Objective To compare the efficacy for aged patients with locally advanced esophageal cancer who accepted 3D-CRT with or without S-1.Methods 62 aged patients with locally advanced esophageal cancer were randomized divided into three groups in Central Hospital of Kaifeng since March,2009.The S-1 combined with radiotherapy group was 26 patients as combined group,the single radiotherapy group was 20 patients and single drug group was 16 patients.S-1 combined group patients accepted 3D-CRT,and the patients were taken S-1 from the first day,the dose was 40 mg/m2 twice a day continually 14 days and then stop 7 days.There were 2 cycles during radiotherapy.The 20 patients accepted 3D-CRT in single radiotherapy group,and the patients in single drug group were taken S-1 only,the dose was 40 mg/m2 twice a day continually 28 days and then stop 14 days within 28 days.Results The response rate was 92.31％ in S-1 combined group,with 13 patients CR,11 patients PR,and 1 patient SD.The response rate was 60.00 ％ in single radiotherapy group,with 4 patients CR,8 patients PR and 6 patients SD.The response rate was 31.25 ％ in single drug group,with 1 patients CR,4 patients PR and 6 patients SD.The effect of the S-1 combined with radiotherapy group was significant better than the others (P ＜ 0.05).The 1,2 and 3 year survival rates in each group were 76.92 ％,57.69 ％,42.31％,75.00 ％,55.00 ％,40.00 ％ and 68.75 ％,50.00 ％,25.00 ％,which there is no significant difference in the three groups.The adverse reaction of hematologic toxicity in S-1 combined with radiotherapy group was little higher than the others,still there was no significant difference in the incidence rate of radiation esophagitis and radiation pneumonitis between S-1 combined with radiotherapy group and single radiotherapy group.Conclusion S-1 plus three dimensional conformal radiotherapy treatments were reliable,and the adverse reactions were mild and well tolerated for elderly patients with locally advanced esophageal cancer.

Objective To investigate the feasibility and clinical application of prospective ECG-gated scan and adaptive cardio se-quence scan of dual-source CT coronary angiography.Methods 255 patients who underwent coronary CT angiography using a dual-source CT scanner were divided into two groups:group A underwent prospective scan,group B underwent retrospective scan.The two groups were further subdivided into low heart rate group and high heart rate group,recorded as A1(n=51),A2(n=89),B1(n=26), B2(n=89),respectively.Group A1 preceded with prospective ECG gated scan;group A2 performed with adaptive cardio sequence scan;group B1 and B2 underwent retrospective scan.All of them applied ATCM (automatic tube current modulation)technique. Effective dose was recorded.The image quality was assessed by two experienced radiologists with a four-point grading scale.Results The excellent or good image quality (score 1 and 2)of the four groups were above 95%,and no statistical differences in images scores was detected in A1 and B1 (P =0.726),A2 and B2 (P =0.079).Effective dose was significantly different in A1 and B1(P <0.001),A2 and B2 (P <0.001),and the former decreased 50% and 40% as compared with the latter.Conclusion Using prospective ECG gated scan and adaptive cardio sequence scan,assessable image quality of coronary artery can be acquired with dual source CT (heart rate<90 beast per minute),and radiation dose can be obviously reduced.

Objective To assess the technical feasibility and efficacy of the combined application of a flexible,self-expanding neurovascular stent(Neuroform)and Gugliebni detachable coils(GDC)in the management of wide-necked intracranial aneurysms in humans.Methods Sixty-five wide-necked aneurysms which underwent 65 endovascular procedures were performed by using intracranial stent and GDC.There was a total of 30 aneurysms at basilar artery including 16 at the basilar tip,9 at the basilar trunk and 5 at the beginning of the basilar artery.And there were 30 aneurysms located at the posterior communicating artery, and 5 aneurysms located at the vertebral artery.The Neuroform stents were deployed to cover the neck of aneurysms.Another microcatheter was introduced into the aneurysm sac through the stent interstices and then detachable coils were released to embolize the aneurysms.Results The combined procedures were successful in all of the 65 patients with wide-necked aneurysms.The stent could pass smoothly through the intracranial artery and got released.Complete occlusion was achieved in 60 patients and incomplete occlusion in 5 patients.In-stent thrombosis occurred in 2 patients.All patients recovered well.Forty-two patients had followe-up angiography at 3 to 6 months after the procedure.Among them,no filling was found for the 39 aneurysms which were densely packed,and 3 aneurysms had neck remnant.Conclusion The implantation of Neuroform stent as a complimentary device to GDC coiling is easy and safe for embolization of wide-necked intracranial aneurysms.It has great advantage for treatment of wide-necked intracranial aneurysms.

OBJECTIVETo study clinical and imaging features of hypothalamic hamartoma in children.

METHODSImaging findings and clinical manifestations of 38 children with hypothalamic hamartomas were retrospectively reviewed. The patients included 25 boys and 13 girls, ranging in age of onset from 1 month to 15 years. All the 38 patients were examined with pre-contrast and post-contrast T1 weighted MR imaging and with non-contrast T2 weighted MR imaging. Meanwhile, 10 patients received CT scan. Hypothalamic hamartomas were confimed by pathologic examinations in the 38 patients.

RESULTSGelastic epilepsy, precocious puberty, other types of epilepsy and disturbance of intelligence were main manifestations in the 38 patients. Gelastic epilepsy was found as an initial clinical symptom in 17 cases, precocious puberty in 13 cases and other types of epilepsy in 8 cases. All masses were located in the suprasellar and interpeduncular cistern. They showed iso-density on CT scan, and homogeneous signal iso-intense to gray matter on T1 and T2 weighted MR images. With contrast MR images, there was no enhancement in the mass. The size or pedunculation of the mass was not correlated with clinical features.

CONCLUSIONSHypothalamic hamartoma may be characterized by precocious puberty and/or gelastic epilepsy and specific imaging findings mentioned above.

Adolescent ; Adult ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Hamartoma ; complications ; diagnosis ; pathology ; Humans ; Hypothalamic Neoplasms ; complications ; diagnosis ; pathology ; Infant ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

Objective To identify a unique protein as a novel genetic marker for rapid molecular typing of Mycobacteriutn tuberculosis Beijing genotype strains by comparing the proteome of Beijing genotype strains with non-Beijing strains.Methods Fifty-six clinical isolates of Mycobacterium tuber- culosis were analyzed by spoligotyping to determine genotypes.The two-dimensional electrophoresis (2 DE)was used to compare the global protein patterns between Beijing genotype strains and non Bei jing strains.Differential expressed proteins were measured by matrix assisted laser desorption ioniza tion lime of flight mass spectrometry(MALDI-TOF-MS).The data obtained from peptide mass fingerprinting were compared in protein database.The genes encoding differential expressed proteins and their upstream were sequenced.Results Forty nine of the 56 isolates were Beijing genotype strains and 7 isolates were non-Beijing strains.A unique protein Rv0927c was identified,which is absent in Beijing genotype strains compared with 7 non Beijing strains and H37Rv.There were two characteristic mutations in Beijing genotype strains,a deletion of AGC at nucleotide position 421 of Rv0927c and a 127 G→A muta- tion in the upstream of Rv0927c.but not in non Beijing strains and H37Rv.Conclusion Characteris tic mutations of Rv0927c in Beijing genotype strains can be used as a novel genetic marker for rapid molecular typing of Mycobacteriuln tuberculosis Beijing genotype strains and non Beijing strains.

Abstract: Objective　China was certified by World Health Organization as a malaria-free country in 2021. Malaria has become a rare infectious disease, and preventing the re-transmission of imported malaria and reducing deaths are the main challenges facing China after elimination of malaria. To analyze and clarify the characteristics of imported malaria deaths, and to provide prevention and treatment recommendations for overseas workers and health care workers. Methods　The data of 17 imported malaria deaths in the analysis of malaria deaths from 2016 to 2020 by the National Severe Malaria Treatment Expert Group were collected, and the relevant clinical epidemiological data and disease course records were analyzed. Results　The 17 malaria deaths were all imported from Africa with Plasmodium falciparum infection (malarial cerebral type), with no obvious regularity in the month of onset. Among them, 16 were male patients, 5 cases with underlying diseases such as diabetes mellitus, and 10 patients were first diagnosed in a second-level or lower hospital. Excluding patients who died of respiratory cardiac arrest in ambulances, the mean time difference between first onset and malaria diagnosis in 16 patients was 6.8 days (median 5.5 days), and the mean time between first onset and antimalarial treatment was 7.4 days (median 6 days), the mean time difference from initial onset to death was 10.3 days (median 8.5 days). Excluding cases with onset abroad and unknown time of return, all 14 patients developed the disease within 30 days after returning to China. Conclusion　All the fatal cases were infected with Plasmodium falciparum imported from Africa. The patients' awareness of actively seeking medical treatment is weak, and the delay in seeking medical treatment caused by the insufficient diagnosis and treatment capacity of health institutions at the township level and below is the main reason for the deaths. It is recommended to strengthen the self-protection awareness of staff in malaria-endemic areas overseas and raise their awareness of malaria. For returnees from areas with high malaria risk, primary medical institutions should pay attention to the patient's travel history in Africa, improve the awareness of malaria diagnosis, malaria diagnosis and treatment capabilities.

Objective Streptococcus pneumoniae can form biofilms .The aim of this study was to investigate the biofilm forma-tion of Streptococcus pneumoniae and the relationship with antibiotic resistance of penicillin etc . Methods A total of 147 clinical iso-lates of Streptococcus pneumoniae were collected from 7 teaching hospitals in Nanjing from 2010 to 2012.Minimal inhibitory concentration (MIC) of penicillin, erythromycin, cefuroxime and ceftriaxone were determined by agar dilution method .Streptococcus pneumoniae with various penicillin MIC was selected randomly as follow:MIC≤0.065μg/mL, 0.5μg/mL, 2μg/mL and≥4μg/mL, which was incuba-ted to form biofilms in 96-well plates and 24-well plates for 24 hours.The A values at 570 nm was measured and the biofilm was observed through confocal laser scanning microscope ( CLSM) . Results The biofilm semi-quantitative detection and CLSM both displayed that all strains formed biofilms.The A value of the group which penicillin MIC was ≤0.065μg/mL (0.228 ±0.063) was higher than the 0.5μg/mL group (0.200 ±0.061) and the≥4μg/mL group (0.186 ±0.050) (P<0.05) , and there was no difference among the groups which penicillin MIC were 0.5μg/mL, 2μg/mL and≥4μg/mL, respectively (P>0.05).The A value of the group which erythromycin MIC was ≤0.5μg/mL (0.211 ±0.068) was higher than the ≥4μg/mL group (0.201 ±0.052) (P>0.05).The A value of the group sensitive to cefuroxime (0.216 ±0.062) was higher than the group resistant to cefuroxime (0.196 ±0.054) (P<0.05). Conclusion Streptococcus pneumoniae can form biofilms .Streptococcus pneumoniae with high antibiotics MIC has a trend of weakened biofilm formation .

Objective To explore the changing levels of serumIL-17 and Dectin-1 and their implication in non-neutropenic pa-tients with invasive pulmonary aspergillosis (IPA).Methods The clinical data were reviewed for 23 non-neutropenic patients with clinical diagnosis of IPA (IPA group),31 patients with clinical diagnosis of pneumonia (pneumonia group)and 51 healthy subjects(control group).The peripheral serum was collected to analyze IL-17 level by ELISA.Serum Dectin-1 level was also determined at the same time.Serum G test,GM test,WBC and CRP level were also assayed for the patients in IPA group.Pa-tient outcome was followed up and analyzed in terms of serum IL-17.Results The serum IL-17 level of the patients in IPA group was significantly higher than that in the control group (P <0.05).The serum IL-17 level in the pneumonia group was not significantly different from that in the control group (P >0.05).The serum Dectin-1 level in IPA group was significantly higher than that in the control group (P <0.05).For the patients in IPA group,serum IL-17 level was positively correlated to serum Dectin-1 level (r=0.81 ,P <0.05),while serum IL-17 and Dectin-1 levels were not correlated to the results of G test, GM test, WBC,CRP or patient outcome (P > 0.05 ). Conclusions Dectin-1 may be produced and Th17 cell immunity activated in response to Aspergillus fumigatus in-fection in non-neutropenic patients.And,serum Dectin-1 level is correlated with Th17 response.

Objective To investigate the clinical features of renal tumor patients with yon Hip-pel-Lindau (VHL) disease. Methods Clinical data of 9 renal tumor cases with VHL disease were analyzed and reviewed. The renal tumor characteristics were compared with data of 46 sporadic renal cell cancer (SRCC) cases during the same period. Results In the 9 renal tumor cases with VHL dis-ease presented, significant statistical differences were found in the aspects of bilateralness (7 vs 0), ipsilateral multicentricity(5 vs 2)and cystic growth pattern(6 vs 1) compared with SRCC (P＜0.01). During the average follow-up period of 54 months, no significant difference was found in the median survival between VHL disease patients and SRCC patients(136 vs 42 months). However, a better tendency of VHL disease over SRCC was found in survival curve study. Conclusions VHL disease should be considered when renal tumors present bilateral, multicentric or with cystic growth pattern. Management should be individualized with close watchful waiting in combination with nephron sparing surgery. Nephrectomy should be avoided when possible.

Objective To investigate the effects of ropivacaine infiltration combined with dezocine on the agitation during recovery from general anesthesia in the patients undergoing cerebral surgery.Methods Sixty patients of both sexes,aged 18-64 yr,of ASA physical status Ⅰ or Ⅱ,undergoing elective neurosurgery under general anesthesia,were randomly divided into 4 groups (n =15 each) using a random number table:control group (group C),ropivacaine group (group R),dezocine group (group D),and ropivacaine + dezocine group (group RD).Group C received local infiltration with normal saline 20 ml at 10 min before skin incision,and normal saline 2 ml was injected intravenously at 30 min before the end of operation.The patients received local infiltration with 0.5％ ropivacaine 20 ml at 10 min before skin incision,and normal saline 2 ml was injected intravenously at 30 min before the end of operation in group R.Group D received local infiltration with normal saline 20 ml at 10 min before skin incision,and dezocine 10 mg was injected intravenously at 30 min before the end of operation.The patients received local infiltration with 0.5％ ropivacaine 20 ml at 10 min before skin incision,and dezocine 10 mg was injected intravenously at 30 min before the end of operation in group RD.The time for recovery from anesthesia,extubation time,and development of agitation after extubation in PACU were recorded.Agitation was assessed and scored.Ramsay sedation score and VAS score were recorded immediately after extubation.The development of cardiovascular events and respiratory depression was recorded within 10 min after extubation.Before induction of anesthesia (T0),at the end of surgery (T1) and immediately after extubation (T2),blood samples were collected from the dorsal artery of foot for deter mination of the levels of blood glucose,plasma cortisone,epinephrine and norepinephrine.Results Compared with group C,the agitation score,incidence of agitation,VAS score,and incidence of postoperative hypertension were significantly decreased in R,D and RD groups,especially in R and D groups.The time for recovery from anesthesia and time for extubation were significantly shorter in R and RD groups than in group C.Ramsay sedation scores were significantly higher at the onset of extubation in R,D and RD groups than in group C.Ramsay sedation scores were significantly higher in D and RD groups than in group R.Compared with group C,the levels of blood glucose,plasma cortisone,epinephrine and norepinephrine were significantly decreased in R,D and RD groups,especially in group RD.Conclusion Ropivacaine infiltration combined with dezocine can reduce the agitation during recovery from general anesthesia in the patients undergoing cerebral surgery.