Objective: To evaluate the long-term result after bioprosthesis replacement, and analyse the risk factors of the late deaths. Methods: From September 1984 to March 1988, 90 patients underwent bioprosthesis replacement in our hospital. There were 39 males (43%) and 51 females (57%) with an average age of 36.1 years. 78 patients had rheumatic disease, 8 degenerative disease, 3 congenital mitral valve anomaly and 1 Ebstein's anomaly. The preoperatively heart function (NYHA) was grade II in 15, grade III in 54, and grade IV in 21. C/T was 0.51～0.90 (average 0.65?0.10). Results: The operative mortality rate was 7。8%. All survived patients were followed up. The mean follow-up time was 7.8 years (range from 3 months to 15.7 years. 35 patients died during the follow-up period. The causes of death cardiac related deaths in 33 patients (88.6%), noncardiac related death in 3 (8.6%), and unknown in 1 (2.8%). Reoperation was performed in 20patients. At 1, 5 and 10 years after operation, the actuarial survival rate of patients were 92.7%, 80.7% and 57.8%, respectively. Multiple regression analysis showed that preoperatively cardiac function, C/T ratio and EF were risk factors for late deaths. Conclusion: The long-term results with bioprosthesis replacement appear satisfactory.

Objective To study the relationship between expression of Fas ligand (FasL) in colorectal cancer tissues and apoptosis of tumor-infiltrating lymphocytes (TIL). Methods FasL protein and its mRNA were measured by immunohistochem istry and in situ hybridization in the consecutive tissue slices of 30 colorecta l cancers respectively. Immunohistochemistry and terminal deoxynucleotidyl tra nsferase mediated dUTP nick end labeling assay (TUNEL) were used to detect the cell count of TIL and the count of TIL being apoptosis in both negative and pos i tive regions of FasL in the consecutive tissue slices of cancers respectively. T UN EL method was used to detect apoptosis of tumor cells among different FasL expre ssion regions. Results ①High expression of FasL was examined in 30 cases of colo rectal cancer; there were expressions of FasL in more than 75% tissues in each slice. ②In the consecutive tissue slices, the location of expression of FasL protein corresponded with that of FasL mRNA. ③FasL expression was not eve n in the same or among different tissues. The cell count of TIL was less in FasL positive region than that in FasL negative region in the same tissue, the latt er be ing as 2.88 times as the former. ④ The cell count of TIL being apoptotic in the positive regions was as 2.13 times as that in the negative ones. ⑤ Apoptotic r ate of tumor cells was higher in FasL negative region (81.2%) than that in FasL positive region (47.4%, P

Pyruvate dehydrogenase kinases(PDKs 1-4) can regulate the activity of mitochondrial pyruvate dehydrogenase complex(PDC) to catalyse the oxidative decarboxylation of pyruvate,and then to link glycolysis to the tricarboxylic acid cycle and ATP production.In this review,we summarize up-to-date information of mechanisms regulating PDKs and the function of PDKs inhibitors in lowering blood glucose level,alleviate damage during heart ischemia and also triggering apoptosis in cancer cells.PDKs will be a possible pharmacological targets in diabetes,heart ischemia and cancer therapy.

Objective To investigate the clinic and endosoopic features of left-sided portal hypertension ( LSPH). Methods Eight patients with left-sided portal hypertension were analyzed retrospectively. Results The main manifestations of patients with LSPH were hematemesis, hematochezia, splenomegaly and hypersplenism. The patients have the features of pancreatic disease, but without the evidences of hepatic disease. Solitary gastric varices account for 62. 5% , both gastric and esophageal varices account for 37. 5% . The patients with features of LSPH often mislead to diagnose as blood diseases or portal hypertension resulted from hepatic cirrhosis. Conclusions Pancreatic diseases may lead to portal hypertension, solitary gastric varices were the important evidence of left-sided portal hypertension.

Objective To compare the effectiveness and adverse effects among three groups of patients with esophageal achalasia treated with small balloon dilation and/or intrasphincteric injection of botulinum toxin. Methods Forty-eight patients were divided randomly into three groups, A, B, and C, treated with small balloon dilation, intrasphincteric injection of botulinum toxin, and combination of these two respectively. At 1 week, 3 months and 1 year after treatment, the clinical scores, lower oesophageal sphincter-ic pressure, and lower oesophageal sphincteric relax rate in three groups were compared. Results At 1 week, 3 months and 1 year after treatment, the effective rates and gaps of pre - and post - treatment LESP and LESRR were higher in group B and C than those in group A. There were no differences between BT group and combination group at 1 week and 3 months, but in 1 year after treatment the effective rates and gaps of LESP and LESRR in combination group were higher than those in BT group. Complications never happened in all groups. Conclusion The combination of small balloon dilation and intrasphincteric injection of botulinum toxin was the effective procedure with the advantages of lasting longer time, less complications and milder chest pain.

Objective To investigate the relative analysis of prognostic factors in primary anorectal malignant melanoma (AMM). Method Twenty-seven patients with AMM were treated, Log-rank and COX analysis were used to find out the relationship of ten factors to survival. Results Log-rank analysis found five of ten factors affecting survival, they were age of patient,diameter of tumor, infiltrated depth,pathological staging and metastasis (P<0.05 or<0.01), while COX analysis only found the diameter of tumor and infiltrated depth had close relationship to survival (P<0.05 or<0.01). Conclusion The diameter of tumor and infiltrated depth are the main factors affecting the survival of AMM, and this indicates the importance of early diagnosis and treatment.

Objective To perform a routine quality assurance procedure for Truebeam multi-leaf collimator (MLC) using MLC quality assurance (QA) phantom,verifying the reliability of MLC during the treatment.Methods MLC QA phantom was a specialized phantom for multi-leaf collimator QA,and contained five radio-opaque spheres that were embedded in an L-shape.The phantom was placed isocentrically on the Truebeam treatment couch for the tests.A quality assurance plan was settled up in the Eclipse v10.0 so that the fields for acquiring the necessary images could be created.The images were acquired by the electronic portal imaging device (EPID),and imported into the PIPSpro software for the analysis.The tests were delivered once a week for six weeks to verify consistency of the delivery,and the images were acquired in the same manner each time.Results For the leaf position test,the average position error was (0.21 ± 0.02) mm.The leaf width was measured at the isocenter,and the average error was (0.04±0.02) mm for the leaf width test.Multi-Port test showed the dynamic leaf shift error,the average error was (0.26 ± 0.04) mm.For the leaf transmission test,the average inter-leaf leakage value was 1.0％ ± 0.14％.Conclusions The MLC system of Truebeam could operate very well and the QA phantom is a useful test tool for the MLC QA.

Objective To compare the dosimetric differences of volumetric modulated arc therapy (VMAT) for preoperative radiotherapy of rectal cancer using 6MV X-ray flattening filter-free (FFF) and flattening filter (FF) modes.Methods FF-VMAT and FFF-VMAT plans were designed for 15 rectal cancer patients with preoperative radiotherapy by planning treatment system (Eclipse 10.0),respectively.Prescription dose of PTV was 50 Gy in 25 fractions.When the plans were normalized to 50 Gy to 95 ％ of PTV,the dose volume histogram (DVH),target and risk organ doses,conformity indexes (CI),homogeneity indexes (HI),low dose volume of normal tissue (B-P),monitor units (MU) and treatment time (TT) were compared between the two kinds of plans.Results FF-VMAT provided the lower Dmean,V105,HI (P ＜ 0.05),and higher CI (P ＜ 0.05) compared with FFF-VMAT.Small intestine (D5),Bladder (D5,Dmean V40,V50),L-femoral head (V40),R-femoral head (Dmean) were lower in FF-VMAT than those in FFF-VMAT (P ＜ 0.05).FF-VMAT had higher B-P (V5) compared with FFF-VMAT (P ＜ 0.05).FF-VMAT reduced the monitor units (MU) by 21％ (382±53 vs 483±26,P ＜ 0.05),as well as the treatment time (TT) in FF-VMAT was no significant difference compared with that in FFF-VMAT [(148±4) s vs (146±3) s,P ＞ 0.05)].Conclusions The qualities of FF-VMAT and FFF-VMAT plans were comparable and both clinically acceptable.When comparing two plans,FF-VMAT showed better target coverage and some of OARs sparing.The MUs of FFF-VMAT were higher than those of FF-VMAT,yet were not delivered within the same time.

Objective To summarize the clinical experience for treating anterior mitral leaflet prolapse with an artificial chordal loop. Methods From January 2008 to August 2009, pre-measured ePTFE loops were used to treat anterior leaflet prolapse in 8 patients, 5 males and 3 females, aged from 28 to 68 ( average 56.0 ± 8.9 ) years. The heart function (NYHA) was class Ⅱ in 2 patients and class Ⅲ in 6. Echocardiography showed chordal rupture in 7 patients, 2 with chordal rupture and elongation and pure chordal elongation in 1. There were 3 patients with A1 segment prolapse of anterior mitral leaflet, 2 with A2 segment prolapse, 3 with both A2 and A3 segments prolepses by Carpentier standardization. There were 2 patients with posterior leaflet chordal rupture in P2 and P3 segment, 1 with cor triatrium. Left ventricular end diastolic diameter (LVEDD) was 53 - 62 mm [average ( 57.2±3.8 ) mm]. Ejection fraction (EF) was 0.60 - 0. 68 ( average 0.63 ± 0.02). Heart-thoracic ratio was 0. 52 ± 0. 17. We measured the normal chordal using both a caliber and by echocardiography ( for comparison after operation). The artificial chordal loops was constructed on the caliber using ePTFE suture, and then fixed the loop to the papillary muscle and the free edge of the anterior leaflet. Results There was no operation death. Hemolysis after 2 days of operation in 1 patient was amended by alkalinization, diuresis and hormone treatment. Pre-discharge transthoracic echocardiography showed mild regurgitation in 1patient, trivial regurgitation in 7. LVEDD were 42 -51mm [average (47. 1 ±2.2) mm] significantly decreased than that of pre-operation. Following parameters were measured and compared with pre-operation: EF 0. 58 ± 0. 03 vs. 0. 63 ± 0. 02, beart function ( NYHA ) class 1.25 ± 0. 42 vs. 2.75 ± 0. 58. Normal chordal length measured by caliber was ( 21.20 ± 1.55 ) mm vs. ( 22. 10 ± 2.68 ) mm by echocardiography. Anticoagulate therapy with warfarin was for 3 months after discharge and followed-up all the patients [1 - 19 months, average (8.2 ± 4.3 ) months]. Post operative echocardiography showed mild regurgitation in 1 patient, no or trivial regurgitation in 7 patients. The heart function class was evident improved compared with pre-operation :6 patients in class Ⅰ , 2 patients in class Ⅱ. Conclusion The pre-measured ePTFE loop is reliable and reproducible confirmed by short term follow-up for treating anterior leaflet prolapse.

PurposeTo perform a quality assurance program for Truebeam imaging system using MIMI phantom, and to evaluate the accuracy of the imaging system center with the radiation isocenter and the accuracy of couch shift.Materials and Methods The reference images of MIMI phantom were acquired using CT scanner. The reference images were imported into the treatment planning system and a simple plan was created. The MIMI phantom was placed on the treatment couch. The images were acquired using the MV/KV imaging system, and a match registration was performed with the reference images from the TPS.Results Measured over six months, the precision of the imager and linac's isocenter was <1 mm, and the couch shift accuracy was <1 mm. The measurements over six months demonstrate that isocenters of the MV/KV imaging systems on Truebeam system are stable.Conclusion The accuracy of the Truebeam imaging system center and couch shift is safe and reliable. The error of Truebeam imaging system center and couch shift can be tested on a monthly base.