It is very important to have a clear and widely accepted definition and classification for clinical diagnosis, rehabilitation, research and social support of children with cerebral palsy, as well as in establishing a regional, national and global monitoring database. There are some new changes about the definition, clinical types and function classification of cerebral palsy recently domestic and abroad, which pay more attention to assessments on function and participation in daily life.

Objective To define whether correlation exists between the enlargement of lateral ventricles and motor development delay. Methods Motor development was assessed with Peabody Developmental Motor Scale (PDMS) in 28 children with cerebral palsy. Correlation between computerized tomography (CT) findings of enlargement of lateral ventricles (ventricle index,body index,width index and frontal horn index) and motor quotients of PDMS(GMQ,FMQ and TMQ) was analyzed. Results Width index was correlated with all three motor quotients (GMQ,FMQ and TMQ)( P

Based on the community-based and family-centered concepts, the Chain Rehabilitation Services for children with cerebral palsy (CP) integrates all kinds of social resources to build the early screening network and community rehabilitation centers, and to enhance the integration of rehabilitation and educational services. This chain model makes it possible to coordinate the related institutes to provide better services for children with CP. Better services and better systematic management of children with CP in Shanghai and surrounding areas has also been achieved through this project.

Objective To study the clinical results and prognostic factors of late course accelerated hyperfractionation radiotherapy (LCAHR) in the treatment of esophageal carcinoma in the elderly. Methods 105 over 60 year-old patients with esophageal carcinoma who received radical LCAHR, were retrospectively analysed. Radical tumoricidal dose of 67.9～72.0?Gy was delivered in 39～43 fractions over 42～53 days. Results The 5-year local control rate was 63.7%. The 5-year disease-free survival and overall survival rate were 22.6% and 34.4%. Acute esophagitis and bronchitis were the most common but acceptable radioreactions Grade 1～2. No significant differences were found either in the clinical response or complication, between the 60～69 year and 70～80 year groups. By multivariate analysis, T stage and KPS score were two independent prognostic factors. Of 67 death cases, 31 died of local relapse, 23 of distant metastases, 8 of both and 5 of other causes. Conclusions LCAHR toxicity ,being tolerable for the older esophageal carcinoma patients,may improve their survival and quality of life.

[Objective]To evaluate the outcome of thoracolumbar fracture with spinal cord injury treated with short-segment pedicle instrumentation.[Method]47 cases of thoracolumbar fracture with spinal cord injury from 1999 to 2004 in our department were collected,all of them were treated with short-segment pedicle instrumentation.The radiologic,neurologic,and functional outcome were assessed.[Result]All of the 47 cases were followed up,the mean follow-up were 51.9 months(18~ 86 months),the average of vertebral anterior and posterior height were corrected from 43.6%,71.4% to 92.2%,96.4%;and 88.3%,93.1% at the last follow-up separately.The Cobb's angle were corrected from 23.5?to 4.3?,and 8.8? at the last follow-up.62.8% of the vertebral canal was occupied pre-operation,and 11.4% post-operation,6.2% at last follow-up.There was significant deference in targets between pre-operation and post-operation(P0.05).Neurologic status improved at least 1 Frankel grade in the patients who had preoperative incomplete paraplegia.61.7% of patients returned to work.[Conclusion]Short-segment pedicle instrumentation can provide good reduction,strong fixation,complete decompression and fusion.The treatment outcome is good.Moreover,it is a less traumatic,simple and safe technique.

[Objective]To investigate the effect of proximal femoral intramedullary nail with spiral blade for the treatment of femoral peritrochanteric fractures with femoral shaft fractures.[Method]From January 2002 to October 2006,21 patients of femoral peritrochanteric fractures with femoral shaft fractures were treated by minimal invasive technique with proximal femoral intramedullary nail and spiral blade.[Result]All 21 patients were followed up from 9 months to 5 years,with an average of 13 months,fractures healed in all patients.There was no nail and screw broken or loosening.The hip and knee joints of ingived limbs retained good function.[Conclusion]It is a good internal fixation operation for treatment of femoral peritrochanteric fractures with femoral shaft fractures(according to the patient's age,the type of fracture and the Singh index of the bone)by using minimal invasive technique with proximal femoral intramedullary nail and spiral blade,the key of treatment is the anatomic reduction of the fractures under minimal invasive surgery.

Objective To define the prognostic factors and local failure in late course accelerated hyperfractionation radiotherapy(LCAHR) for esophageal carcinoma.Methods A retrospective study was conducted in 201 esophageal squamous cell carcinoma patients treated by LCAHR during the period between August 1994 to January 2000.The radiotherapeutic portals were set and based on CT scan and esophagograms. All patients received a mean dose of 41.4 Gy /23 F/4～5 WK. With conventional fractionation regimen during the first two thirds of the course,and followed by LCAHR with reduced fields, at dose of 27 Gy/18 d,1.5 Gy per fraction,twice daily. The total dose varied up to 67～70 Gy/40～43 F/40～49 d. Results The 1 ,3 and 5 year actuarial survivals were 72.5% ,35.6% and 31.1%. The 1 ,3 and 5 year local control rates were 82.2%, 71.3% and 71.3%,respectively. Of the 95 patients who died, 34(35.8%) did so from local failure , 32(33.7%) from distant metastasis(33.7 %), 13(3.7%) from lymphatic metastasis, 4(4.2%) frome both local and distant metastasis and 12(12.7%) from complications.Conclusions It is showed that significant improvement in local control and survival are observed after LCAHR for esophageal carcinoma in comparison to conventional fractionated regimen. The prevention and management of distant metastasis and lymphatic spread have become the major problems in the future.

The expressions of matrix metalloproteinnse-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1) ,and NF-κB in 157 cases of papillary thyroid cancer and 30 cases of papillary thyroid tumors were detected by immunohistochemistry and in situ hybridization. The expressions of MMP-9 and NF-κB protein and mRNA in papillary thyroid cancers were significantly higher than those in benign tumors (all P <0.01), and increased according to the pathological grading (P<0.01). The expressions of MMP-9 and NF-κB protein and mRNA in papillary thyroid cancers with cervical lymph node metastasis were higher than those without metastasis (both P <0.01). The expressions of TIMP-1 protein and mRNA appeared an opposite direction of MMP-9 expression.

A fair,just,and credible mediation institution is required to ensure the effective implementation of medical liability insurance,relieve physician-patient conflicts,and protect the legal rights of medical institutions,patients and insurance corporations as well.Medical disputes mediation institution,as the arbitrator of physician-patient conflicts,clarifies the rights and obligations on all parties,including doctors,patients,and the insurance corporations as well,safeguards the legal rights of all parties,standardizes and simplifies the settlement procedure of medical disputes,and provides an effective approach to relieving the conflicts between doctors and patients.

Objective To summarize the experience in diagnosis and treatment of primary splenic neoplasm (PSN). Methods The clinical data of 31 patients with PSN treated in our hospital were retrospectively analyzed. Results Amongst the patients, 25 were diagnosed as PSN postoperatively. Fifteen out of the 19 patients with benignancy were treated with splenectomy, and the others underwent partial splenectomy or tumor excision. Eleven out of the 12 patients with malignancy received splenectomy (including two by excision of pancreatic body and tail), and the other one underwent biopsy alone. The pathological types were as follows: varieties of cyst in 11, angiocavemoma in 4, inflammatory pseudotumor in 2, cavernous lymphangioma in 1, cystic degeratin of liomyoma in 1, malignant lymphoma and lymphsarcoma in 6, hemangiosarcoma in 3, fibrosarcoma in 1, liomyosarcoma in 1 and malignant fibrous histiocytoma in 1. Three patients with malignancy survived for 5 years. The reason was that they received radical splenectomy in combination with chemotherapy or radiotherapy and immunotherapy. Conclusions PSN should be diagnosed mainly according to clinical manifestations and image examination. The differentiation between benignancy and malignancy depends on CT, hemangiography and determination of seros AKP and ? GT levels. Early diagnosis, radical operation and comprehensive treatment are important for improving the prognosis of PSN.