Objective To investigate the value of DWI imaging combined with T2WI imaging and CT image fusion technology and explore the role of DWI imaging in the determination of target areas in radiotherapy for advanced esophageal cancer.Methods Twenty-three patients with locally advanced esophageal cancer were included in this study.All the patients were fixed by a heat plastic device.Each patient was examined by CT,T2WI and DWI scan in the same position as the radiotherapy treatment.Images obtained from the three sequences were transmitted to the Eclipse 11.0 treatment planning system.All images were registered at Eclipse workstation as to normalized mutual information registration.The target areas were delineated by the clinical radiation physicians in the CT imaging,and CT and DWI fusion images.The target areas of the two kinds of image were evaluated using fusion function and statistical function of the treatment planning system.Results Target parameters differed significantly between CT base and CT/MRI fusion base.The results of the target volume outline closer by CT and MRI fusion image base in the three groups of clinicians.Conclusion The target volume between the groups is closer by using CT and DWI fusion image.DWI image has a good assisting effect in determining the target area of locally advanced esophageal cancer.

AIM:To measure levels of various inflammation-related cytokines in the aqueous humor of patients with neovascular glaucoma(NVG)and age-related cataract, and to evaluate changes in these cytokines before and after an intravitreal injection of ranibizumab.

METHODS:This study investigated 21 eyes of 21 patients with NVG and 20 eyes of 20 control subjects with age-related cataract. The NVG eyes received an intravitreal injection of ranibizumab treatment before Ahmed glaucoma valve implantation. Aqueous humor was collected before intravitreal injection of ranibizumab and before Ahmed glaucoma valve implantation. Aqueous humor samples were collected from the cataract patients at the time of cataract surgery. The levels of inflammation-related cytokines in the aqueous humor were measured with a Multiplex bead immunoassay technique.

RESULTS:The NVG eyes showed significantly elevated concentrations of interleukin(IL)-1β, IL-6, IL-8, monocyte chemotactic protein-1(MCP-1), and vascular endothelial growth factor(VEGF)(all P<0.001)when compared with the eyes of the cataract patients. Following the intravitreal injection of ranibizumab, the concentrations of IL-6, IL-8, MCP-1, and VEGF in the NVG eyes showed a dramatic and statistically significant decrease. The correlations between the levels of inflammation-related cytokines and age, intraocular pressure(IOP)before operations in the NVG patients did not reach statistical significance.

CONCLUSION:The inflammation-related cytokines were significantly elevated in NVG eyes. Intravitreal injection of ranibizumab dramatically and significantly reduced the levels of some inflammation-related cytokines.

AIM: To measure the foveal avascular zone(FAZ)area and to investigate the characteristics of the FAZ area in normal eyes, using optical coherence tomography(OCT)angiography.

METHODS: This was a cross-sectional study. The FAZ area was measured in 69 participants, for a total of 138 eyes, using RTVue-100 OCT. The relations between the FAZ area and the potential factors were evaluated by univariate and multivariate linear regression analysis. Differences between the right and left eyes were calculated, and values were compared by means of a paired t test. Pearson correlation analysis was performed to assess the relationships of the FAZ area between the right and left eyes.

RESULTS: The mean FAZ area was 0.30±0.11mm² in all subjects. For the male subjects, the mean FAZ area was 0.29±0.13mm², and for the female subjects 0.31±0.09mm², with no significant difference(t=-1.346,P=0.180). The FAZ area did not correlate with all the potential factors. The mean FAZ area in the right eye was 0.30±0.11mm², and in the left eye was 0.30±0.10mm²,with no significant difference(P=0.943). There was a strong correlation between the right and left eyes for the FAZ area.

CONCLUSION: OCT angiography is a noninvasive method of visualizing and measuring the FAZ area in normal subjects. The FAZ area does not correlate with old age, sex and other factors. It shows significant interocular symmetry in normal subjects.

Objective To compare the efficacy of laryngeal tube suction Ⅱ (LTS Ⅱ ) and ProSeal laryngeal mask airway (PLMA) for airway management during general anesthesia. Methods One hundred and twenty adult ASA Ⅰ or Ⅱ female patients, aged 30-50, with body mass index ＜ 30 kg/m2, undergoing general anesthesia for elective surgery were randomly divided into 2 groups ( n = 60 each) : PLMA group and LTS Ⅱ group. Each group was further divided into 2 subgroups: PLMA controlled ventilation group (group PC), PLMA spontaneous breathing group (group PS), LTS Ⅱ controlled ventilation group (group LC) and LTS Ⅱ spontaneous breathing group (group LS) . The rate of successful insertion was recorded. PetCO2 , peak airway pressure, lung compliance and incidence of gas leakage during controlled ventilation were recorded before operation, 10 min after the start of operation and at the end of operation. The tidal volume and PetCO2 were recorded in patients breathing spontaneously when the breathing was stable. The bucking and body movement were observed during removal of LTS Ⅱ or PLMA. The side effects in 24 h after surgery were recorded.Results Insertion was successful in all the patients. During either spontaneous breathing or controlled ventilation, the peak airway pressure was significantly higher in the patients with LTS Ⅱ than in the patients with PLMA ( P ＜ 0.05), and there wag no significant difference in the other ventilatory parameters between the two devices. There was no significant difference in the incidences of postoperative complications among the groups ( P ＞ 0.05) . Conclusion The efficacy of PLMA for airway manage ment is better than that of LTSⅡ during general anesthesia.

ObjectiveTo retrospectively analysis the role of intercostal artery reconstruction in spinal cord protection for patients with extent thoracoabdominal aotic aneurysm (TAAA) repair.MethodsFrom August 2003 to August 2010,extent Crawford Ⅱ TAAA repair were performed in 81 consecutive patients with mean age (39.4 ± 10.3) years and 61 (75.3％)were males.All the procedures were performed under profound hypothermia with interval cardiac arrest.Patientswere opened with a thoracoabdominal incision.Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium.T6 to T12 intercostal arteries and L1,2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8mm branch for keeping spinal cord blood perfusion.Visceral arteries were joined into a patch and anastomosed to the end of the main graft.Left renal artery was anastomosed to an 8mm branch or joined to the patch.The other 10mm branches were anastomosed to iliac arteries.ResultsWith 100％ follow-up,early mortality was 7.4％ (6/81),one patient was dead result from cerebral hemorrhage,three from renal failure,one from heart failure because of myocardial infarction and one from rupture of cliac artery dissection.Postoperative spinal cord deficits was 3.7％ (3/81),temporary paraplegia were observed in 2 patients and paraparesis occurred in 1 patient,but all of them were without bladder or rectum deficits.Neo- intercostal arteries were clogged in 12 patients within follow-up,and two of those patients with Marfan syndrome underwent pseudoaneurysm after intercostal arteries reconstruction.The mean survival time in this group is (54.22 ± 3.03 )months (95％ CI:44.37 months,59.90 months)with survival rate 92.37％ after 1 year,89.02％ after 2 years,85.54％ after 5 years.Three patient were dead with long term follow-up,one were resulted from cerebral hemorrhage at 20th month,one from rupture of ascending aorta at 23rd month and the last from rupture of aorta ulcer.ConclusionIntercostal artery reconstruction is a reliable method in spinal cord protection for patients with TAAA repair.It is a feasible method with acceptable surgical risks and satisfactory results.It can achieve long term result with less risk of spinal cord deficits and good quality of daily life.

Objective Retrospectively analyze the mid-term clinical results of single-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement(T/STAR).This study describes our experience in this operation in single center of aortic disease at Fuwai Hospital.Methods From February 2004 to February 2011,21 patients with hypertension or Marfan syndrome underwent one-stage total or subtotal aortic replacement for aortic dissection or aortic aneurysms.16 male and 5 female,aged (34 ±9) years.Operations wore performed under circulatory arrest with profound hypothermia.Patients were opened with a mid-sternotomy and a thoracoabdominal incision.Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium.During cooling,the ascending aorta or aortic root was replaced.At the nasopharyngeal temperature of 20 ℃,the aortic arch was replaced with selective antegrade cerebral perfusion.Staged aortic occlusions allowed for replacement of descending thoracic and abdominal aorta.T6 to T12 intercostal arteries and L1,2 lumbar arteries were formed to a neo-intercostal artery in place and were connected to an 8 mm branch for keeping spinal cord blood perfusion.Visceral arteries were joined into a patch and anastomosed to the end of the main graft.Left renal artery was anastomosed to an 8mm branch or joined to the patch.The other 10 mm branches were anastomosed to iliac arteries.Results Early mortality was4.8％ ( 1/21 eases),the only one patient was dead result from renal failure and multiple organ failure.There were no postoperative spinal cord deficits occurred,two patients were stroked at day 5th and 7th respectively.Three patients were operated with tracheotomy because of respiratory insufficiency.Operation was undertaken on one patient with splenenctomy result of spleen rupture during first aortic aneurysms repair.All patients were follow-up,ranging from 18 to 84 months postoperatively,all 20 survivors were alive and had good functional status.One patient was reoperated with aortic valve replacement because of massive valve insufficiency after two years.Neo- intercostal arteries were clogged in 3 patients within follow-up,and two of those patients with Marfan syndrome underwent pseudoaneurysm after intercostal arteries reconstruction.Conclusion Single-stage repair of extensive aortic aneurysms with total or subtotal aortic replacement is safely and effectively.It is feasible with acceptable surgical risks and satisfactory results.It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement and has satisfactory mid-term results.

Objective To analyze risk factors for acute kidney injury after aortic arch operation under deep hypothermic circulatory arrest.Methods Between January 2005 and June 2011,549 cases aortic arch replacement under deep hypothermic circulatory arrest were retrospectively analyzed.According to the occurrence of acute kidney injury they were divided into two groups.Univariate and multivariate analysis (multiple logistic regression) were used to identify the risk factors.Results AKI occurred in 102 cases (18.6％) and 27 cases(4.9％) had dialysis.Multiple logistic regression showed that body mess Index(OR =1.072,95％ CI:1.006-1.141,P =0.031),serum creatinin (OR =1.011,95％ CI:1.006-1.017,P =0.000),cardiopulmonary bypass time(OR =1.006,95 ％ CI:1.002-1.009,P =0.005) and the peak intraoperative glucose level (OR =1.007,95 ％ CI:1.002-1.011,P =0.003) were independent risk factors for AKI.Conclusion The higher BMI,serum creatinin level maybe indicate the occurrence of AKI,and AKI maybe can be reduced by controlling CPB time and intraoperative hyperglycemia.

Objective Retrospectively analyze 47 cases received reoperation with aortic disease after aortic valve replacement to deepen the understanding of aortic valve disease.Methods From January 2003 to June 2012,47 patients with previous aortic valve replacement received aortic root or other aortic operation because of new aortic disease.38 male and 9 female,the interval (6.0 ± 3.8) years. All cases with new aortic disease were diagnosed by cardiac ultrasound and aortic computed tomography.Bentall's procedure were operated on 14 patients,total aortic arch replacement with elephant trunk procedure on 14 patients,aortic root and aortic arch with elephant trunk procedure on 7 patients,ascending aortic replacement on 10patients,total thoracic and abdominal aorta replacement on 2 cases.All patients were followed by clinic interview or telephone.Results Aortic dissection and aneurysmal dilatation were occurred on ascending aorta,each account for 50％,in patients with previous aortic valve replacement because of rheumatic valve disease and bicuspid aortic valve; 3 cases with Marfan syndrome occurred ascending aortic dilatation and 4 cases occurred aortic dissection.Diameter in ascending aorta increased (5.2 + 7.1)mm per year and aortic sinus (3.3 ± 3.1)mm per year.The value of ascending aortic dilatation per year in patients with rheumatic disease was higher than patients with Marfan syndrome(P ＜ 0.05).47 patients were re-operated in fuwai hospital,1 patients died in operating room because aortic dissection seriously involved right coronary artery.7 patients have renal insufficiency after operation and all were cured by hemofiltration; neurological complication occurred in 14 patients including that 7 patients stroked and 7 patients had transient brain dysfunciotn.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time were(53.49 +33.79) months.8 cases were died during follow-up and threeyear survival rate was 83％.There were no cases received operation due to aortic disease during follow-up.Conclusion Deepening the understanding of aortic valve disease combine ascending aorta changes,especially pay attention to patients with previous aortic valve replacement because of Marfan syndrome and rheumatic disease during follow-up after first operation,all efforts should decrease the occurrence of aortic adverse events in long term.

Acute Achilles tendon rupture is a common sports injury, is currently the best treatment for acute Achilles tendon rupture there are more controversial programs in the clinical, their treatment is divided into conservative treatment and surgical treatment. Conservative treatment for a long time, and then the higher Achilles tendon rupture rate, postoperative recovery slow. There are a number of complications traditional open surgery, and minimally invasive surgery in recent years developed a new technology that minimizes the exposure of the wound, reduce surgical trauma scope, shorten the operation time and reduce wound infection rate increasing importance in clinical practice, worthy of recommendation.

Objective: To investigate the feasibility of a nurse-led exercise and cognitive behavioral intervention for medium-advanced hepatocellular carcinoma patients with cancer-related fatigue, sleep quality and depression outcomes. Methods: A total of seventy-nine medium-advanced hepatocellular carcinoma patients were enrolled in this study, the patients were randomly assigned to intervention group and control group. The control group given conventional nursing intervention, intervention group received exercise and cognitive behavioral therapy. The baseline characteristics between two groups were compared, the fatigue outcome was measured by the Piper Fatigue Scale at before intervention, after a 2-week intervention, after a 6-week intervention. Besides, depression and sleep quality were measured using the self-rating depression scale and the Pittsburgh sleep quality index questionnaire, respectively. Results: After 2-week and 6-week of intervention, the fatigue scores in the intervention group (4.14±0.40 and 3.91±0.37) were markedly higher than in the control group (4.94±0.38 and 5.03±0.44) (t=9.116,12.195, all P<0.05). Moreover, the intervention group (44.74±6.01) points and (41.30±7.43) points demonstrated lower scores of depressions compared to the control group (50.53±7.49) and (48.39±6.16) after 2-week and 6-week of intervention (t=3.771,4.630, all P<0.05). The intervention group (7.25±0.36) points and (6.29±0.96) points also showed lower scores of sleep quality when compared to the control group (8.86±0.57) points and (7.86±0.91) points after 2-week and 6-week of intervention (t=2.013, 2.189, all P<0.05). Conclusion Nurse-delivered exercise and cognitive behavioral intervention have benefits in helping medium-advanced hepatocellular carcinoma patients to decrease cancer-related fatigue, depressive symptoms, and improving their quality of sleep.