Objective To discuss the technical method,safety and clinical efficacy of CT-guided 125I radioactive seed implantation for the treatment of mediastinal lymph node metastases.Methods CT-guided 125I radioactive seed implantation was carried out in 11 patients with mediastinal lymph node metastases.Before 125I seed implantation,the interstitial brachytherapy treatment planning system (TPS) was employed to formulate a treatment plan.The particles with radioactivity of (1.11-2.96) × 107Bq (0.3-0.8 mCi) were used for the implantation.Postoperative complications were recorded.The local lesion control rate and the effective rate of pain relief were evaluated at one,3,6 and 12 months after 125I seed implantation.Results After 125I seed implantation,pneumothorax occurred in 3 patients,tracheal fistula in one patient,and pulmonary infection in one patient.The local lesion control rates at one,3,6 and 12 months were 81.8％,90.9％,72.7％ and 72.7％ respectively;the effective rate of pain relief at one week,one,3,6 and 12 months were 100％,90.9％,90.9％,81.8％ and 72.7％ respectively.Conclusion For the treatment of mediastinal lymph node metastases,CT-guided radioactive 125I seed implantation is less-invasive with less complications,and it carries reliable local lesion control rate.Therefore,this technique is a safe therapeutic means.

Objective To explore the expression of vascular endothelial growth factor (VEGF) and apoptosis of the tumor cells in the different regions of rabbit liver VX2 tumor after radiofrequency ablation (RFA).Methods Forty-eight experimental rabbits were implanted with VX2 tumor.After successfully established the model,the rabbits were randomly divided into control group (n=6) and RFA group (n=42).In the RFA group,7 rabbits at each time point were killed at immediately,1 day,2 days,1 week,2 weeks,3 weeks after RFA,and the tumor specimens were retained and performed with HE staining,VEGF,Annexin V-FITC/PI labeling,flow cytometry analysis.The changes of VEGF and apoptosis of the cells in different periods and different zones after RFA were observed.Results After the operation,the difference of the VEGF value of the needle zone,coagulation necrotic zone and junction zone had statistically significant (all P＜0.05).The difference of the VEGF value in each zone between immediately and the other time points after operation by pairwise comparisons were significantly different (all P＜0.05).The VEGF value of the needle zone and coagulation necrotic zone reached the peak after operation immediately,which declined from 1 day to 3 weeks after operative.And VEGF of the junction zone increased from immediately to 1 week after operation,and declined 2 weeks after operation.There were significant differences in the apoptosis rate of the three zones after RFA compared with control group (all P＜0.05).The apoptosis rate in all zones were at the peak on the 1 day after operation,and then showed a downward trend.Conclusion The reduction of VEGF and apoptosis of tumor cells in the needle zone and coagulation necrotic zone are significant,but tumor remnant remains visible in the junction zone.In the third week after RFA,the proliferation of the remaining tumor cells can be recurrent to preoperative levels,which suggests that the further treatment should be performed at this period.

Objective:To explore the epidemiological characteristics of geriatric hip fractures in Beijing so as to provide evidence for effective prevention and control measures.Methods:This multicenter study was conducted in 3 urban (Beijing Jishuitan Hospital, Beijing Hospital and Beijing Anzhen Hospital) and 3 suburban hospitals (Beijing Shunyi District Hospital, Beijing Changping District Hospital and Beijing Liangxiang Hospital) in Beijing from November 2018 to November 2019. Eligible patients were those aged ≥ 65 years with hip fracture confirmed by X-ray and being admitted to hospital within 21 days of injury. To explore the epidemiological characteristics of geriatric hip fractures in Beijing, such data were collected as patients' age, gender, comorbidities, as well as type, site, time and cause of the fracture.Results:① A total of 2,071 patients were included in this suevey. They were 653 males and 1,418 females (M∶F=1∶2.17). Their age ranged from 65 to 102 years (average, 79.8 years). The patients aged from 75 to 84 years were the most common, accounting for 44.81% (928/2,071). ② Femoral neck fractures accounted for 43.41% (899/2,071), and intertrochanteric fractures accounted for 56.59% (1,172/2,071). The age of the patients with femoral neck fracture was (78.6±7.7) years, which was significantly younger than that of those with intertrochanteric fracture [(80.7±7.4) years] ( P<0.05). ③ 94.69% of the hip fractures (1,961/2,071) were caused by falling, and 71.27% fractures (1,476/2,071) happened at home. ④ Approximately 83.00% of the patients (1,719/2,071) had one or more comorbid conditions. Hypertension was the most prevalent disease (57.89%, 1,199/2,071), followed by diabetes (27.09%, 561/2,071), and coronary atherosclerotic heart disease (22.02%, 456/2,071). Conclusions:In Beijing, significantly more geriatric females sustain a hip fracture than males, and the proportion of those aged from 75 to 84 year is the largest. The proportion of intertrochanteric fractures increases with age. Falls are the leading cause for geriatric hip fractures. Most of the patients have one or more chronic comorbid conditions. Corresponding prevention and intervention measures should be formulated according to the distribution characteristics of elderly hip fractures in Beijing.

Objective:To improve the quality standard of Xiaoer Shenzhu Jianpi Pills.Methods:The microscopic identification method was used to qualitatively identify Hordei Fructus Germinatus.TLC was used to qualitatively i-dentify of Atractylodis Macrocephalae Rhizoma,Glycyrrhizae Radix Et Rhizoma,Citri Reticulatae Pericapium.HPLC was adopted to determine the contents of hesperidin and ammonium glycyrrhizinate.Results:The microscop-ic identification of Hordei Fructus Germinatus had strong specificity and high viewing rate.The TLC identification spots of Atractylodis Macrocephalae Rhizoma,Glycyrrhizae Radix Et Rhizoma,Citri Reticulatae Pericapium were clear,with good separation and durability.The linear ranges of hesperidin and ammonium glycyrrhizinate were 0.060 0-1.501 0 μg and 0.020 1-0.502 2 μg,respectively(r≥0.999 8).The average recoveries(n=9)were 99％,96％and RSDs were 2.8％and 1.8％.The RSDs of precision,stability and repeatability of the two components were less than 3.0％.Conclusion:The newly established quality standard increases the quality control research of microscopic identification,thin layer chromatography and content determination.The experimental method is accurate and reliable,simple and fast,and has good applicability.It can be used for the quality control and evaluation of Xiaoer Shenzhu Jianpi Pills.

Objective To investigate the clinical efficacies of free endoscopic nasobiliary drainage (ENBD) in primary duct closure (PDC) following laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis.Methods The retrospective cohort study was conducted.The clinical data of 312 patients with extrahepatic bile duct stones accompanied with or without cholecystolithiasis who were admitted to the 11 medical centers [86 in the Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,62 in the Second Affiliated Hospital of Zhejiang University School of Medicine,44 in the West China Hospital of Sichuan University,29 in the First Affiliated Hospital of Xi'an Jiaotong University,27 in the First Hospital Affiliated to Army Medical University (Third Military Medical University),25 in the Hunan Provincial People's Hospital,17 in the Beijing Friendship Hospital of Capital Medical University,10 in the First Affiliated Hospital of Hainan Medical University,5 in the Henan Provincial People's Hospital,4 in the Beijing Tian Tan Hospital of Capital Medical University,3 in the First Affiliated Hospital of Fujian Medical University] from January 2011 to June 2017 were collected.All patients underwent LCBDE+PDC,and 81 and 231 patients with and without ENBD were respectively allocated into the ENBD group and PDC group.Observation indicators:(1) comparisons of operation situations;(2) comparisons of postoperative recovery;(3) comparisons of postoperative complications;(4) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative complications up to June 2017.Measurement data with normal distribution were represented as x±s.Comparison between groups was analyzed by the t test.Measurement data with skewed distribution were represented M [interquartile range (IQR)],and comparison between groups was analyzed by the nonparametic test.Comparisons of count data were analyzed using the chi-square test and Fisher exact probability.Results (1) Comparisons of operation situations:all the 312 patients underwent successful laparoscopic LCBDE + PDC,without conversion to open surgery,including postoperative death of 1 patient in the PDC group.The common bile duct diameter,cases using interrupted sutures,continuous sutures,absorbable threads and nonabsorbable threads were respectively (1.2±0.4)cm,106,125,195,36 in the PDC group and (1.1±0.5)cm,76,5,79,2 in the ENBD group,with statistically significant differences between groups (t =2.497,x2 =56.706,8.457,P＜0.05).The numbers of stones,stone diameter,cases with common bile duct wall (≤ 3 mm and ＞3 mm),normal and abnormal Oddi sphincter contraction function,volume of intraoperative blood loss and operation time were respectively 2.1±1.7,(1.1-±0.6)cm,148,83,226,5,20 mL (10-45 mL),(116± 49)minutes in the PDC group and 1.9±1.6,(1.0±0.6)cm,49,32,75,6,20 mL (15-30 mL),(113± 23)minutes in the ENBD group,with no statistically significant difference between groups (t =1.021,0.329,x2 =0.329,3.428,Z=1.147,t=0.521,P＞0.05).The further analysis:of 312 patients,cases and time using interrupted sutures and continuous sutures were respectively 182,130 and (133±.49) minutes,(103±34) minutes,with a statistically significant difference between groups (t =-6.605,P＜0.05).The volume of intraoperative blood loss and cases with postoperative complications using interrupted sutures and continuous sutures were respectively 20 mL (15-31 mL),21 and 20 mL (10-45 mL),18,with no statistically significant difference between groups (Z =-0.285,x2 =0.369,P＞ 0.05).Of 312 patients,cases,operation time,volume of intraoperative blood loss and postoperative complications using absorbable threads and non-absorbable threads were respectively 274,(116±44)minutes,20 mL (15-40 mL),33 and 38,(115±35) minutes,18 mL (10-26 mL),6,with no statistically significant difference between groups (Z =0.971,t =0.023,x2 =0.154,P＞ 0.05).(2) Comparisons of postoperative recovery:recovery time of gastrointestinal function,time of abdominal drainage-tube removal,using time of antibiotics and duration of hospital stay were respectively (2.0± 1.5) days,(4.0 ± 2.4) days,(4.0±2.8) days,(5.5±3.0) days in the PDC group and (4.0±1.9) days,(6.9±3.5) days,(10.0± 3.9) days,(11.1±3.7)days in the ENBD group,with statistically significant differences between groups (t =-9.507,-8.258,-15.103,-13.575,P＜0.05).The total expenses of hospital stay in the Affiliated Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology were respectively (5.1 ±0.6)× 104 yuan in the PDC group and (6.5-±0.5)× 104 yuan in the ENBD group,with a statistically significant difference between groups (t =-9.516,P＜0.05).(3) Comparisons of postoperative complications:incidence of complications in the PDC group was 14.29％ (33/231),including 16 with biliary fistula,11 with biliary tract infection,3 with wound infection,1 with biliary tract bleeding,1 with residual stones of common bile duct and 1 with death;incidence of complications in the ENBD group was 6.17％ (5/81),including 2 with biliary fistula,2 with biliary tract infection and 1 with biliary tract bleeding,showing no statistically significant difference between groups (x2 =3.151,P＞0.05).(4) Follow-up situations:of 312 patients,252 were followed up for 2-67 month,with a median time of 15 months,including 175 in the PDC group and 77 in the ENBD group.During the follow up,there was no occurrence of jaundice,cholangitis and pancreatitis,and stone recurrence and postoperative cholangiostenosis were not detected by abdominal color Doppler ultrasound or CT or magnetic resonanced cholangio-pancreatography.Conclusion On the basis of grasping operative indication strictly,ENBD in PDC following LCBDE for choledocholithiasis is safe and effective.

Objective:To evaluate the safety and efficacy of combination of transjugular intrahepatic portosystemic shunt (TIPS) combined with interventional therapy for primary hepatic carcinoma complicated with portal hypertension.Methods:From October 2013 to December 2017, medical records of 141 patients with primary hepatic carcinoma complicated with portal hypertension hospitalized and treated in Anhui Provincial Cancer Hospital were collected. According to the inclusion and exclusion criteria, 32 cases were in the TIPS combined with interventional treatment group and 29 cases were included in the intervention-only group after age, gender, mean tumor diameter and Child-Pugh classification matched with TIPS combined with intervention treatment group. The efficacy of TIPS was obsented, and the related complications and prognosis of the two groups at six, 12 and 24 months after treatment were compared. Independent sample t test, Mann-Whitney U test and Chi-square test were used for statistical analysis, and Kaplan-Merier method was used for survival analysis. Results:There were no statistically significant differences between TIPS combined with intervention group and intervention-only group in age, gender, mean tumor diameter, Child-Pugh classification, Child-Turcotte-Pugh (CTP) score, Barcelona staging, interventional treatment, causes of liver cirrhosis, portal hypertension related symptoms , portal vein tumor thrombus, alanine aminotransferase (ALT), and total bilirubin (TBil) (all P>0.05). The success rate of TIPS of patients in TIPS combined with intervention group was 100% (32/32). All the portal hypertension related symptoms after TIPS were relieved, and the remission rate was 100% (32/32). Compared with that before TIPS, after TIPS, the portal vein pressure decreased ((36.5±6.9) cmH 2O vs. (25.5±5.6) cmH 2O (1 cmH 2O=0.098 kPa)), the diameter of portal vein decreased ((15.9±3.5) mm vs. (13.7±2.7) mm), and ascites volume decreased (abdominal circumference ((105.6±13.9) cm vs. (88.0±9.8) cm), red blood cell count ((2.6±0.8)×10 12/L vs. (3.3±1.3)×10 12 /L) and hemoglobin level ((78.9±15.5) g/L vs. (108.4±14.6) g/L) both increased, and the differences were statistically significant ( t=2.866, 3.105, 10.769, -3.548 and -3.869, all P<0.01). The stent patency rate six months after TIPS was 100% (32/32), the 12-month patency rate was 94% (30/32), and the 24-month patency rate was 84% (27/32). Six months, 12 months and 24 months after treatment, the incidence of ascites of patients in the TIPS combined with interventional treatment group was 0, 3.1% (1/32) and 9.4% (3/32), respectively, and the incidence of bleeding was 3.1% (1/32), 9.4% (3/32) and 15. 6% (5/32), respectively, which were all lower than those of the intervention-only group (13.8%, 4/29; 27.6%, 8/29; 65.5%, 19/29; 20.7%, 6/29; 34.5%, 10/29 and 62.1%, 18/29), and the differences were statistically significant ( χ2=4.72, 7.24, 20.80; and 4.62, 5.72, 13.97; all P<0.05). There were no statistically significant differences in the incidence rates of hepatic encephalopathy 6 and 12 months after treatment between the two groups (both P>0.05). The incidence of hepatic encephalopathy of intervention-only group (48.3%, 14/29) 24 months after treatment was higher than that of TIPS combined with intervention group (21.9%, 7/32), and the difference was statistically significant ( χ2=4.70, P=0.030). The results of Kaplan-Merier analysis indicated that 12 and 24 months after treatment the cumulative survival rates of TIPS combined with intervention group (84.4%, 27/32 and 53.1%, 17/32) were both higher than those of the intervention-only group (41.4%, 12/29 and 13.8%, 4/29), and the differences were statistically significant ( χ2=12.20 and 5.06, both P<0.05). The median survival time of TIPS combined with intervention group was 25 months, which was longer than that of the intervention-only group (12 months), and the difference was statistically significant ( Z=3.341, P=0.001). Conclusions:TIPS combined with interventional therapy is safe and effective in the treatment of primary hepatic carcinoma complicated with portal hypertension, which can improve the quality of life and increase the survival rate.

Adenoid cystic carcinoma usually occurs in the salivary glands of the head and neck. It is a malignant tumor with a high degree of malignancy, resistance to radiotherapy and chemotherapy and poor prognosis. The clinical course of adenoid cystic carcinoma is slow and easy to be misdiagnosed. The main diagnosis and treatment means are individualized and precise treatment under the multi-disciplinary consultation mode, that is, surgical treatment and radiotherapy and chemotherapy. Adenoid cystic carcinoma is prone to relapse and hematologic metastasis, and the traditional radiotherapy and chemotherapy based therapies have not achieved satisfactory efficacy in the past three decades. How to detect, diagnose and treat early is an urgent task faced by clinicians.
Humans ; Carcinoma, Adenoid Cystic/pathology* ; Neoplasm Recurrence, Local ; Neck/pathology* ; Oropharynx/pathology* ; Diagnostic Errors