A hybrid 18F-FDG positron emission tomography and computed tomography (18 F-FDG PET-CT) image can offer the functional and anatomic information simultaneously.Compared with conventional methods,such as CT,EUS,it has advantages in determining the TNM staging,especially in measuring the length of primary tumor and detecting the metastasis of distant lymph nodes and organs.Moreover,it can guide the treatment and evaluate therapeutic effect of esophageal carcinoma.

Objective To compare and analyze the clinical effects and reliabilities of intermandibular flexible distraction and rigid internal fixation in treating mandibular condylar fractures. Methods Of 40 patients with mandibular condylar fractures, 21 cases were managed with intermandibular flexible distraction (external fixation group, Group A) and 19 with rigid titanium internal fixation (internal fixation group, Group B). There were 15 cases with high position fractures and 25 with low position ones. Results During 2-4 weeks postoperatively, X-rays confirmed the condylar fracture healing in all cases with no loosened mini-tinum plates in the Group B. There were 10 cases in the Group A and 14 cases in the Group B with the opening width over 30 mm, and 11 cases in the Group A and 5 in the Group B with the opening width less than 30 mm. Conclusions Both external and internal fixations can attain condylar fracture healing. However, compared with the internal fixation, the reduction of external fixation is less exact and the function recovery slower after operation, especially in the low position fractures. No irreversible damages on TMJ happen in all cases.

Objective To study the characteristics of its pathologic and neurophysiologic changes of a ani-mal model of cervical spinal cord compression, and to explore the relationship between the severity of spinal cord inju-ry and its functions. Methods Thirty-two rabbits were divided into 4 groups randomly. A catheter was inserted intothe vertebral canal and a balloon was inflated to compress spinal cord in epidural space. According to the diameter ofballoon, the animals were divided into 4 groups (A, B, C, D group), Each group consisted of 8 rabbits. The corti-cal somatosensory evoked potential (CSEP) and motor evoked potential (MEP) were used to assess neurologicalfunction. Motor function behavior was scored before and on 1, 3, 7 and 14 days after surgery. Histological observa-tions were performed, pathological changes were observed by light and electron microscope. Results Spinal cordcompression resulted in a gradual increase of the peak latency and significant decrease of the peak amplitude. The la-tency and amplitude of MEP were changed more dramatically than those of CSEP. The result indicated that MEP wasmore sensitive than CSEP to the compression. Analysis also revealed that the severer the pathologic changes, the lon-ger the latency and the lower the amplitude of the evoked potentials. Conclusion The animal model presented inthis paper was simple and standardized. Evoked potentials as a noninvasive technique have great value in monitoringspinal cord function. The variance of amplitude and the latency in significantly correlate with the degree of compres-sion of the spinal cord.

Objective To evaluate the treatment efficacy and treatment-related toxicity of late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy (CHT) for locally advanced esophageal squamous cell carcinoma (ESCC).Methods A total of 46 patients with histologically confirmed ESCC,11 in the stage Ⅱa,3 in the stage Ⅱb,and 32 in the stage Ⅲ,underwent conventional fractioned radiation of 40 Gy in 20 fractions on the primary and metastatic lymph nodes,and high-risk lymph node drainage regions,and then the primary and metastatic lymph nodes were irradiated as boost with an additional dose of 19.6 Gy in 14 fractions (1.4 Gy twice a day),and the total prescribed dose was 59.6 Gy in 34 fractions.Two cycles of CHT were administered concurrently during the radiotherapy.The 1-,3-,and 5-year overall survival (OS) rates and local control rates (LCRs) were evaluated by Kaplan-Meier method,and treatment-related toxicity was analyzed based on the RTOG and CTCAE criteria 3.0.Results All patients received the whole course of treatment.The median followup time was 34.4 months (6-67 months).The overall response rate was 91.3％ (42/46).The median OS was 38.5 months (95％ CI 29.6-47.4 months).The 1-,3-,and 5-year OS rates and LCRs were 78.6％,49.4％,and 39.9％,and 84.3％,68.2％,and 61.4％ respectively.The incidence of ≥ G3 radiationinduced esophagitis was 23.9％.Three kinds of serious (≥G3) hematologic toxicities were recorded,including leucopenia (26.1％),thrombocytopenia (13.0％),and anemia (10.9％).Esophagotracheal fistula was recorded in 2 patients (4.3％).Conclusion LCAHRT plus CTH can be favorable for the patients with locally advanced ESCC,however,the treatment-related toxicities may be serious.

Objective To compare 18 F-FDG PET/CT and electronic endoscopy for measuring the length of esophageal squamous cell carcinoma (ESCC) and to evaluate the optimal SUV threshold for contour determination of the size of the lesion.Methods Twenty-four patients (19 males and 5 females,median age:59 years) with histologically confirmed ESCC were enrolled.Three patients had stage Ⅱ,14 had stage Ⅲ and 7 had stage Ⅳ diseases.PET studies were performed before treatment.The length of ESCC was measured on FDG PET imaging using different SUV thresholds of 2.0 (L2.0),2.5 (L2.5),3.0 (L3.0),3.5 (L3.5),and 35％(L35),40％(L40),45％(L45),50％(L50),55％(L55) of SUVmax.The length of ESCC on PET imaging was compared with the length of gross tumor in vivo measured by electronic endoscopy (Lst) to determine the optimal threshold of SUV using paired t test.Pearson correlation analysis was used to assess the correlation.Results The SUVmax of primary tumor was 14.51±5.72 and the Lst was (5.27± 2.45) cm.The length was in a descending order of L2.0,L2.5,Lst,L3.0,L3.5,L35,L40,L45,L50 and L55 when using different criteria.There were significant differences between the Lst and the lengths measured on PET except those by L2.5 and L3.0((5.65±2.69) cm,(5.11±2.51) cm; t=-1.74 and 0.76,both P＞0.05).The lengths measured on PET by all criteria were significandy correlated with the Lst,respectively,with the better r values by L3.5(0.935),L2.5(0.920) and L3.0(0.919) (all P＜0.01).When SUVm~＜15,there were no significant differences between the Lst ((4.82±2.14) cm) and L2.5((4.95±2.76) cm),L3.0((4.45±2.50) cm) and L35((4.42±1.85) cm),respectively (t=-0.439,1.299,2.011,all P＞0.05).The best correlation (r=0.953,P＜0.05) was between Lst and Lz5.When SUVmax ≥ 15,there was no significant difference between Lst ((5.67±2.64) cm) and L3.0((6.11±2.61) cm; t=-0.897,P＞0.05; r=0.791,P＜ 0.05).Conclusions For better correlation of ESCC lesion size,it is suggested that the optimal threshold of SUV for contouring is 2.5 for tumor SUVmax＜15,and 3.0 for tumor SUVmax ≥ 15.A larger sampling size is needed for further confirmation or modification.

Objective To assess the efficacy and the adverse effects of improved late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy for locally advanced esophageal squamous cell carcinoma (ESCC).Methods 68 Patients with pathologically confirmed ESCC were enrolled.Conventional fractionation was implemented to 40 Gy/20 fractions,followed by LCAHRT delivered 2 fractions of 1.4 Gy with an interval of 6-8 hours per day to 14 fractions,thus the total dose was 59.6 Gy.Two cycles of cisplatin-based chemotherapy were administered concurrently,followed by two more cycles.The short-term efficacy of treatment,overall survival for 1-,3-,5-year,and treatment-related toxicity were evaluated.Results All patients successfully completed LCAHRT and the overall response rate was 91.6％ (62/68).The overall survival rate of 1-,3-,and 5-year was 75.5％,46.5％,22.7％,respectively.The incidence of radiation esophagitis (grade 3 or greater) was 26.4％,and no patients developed grade 3 or worse radiation pneumonitis.The radiation-induced skin injury were most of grade 0 or 1.Grade 3 of leucopenia and neutropenia were observed in 29.4％ and 7.4％ of patients,respectively,and grade 4 were both in 2.9％.During long-term follow-up,no esophageal stenosis and severe pulmonary fibrosis was developed except for two cases(2.9％)of esophageal mediastinal fistula.Conclusion Late course accelerated hyperfractionated radiotherapy combined with chemotherapy yields promising long-term survival,with lower treatment-related toxicity for patients of locally advanced esophageal squamous cell carcinoma.

OBJECTIVE To explore the influence of superoxidase (SOD)-enriched cili juice (CJSOD)on immune function of arseniasis rats,in order to provide a experi mental basis for the search of drugs of immune regulation of the ende mic arsenic poisoning.METHODS Wistar rats were rando mly divided into arsenic 25,50 and 100mg·g-1 groups to be fed 164.67 pp marsenic conta minated grain at levels of 15%,30% and 60%,experi mental period was 90d,CJSOD intervention group was fed with feed contained arsenic 100mg·kg-1 for 90d,then CJSOD was ad ministered at 10mL·kg-1 (6d /week) for 45d.The urine arsenic contents,blood T-ly mphocyte subsets (CD3 +,CD4 +,CD8 + T cell),seru mimmunoglobulin (IgG,IgM,IgA)and complement (C3,C4)were analyzed.RESULTS Co mpared with the normal control group,As 50 and 100mg·kg-1 group had significantly lower CD3 +(46.21 ± 21 .62,31 .31 ±7.73),CD4 +(30.36 ±9.97,25.94 ±12.94)and the ratio of CD4 +/CD8 +(1 .12 ±0.41 , 1 .12 ±0.41 ).As 100mg·kg-1 group showed clearly high levels of C4(81 .18 ±13.23)(P <0.05). Co mpared with the As 100mg·kg-1 group,after intervention with CJSOD,the positive rate of CD3 +(54.06 ±25.77),CD4 +(42.50 ±17.01 ),and the ratio of CD4 +/CD8 +(1 .80 ±0.71 )were significantly increased,while the result of C4 (68.70 ±10.30)and the urine arsenic contents 〔253.82 (158.21 ~494. 11 )〕was significantly decreased(P <0.05).The levels of urine arsenic in rat and CD3 +,CD4 +and CD4 +/CD8 + were negatively correlated,while positive correlation existed between the level of urine arsenic and C4(P <0.01 ).CONCLUSION Arsenic inhibit the immune function in rats.Arsenic load levels were positively correlated with the degree of inhibition.CJSOD preparation can i mprove the immune function of arseniasis rats.

As a mature management method, the matrix management model has been embraced by various sectors at large. This article introduced the practice of a tertiary general hospital in combining hospital ethics with medical administration and code of conduct for medical service, leveraging the matrix management mode in hospital ethics construction. By sorting out the risk exposure in hospital ethics, the hospital identified specific responsibilities and departments involved. On such basis, eight stable matrix-based ethics working groups were established, namely hospital ethics training, hospital ethics publicity, hospital ethics interview, prevention against prescription statistics for drug rebate, patient rights protection, management of physician practice in other medical facilities, academic cooperation, and hospital ethics tour inspections. Matrix-based management meets the characteristics of hospital ethics development as it not only enables multi-department management needs, but also improves the efficiency. With the advancement and connotation enrichment of hospital ethics development, matrix management can become a regular management mode.

Background and objective The incidence rate of lung cancer in Xuanwei has been continuously in-creasing in recent years,and it also features high incidence across all age groups and high mortality rates among female lung cancer patients.Therefore,the search for more stable biomarkers for the diagnosis of Xuanwei lung cancer holds tremendous clinical application prospects.This study aims to explore the clinical application value of these four microRNAs(miRNAs)in-dividually and in combination with traditional lung cancer tumor markers in the detection and diagnosis of Xuanwei lung can-cer.Methods By detecting the expression levels of four miRNAs and five traditional lung cancer tumor markers in the serum of 45 Xuanwei lung cancer patients and healthy physical examination participants,the Logistic regression model was employed to comprehensively evaluate the sensitivity,specificity,diagnostic efficacy,and other relevant statistical indicators of the four miR-NAs in the diagnosis of Xuanwei lung cancer.Results Among the individual miRNAs,miR-4646-5p and miR-3654 showed significant differences in expression levels between the Xuanwei lung cancer group and the control group(P＜0.05).miR-3654 demonstrated the best diagnostic performance with a sensitivity of 86.7％ ,specificity of 82.2％ ,and an area under the curve of 0.847.Combining miR-3654 with miR-4646-5p and carcinoembryonic antigen(CEA)resulted in the highest diagnostic ef-ficacy for Xuanwei lung cancer,with a sensitivity of 73.3％ ,specificity of 93.3％ ,area under the curve of 0.901,and a positive predictive value of 91.7％ .Conclusion Among the four miRNAs,serum miR-3654 exhibits the best diagnostic efficacy for Xuanwei lung cancer.Combined with miR-4646-5p and CEA,its diagnostic value for Xuanwei lung cancer can be effectively enhanced,making it a promising screening indicator for Xuanwei lung cancer.

Health service is an important part of the integrated development of the Yangtze River Delta. Taking the cooperation practice between Shanghai Tenth People′s Hospital and Suzhou Yinshanhu Hospital as an example, this article introduced the multi-agent cooperation mode of the loose medical alliance including the government, urban hospitals and cross provincial grassroots medical institutions. Among them, the local government provided policy, fund guarantee and guidance, the urban hospital exported management ideas, medicine talents and technologies, and the primary hospital conducted dual training by inviting in and going out to achieve double growth. Through the high gap cooperation between tertiary hospital and primary hospital, Yinshanhu hospital had been comprehensively developed. The loose medical alliance with multi subject coordination and cross region could give full play to the advantages of the loose healthcare alliance mode, achieve multi-win, and have reference significance for promoting the regional integration of medical and health services in the Yangtze River Delta.