[Objective]To introduce the surgical technique and its rationale and to evaluate the early and mid-term clinical outcome of routine core decompression and insertion of a biomaterial loaded allograft threaded cage(ATC)in the treatment of necrotic femoral head．[Methods]Seventy-six patients(78 hips)with femoral head necrosis were allocated to a program of either core decompression or core decompression and implantation of ATC．[Results]At review all patients had a minimum follow-up of 24-months(24 to 68 months)．In the control group，no significant improvement in Harris hip score(HHS)was found，and 13 of the 22 hips had deteriorated to stageⅢ．In the treatment group．the mean HHS was improved from 62．8 to 81．6．Collapse was seen in 1 hip，and this collapse Was progressive in 3 hips．[Conclusion]It，s thus evident that the technique is attractive as a salvage procedure．which shows encouraging Success rates and early clinical results.

The present study examined the role of Wnt/β-catenin signaling pathway in the degeneration of nucleus pulposus cells and the protective effect of DKK1 on nucleus pulposus cells. The model of nucleus pulposus cell degeneration was induced by intra-disc injection of TNF-α, and the expression of β-catenin protein was detected by Western blotting. The cultured rabbit nucleus pulposus cells were divided into 4 groups. In group A, the cells were cultured with normal medium and served as control group. In group B, the cells were cultured with TNF-α and acted as degeneration group. In group C, the cells were cultured with TNF-α and transfected with Adv-eGFP and was used as fluorescence control group. In group D, the cells were cultured with TNF-α and transfected with Adv-hDKK1-eGFP, serving as intervention group. The expression of type II collagen, proteoglycan, β-catenin, and MMP-13 in each group was detected by immunocytochemistry and RT-PCR. The result showed that TNF-α increased the expression of β-catenin and MMP-13, and significantly inhibited the synthesis of type II collagen and proteoglycan, which resulted in the degeneration of nucleus pulposus cells. This effect could be obviously reversed by DKK1. We are led to concluded that TNF-α could activate the Wnt/β-catenin signaling pathway, and increase the expression of MMP-13, thereby resulting in disc degeneration. Specifically blocking Wnt/β-catenin signaling pathway by DKK-1 could protect the normal metabolism of intervertebral disc tissue. The Wnt pathway plays an important role in the progression of the intervertebral disc degeneration.

Objective To evaluate the value of radiotherapy following rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone ( R?CHOP )?based chemotherapy for patients with early?stage Waldeyer’ s ring diffuse large B?cell lymphoma ( WR?DLBCL). Methods Eighty?three patients diagnosed with early?stage WR?DLBCL who were admitted to our hospital from 2000 to 2013 were enrolled in the study. In these patients, twenty?five had stageⅠdisease and fifty?eight had stageⅡdisease. All patients received R?CHOP?based chemotherapy with ( n= 62 ) or without ( n= 21 ) involved?field radiotherapy ( Waldeyer’ s ring plus cervical lymph nodes ) . The overall survival ( OS ) , progression?free survival ( PFS) , and local?regional control ( LRC) rates were calculated using the Kaplan?Meier method. The univariate analysis was performed using the log?rank method. The multivariate analysis was performed using the Cox regression model. Results In all patients, the 5?year sample size was 18;the 5?year OS, PFS, and LRC rates were 89%, 84%, and 90%, respectively. According to the univariate analysis, patient age greater than 60 years, an increased lactate dehydrogenase level, Eastern Cooperative Oncology Group ( ECOG ) performance status no less than 2, and International Prognostic Index ( IPI ) no less than 2 were poor prognostic factors. Patient age greater than 60 years, a tumor size no less than 5 cm, ECOG performance status no less than 2, and IPI no less than 2 were influencing factors for PFS and LRC rates. In addition to the treatment with rituximab, patients treated with consolidative radiotherapy had significantly higher PFS and LRC rates (94% vs. 58%, P=0?003;100% vs. 61%, P=0?000) as well as slightly higher OS rate ( 9 4%vs . 7 1%, P=0?0 6 3 ) than those treated without radiotherapy . Conclusions Consolidative radiotherapy following R?CHOP?based chemotherapy significantly improves PFS, LRC, and probably OS rates for early?stage WR?DLBCL. This conclusion still needs to be confirmed by prospective studies with a large sample size.

Objective To evaluate the clinical features, treatment outcome, and prognostic factors in patients with primary Waldeyer’ s ring diffuse large B?cell lymphoma (WR?DLBCL). Methods This study included 200 patients with a confirmed diagnosis of primary WR?DLBCL admitted to our hospital from 2000 to 2013, who consisted of 50 stage I patients, 125 stage II patients, and 25 stage III?IV patients. Most patients received 4?6 cycles of CHOP or CHOP?based chemotherapy with or without involved field radiotherapy (Waldeyer′s ring+cervical lymph node region). Results The 5?year sample size was 71. The 5?year overall survival (OS), progression?free survival (PFS), and locoregional control (LRC) rates for the whole group were 78%, 72%, and 87%, respectively. In the 175 early stage patients, chemoradiotherapy resulted in significantly higher OS, PFS, and LRC than chemotherapy alone (86% vs. 70%, P= 0?? 001;84% vs. 58%, P= 0?? 000;97% vs. 66%, P= 0?? 000). Univariate analysis showed that age, tumor size, stage, lactate dehydrogenase level, and International Prognostic Index were prognostic factors for OS, PFS, and LRC ( P= 0?? 000?0?? 036), while the prognostic factors for PFS also included Eastern Cooperative Oncology Group score and cervical nodal involvement (P= 0?? 018). Multivariate analysis showed that age and stage were prognostic factors for OS and LRC (P= 0?? 003?0?? 022), and age was the prognostic factor for PFS (P= 0?? 000). Conclusions WR?DLBCL has distinct clinical features and favorable prognoses. For early stage patients, combined?modality therapy results in significantly higher OS, PFS, and LRC.

BACKGROUNDIt has been known that Kangfuxin, a drug derived from Periplaneta Americana, can induce cell apoptosis of many cancer cell lines in vitro. The aim of this study is to investigate the inhibitory effect and mechanism of Periplaneta Americana extract (PAE) on 3LL lung cancer in mice.

METHODSThe C57BL/6J mice transplanted with 3LL lung cancer were divided into normal saline (NS), PAE high dose (PAE-H) and PAE low dose (PAE-L) groups. The body weight changes and inhibitory rate of tumor growth in each group were observed. In addition, the cell cycle, apoptosis index (AI) and the expression of apoptosis associated genes were analysed by flow cytometry (FCM).

RESULTSThe body weights were decreased in PAE-L and PAE-H treated group compared with NS group and the inhibitive rate of tumor growth was 41.24% and 81.08% respectively. FCM assay indicated that PAE could induce apoptosis of lung cancer cell, and the apoptosis rate was concentration-dependent. At the same time, the number of S and G2/M phase cells was decreased, most of the cells were arrested in G1/G1 phase. The result of TUNEL showed that there were apoptosis and necrosis associated with upregulated expression of Fas, FasR and p53 genes, and downregulated expression of Bcl-2.

CONCLUSIONSPAE may inhibit the growth of 3LL lung cancer in mice and induce apoptosis of 3LL lung cancer cells. It might be related to its effects on the regulation of apoptotic gene expression.

The patient was a young woman with a history of syphilis, gross hematuria onset, chronic course, exacerbation in the second and third trimesters. The clinical manifestations were gross hematuria, nephrotic syndrome, rapidly progressive glomerulonephritis requiring dialysis, decreased complement C3 and C4, and monoclonal IgG-kappa deposition in blood and urine immunofixation electrophoresis. Membranous proliferative glomerulonephritis with crescent formation under renal pathological light microscopy, only single IgG3 deposition in the immunofluorescent IgG subtype, and restrictive expression of light chain kappa, were diagnosed as proliferative glomerulonephritis with monoclonal IgG (IgG3-kappa) deposits (PGNMID). The was the first case with a history of syphilis that worsened during pregnancy. After treatment with bortezomib, cyclophosphamide, and dexamethasone, the patient was finally released from dialysis, renal function recovered, and proteinuria improved.

Objective There is still a lack of effective clinical prognostic factors for predicting outcomes and guiding treatments in extranodal nasal-type NK/T-cell lymphoma (NKTCL).This study was aimed to investigate the clinical features and prognostic role of primary tumor burden (PTB).Methods A total of 1383 patients were recruited from ten hospitals, including 947 stage Ⅰ patients (68.5%), 326 stage Ⅱ patients (23.6%), and 110 stage Ⅲ-IV patients (8.0%).There were 751 patients (54.3%) presenting with high PTB (H-PTB).The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was conducted for survival difference analysis.Meanwhile, a multivariate analysis was performed using the Cox regression model.Results H-PTB was associated with high invasive potential, high frequency of B symptoms, advanced stage, regional lymph node involvement, lactate dehydrogenase elevation, and poor performance status.The patients with H-PTB had significantly lower 5-year overall survival (OS) and progression-free survival (PFS) rates than those with low PTB (L-PTB)(OS:50.2% vs.72.1%, P=0.000;PFS:41.8% vs.62.5, P=0.000).PTB was an independent prognostic factor for both OS (HR=1.851) and PFS (HR=1.755) according to the Cox multivariate analysis.Moreover, H-PTB was associated with significantly lower locoregional control (LRC) in early-stage NKTCL, and the 5-year LRC rate was 71.6% in patients with H-PTB and 84.3% in those with L-PTB (P=0.000).Conclusions H-PTB is associated with multiple adverse clinical features in NKTCL, and it is an independent indicator for poor outcomes and LRC.H-PTB can be used as a reliable indicator for risk stratification and treatment decision.

Objective To investigate the clinical characteristics and long-term outcome of patients with mucosa-associated lymphoid tissue ( MALT) lymphoma of Waldeyer's ring. Methods Ten patients were retrospectively analyzed. Seven patients had stage ⅠE and 3 patients had stage ⅡE disease. All patients received radiation therapy with a median dose of 40 Gy, and 7 patients also received 1 t0 4 cycles of CHOP-based chemotherapy before radiation. Results The ratio of male to　female was 1∶9. The median age was 58 years. No patient had B symptoms. One patient had elevated LDH level. The complete response rate after treatment was 100％. With median follow-up periods of 90 months, 1 patient died from rectal cancer. One patient developed brain metastasis and was salvaged by radiotherapy. The 5-year overall survival, cancer specific survival and progression-free survival rates were 90％ , 100％ and 80％ , respectively. Conclusions The clinical characteristics of Waldeyer's ring MALT lymphoma were similar to that of nongastric MALT lymphoma. For patients with Waldeyer's ring MALT lymphoma, primary radiotherapy can result in excellent long-term survival.

ObjectiveThis study aimed to compare the clinical characteristics and prognoses of primary Waldeyer's ring diffuse large B-cell lymphoma (DLBCL) and extranodal nasal-type NK/T-cell lymphoma ( ENKTCL).MethodsFrom 2000 to 2008,122 patients with primary Waldeyer's ring DLBCL and 44 patients with primary Waldeyer' s ring ENKTCL consecutively diagnosed were retrospectively compared.Patients with DLBCL usually received 4-6 cycles of CHOP-based chemotherapy followed by involved-field radiotherapy.Patients with early stage ENKTCL usually received extended-field radiotherapy with or without subsequent chemotherapy,or short courses ( 1 - 3 cycles ) of chemotherapy followed by radiotherapy.Kaplan-Meier method was used for survival analysis.Logrank method was used for univariate analysis.ResultsThe follow-up rate was 82％.The number of patients followed 5 years were 32 and 15 in DLBCL and ENKTCL.DLBCL mainly presented with stage Ⅱ tonsillar disease with regional lymph node involvement.ENKTCL occurred predominately in young males,as nasopharyngeal stage I disease with B symptoms and involving adjacent structures.The 5-year overall survival (OS) and progression-free survival (PFS) rates were 74％ and 67％ in DLBCL,and 68％ and 59％ in ENKTCL (x2=0.53,1.06,P=0.468,0.303),respectively.In stage Ⅰ and Ⅱ diseases,the 5-year OS and PFS rates were 79％ and 76％ for DLBCL compared to 72％ and 62％ for ENKTCL (x2 =1.20,2.46,P=0.273,0.117).On univariate analysis,age ＞ 60 years,elevated lactate dehydrogenase,eastern cooperative oncology group performance status ＞ 1,international prognosis index ( IPI ) score ≥ 1,stage Ⅲ/Ⅳ diseases and bulky disease were associated with unfavorable survival for DLBCL (x2=9.40,12.72,6.15,10.36,12.48,5.53,P=0.002,0.000,0.013,0.001,0.000,0.019),and only age＞60 years and IPI score ≥ 1 were associated with poor survival for ENKTCL (x2 =3.98,8.41,P =0.046,0.004).ConclusionsThese results indicate that remarkable clinical disparities exist between DLBCL and ENKTCL in Waldeyer's ring. Different treatment strategies for each can result in similarly favorable prognoses.

The present study examined the role of Wnt/β-catenin signaling pathway in the degeneration of nucleus pulposus cells and the protective effect of DKK1 on nucleus pulposus cells.The model of nucleus pulposus cell degeneration was induced by intra-disc injection of TNF-α,and the expression of β-catenin protein was detected by Western blotting.The cultured rabbit nucleus pulposus cells were divided into 4 groups.In group A,the cells were cultured with normal medium and served as control group.In group B,the cells were cultured with TNF-α and acted as degeneration group.In group C,the cells were cultured with TNF-α and transfected with Adv-eGFP and was used as fluorescence control group.In group D,the cells were cultured with TNF-α and transfected with Adv-hDKK1-eGFP,serving as intervention group.The expression of type Ⅱ collagen,proteoglycan,β-catenin,and MMP-13 in each group was detected by immunocytochemistry and RT-PCR.The result showed that TNF-α increased the expression of β-catenin and MMP-13,and significantly inhibited the synthesis of type Ⅱ collagen and proteoglycan,which resulted in the degeneration of nucleus pulposus cells.This effect could be obviously reversed by DKK1.We are led to concluded that TNF-α could activate the Wnt/β-catenin signaling pathway,and increase the expression of MMP-13,thereby resulting in disc degeneration.Specifically blocking Wnt/β-catenin signaling pathway by DKK-1 could protect the normal metabolism of intervertebral disc tissue.The Wnt pathway plays an important role in the progression of the intervertebral disc degeneration.