objective To analysis the varying degrees of the M protein staining after immunofixation electrophoresis(IFE)and study its applications in clinical diagnosis.Methods 196 cases of clinical serum samples were tested by using IFE,we analyzed the positive electrophoretic bands of M protein and performed statistical analysis by using SPSS17.0.The M proteins were analyzed ret-rospectively.Results 103 patients were diagnosed with monoclonal gammopathy in 196 patients with positive M protein bands,in-cluding 96 cases of multiple myeloma(MM)and 7 cases of other monoclonal gammopathy;93 patients were non-monoclonal gam-mopathy.By analyzing the M band staining in different clinical groups,we found that M bands were mainly with dense and thick staining in monoclonal immunoglobulin group,the dense staining rate of MM was 90.6%,and the difference between MM and the other monoclonal gammopathy was not significant(P >0.05).In contrast,M bands were in light and narrow staining in non-mono-clonal immunoglobulin group,the rate of which was 25.8%,the difference between non-monoclonal immunoglobulin group and monoclonal immunoglobulin group was statistically significant(P <0.01).The proportion of allelic band in MM,other monoclonal gammopathy,non-monoclonal gammopathy were 39.6%,28.6% and 2.2% respectively,the differences were statistically significant (P <0.01).Conclusion The M band,accompanied by allelic band in IFE staining,is helpful in the diagnosis of monoclonal gam-mopathy,especially MM.The appearance of M protein provides early warning of monoclonal gammopathy.

Objective To discuss and validate which method is more effectiveness for central placenta previa through analysing the clinical outcomes of the management of hemorrhage between uterine packing and stitching hemo-stasis during cesarean section.Methods 48 pregnant women with central placenta previa was conducted in this ret-rospective study,which were all cesarean section delivery.These patients were divided into two groups.24 patients with uterine packing with gauze in the control of massive hemorrhage during cesarean section were indetified,other-wise,the other 24 patients were conducted with sewing and ligation uterine.And then,the effectiveness and outcomes were compared.Results These all patients were alive and keep the uterus.The average estimated blood loss of the stiching group was (554 ±327)mL,obviously less than the uterine packing group,which was (828 ±584)mL,and the difference was statisatically significant (t =6.689,P<0.01 ).The rate of blood transfusion during operation was 8.33% (2/24)in the group of stiching,and was 50.0%(12/24)in the uterine packing group(P<0.05).Similar-ly,the operation time of the stiching hemostasis group,which was (48.9 ±10.0)min,was evidently shorter than (68.3 ±13.3)min of the other group(t=8.126,P<0.01).The two groups had no significant difference in therate of primary healing of incision,postoperative fever and admission time(P>0.05).Conclusion The uterine stiching is an effective,rapid and simple technique in the control of hemorrhage of central placenta previa.

? amyloid protein(A?) including A?40 and A?42 are the important bioactive substances in vivo.Their toxic and beneficial attributes in the body depend on its concentration.The brain A? level is maintained by two balances under the physiological condition.The first balance is the generation involved in ?-secretase and ?-secretase and the degradation involved in neprilysin(NEP) and insulin-degrading enzyme(IDE) of A?. The second one is the balance between the receptor for advanced end glycation products(RAGE)-mediated influx and low-density lipoprotein receptor related protein 1(LRP1)-mediated efflux of A? across the blood-brain barrier(BBB).Breakdowning any one of the two balances would result in the aggregation and precipitation of A? in the brain,which is a crucial event in the pathogenesis of Alzheimer's disease(AD).This paper reviews the regulation of brain A? level under the physiological condition and the reducing strategies on the level of brain A? under the pathological condition for developing new drugs in the treatment of AD.

Objective To investigate the effect of the extent of postoperative prophylactic radiotherapy after radical surgery on the long-term survival in patients with thoracic esophageal carcinoma.Methods A retrospective analysis was performed on the clinical data of 201 patients with thoracic esophageal cancer who received postoperative prophylactic radiotherapy after radical surgery from 2000 to 2007.The effect of the extent of radiotherapy on survival was evaluated,and the possible prognostic factors were subjected to multivariate Cox regression analysis.The Kaplan-Meier method was used to calculate overall survival (OS) rates,and the log-rank test was used for survival difference analysis.Results The 5-year follow-up rate was 97.0％.The OS rates for patients who received radiotherapy to the whole mediastinum,whole mediastinum + lymph nodes along the left gastric artery,whole mediastinum + bilateral supraclavicular regions,upper and middle mediastinum + bilateral supraclavicular regions,and whole mediastinum + bilateral supraclavicular regions + lymph nodes along the left gastric artery were 21.7％,37.1％,38.7％,34.8％,and 19.8％,respectively (P =0.406).Multivariate analysis showed that postoperative N stage was the independent prognostic factor (P =0.009).After prophylactic irradiation,metastases to the supraclavicular lymph nodes,lymph nodes in the upper and middle mediastinum,and abdominal lymph nodes were observed in 11,34,and 10 patients,respectively.Conclusions The extent of postoperative prophylactic radiotherapy after radical surgery for thoracic esophageal carcinoma only includes upper and middle mediastinum and bilateral supraclavicular regions.

Objective To study CT features of thymoma,so that to improve the accuracy of CT diagnosis and differential diagnosis.Methods 31 cases of thymomas proved by surgery and pathology were examined with conventional CT scans.CT findings of thymoma were analyzed.Results The lesions in 27 cases(87.1%)were located in the anterior upper and middle mediastinum.There were benign lesion in 11,including mass-cardiovascular interface(MCI) with convex type(8 cases),flatness type(1 cases) and concave type(2 cases).20 cases were malignant lesion,including MCI with cast type(18 cases) and concave type(2 cases).Irregular invasion to adjacent organs was found in 11 cases,others included pericardiac effusion(n=6),pericardial and mediastinal invasion(n=2),pleural effusion(n=4),pneumonia(n=2),lung,bone,mediastinal lymphadens metastasis(n=2) and liver,pancreas metastasis(n=1).Conclusion CT scans is of significant value in diagnosis and differential diagnosis of thymoma.

Humans ; Hyperthyroidism ; Infant, Newborn

OBJECTIVETo explore the clinical effects of minor bone anchors and palmaris longus tendon graft in treating chronic mallet fingers deformity.

METHODSFrom January 2008 to June 2013, 26 patients with chronic mallet fingers deformity were treated with minor bone anchors and palmaris longus tendon graft. There were 18 males and 8 females, aged from 18 to 52 years old with an average of (32.0±1.3) years. Among them, 8 cases caused by machine injury, 6 cases by fall injury, 6 cases by sprain from fight, 4 cases by tendon spontaneous rupture, 2 cases by knife trauma. There was no tendon attachment of extensor tendon check in 16 cases, and with 0.3 to 0.5 cm tendon attachment in 10 cases. All patients had the flexion deformity and the disability of dorsiflexion activity. During operation, the distal interphalangeal joint was fixed in 10° to 20° dorsiflexion by a Kirshner wire, the minor bone anchor was used to reconstruct the extensor tendon insertion, the palmaris longus tendon slice was transplanted the decayed area of extensor tendon insertion. Four weeks postoperatively, the Kirshner wire was removed and the plaster external fixation was used, and the patient began function exercises. Postoperative complications were observed and fingers functions were assessed according to Dargan standard.

RESULTSThe patients were followed up from 6 to 14 months with an average of (5.0±0.3) months. Wound superficial infection occurred in 2 cases, the skin pressure ulcer in 2 cases, joint activities disability in 1 case; these symptoms got improvement after symptomatic treatment. Traumatic arthritis occurred in 2 cases, 1 case was improved after treatment, and 1 case had chronic pain for a long time. No internal fixation loosening or breakage and tendon rupture were found. According to Dargan standard to evaluate the finger function, 17 cases got excellent results, 8 good, and 1 poor.

CONCLUSIONIt is an effective way to treat the chronic mallet finger deformity using minor bone anchors and palmaris longus tendon graft, and the method has advantages of reliable fixation, easy operation, satisfactory effect and less complication.

Adolescent ; Adult ; Female ; Finger Injuries ; surgery ; Fracture Fixation, Internal ; Hand Deformities, Acquired ; surgery ; Humans ; Male ; Middle Aged ; Suture Anchors ; Tendon Transfer

Objective To evaluate the safety and effectiveness of conscious sedation and intravenous anesthesia used to endoscopic retrograde cholangio pancreatiography (ERCP) in treatment of extrahepatic bile duct stones.Methods A total of 100 cases of extrahepatic bile duct stones patients in treatment of ERCP were encoded by the group order,50 cases of odd used intravenous anesthesia (intravenous anesthesia group),intravenous injection of propofol; 50 cases of even used conscious sedation (conscious sedation group),muscle injection of diazepam and pethidine.Intraoperative reaction (extubation behavior,own postural changes),changes in vital signs,operating time,the success rate of stone and complication were observed in two groups.Results The incidence of intraoperative extubation behavior and own postural changes in conscious sedation group were significantly higher than those in intravenous anesthesia group [24％ (12/50) vs.2％ (1/50),18％ (9/50) vs.0],and the differences were statistically significant (P ＜ 0.01).The heart rate and mean artery pressure in two groups were decreased at 5 minutes after administration than that before operation,and the difference was statistically significant (P ＜ 0.05),but there was no statistical significance at 10 min after entering the mirror and postoperative awake compared with before operation (P ＞ 0.05).Pulse oxygen saturation between two groups had no statistical significance (P ＞0.05).The success rate of stone in two groups were 98％ (49/50).Operating time in intravenous anesthesia group was obviously shorter than that in conscious sedation group [(38.2 ± 6.3) min vs.(49.1 ± 9.9) min] (P ＜ 0.01).The complications between two groups had no statistical significance (P ＞ 0.05).Conclusion Conscious sedation and intravenous anesthesia can be used to ERCP in treatment of extrahepatic bile duct stones,but intravenous anesthesia can obviously reduce patients discomfort,shorten the operation time.