Objective To evaluate the value of spectral CT imaging for the differential diagnosis of squamous cell carcinoma (SQCC) and adenocarcinoma (ADC) of the esophagogastric junction. Methods Forty-five patients with a mass in the esophagogastric junction proved by pathology underwent enhanced scan with spectral CT, including 20 cases of SQCC and 25 cases of ADC. Iodine concentration (IC) , water concentration (WC) , effective atomic number (Eff-Z) and spectral curve slope (λHU) of arterial phase (AP) and venous phase (VP) in the ROI of the mass were measured with gemstone spectral imaging post-processing software. The independent samples t test was used to compare the quantitative parameters above between two groups on the premise of satisfying normal distribution. ROC curves were drawn for the parameters which showed statistical differences and area under the curve (AUC) was used to measure and compare their respective differential diagnostic performance as well as the best threshold value. Results In AP,the average IC, Eff-Z, andλHU of ADC were (1.75±0.40) mg/ml, 8.65±0.22, and 3.33±0.74, respectively. The corresponding parameters of SQCC were (1.40 ± 0.35) mg/ml, 8.50 ± 0.20, and 2.71 ± 0.66, respectively. These parameters of ADC were significantly higher than that of SQCC (t=-2.833,-2.879,-2.678;P<0.05) . In VP, the average IC, Eff-Z, and λHU of ADC were (2.17 ± 0.23) mg/ml, 8.87 ± 0.11, and 4.10 ± 0.44, respectively. The corresponding parameters of SQCC were (1.67 ± 0.20) mg/ml, 8.60 ± 0.11, and 3.19 ± 0.41, respectively. The difference between ADC and SQCC was statistically significant (t=-6.963,-7.218,-6.521;P<0.05). For the average WC, No difference between the two groups in AP and VP was found. ROC curve analysis showed that IC, Eff-Z, andλHU in VP had better differential diagnostic performances than IC, Eff-Z, and λHU in AP, especially Eff-Z in VP. The AUC for it was 0.97. Using 8.72 as a threshold value, the sensitivity and specificity for diagnosis were 88.9% and 94.7% , respectively. Conclusion Multi-parameters quantitative analysis with spectral CT could be useful in the differential diagnosis of SQCC and ADC of the esophagogastric junction.

A series of quinoline-polyamine conjugates (8a-8n) were designed, synthesized and evaluated as inhibitors of cholinesterases (ChEs). Some of these compounds had potent ChEs inhibitory activity with IC50 values at micromolar range. Compound 8n exhibited the strongest inhibition on acetylcholinesterase (AChE) with an IC50 value of 8.78 micromol x L(-1), and compound 8i showed the most potent inhibition on butyrylcholinesterase (BChE) with IC50 value of 1.60 micromol x L(-1) which was slightly better than rivastigmine. The structure-activity relationship revealed that the chain length of polyamine and linker played important roles for inhibitory activity. Molecular modeling studies showed that 8i targeted both the catalytic active site (CAS) and the peripheral anionic site (PAS) of cholinesterases.

Objective To study the effects of light on body weight,learning and memory of mice.Methods Fifty mice aged 20 days were randomly assigned to one of the five groups: 200 W light group,100 W light group,60 W light group,40 W light group and normal control group,with 10 in each.They were exposed to different intensities of light 8 hours per day for 1 week.Then we monitored their body weight,examined the mean latency and inaccuracy number in step-down test,and examined the mean latency using a Morris' water maze to observe the effect of light pollution on the mice's learning and memory.Results Compared with the other four groups,there were significant decelerations of body weight increase in 200 W light group.No significant difference in body weight gain was found among the other four groups.The four light-treatment groups had no significant differences from control group in the mean latency,inaccuracy number in step-down test or the mean latency,or the mean crosses to the target in the Morris' water maze.Conclusion Short time high-intensity light can inhibit body weight increase in mice,but short-time light has no effect on the learning and memory of mice.

Objective To evaluate the efficacy and toxicity of weekly docetaxel and cisplatin in previously untreated patients with advanced non-small-cell lung carcinoma. Methods Between January 2002 and December 2003 ,34 patients with pathologically comfirmed advanced non-small-cell lung carcinoma who had not received treatment were enrolled. The mean age was under 66 years. The patients received intravenous infusions of docetaxel(25 mg/m2,dayl ,8,15) with dexamethasone premedication and cisplatin(25 mg/m2,dayl ,8,15) ,followed by a week of rest. The remedies which were less than 6 regimens lasted to disease progression or severe toxicity. Therapeutic effect was evaluated by CT scan every two courses . The patients were followed up for 24 months. Descriptive statistics and SPSSIO. 0 software were used to analyse the results. Results 34 patients finished 90 courses. The mean was 2. 6 courses. All patients were followed up. Two patients achieved complete responses, ten patients achieved partial responses, ten patients achieved stable disease. An objective response rate of 35. 29% (95% confidence interval 19. 25%-51. 33% )was obtained. Patients life quality was significantly improved. The median time to progression was 4. 1 months, and median overall survival was 11 months. The 1-year survival rate was 47. 06% , the 2-year survival rate was 11.76% . Toxicities were mild. Grade 3 to 4 neutropenia (11.76%), anemia (5.88%), hyponatremia (5.88%), alopecie (17.64%) and nausea/vomiting (5. 88% ) were observed. Conclusion Weekly Cisplatin plus docetaxel is an effective and well-tolerated regimen in chemo-naive patients with advanced NSCLC. Well-designed clinical trials should be conducted.

AIM: To compare the measurement of anterior chamber depth(ACD) inclusive of corneal thickness using intrao-cular lens(IOL) master and ultrasound biomicroscopy (UBM) and evaluate the repeatability of each method.METHODS: Two consecutive measurements of ACD were prospectively performed using IOL master and UBM in 60 eyes in 60 individuals. Mean values were compared using the paired t test. For each individual, ACD measure-ments was performed 5 times to estimate the repeatability of each method by a coefficient of variation(CV).RESULTS: The mean ACD was 2.95±0.25mm with the IOL master and 2.96±0.22mm with the UBM. This diffe-rence was not statistically significant (P=0.631).The coefficient of variation (CV) was 0.56%±0.26% and 0.65%± 0.36% in IOL master and UBM, respectively.CONCLUSION: The mean ACD of IOL master was the same as UBM. The repeatability of IOL master is better than UBM.

OBJECTIVE: To analyze the characteristics of medical malpractice from different grades of hospitals and to explore forensic investigation strategies in assessing medical dispute. METHODS: A total of 206 cases of medical dispute from 2009 to 2010 investigated by the Department of Forensic Medicine in Nanjing Medical University were selected and analyzed according to fault incidence, fault-prone part, and degree of causality in the treatment. RESULTS: Among the 206 cases analyzed, tertiary hospitals, secondary hospitals and primary hospitals showed medium, high and low error rate, respectively. A majority of medical malpractice cases were distributed in the departments of surgery, medicine and gynecology. CONCLUSION The frequency and severity of medical malpractice in primary hospitals were high, which were gradually reduced in tertiary and secondary hospitals.
Dissent and Disputes ; Expert Testimony ; Forensic Medicine ; Gynecology/statistics & numerical data* ; Hospital Departments/statistics & numerical data* ; Humans ; Incidence ; Malpractice/statistics & numerical data* ; Medical Errors/statistics & numerical data* ; Retrospective Studies ; Time Factors

OBJECTIVETo discuss the clinical effects and superiority of applying external fixation and bone transport to treat osteomyelitis and bone defect of femoral bone.

METHODSFrom August 2008 to December 2013,16 patients with osteomyelitis and bone defect of femoral bone were treated including 11 males and 5 females with an average age of 42 years old ranging from 13 to 62 years old. The average course of disease was 18 months ranging from 2 months to 4.5 years, and the average length of bone defect was 7.8 cm ranging from 4.5 to 15 cm. The bone defect of all cases were treated by external fixation and bone transport, the bone transport began at 1 week after operation, 1 mm per day and 4 times per day.

RESULTSAll patients were followed up for 10 to 36 months (means 22.5 months). One patient did not cooperate with treatment leads to the failure, then took the amputation. The remaining 15 cases of osteomyelitis were under control, including 12 cases of bone transport achieved one stage bone union, 3 cases achieved bone union via bone graft from iliac bone. The bone union time was 5 to 13 months(means 7.9 months). Thirteen patients almost obtained the same length of two lower extremities,2 patients had shortening of 1.5 to 2 cm. The time of moving the external fixation was from 6 to 16 months (means 9.3 months).

CONCLUSIONApplication of external fixation and bone transport is an effective method in treating the osteomyelitis and bone defect that can control the infection, eradicate wounds, and be the equalization of limb length.

Adolescent ; Adult ; Bone Transplantation ; External Fixators ; Female ; Femur ; surgery ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery

AIM: To explore whether strontium ranelate ( Sr ) promotes osteogenic differentiation of rat bone mesenchymal stem cells (BMSCs) through the Hedgehog/Gli1 signaling pathway.METHODS:BMSCs were isolated from 4-week-old rats by adherent culture and induced to differentiate into osteoblasts .According to the experimental purposes , the cells were exposed to different concentrations of Sr , cyclopamine ( Cy, an inhibitor of Hedgehog receptor ) or Gli1-siR-NA.The expression of Gli1 and Runx2 in the cells was detected by Western blotting .The activity of alkaline phosphatase ( ALP) was measured by the method of colorimetry , and the mineralized nodules were observed under microscope with aliz-arin red staining .RESULTS:Exposure to Sr at concentrations of 0.1 to 5 mmol/L for 7 d markedly increased the expres-sion of Gli1 in the BMSCs , and the increase in Gli1 expression was the most obvious following Sr exposure at concentration of 3 mmol/L.Cy at concentration of 10 μmol/L inhibited Sr-induced up-regulation of Gli1 expression.Transfection of the BMSCs with Gli1-siRNA not only obviously inhibited Sr-induced up-regulation of Gli1 and Runx2 ( a downstream protein of Gli1) expression, but also antagonized Sr-induced enhancement of ALP activity and the formation of mineralized nodules . CONCLUSION:The Hedgehog/Gli1 pathway is involved in Sr-induced osteogenic differentiation of rat BMSCs .

Objective To explore the strategy and outcomes of surgical treatment of thoracic ossification of ligamentum flavum(OLF),especially combined with ossification of posterior longitudinal ligament,thoracic kyphosis and epidural adhesion.Methods Fifty-three cases of thoracic OLF from January 2003 to December 2009 were reviewed retrospectively.All patients were treated by the methods of en bloc resection of semi-facet and lamina.All patients were followed up for more than half an year,including 32 males and 21 females,aged from 43 to 73 years(average 54.7 years).The lesions located in upper thoracic for 18 patients,and in thoracolumbar for 35 patients.For multi-level or jumping OLF patients,the responsible levels were determined by combination of images and clinical symptoms.For multi-level OLF with ossification of posterior longitudinal ligament(OPLL)or thoracic kyphosis(＞50°),multi-level pedicle screw fixation and correction of kyphosis were performed.For dural adhesion patients,part of cerebrospinal fluid was released with a caudal incision of dural sac resulting in collapse and epidural arachnoid separation.Ossific and adhesion dura mater were removed with integrity of arachnoid.The surgical outcomes were evaluated with preoperative and postoperative thoracic Japanese Orthopaedic Association(JOA)score,Nurick grade and neurologic functional recovery ratio.Results Fifty-three cases were followed up for 6 months to 6 years,with an average of 18 months.The average preoperative JOA score was 4.3±2.3,which significantly increased to 8.3±1.8 after operation.Postoperative neurologic functional recovery rates were 11% to 80%(average 65.8%),including excellent in 18 cases,good in 20,fair in 10,and poor in 5.The excellent or good rate was 71.7%.The mean preoperative Nurick grade was 3.7(2-5 grade)and decreased to 2.3 grade after operation.Conclusion En bloc resection of semi-facet and lamina is a safe and effective method for treatment of thoracic OLF.For the patients with OPLL or kyphosis,pedicle screws fixation and kyphosis correction was beneficial for recovery of neurologic function of thoracic OLF patients.

Objective To analyse the dysfunction of immunity and clinical significance in patients with cardiac cancer.Methods The level of CD4+ CD25hi CD127low Treg cells were detected by flow cytometry (FCM),and serum IL-10 and TGF-β1 levels were determined by enzyme linked immunosorbent assay (ELISA) kit in 56 patients with cardiac cancer.15 healthy volunteers were tested as normal controls.The clinical data of each patient were collected and analyzed. Results There was a significantly higher percentage of CD4+ CD25hi CD127low Treg cells in patients with cardiac cancer (5.73±1.56)% than that (4.45±1.06)% of healthy volunteers (P<0.01).The IL-10 and TGF-β1 levels in the serum of patients with cardiac cancer were also significantly higher than that of healthy volunteers (P<0.05).There was a positive correlation between levels of IL-10.TGF-β1 and the levels of CD4+ CD25hi CD127low Treg cells.The number of CD4+ CD25hi CD127low regulatory T cells in the peripheral blood of cardiac cancer patients were significantly correlated with clinical stages and metastasis lymph node.Conclusion The CD4+ CD25hi CD127low Treg cells in the peripheral blood of cardiac cancer patients is significantly increased in comparison with that in healthy volunteers,and was also correlated with different stages.The abnormal levels of CD4+ CD25hi CD127low Treg cells may be related to tumor progression in patients with cardiac cancer.