Objective To investigate the feasibility and safety of endoscopic ultrasonography (EUS) guided interstitial chemotherapy for the pancreas in canine model. Methods A therapeutic 19gauge needle was inserted into the pancreas with EUS guidance,and seeds with sustained release of 5-iluorouracil were implanted into the tissue. After 14 days of clinical observation,the animals were sacrificed and the tissue response to local chemotherapy was examined. Results All the seeds were implanted successfuUy and no migration was observed. Chemotherapy induced tissue fibrous necrosis was localized in the pancreas without significant complications. The apoptotic index of tissue within 1 cm of the seeds increased.Biochemical parameters were normal in all the dogs. Conclusion EUS-guided implantation of seeds is a safe,simple and minimally invasive technique for interstitial chemotherapy in the pancreas.

BACKGROUND: Foreign scholars use thermotherapy, a new pathway for synthetic therapy of tumor, to perform hyperpyrexia combined with chemical drug radiotherapy of intraperitoneal infiltration and metastasis or to study on the therapeutic effect of metaphase and advanced stage tumor. Especially, establishing thermal biology and thermal dosiology is a scientific and quantified track for synthetic therapy of thermal radiotherapy, thermal chemotherapy and hyperthermal perfusion of tumor.OBJECTIVE: To analyze the thermal dose effect of regional radiofrequency (RF) hyperthemia combined with radiotherapy, chemotherapy and thermal perfusion on metaphase and advanced stage tumor.DESIGN: Controlled observation.SETTING: Key Department of Traditional Chinese and Western Medicine for Tumor, the 107 Hospital of Chinese PLA (General Center for Non-traumatic Treatment and Diagnosis of Tumor).PARTICIPANTS: Totally 1 455 patients with metaphase and advanced-stage tumor admitted to the General Center for Non-traumatic Treatment and Diagnosis of Tumor, the 107 Hospital of Chinese PLA between June and September 2006 who received conservative palliative treatment in the Department of Internal Medicine were recruited in this study. They were all confirmed by pathology and imageology. ECOG was scored 2 to 4 points. Informed consents of detection and treatment were obtained from all the involved patients. The study was approved by the Hospital Ethics Committee.According to the therapeutic regimen, the patients were assigned into thermal perfusion group (n =53), thermal radiotherapy group (n =874), thermal chemotherapy group (n =458) and simple hyperthemia group (n =70).METHODS: After admission, patients in each group were performed peritoneal and pelvic cavity perfusion,intensity-modulated radiation therapy, routine chemotherapy and integrated traditional and western medicine palliative therapy, respectively. Meanwhile, they received RF hyperthemia using in vitro endogenic magnetic field hyperthermia system. A thermocouple was placed in the abdominal cavity. Temperature at 3 different sites in the abdominal cavity was collected, and meanwhile two different sites for measuring temperature at rectum and external acoustic meatus were monitored. The maximal temperature (Tmax), minimal temperature (Tmin) and the average temperature (Tave) of therapeutic target were recorded. 40 ℃/min was used as thermal dose, thermal perfusion was performed once a week, and RF hyperthemia was conducted twice a week, 60 minutes once. Target temperature was 39.5 to 43 ℃, and the thermal dose of 40 ℃/min was calculated out. Intensity-modulated radiation therapy was conducted within 1 hour before heating at (3-5)Gy/time, 3 to 4 times a week. Total dose was DT 30 to 50Gy. Thermal perfusion was conducted 2 to 3 times a week, and intensity-modulated radiation therapy was conducted once to twice a week and 6 to 8 times a course of treatment. The thermal effect of each patient was analyzed at different temperature and different diseases.MAIN OUTCOME MEASURES: ① To analyze the effect of effective thermal dose. ② To evaluate the therapeutic effect and the improvement of quality of life according to World Health Organization (WHO) objective therapeutic effect evaluation criteria and Zubrod-ECOG-WHO scores. ③To observe the changes in abdominal dropsy.RESULTS: Altogether 1 455 patients with metaphase and advanced stage participated in the final analysis. ①After perfusion, body temperature was over 39.5 ℃ in most cases after 15-minute warming, over 40.0 ℃ after another 25-minute warming, over 41.0 ℃ after additional 35-minute arming, and even to 43.0 ℃ after frequent such a thermal therapy. Temperature over 41 ℃ was found in 91 cases, at 40 ℃-40.9 ℃ in 414 cases and at 39.5 ℃-39.9 ℃ in 950 cases. ② The thermal effect of 40 ℃/min could obviously improve the therapeutic effects of graded intensity-modulated radiation therapy, low-dose chemotherapy and thermal perfusion group. The total effective rate of thermal perfusion group, thermal radiotherapy group, thermal chemotherapy group and simple hyperthemia group was 81.6%, 81.9%, 80% and 50%, respectively. The clinical therapeutic effect of 40 ℃-40.9 ℃ and 39.5 ℃-39.9 ℃ in the thermal perfusion group, thermal radiotherapy group and thermal chemotherapy group was significantly better than that in the simple hyperthemia group (P ＜ 0.05). ③ Comparison of Zubrod-ECOG-WHO score of patients before and after therapy: After therapy, Zubrod-ECOG-WHO score was enhanced in 76.3% patients. ④The changes in abdominal dropsy of patients before and after therapy: After therapy, abdominal dropsy changed in 75% patients.⑤The therapeutic effects of different diseases at different temperature: For the same disease, the therapeutic effects over 41 ℃ and at 40 ℃-40.9 ℃ were significantly different from those at 39.5 ℃-39.9 ℃(P ＜ 0.05); However, the therapeutic effects over 41 ℃ were not significantly different from those at 40 ℃-40.9 ℃ (P ＞ 0.05).CONCLUSION: ①The effects of regional RF hyperthemia combined with intensity-modulated radiation therapy are confirmed in the treatment of metaphase and advanced-stage of tumor. ② The therapeutic effects strengthen correspondingly with 40 ℃/min thermal dose increase or temperature increase.

Objective:Three-dimensional (3D) ultrasound (US) is increasingly being introduced in the clinic,both for diagnostics and image guidance.Although dedicated 3D US probes exist,because of its expensive cost,3D US can also be acquired with the still frequently used two-dimensional (2D) US probes.Methods:Obtaining 3D volumes with 2D US probes is a two-step process.First,a positioning sensor must be attached to the probe for 2D image matching;second,a reconstruction of a 3D volume can be performed into a regular voxel grid.Results:This paper presents a way to realize the 3D US in irled-based Image Guided Radiotherapy using a homemade 2D US.Conclusions:The experiments demonstrate a method of saving costs and having advantages in clinic application.

Objective To investigate the differences of EUS images between stromal tumors and leiomyoma in esophagus and cardia. Methods EUS image of 13 cases of stromal tumors and 11 cases of leiomyoma diagnozed immunohistochemically were collected. Information of gray scale including mean value and dissociation of lesions and submucosal layer were analyzed. Gray scale values of lesions were calibrated according to that of the submucosal layer. Results The mean value of corrected gray scale of stromal tumors was 0. 285, which was significantly different from that of leiomyoma (0. 185, P ＜ 0. 05). Dissociation of gray scale of stromal tumors was 8. 14, which was also significantly different from that of leiomyomia (4. 59,P ＜0. 05). Conclusion In esophagus and cardia, stromal tumors exhibits higher and more inhomogeneous ultrasound echo than leiomyoma.

Objective To evaluate the diagnostic value of endoscopic ultrasonic elastography in lymph node staging of gastrointestinal tumors.Methods Thirty-nine abdominal lymph nodes and 26 mediastinal lymph nodes of 35 patients with gastric cancer or esophageal carcer were examined by endoscopic ultrasonic elastography of five-point elastic score.Lymph node at 1-3 points was regarded as negative(benign),while 4-5 points as positive(malignant).The diagnostic value of EUS elastography was determined by comparing the results with pathological findings.Results Of all the 65 lymph nodes,49 were diagnosed as positive and 16 negative.The sensitivity and specificity of EUSE in the diagnosis of malignant lymph nodes were 91.1%and 60.0%.respectively.Conclusion EUSE is helpful for diagnosis of malignant metastasic lymph nodes.

Objective Yangqing Chenfei Formula - To investigate the effect of (YCF) on epithelial mesenchymal transition (EMT) Methods in lung tissues of silicosis model rats. Specific pathogen free adult male SD rats were randomly divided into control group, model group, tetrandrine group and YCF group, with eight rats in each group. The rats in the model group, tetrandrine group and YCF group were intratracheally injected with 1.00 mL of silica suspension with a mass concentration of 50.0 g/L, and the rats in the control group were given an equal volume of 0.9% sodium chloride solution. On the 15th day after modeling, the tetrandrine group was given tetrandrine at a dose of 27.0 mg/kg body weight, the YCF group was given YCF with a dose of 8.91 g/kg body weight, while both the control group and model group were given 2.00 mL 0.9% sodium chloride solution. Gavage wasperformed twice a day in the morning and evening for 14 days. On day 29 of the experiment, after evaluating the tidal volume, - functional residual volume (FRC) and vital capacity of rats in each group, lung tissues were collected, and hematoxylin eosin staining and Masson staining were performed to examine the histopathological changes, and the fibrosis score was evaluated. - - Hydroxyproline level was detected by colorimetry. The expression of type Ⅰ collagen (COL Ⅰ), type Ⅲ collagen (COL Ⅲ), - - - - - - E cadherin (E Cad), N cadherin (N Cad) and α smooth muscle actin (α SMA) protein was detected by immunohistochemistry. - The expression of epithelial cell adhesion molecule (EpCAM) and fibroblast specific protein 1 (FSP 1) was detected by Results immunofluorescence. The lung structure was intact and the alveolar structure was normal in the control group. The alveolar structure was destroyed, the alveolar wall was thickened, and cellular nodules were observed/n the model group. The lung tissue lesions of rats in the tetrandrine group and YCF group were reduced compared with that in the model group, and there was no difference in the degree of lesions between the two groups. The tidal volume, FRC and vital capacity of rats in model P< - P< group decreased (all 0.05), the relative expression of E Cad protein in lung tissue decreased ( 0.05), the fibrosis score and - - - - the level of hydroxyproline, the protein relative expression of COL Ⅰ, COL Ⅲ, N Cad and α SMA in lung tissue increased (all P< - 0.05), while the fluorescence intensity of EpCAM protein decreased, and that of FSP 1 protein increased compared with the P< control group. The tidal volume, FRC and vital capacity of rats in tetrandrine and YCF groups increased (all 0.05), the fibrosis - - - score and the level of hydroxyproline, the protein relative expression of COL Ⅰ, N Cad and α SMA in lung tissue decreased (all P< - P< 0.05), the relative expression of E Cad protein in lung tissues increased ( 0.05), while the EpCAM protein fluorescence - intensity increased and FSP 1 protein fluorescence intensity decreased compared with the model group. The relative expression - P< Conclusion of N Cad protein in lung tissues of YCF group was lower than that of the tetrandrine group ( 0.05). YCF can - improve the lung function, alleviate collagen deposition in lung tissues, and inhibit the epithelial mesenchymal transition in silicosis model rats, and then attenuates the progression of silicotic fibrosis.

Objective To investigate the clinical characteristics and diagnostic main points of poliomyelitis-like syndrome(PS).Met-hods The clinical data of 15 children with PS were analyzed retrospectively including nervous system manifestation,results of lab andauxiliary examination,diagnosis and reason of misdiagnosis,treatment and progress.Results PS in all 15 children was characterized by mean age of onset(3.3 years),and forerunner infection(in 11 cases,73%)with acute upper respiratory infection of diarrhea 1-2 weeks pre-onset or during onset.All cases were acute flaccid paralysis,12 cases(80%) of which were only one limb.The positive outcome of serologic examination in PS consisted of 4 cases in coxsackie virus-IgM,1 case in EB virus-IgM,1 case in herpes simplex virus-IgM and 1 case in mycoplasma-IgM.All children showed the electromyologram changes in nerve damage.The muscle force of 4 cases increased one grade.Conclusions Children with PS are characterized by the age of onset under 5 years old,acute flaccid paralysis(mostly affected one limb),and the most pathogen being enterovirus.The electromyologram examination can help establish a definite diagnosis in PS.

Objective To evaluate the efficacy and safety of levetiracetam (LEV) monotherapy on children with epilepsy.Methods Forty-one children (26 cases were male,15 cases were female) with epilepsy aged 7 months to 13 years were treated with LEV as monotherapy.These patients were selected from Department of Neurology ,Wuhan Children′s Hospital, from Aug.2007 to Aug.2009.The starting do-sage of LEV was (13.6?4.7) mg?kg-1?d-1,twice daily,and its objective dosage was (25.7?7.5) mg?kg-1?d-1,twice daily.LEV monotherapy was investigated by a self-controlled and open-label research,and the follow-up period ranged from 6 months to 2 years.Results The effective rate was 68.3% (28 cases),with 39.0% (16 cases) achieving seizure freedom in LEV monotherapy of children with epilepsy.Thirteen patients (31.7%) had poor efficacy in reduction of seizures,7 patients (17.1%) discontinued LEV monotherapy due to either an inadequate seizure control or aggravated seizures.Fifteen patients (36.6%) had the therapy-related adverse events in LEV monotherapy,including gastrointestinal dysfunction (5 cases),irritability (5 cases),dizziness (2 cases) and somnolence (2 cases).The adverse effects appeared in 2-4 weeks of early LEV therapy and were spontaneously disappeared in 1 week to 1 month of continuing therapy.Conclusions The LEV monotherapy is effective and safe for the control of partial and generalized seizures in children with epilepsy.LEV appears to be a broad-spectrum,first-line anti-epileptic drug in treatment of children with epilepsy.

Objective To evaluate the short-term safety and efficacy of endoscopic implantation of self-expandable metallic stent (SEMs) for malignant colorectal obstruction.Methods A total of 208 patients who had undergone endoscopic SEMs implantation for malignant colonic obstruction from January 2012 to May 2014 at the endoscopy center of Shengjing hospital were enrolled.The technical and clinical success rate and the complications were reviewed.Results The technical and clinical success rates were 99.04％ (206/208) and 96.15％ (200/208), respectively.Abdominal pain, perforation and bleeding were the most common post-procedure complications, the rates of which were 13.46％ (28/208), 2.88％ (6/208), 1.92％ (4/208), respectively.The abdominal pain in most patients was self-relieving except for 6 patients with perforation of colon.Patients with perforation were cured by emergency surgery.One patient with intraperitoneal hemorrhage was also cured by emergency surgery, the other patients developing bleeding recovered themselves.Conclusion The success rate of endoscopic SEMs implantation is satisfactory in the study.As a bridge to surgery or a palliative care method, endoscopic SEMs implantation is effective and safe for malignant colorectal obstruction.

Objective To evaluate the efficacy of endoscopic metal stent implantation for afferent limb obstruction after pancreaticoduodenectomy(PD). Methods A retrospective analysis of 5 patients with afferent limb obstruction after PD treated by endoscopic metal stent implantation was performed.Data of each patient was reviewed including the records of the endoscopic procedure,the complications and the clinical outcomes. Results All the metal stents were implanted successfully in the 5 patients. The abdominal disten-sion and cholangeitis were well relieved in all the patients. The liver function improved in all the patients in 3 to 5 days.No abdominal discomfort,bleeding,perforation,or stent dislocation occurred.CT scan showed that all stents were well expanded.The survival time of the 5 patients were 3 to 8 months,and 4. 6 months on av-erage. There was no recurrence of afferent limb obstruction. Conclusion For afferent limb obstruction after PD,endoscopic metal stent implantation is effective in relieving obstruction,the symptoms,and improving the quality of life.