Objective To evaluate the effect of mechanical dilation on cardia achalasia under an endoscope.Methods A total of 62 patients with cardia achalasia were treated with mechanical dilation by using a self-designed dilator under a gastroscope.Of the cases,one had experienced a failure of heller surgery,and four had received ballon dilation before the gastroscopy.Results Among the cases,2 were convered to open thoracic surgery becaues of rupture of the esophagus,1 patient could not tolerate the operation,1 received a second dilation because of unsatisfied outcome of the first attempt.In the other 58 patients,the surgery was completed in the first attempt.The mean dilation time was 3.5 minutes(ranged from 2 to 5 minutes).Slight mucosal hemorrhage was observed during the operation,while no continuous bleeding occurred.Cold liquid diet was given to the patients 2 hours after the dilation,and then semiliquid diet was prescribed in 6 hours,after that the patients began to take normal diet gradually.The patients were followed up for 2 to 11 years with a mean of 7.5.All of them were cured without recurrence.Conclusions Endoscopic mechanical dilation is microinvasive,safe,and effective for cardia achalasia.It is worth being widely used because of a low cost and reliable long-term outcomes.

Adolescent ; Child ; Child, Preschool ; Female ; Homeodomain Proteins ; genetics ; Humans ; Infant ; Male ; Oncogene Proteins, Fusion ; genetics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics

Child ; Gene Rearrangement, T-Lymphocyte ; Humans ; Neoplasm, Residual ; diagnosis ; Polymerase Chain Reaction ; methods ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; Receptors, Antigen, T-Cell ; genetics

Objective To analyze the second time blood screening results of ALT deferred donors,and to evaluate the importance of alanine aminotransferase(ALT) testing on the improvement of blood safety.Methods The ALT testing results of 565 360 blood donors from Feb.2006 to Jan.2008 of Shanghai Blood Center were studied retrospectively.The screening results and donation intervals of such donors who delayed their donation just because of their former unqualified ALT level were also analyzed.Results A total of 32 042 donors(5.67%) failed in ALT testing among 565 360 donors.And 3 395 ALT deferred donors participated the second time blood donation,among which 2 205(64.95%) passed the blood screening tests,while the other 1 190(35.05%) failed.Among the 1 190 unqualified blood donors,1 151(33.90%)failed again in ALT testing,and 11(0.32%) in Syphilis,12(0.35%) in HBsAg,7(0.21%) in anti-HCV and 1 in anit-HIV(0.03%).Meanwhile,donors failed both in ALT testing combined with HBsAg,anti-HCV,and anit-HIV sero-converted were 1(0.03%),2(0.06%) and 1(0.03%),respectively.And 72.64% of ALT deferred donors participated the second time blood donation within 6 months.The average donation intervals of donors with qualified ALT level but sero-converted were 140 days(from 24 to 267 days),and those with both unqualified ALT level and sero-converted were 158 days(from 91 to 220 days).Conclusion Before the new methods such as NAT were applied to blood donation screening system,ALT test could prevent the window-period failure of ELISA screening so as to improve the blood safety.

ObjectiveTo investigate advantage and disadvantage of different rehabilitation therapies used for cerebral palsy (CP) children complicated with epilepsy (EP).Methods140 CP children complicated with EP screened from 1402 CP cases, were analyzed for CP and EP types, MRI or CT, brain stem auditory evoked potentials (BAEP). All cases were treated with anti-epilepsy drugs (AEDs). Different rehabilitation therapies, including electrotherapeutic modalities, acupuncture, point injection, cerebroprotein hydrolysate injection, manual therapy, functional training, Chinese herb braising therapy, and cattle encephalon glycoside and ignotin injection were assessed.ResultsIn all 140 cases, a majority of EP types were myoclonic seizure and west syndrome, CP type was spasticity. Abnormality showed in MRI or CT (98%) and BAEP (90%). AEDs were effective for all 140 cases. Electrotherapeutic modalities, acupuncture, point injection, and cerebroprotein hydrolysate injection could make EP severely, but manual therapy, functional training, Chinese herb braising therapy, cattle encephalon glycoside and ignotin injection had no adverse effects on EP cases.ConclusionThe principles of rehabilitation treatment for the CP children complicated with EP are taking AEDs early and in a long term, avoiding electrotherapeutic modalities, acupuncture, point injection, and cerebroprotein hydrolysate injection, using manual therapy, functional training, Chinese herb braising therapy, and cattle encephalon glycoside and ignotin injection.

To summarize the experience about the preoperative and postoperative nursing of 11 cases with neurogenic bladder treated by sacral neuromodulation. The main nursing interventions of this procedure involved accurate recording of voiding diaries and postvoid residual, effective psychological nursing and health education of related disease information, standard videourodynamic examination. 11 patients acquired more or less benefit after the screening test and were discharged successfully, among them 2 cases had the permanent implantation of the stimulation device.

AIM: To summarize clinical characteristics and pathogenesis of iridocorneal endothelial syndrome ( ICE ) and investigate the treatment and prognosis.
METHODS:The clinical data of 12 cases (12 eyes) who received treatment in southwest hospital during Jun. 2007 to Feb. 2015 were analyzed retrospectively. The essential progressive atrophy of iris included 7 eyes, Chandler syndrome included 3 eyes, Congan - Reese syndrome included 2 eyes.
RESULTS: A total of 8 eyes were carried out once or multiple filtration surgery; 4 eyes were treated with glaucoma valve implantation. Postoperative follow- up time ranged from 15mo to 5y with the average of 30mo. Three months to 16mo after the surgery, the intraocular pressure of 4 patients were elevated again. Postoperative intraocular pressure was poorly controlled.
CONCLUSION:ICE syndrome is a group of clinically rare and serious eye disease. The excessive proliferation of ICE cells causes the existence of the corneal endothelial cells adhesion to the chamber angle and iris surface, which cause iris atrophy, secondary glaucoma, corneal endothelial decompensation. Currently, glaucoma filtration surgery and glaucoma valve implantation can only control intraocular pressure for several months, but the long-term prognosis is poor.

Objective: To explore the pattem of lymphatic metastasis and influencing factors of thoracic esophageal carcinoma. Methods: We reviewed the pathological specimens from 229 esophageal carcinoma patients who underwent radical esophagectomy with two-field lymphadenectomy. A total of 2,458 lymph nodes were dissected. We analyzed the lymph node metastasis pattern of the primary tumor in different loca-tions and the corresponding influencing factors such as pathological T stage, tumor length, pathological mor-phology and tumor differentiation. Results: Lymph node metastasis rates were 44.5% (102/229) and 10.5% (258/2458), respectively. For patients with upper thoracic esophageal carcinomas, lymphatic metastasis rates in the superior mediastinum, the middle mediastinum, the inferior mediastinum and the abdominal cavity were 19.0%, 6.7%, 9.8% and 12.2%, respectively. For patients with middle thoracic esophageal carcinomas, the rates were 26.1%, 7.4%, 11.8% and 11.9%, respectively. For patietns with lower thoracic esophageal carcino-mas, the rates were 0, 1.6%, 5.3%, and 10.0%, respectively. Lymphatic metastasis rate in T_1, T_2, T_3, T_4, stage cancer were 28.6%, 43.8%, 47.6%, and 31.3%, respectively; the rate of positive lymph nodes were 7.9%, 10.8%, 10.7%, and 10.8%, respectively, with no significant differences among the four stages (x~2=2.733, P=0.435 and x~2=0.686, P=0.876). Lymphatic metastasis rate and rate of positive lymph nodes in patients with tu-mor ≤3cm, 3 to 5cm, and >5cm were 45.2% and 43.4%, 46.2% and 9.1%, and 11.6% and 11.7%, respective-ly, with no significant differences (x~2=0.094, P=0.954 and x~2=3.933, P=0.140). Lymphatic metastasis ratios of the pathological morphology in medullary, ulcerative, mushroom and stenotic types were 14.0%, 9.6%, 4.3% and 18.3%, respectively (x~2=19.292, P=0.000). Lymphatic metastasis rate and rate of positive lymph nodes of squamous cell carcinoma of moderately and poorly differentiation were 42.5%, 75.0% and 9.5%, 18.6%, re-spectively (x~2=4.852, P=0.028 and x~2=11.323, P=0.001). Patients with squamous cell carcinoma of poorly dif-ferentiation had a higher rate of lymph node metastasis. Conclusion: Lymphatic metastasis of esophageal car-cinoma metastasize widely even if in early T stage. Pathological morphology and tumor differentiation are re-lating facors of lymph node metastasis of thoracic esophageal carcinoma.

Objective To investigate the result and side effect of late course accelerated three-di-mensional conformal radiotherapy (3DCRT) for esophageal carcinoma. Methods From July 2003 to March 2006, 55 patients with esophageal carcinoma receiving 3DCRT were randomly divided into late course accel-erated radiation group (group A, 27 patients) and conventional fractionation group (group B, 28 patients). The prescribed dose in group B was 64 -66 Gy, 2 Gy per fraction, 1 fraction per day, 5 fractions per week for about 6.5 weeks. Patients in group A received conventional fractionation irradiation for the first 4 weeks. Then the dose was increased to 3 Gy per fraction to a total dose of 67 -70 Gy. The treatment course in group A was about 6 weeks. The treatment response, acute site effects, 1-, 3-and 5-year local control rates and o-verall survival rates of the two groups were observed. Results In group A, 23 patients (85%) achievedcomplete response (CR) and 4(15%) achieved partial response (PR). While in group B, 16 patients (57%) achieved CR and 12(43%) achieved PR. The CR rate was significant higher in group A (χ~2 = 5.24,P=0.022). The 1-, 3-, 5-year local control rates were 85%, 54%, 54% in group A, and 70%, 56%, 33 % in group B (χ~2 = 0.68, P = 0.409), respectively. The 1 -,3-,5-year overall survival rates of the two groups were 81%, 37%, 29% and 61%, 39%, 23% (χ~2 = 0.06, P = O. 804), respectively. Both lo-cal control and overall survival were similar between the two groups. The incidences of acute radiation esoph-agitis in the two groups were similar (85% vs. 89% ;χ~2 =0. 00,P=0. 959), and the incidence of radiation pneumonitis was slightly higher in group A than in group B (67% vs 43% ;χ~2 =3.14,P =0.076). By the last follow up, 19 patients in group A and 21 in group B died. Among them, 10 in group A and 15 in group B died of local failure, while 7 in group A and 5 in group B died of metastasis. Conclusions When com-pared with conventional fractionation 3DCRT, late course accelerated 3DCRT for esophageal carcinoma can achieve better results in clinical response, though not in long-term local control or survival. The incidence of acute radiation esophagitis and pneumonitis is clinically acceptable.

Objective To observe the incidence of RP in NSCLC and esophageal carcinoma treated with 3DCRT and investigate the relationship between acute RP and lung function and dosimetric parameters.Methods From October 2006 to August 2008, 3DCRT plus concurrent chemotherapy of NP or LFP were applied to 64 patients with locally advanced NSCLC or esophageal carcinoma. twenty-three patients suffered form NSCLC and 41 patients from esophageal carcinoma, the prescription doses were 60 Gy/30fx and 58 -64 Gy/29 -32fx, respectively. Results For patients with esophageal carcinoma, 34% developed RP(9 grade 1,3 grade 2 and 2 grade 3). For patients with NSCLC, 96% developed RP(9 grade 1, 8 grade 2 and 5 grade 3). There was significant difference between the two groups(t =5. 55,P=0. 000). The FEV1.0/FVC and DLCO of patients with NSCLC were significantly lower than those of esophageal carcinoma, the ratio were 75.6%:82.7%(t=2.75,P=0.008)and 71.7%:81.0%(t=2.50, P=0.015),respectively. For patients whose FEV1.0, FEV1.0/FVC%, DLCO ＜80% and ≥80% before irradiation,the incidence of ≥2grade ARP were 35% vs 25% ,31% vs 26% and 35% vs 19%, respectively(x2 = 1.81,0.15,2. 13,P =0.179,0.697,0.144). While for patients whose FEV1.0 ＜ 70% and ≥70%, the incidence of severe ARP were 67% and 22% ,respectively(x2 =5.64, P =0.018). Spearman correlated analysis indicated that all the dosimetric parameters had relation with ≥ 2 grade ARP . The V20 of lung and MLD were found independently associated with RP according to multivariate analysis(x2 = 4.61,6.97, P = 0.032,0.008).Conclusions Parameters of basic lung function can predict the incidence of ≥2 grade RP to some extent,especially when the value of FEV1.0, FEV1.0/FVC%, and DLCO was lower. However, the V20 of lung and MLD may be the most valuable predictors.