Objective To evaluate the possibility of no-beparin open operation at low costal arch in live donor nephrectomy via retroperitoneal approach. Methods The effects of 134 cases no-beparin operation and 82 eases heparinized operation at low costal arch in live donor nephrectomy via retroperitoneal approach during 2003.5 to 2008.5 in our hospital were retrospective analyzed. Results The kidneys of the donors in two groups were successfully harvested. The operation time varied from 110 rain to 200 rnin, and warm isebemia time varied from lOs to 20s. Delayed graft function (DGF) was oceurred in one ease in each group. There was no signifieant difference in live donor nephreetomy between the two groups(P >0. 05), but the no-beparin group had less bleeding. Conclusion The no-beparin open operation at low eostal arch in live donor nephrectomy via retroperitoneal approach is technieal]y feasible and safe, and has less bleeding, and little influence on the allograft.

It’s still controversial whether there is specificity of acupoints, because numerous studies showed that stimulation to acupoints and sham acupoints produced parallel clinical efficacies. For example, acupoint specificity was not detected when Visual Analogue Scale was adopted to evaluate pain, while hemodynamic and neuroimaging studies suggested the existence of acupoint specificity. This article reviewed and summarized relevant studies that supported or didn’t support acupoint specificity. Further researches are required to prove the existence of specificity of acupoints.

Objective To compare and observe the effect of GASMAN software computer aided and traditional teaching method in the teaching of inhalation anesthesia. Methods 48 members of interns who need to enter the inhalation anesthesia department to study the theory of inhalation anesthesia were ran-domly divided into either GASMAN software group or traditional group with 24 people in each group, using the above two methods to carry on the study of inhalation anesthesia. After the end of the teaching course, the study effect and the satisfaction degree of the two groups of students were investigated by the written exam and questionnaire. SPSS 11.5 was used for statistical analysis, using±s to express measurement data. The results of the examination were compared with the independent sample t test, and the satisfaction survey feedback was compared with chi square test, The difference was statistically significant (P<0.05 ). Result The mean score of GASMAN software group (95.4 ±2.7) was significantly higher than that of tra-ditional group (85.0 ±3.5) (t=11.5,P=0.000). Satisfaction survey results showed that GASMAN computer assisted instruction software learning was easier for students to accept, and there were significant difference between two groups (P=0.001). Conclusion Teaching mode of GASMAN software is a good learning technique of inhalation anesthesia, which is worthy of promotion.

Objective: To investigate the impact of clinicopathological features, gene rearrangements and protein expression of bcl-6, bcl-2, C-MYC and chemotherapy regime on the prognosis of patients with primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL). Methods: Thirty-three cases of PCNS-DLBCL diagnosed from January 2006 to December 2016 at Zhejiang Cancer Hospital were collected. The expression of CD10, bcl-6, bcl-2, MUM1 and MYC were detected by immunohistochemical staining (IHC). The presence of EB virus was detected by in situ hybridization(EBER). Copy number variation (ICN) and translocation status of bcl-6, bcl-2 and C-MYC genes were detected by fluorescence in situ hybridization (FISH). The relationship between the above indexes and the prognosis was analyzed by univariate, bivariate survival analysis and multiple Cox hazard regression analysis. Results: The study included 33 patients of PCNS-DLBCL, without evidence of primary or secondary immunodeficient disease. Male to female ratio was 1.36∶1.00, and the average age was 56 years. Twenty cases had single lesion while 13 had multiple lesions. Deep brain involvement was seen in 12 cases. All patients underwent partial or total tumor resection. Five patients received whole brain post-surgery radiotherapy, nine patients received high-dose methotrexate (HD-MTX) based chemotherapy, and 12 patients received whole-brain radiotherapy combined with HD-MTX based chemotherapy. Severn patients received no further treatment and rituximab was used in 8 patients. According to the Hans model, 27 cases were classified as non-GCB subtypes (81.8%). Bcl-2 was positive in 25 cases (75.8%, 25/33) and highly expressed in 8 (24.2%). MYC was positive in 12 cases (36.4%) and double expression of bcl-2 and MYC was seen in 6 cases. EBER positive rate was 10.0%(3/30), all of which had multiple lesions. Two bcl-6 gene translocations and 3 amplifications were found in 28 patients. Two translocations, 3 ICN or with both bcl-2 gene translocation and ICN were found in 30 patients. Four ICNs of C-MYC gene were found in 28 patients. Elevated protein in cerebrospinal fluid (CSF) was found in 13 patients. LDH increased in 10 cases. Follow-up period was 2-90 months with the average survival time of (23.0±3.7) months and two-year survival rate of 39.0%. Univariate survival analysis showed that overexpression of bcl-2 protein (≥70%) and MYC protein (≥40%), bcl-2 gene abnormality (including copy number increase and translocation), C-MYC gene copy number increased were adverse factors for survival. C-MYC/ bcl-2 gene double hit was seen in 2 cases. Bivariate survival analysis found that of bcl-2/MYC protein double expression and bcl-2 and C-MYC genes double aberration were significantly associated with adverse outcomes. Cox multivariate risk regression analysis found that gender, cerebrospinal fluid protein increasing, and ICN of C-MYC gene were independent poor prognostic factors. DH-MTX based comprehensive chemotherapy was associated with better prognosis. Conclusions Double hit at genomic level (copy number variations and gene rearrangements) and double protein expression of bcl-2 and C-MYC in PCNS-DLBCL are significantly associated with an adverse outcome. DH-MTX based comprehensive treatment may prolong the patient survival.

The development process of joint kinematics and kinetics is expatiated from the aspects of technology and method. Firstly, the classical mechanics-based methods are introduced. Secondly, the computer assisted methods are analyzed from the technical aspects of video tracking, fluoroscopy and MR imaging separately. Then the assistance of robotic technique in this field is discussed. Finally the potential trend in the joint kinematics and kinetics is concluded.
Biomechanical Phenomena ; Computer Simulation ; Humans ; Image Interpretation, Computer-Assisted ; methods ; Joints ; physiology ; Magnetic Resonance Imaging ; Movement ; physiology ; Range of Motion, Articular ; physiology

Objective: To investigate the expression of BRCA-associated protein 1 (BAP1) in malignant mesothelioma, non-small cell lung cancer and carcinosarcoma, and its application in the differential diagnosis. Methods: Twenty-two cases of malignant mesothelioma including 17 epithelioid type, 2 sarcomatoid type and 3 biphasic type were collected.As the study control, 80 non-small cell lung cancers infringement pleural membrane(including 40 lung adenocarcinomas and 40 lung squamous cell carcinomas) and 15 carcinosarcomas were included. BAP1 expression was detected using immunohistochemical method. A differential diagnosis antibody panel, including calretinin, WT1, CK5/6, D2-40, CAM5.2, CEA, TTF1, Napsin A, p63 and p40 was tested in all cases. Results: All 80 cases of non-small cell lung cancer and 15 cases of carcinosarcoma were BAP1 positive. In contrast, 64% (14/22) of malignant mesotheliomas lost BAP1 expression (P<0.01). Addition of BAP1 to the mesothelioma marker panel, the diagnostic accuracy of malignant mesothelioma was enhanced to 93%. Focal expression of BAP1 in tumors suggested multiclonal evolution of mesothelioma. Conclusions Loss of BAP1 expression helps to confirm the diagnosis of malignant mesothelioma whereas all non-small cell lung cancer expresses BAP1. It is therefore recommended that BAP1 can be used in conjunction with other immunohistochemical markers to improve the diagnostic accuracy of malignant mesothelioma.

Objective To explore the curative effectiveness of comprehensive voice training methods on teachers' voice disorders patients by using subjective and objective assessment. Methods Forty-seven teachers' voice disorders patients suffering from voice symptoms without organic disease and complete follow-up data as the research object were treated with a three-month comprehensive voice training program. Training content included relieving laryngeal muscle tension, improving the throat vocal cord movement and reconstruction methods of pronunciation. The use of voice acoustic analysis and voice handicap index(VHI) were compared before and after training. Results The jitter and shimmer were significantly decreased after comprehensive voice training from 1.06(0.79,1.38)％and 2.71(2.16,3.24)％to 0.78 (0.59, 0.99)％ and 1.64(1.03,2.45)％, the differences were significant (Z=3.249,-4.121, P<0.05). Maximum phonation time and dysphonia severity index were significantly increased obviously from (9.87 ± 2.61)s and-2.23±0.75 to (12.81±1.97)s and-0.43±1.65 respectively, the differences were significant (t=-6.057,-5.273, P<0.05). After the training, the VHI score of voice disorder index decreased from (37.41±4.96)points to (26.31± 4.29) points after the comprehensive voice training. In addition to emotional function, the difference was statistically significant(t=12.715, 5.881, 11.483, P<0.05). Conclusions Voice training can reduce the degree of voice disorders effectively, increase the power of the respiratory system, therefore improve the voice quality of teachers with voice disorders. The subjective and objective combination assessment can evaluate the quality of the patient′s voice more thoroughly and evaluate the clinical efficacy of voice training further.

OBJECTIVETo investigate the effect of BCL-2/MYC double-hit on prognosis in diffuse large B-cell lymphoma（DLBCL）.

METHODSA retrospective study was conducted to investigate clinical and pathological data of 111 patients with DLBCL. CD10, BCL-6, MUM-1, BCL-2 protein expressions were examined by immune-histochemical methods, and abnormal BCL-2 and MYC genes were analyzed by FISH for patients with sufficient pathological data. SAS 8.2 was adopted to perform Chi- square test, COX's proportional Hazard Model, Life table survival analyses.

RESULTSOf 111 patients, male 77 cases, female 34 cases, the median age was 55（14-85）years, CD10, BCL-6, MUM-1, BCL-2 positive rates were 15.7%（16/102）, 58.8%（60/102）, 33.0%（34/103）, 74.8（77/103）respectively, the abnormal rate of BCL-2 gene was 43.1%（25/58, 24 cases with multiple copies, 1 case with translocation）, and the abnormal rate of MYC gene was 20.4%（10/49, 10 cases with multiple copies）. Coexistence of BCL-2 and MYC genes abnormalities accounted for 13.0%（6/46）. According to the classification of Hans model, GCB subgroup accounted for 41.2%（42/102）, and non-GCB subgroup 58.8%（60/102）, the median survival time was 24 months, 3-year and 5-year overall survival rates were 48.5% and 39.7% respectively. Overall survival rates of normal and abnormal BCL-2 gene were 34.2%，22.8%, respectively with no statistical significance（P=0.770）. Overall survival rates of normal and abnormal MYC gene were 35.9% and 22.2% ，with no statistical significance（P=0.650）. Overall survival rate of double-hit was 0, far worse than that of single abnormal gene（P=0.034）, which implied double-hit of BCL-2 and MYC gene abnormality to be adverse prognostic factors. BCL-6 protein express could be classified as benign prognostic factors, while ECOG score≥2, escalated IPI index as adverse prognostic factors, and further COX risk model regression analysis indicated that ECOG score, IPI grading and treatment methods were independently adverse factors affecting prognosis. Comprehensive therapy based on chemotherapy could improve outcome.

CONCLUSIONBCL-2/MYC genes double-hit was the factor for the adverse outcome in DLBCL patients. However, ECOG score, IPI risk grading and treatment methods were the independent factors affecting prognosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Genes, myc ; Humans ; Lymphoma, Large B-Cell, Diffuse ; Male ; Middle Aged ; Prognosis ; Proto-Oncogene Proteins c-bcl-2 ; Retrospective Studies ; Survival Rate ; Translocation, Genetic ; Young Adult

Objective:To analyze survival in patients with advanced oral cancer from prospective clinical trials. Methods:From 2008 to 2010, 256 patients with oral cancer at clinical stage III/IVA were randomly categorized into two groups. Patients in the experi-mental group received neo-adjuvant chemotherapy, surgery, and post-operative radiation, and patients in the control group underwent surgery and post-operative radiation. All patients were routinely followed-up after treatments. Survival was analyzed using Kaplan–Meier method and log-rank test, and differences were considered statistically significant at P value lower than 0.05. Results: Each group was composed of 128 patients. With the median follow-up period of 60 months, the 5-year overall survival rate was 61.7%and the disease-free survival rate was 53.9%. The overall survival rate (P=0.350) and the disease-free survival rate (P=0.160) were not sig-nificantly different between the experimental and control groups. Patients with positive pathological response to neo-adjuvant chemo-therapy exhibited significantly improved overall survival (P＜0.05). Conclusion:Radical surgery should be emphasized to improve the prognosis of oral cancer. Functional reconstruction could also improve the quality of life and survival of patients. Despite that neo-adju-vant chemotherapy could not improve the survival of patients with advanced oral cancer in entirety, it could benefit patients exhibiting positive treatment responses.