Objective To investigate the effects and toxic side effects of concurrent radiotherapy and chemotherapy combined with adjuvant chemotherapy in nasopharyngeal carcinoma.Methods 141 patients of nasopharyngeal carcinoma divided into two groups randomly.All patients treated two-dimension exact radiotherapy and concurrent chemotherapy which combined DDP and 5-Fu intravenously for two circles,then experiment group started adjuvant chemotherapy 3 weeks later after above treatment,which intravenous DDP and 5-Fu for other three circles.Results All patients completed concurrent radiotherapy and chemotherapy,63 patients of treatment group completed adjuvant chemotherapy.The mainly toxic side effect was mucositis,leukopenia and low-platelet,and gastrointestinal reaction during therapy,there is no statistical significance in two groups.The regression rate of lymph nodes is 94.4 ％(n=67)and 87.3 ％(n=62)in nasopharynx and neck after 3 month of radiotherapy and concurrent chemotherapy.All patients followed up 3 years.The total survival rate of two groups were 94.3 ％,84.8 ％,78.6 ％ and 90.1％,75.0 ％,62.5 ％ respectly in 1,2 and 3 year,the mean survival period was 36 months and 27 months,and this differece was statistical significance(x2=7.356,P=0.007).The total survival rate of Ⅲ stage patients of two groups were 98.2 ％,92.5 ％,83.7 ％ and 93.0 ％,83.2 ％,68.2 ％ respectly in 1,2 and 3 year,the both mean survival period was 36 months,and this differece was statistical significance(x2=8.081,P=0.005).The total survival rate of Ⅳ stage patients of two groups were 81.3 ％、53.8 ％、42.9 ％ and 78.6 ％、36.4 ％ 、22.3 ％ respectly in 1,2 and 3 year,the meat survival period were 22 month and 14 month respectly,and this differece was statistical significance(x2=3.903,P=0.048).The progression-free survival rate of two groups were 90.0 ％、76.2 ％、68.8 ％,and 81.7 ％、60.3 ％、34.3 ％ respectly in 1,2 and 3 year,the meat progression-free survival period was 30months and 22months,and this differece was statistical significance as well(x2=13.616,P=0.000).Conclusion The therapy of concurrent radiotherapy and chemotherapy combined with adjuvant chemotherapy was obviously increased total survival rate and progression-free survival rate in nasopharyngeal carcinoma,especially to Ⅲ and Ⅳ stage patient of nasopharyngeal carcinoma.But the long period effects still remains unclear.

Objective To discuss the nonoperative management strategy to prevent the conversion of acute pancreatitis to the severe form.Methods In recent 4 years,286 patients with mild acute pancreatitis admitted to our hospital were divided into control group and treatment observation group;routine conservative management was performed in control group,and the strategy of improving pancreatic microcirculation and preventing cell Ca~2+ overload and inhibiting pancreatic protease was added to the treatment observation group.Results Among the 144 patients with mild acute pancreatitis in control group,conversion to severe acute pancreatitis occurred in 20 patients,and 14 of the 20 patients with severe acute pancreatitis developed systemic complications.Among the 142 cases in treatment observation group,the conversion of mild to severe acute pancreatitis occurred in 8 patients,and 2 of the 8 patients developed systemic complications.Serum C-reactive protein levels and Balthazar CT severity index were significantly decreased at each time point in treatment observation group compared to control group.Conclusions In addition to routine management,improving pancreatic microcirculation,preventing cell Ca~2+ overload and inhibiting pancreatic protease might serve as a benificial strategy for preventing the progression of mild acute pancreatitis to the severe form.

Humans ; Enhanced Recovery After Surgery ; Stomach Neoplasms/surgery* ; Length of Stay ; Laparoscopy ; Postoperative Complications ; Gastrectomy

Objective To observe prospectively and systematically the effect and safety of rhendostati injection (endostar) combined with FOLFOX as a second line chemotherapy for advanced/metastatic colorectal cancer. Methods 23 patients with histological confirmed advanced/metastatic colorectal cancer after first line chemotherapy failure were observed. The dosage of 15 mg/time of endostar solved in 500ml normal saline was slowly intravenously dropped 4 h from day 1 to day 14. Oxaliplatin 85 mg/m~2 iv 2-3 h dl, d15. CF 200 mg/m~2 iv 2 h followed by 5-Fu 400 mg iv bolus and 5-Fu 600 mg/m~2 iv 22 h dl-2, d15-16 were given, every 4 weeks as one cycle. Efficacy was evaluated after 2 cycles according to RECIST criteria. Results 23 cases had been completed totally 56 cycles. Among 23 cases, 8 cases were PR, 12 cases SD, and 3 cases PD. The objective response rate (RR) was 34.8 % (8/23), and the disease control rate (DCR) was 87.0 % (20/23). The median time to progression was 7 months. The 1-year survival rate were 50.0 %. The 2-year survival rate was 40.0 %. The occurrence rate of G3/4 toxicities was low, including neutropenia(21.7 %), anemia(4.3 %), thrombocytopenia (13.0 %). Those toxicities were mainly related with the chemotherapy agents. Meanwhile transient electrocardiogram changes mild ST-T of changes occurred in 3 cases. 2 cases were mild hypertension and were symptomatically controlled. Conclusion There are better efficacies of endostar combined with FOLFOX chemotherapy for advanced/metastatic colorectal cancer, and it is low toxic and tolerable. It is worth of further clinical observation. More experiences need to be accumulated.

Actins ; metabolism ; Adult ; Antigens, Neoplasm ; metabolism ; Diagnosis, Differential ; Epithelioid Cells ; chemistry ; pathology ; Female ; Humans ; Hysterectomy ; Immunohistochemistry ; Melanoma-Specific Antigens ; Mesenchymoma ; metabolism ; pathology ; surgery ; Neoplasm Proteins ; metabolism ; Uterine Neoplasms ; metabolism ; pathology ; surgery

Retrospective analysis of multi-slice computed tomography (MSCT) manifestations were conducted for 8 cases of pathologically confirmed primary pulmonary sarcomatoid carcinoma.And the relevant literature was also reviewed.The lesion sites were right upper lobe (n =5),lower lobe (n =2) and left upper lobe (n =1).One case was difficult to distinguish because of its huge mass and the remainder was all peripheral.With pseudocapsule (n =4),coarse calcification (n =1),hilar & mediastinal node metastasis (n =2) and cavity (n =1).The manifestations included extensive lung alveolar septal thickening & ground glass (n =1) and massive deep leaf & glitches (n =2).The scans were non-enhanced alone (n =1) and non-enhanced & enhanced (n =7).Six cases had shaped enhancement while another 5 uneven thickness of annular enhancement.And 4 cases had floating-ice change.Primary pulmonary sarcomatoid carcinoma is common in subpleural lung lobe.And the floating-ice sign is valuable in the diagnosis of sarcomatoid carcinoma.

Objective To investigate and analysis the actuality and demands of scientific researchers in state clinical research facility of TCM, in order to provide evidences for policy making. Methods All the trainees taken part in the meeting for the training of clinical research method were assigned to answer the self-designed questionnaire. Results Of all these people, 47.58 percent people had senior professional title, 84.14 percent people had doctorate or master degree, 57.24 percent people had participated in project research at provincial or ministerial level as key personnel, 35.17 percent people had participated in a key disease research as directors, 65.52 percent people had taken methodology training of clinical research,30.34% of who trained by evidence-based medicine. The majority of these people had clear understanding in methodology of clinical research, who believed that evidence-based medicine and system evaluation are the most difficult subjects to understand and practice, hoping to learn more about the knowledge on statistics. Conclusion Clinical researchers of state clinical research facility of TCM had sound basis for scientific research, but relatively lacking of key disease research and systematic knowledge of scientific methodology, which needed to be enhanced.

Objective To analyze the basic clinical characteristics,auxiliary diagnostic indexes,bacterial infection spectrum and drug resistance of child urinary tract infection to provide the basis for the prevention,diagnosis and treatment of child UTI.Methods The clinical data in the inpatients with UTI or complicating UTI in our hospital from January 2012 to March 2014 were collected. The repeated strains were excluded.The differences in the pathogens between the patients with complicated UTI and the patients with non-complicated UTI were comprehensively analyzed.Results The onset peak of child UTI for the first time was 0 -0.5 years old.Escherichia coli ,Klebsiella and Pseudomonas aeruginosa are the major pathogens of child UTI,in which 110 strains were Escherichia coli,accounting for 52.9%.The enterobacteriaceae pathogens of UTI had higher sensitivity to carbapenems antibacterial drugs,with the resistance rate of less than 10%;the resistance rate of others detected antibacterial drugs was more than 20%.Con-clusion UTI in the children inpatients of this area has higher drug resistance rate,in the treatment of child UTI,the antibacterial drugs should be rationally used by combining the bacterial drug resistance situation in the local place and the disease severity in or-der to avoid the aggravation of bacterial drug resistance.

An autopsy case of sudden death induced by alimentary tract hemorrhage was presented, which was caused by the unexpected rupture of clinically unrecognized tuberculous abdominal aortic aneurysm (TAAA). The initial diagnosis was made of the syndrome of coronary heart disease and hypertensive disease. The detailed autopsy showed that the alimentary tract hemorrhage was caused by a sudden rupture of the mass after posture changing was ascertained as the cause of death. The diagnosis of TAAA was determined by the autopsy findings. Analysis for the medical dispute of TAAA was described, and the difficulty of the diagnosis and medico-legal implications were also discussed.
Aneurysm, Ruptured/diagnosis* ; Aortic Aneurysm, Abdominal/diagnosis* ; Autopsy ; Death, Sudden ; Hemorrhage/etiology* ; Humans ; Tuberculosis/diagnosis*

OBJECTIVETo investigate the diagnosis and differential diagnosis of extranodal Rosai-Dorfman disease.

METHODSTwo cases of extranodal Rosai-Dorfman disease were studied using hematoxylin-eosin, and immunohistochemical staining, along with a literature review.

RESULTSThe lesions of RDD were characterized by the presence of large histiocytes with emperipolesis, accompanied by infiltration of lymphocytes, plasma cells and other inflammatory cells. The large histiocytes had an abundant cytoplasm, pale to eosinophilic in appearance, positive for S-100 protein staining, with a vesicular nucleus and a small basophilic nucleolus in each cell.

CONCLUSIONSExtranodal Rosai-Dorfman disease is known as an idiopathic proliferative disease of histiocytes with a distinct morphologic feature and is very rare. Differential diagnosis from other types of fibrohistiocytic proliferation lesions is recommended.

Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Brain ; pathology ; surgery ; Brain Diseases ; metabolism ; pathology ; surgery ; Dermatologic Surgical Procedures ; Diagnosis, Differential ; Histiocytosis, Sinus ; metabolism ; pathology ; surgery ; Humans ; Male ; Middle Aged ; S100 Proteins ; metabolism ; Skin ; pathology ; Skin Diseases ; metabolism ; pathology ; surgery