Xiao Chai Hu Tang (XCHT), a blended decoction of multiple chinese medicinal herbs, was tested in combination with radiation therapy for moderate or advanced squamous carcinoma of the esophagus. A total of 66 such patients were randomized into a combined group (33 patients, XCHT + radiotherapy) and a radiation only group (33 patients, RT). Telecobalt irradiation, D T 40～70 Gy, was given to the RT group. Similar telecobalt, D T 40～68 Gy with concomitant XCHT, I dose po/day to a total of 28～50 doses, was given to the combined group. The grades Ⅰ+Ⅱresponse rate of the combined group were higher than that of the RT group. The 1-, 3-and 5 year survival rates of the combined group (69.7%, 40.9%, 25.0%) also surpassed those of the RT group (45.5%, 14.3%, 9.1%). There was statistical significance in the differences in the 1-and 3-years survival rates between the combined and RT groupsFurthermore, XCHT was able to alleviate some of the toxic reactions of radiotherapy for esophageal carcinoma.

Objective To study the predetermination value of multi-slice spiral CT for showing the major blood vessels,bile and pancreatic ducts around normal duodenal papilla before EST.Methods A 16-slice spiral CT was used to perform 28s and 68s enhanced scan for normal structures surrounding duodenal papilla in 30 subjects.Post-processing was done to the raw data with thin-slice maximum intensity projection (TSMIP) and thin-slice average intensity projection (TSAIP),and then the structure of bile and pancreatic ducts,duodenal artery and pancreatic-duodenal conjunction were reconstructed.The reconstructed images were double-blind evaluated.Distances between papilla and upper,front,and behind edge of the pancreatic-duodenal conjunction,situation of the duodenal papilla artery and the distance from the papilla artery end to the papilla were recorded.Results After dual-phase enhanced scan,the post-processing results for the images of the surrounding structure of pancreatic and duodenal papilla were stable and the results of double-blind evaluation were consistent.Image scores of the arteries surrounding duodenal papilla and pancreatic duct at 28th second were significantly higher than those of 68th second,whereas bile duct and the ampulla structure image scores of 68th second were higher.TSMIP of local vascular structure could display anterior-superior pancreatic-duodenal artery (ASPDA) in 93.3％ of the subjects,posterior-superior pancreatic-duodenal artery (PSPDA) in 73.3％,inferior pancreatic-duodenal artery (IPDA) in 73.3％,duodenal-papillary artery (DPA) in 56.7％,bile duct in 96.7％,pancreatic duct in 90.0％ aud pancreatic and duodenal parenchima in 100.0％.The DPAs all started from PSPDA origin and down to papilla,with only 2 cases of 30 (6.7％) reached the upper edge of the duodenal papilla.Others showed arteries turned thin obviously at 12 mm above the papilla; the normal common bile duct can be tracked to the opening of the papilla.The Coronal Oblique TSAIP imaging showed the distance from the duodenal papilla-bile duct ending to the lower edge of the pancreatic-duodeual upper conjunction was 15.7±1.9 mm.Distance from papilla to the front edge of pancreatic-duodenal conjunction was 16.6±3.2 mm and to the behind edge was 1.7±0.4 mm.Distance (depth) from the inner edge of the papilla to the bile-pancreatic conjunction was 8.0±1.7 mm.Conclusion The 3D reconstruction of the Multi-slice spiral enhancement CT Imaging can providc high quality images of relative vascular,bile-pancreatic and obvious surrounding structures to the forthcoming operation.Massive hemorrhage and perforation risks of EST can be evaluated based on the vascular distribution and directions around duodenum and pancreas and the bile duct imaging.

Objective To evaluate effects and possible mechanisms of ileal transposition on spontaneous non-obese type 2 diabetic GK rats.Methods 20 GK rats were randomly divided into two groups:ileal transposition group and sham operation group (n =10).We observed and determined the weight change,daily average food consumption and FBG (fasting blood-glucose) level of rats before the operation (0 weeks) and 1,4,8,16 and 24 weeks after the surgery.Glucose tolerance test (GTT) was carried out and GLP-1 (glucagon-like peptide-1) concentration measured before the operation (0 weeks) and 4,8,16 and 24 weeks after the surgery and the fasting insulin concentration before the surgery (0 weeks)and 4,24 weeks after the surgery measured,and the indicator of HOMA-IR calculated.Results There was no significant difference in the operating time between the two groups [(87 ± 8) min vs.(84 ± 7)min],P ＞ 0.05.Compared with those before surgery,body weight and food consumption of the two groups of rats decreased significantly a week after surgery (P ＜ 0.05),and then the body weight and food consumption of the two groups of rats all gradually increased,but the difference of the two groups of rats has no statistical significance 1-24 weeks after surgery (P ＞ 0.05).The FBG of the two groups of rats a week after surgery [ileal transposition group (6.1 ± 0.6) mmol/L,sham operation group (6.2 ± 0.8) mmol/L]decreased significantly compared with that before surgery [(7.0 ± 0.5) mmol/L and (6.9 ± 0.5) mmol/L](P ＜ 0.05),and then FBG of the two groups of rats all rose again.The FBG of the rats in surgery group decreased slowly from 8 to 24 weeks after surgery,while the FBG of the rats in the sham surgery group maintained the preoperative level,and the differences of the FBG of the two groups all have statistical significance 8-24 weeks after surgery (P ＜ 0.05).Four weeks after surgery,OGTT of the ileal transposition group significantly improved (P ＜ 0.01).24 weeks after surgery,fasting insulin levels of the ileal transposition group were lower [(0.26 ± 0.08) ng/mL vs.(0.42 ± 0.09) ng/ml],P ＜ 0.05.Compared with the sham surgery group,and HOMA-IR was lower (1.1 ± 0.4) vs.(2.6 ± 0.4),P ＜ 0.05.Four weeks after surgery,oral glucose-stimulated peak (30 min) levels of blood GLP-1 increased markedly in operation groups after surgery (P ＜ 0.01).Conclusions Ileal transposition is effective for the treatment of non-obese T2DM rats,and the control of blood glucose does not depend on the reduction of body weight and food comsumption,and the high secretion of GLP-1 after ileal interposition seem to be helpful in diabetes control.

Objective To report a multiple metastatic renal cell carcinoma (RCC) case successfully treated with cytoreductive nephrectomy after neoadjuvant Sunitinib,and discuss the efficacy and treatment regime of neoadjuvant targeting therapy.Methods A 51 years man presented with painless gross hematuria for one week and admitted into our hospital in August 2010.Abdominal CT demonstrated a 6.6 cm ×6.3 cm left lower pole renal tumor associated with renal vein tumor thrombus,bulky hilar lymph nodes and extensive local invasion.The patient was also found to have lung and right tibial metastasis.The clinical stage was T3bN1 M1.Percutaneous biopsy confirmed clear cell renal carcinoma.Neoadjuvant Sunitinib 50 mg daily was administered with 4 weeks on,2 weeks off schedule for two cycles.Cytoreductive nephrectomy was preformed 2 weeks after discontinuation of neoadjuvant Sunitinib.Imaging evaluation was performed to assess the primary tumor and metastatic sites.The patient was followed up till present.Results After two cycles of neoadjuvant treatment,CT scan revealed 23％ size reduction of left renal tumor to 5.1 cm ×4.4 cm,renal vein tumor thrombus regression,local perirenal invasion improvement,lung metastasis resolution and static right tibial metastasis.According to RECIST criteria,the objective response was stabilization of disease (SD).Cytoreductive nephrectomy was successfully performed to remove the primary tumor in December 2010.Pathology revealed Fuhrman Ⅱ renal cell carcinoma with major necrosis in primary tumor and thrombus localized in renal vein.During 6 months of post-operative follow-up,there was no local recurrence,lung metastasis had vanished completely and tibial metastasis had not progressed.Local recurrence and other distant metastasis were not demonstrated in 20mon follow-up till now.Disease control of this patient was partial response (PR) by RECIST.Conclusions Neoadjuvant Sunitinib treatment could result in downstaging of primary tumor and facilitate cytoreductive nephrectomy,thus eventually increase patient overall survival.

Objective:To compare the clinical efficacy between wrist arthroscopy-assisted ulnar head Wafer resection and ulnar shortening osteotomy in the treatment of ulnar impaction syndrome.Methods:From March 2012 to February 2017, 45 patients with ulnar impaction syndrome were treated at Department of Hand Surgery, No. 6 Hospital of Ningbo. They were 26 males and 19 females, aged from 28 to 48 years (average, 38 years). The right side was affected in 31 cases and the left side in 14. They were divided into 2 groups according to different surgical methods: 22 patients were subjected to arthroscopy-assisted ulnar head Wafer resection (the resection group) and 23 to open ulnar shortening osteotomy and internal fixation (the osteotomy group). Preoperative X-rays were taken to evaluate the height of positive ulnar variances and MRI was used to initially assess the damages to triangular fibrocartilage disc complex (TFCC), the semilunare and the tri-quetrum. Arthroscopy was conducted to evaluate intra-articular conditions, remove hyperplastic synovial membrane and repair the injured TFCC. In the resection group, the patients underwent arthroscopic ulnar head Wafer resection while in the osteotomy group, the patients underwent open ulnar shortening osteotomy and plate fixation. The platelet-rich plasma (PRP) was injected into the wrist joint in all cases after operation. Regular follow-ups and X-rays were performed to observe healing of the ulna. The wrist function was evaluated by the modified Mayo scoring system.Results:There was no significant difference in the general data between the resection group and the osteotomy group, showing comparability beween groups( P>0.05). Twenty patients in the resection group were followed up for an average time of 13.7 months. Their modified Mayo scores were 80.3±6.2; 7 of them were rated as excellent, 11 as good and 2 as fair, yielding a good and excellent rate of 90.0%(18/20). Twenty-two patients in the osteotomy group were followed up for an average time of 14.3 months. Three of them reported slight pain at 6-month follow-up. Their modified Mayo scores were 85.1±5.9; 6 of them were rated as excellent, 13 as good and 3 as fair, yielding a good and excellent rate of 86.4%(19/22). There was a significant difference in the modified Mayo scores between the 2 groups ( P<0.05). Conclusion:In treatment of ulnar impaction syndrome with the height of positive ulnar variances ≤3 mm, wrist arthroscopy-assisted ulnar head Wafer resection can obtain better clinical results than ulnar shortening osteotomy.

There is a high probability of scaphoid nonunion after scaphoid fracture, which can lead to wrist arthritis and further to progressive aggravation of joint function, seriously affecting daily life and work. Currently, there are a variety of treatment methods for scaphoid bone nonunion at home and abroad, and surgical treatment is the major option, which includes open surgery and arthroscopy assisted minimally invasive surgery. Different operative methods have corresponding indications and contraindications with different therapeutic effects. Arthroscopic assisted technique is novel, minimally invasive, and reliable. This article reviews the treatment methods of scaphoid nonunion, including screw internal fixation, non vascularized bone graft, vascularized bone graft, anastomotic vascularized bone graft, bone block resection, arthrodesis, and arthroscopic minimally invasive surgery, so as to provide references for clinical treatment of scaphoid nonunion.

ObjectiveTo explore the intervention effect and molecular mechanism of Dabufei decoction in Dunhuang formula combined with cisplatin on Lewis lung adenocarcinoma-bearing mice. MethodFifty C57BL/6J mice were used， with 10 randomly assigned to the blank group （without modeling）， and 40 subcutaneously inoculated with Lewis cells to establish a Lewis lung adenocarcinoma-bearing mouse model. These 40 mice were randomly divided into the following four groups （with 10 mice in each group）： Model group （equal volume of physiological saline）， cisplatin group （5 mg·kg^-1）， Dabufei decoction group （14.35 g·kg^-1·d^-1）， and Dabufei decoction combined with cisplatin group （Dabufei decoction 14.35 g·kg^-1·d^-1 + cisplatin 5 mg·kg^-1）. Each group was treated continuously for 14 days. The general condition of the mice was observed， body weight changes were recorded， and the tumor inhibition rate， spleen index， and thymus index were calculated. Peripheral blood white blood cell （WBC）， platelet （PLT）， and hemoglobin （HGB） were detected by routine blood tests. Flow cytometry was used to detect the expression of CD4⁺CD25⁺FoxP3⁺ regulatory T cells （Treg） and natural killer （NK） cells in the spleen. Western blot and real-time quantitative polymerase chain reaction （Real-time PCR） were used to determine the expression of proteins and mRNA related to the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway in tumor tissues. ResultCompared with the blank group， the model group showed decreased body weight （P<0.05）， spleen index， and thymus index （P<0.05）， decreased percentage of NK cells in the spleen （P<0.05）， increased percentage of Treg cells （P<0.05）， and decreased counts of WBC， PLT， and HGB （P<0.05）. Compared with the model group， the Dabufei decoction group exhibited significant tumor growth inhibition， increased body weight， and reduced tumor weight （P<0.05）， increased percentage of NK cells （P<0.05）， decreased proportion of Treg cells （P<0.05）， and increased counts of WBC， PLT， and HGB （P<0.05）. In the cisplatin group， tumor growth was significantly inhibited， body weight significantly decreased （P<0.05）， and tumor weight significantly reduced （P<0.05）. The spleen index and thymus index decreased （P<0.05）， and the percentage of Treg cells significantly decreased （P<0.05）. The counts of WBC， PLT， and HGB significantly decreased （P<0.05）. In the Dabufei decoction combined with cisplatin group， tumor growth was significantly inhibited， and tumor weight significantly reduced （P<0.05）. The levels of phosphorylated PI3K， Akt， and mTOR proteins and mRNA in tumor tissues were significantly reduced in all medication groups （P<0.05）. Compared with the cisplatin group， the Dabufei decoction combined with cisplatin group showed significantly inhibited tumor growth， reduced tumor weight （P<0.05）， increased body weight （P<0.05）， increased spleen index and thymus index （P<0.05）， increased percentage of NK cells （P<0.05）， decreased percentage of Treg cells （P<0.05）， significantly increased counts of WBC， PLT， and HGB （P<0.05）， and reduced levels of phosphorylated PI3K， Akt， and mTOR and their mRNA （P<0.05）. ConclusionDabufei decoction combined with cisplatin has a synergistic effect with reduced toxicity， effectively regulating immune function， increasing the proportion of NK cells， reducing the proportion of Treg cells， improving bone marrow suppression， and downregulating the PI3K/Akt/mTOR signaling pathway to inhibit tumor growth in Lewis lung adenocarcinoma-bearing mice.

BACKGROUNDWhat benefits and toxicities patients acquire from the use of bevacizumab combined with firstline chemotherapy remains controversial. This study was performed to evaluate the efficacy and safety of first-line chemotherapy plus bevacizumab in patients with metastatic colorectal cancer (mCRC).

METHODSSeveral databases, including PubMed, Embase, and Cochrane Library, were searched up to April 30, 2013. Eligible studies were only randomized, controlled trials (RCTs) with a direct comparison between mCRC patients treated with and without bevacizumab. Overall risk ratio (RR), hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CI) were calculated employing fixed or random-effects models depending on the heterogeneity of the included trials.

RESULTSSix RCTs, including 1582 patients in chemotherapy plus bevacizumab group and 1484 patients in chemotherapyalone group, were included. Overall, the addition of bevacizumab to first-line chemotherapy increased overall response rate (ORR) by 4.5%, prolonged both progression-free survival (PFS) and overall survival (OS), and increased the rate of total Grades 3 or 4 adverse events (G3/4AEs) by 6.9%. Significant differences were found in ORR (RR = 1.22 (95% CI 1.01-1.46), P = 0.03), PFS (HR = 0.60 (95% CI 0.47-0.77), P < 0.0001), OS (HR = 0.83 (95% CI 0.70-0.97), P = 0.02), and any G3/4AEs (OR = 1.56 (95% CI 1.29-1.89), P < 0.00001).

CONCLUSIONBevacizumab is a valuable addition to the current first-line chemotherapy regimens used in patients with mCRC, because of conferring a significant improvement in ORR, PFS, and OS, even though it increased adverse events.

Angiogenesis Inhibitors ; therapeutic use ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Bevacizumab ; Colorectal Neoplasms ; drug therapy ; Humans ; Odds Ratio

Tuberculosis （TB） and human immunodeficiency virus infection / acquired immune deficiency syndrome （HIV/AIDS） are both serious global public health threats. Early detection of infected persons and/or patients through TB/HIV bi-directional screening is crucial for prevention and control strategy in China and globally. In recent years， with the promotion and application of new TB and HIV detection technologies worldwide， TB/HIV bi-directional screening technologies and strategies have made remarkable changes. This expert consensus introduces the significance and challenges of TB/HIV bi-directional screening， summarizes important progress of research and applications， and makes recommendations on screening measures and procedures to further strengthen TB/HIV bi-directional screening in China.