Objective To evaluate the efficacy of inspiring carbogen and low concentration oxygen combined with late coupe accelerated hyperfraction radiotherapy on esophageal carcinoma.Methods 74 patients with esophageal carcinoma were randomly divided into two groups:the trial group and the centrol group,which consisted of 37 patients respectively.6MV X-ray was employed in the two groups.The schedule of the trial group was as following:conventional radiotherapy of 1.8～2.0Gy per day was employed during the first phase to a total dose of 38～40Gy,followed by late course accelerated hyperfraetion radiotherapy(twice fractions per day,interval between two fractions more than 6 hours,1.3～1.4Gy per fraction,middle total dose of 64.2Gy).Carbogen and low concentraetion oxygen was inspired during the course of radiation.Results 71 patients were enrolled.At the end of radiation at a total dose of 38～40Gy,complete remission rate(CRR)in the trial group was 31%,whereas that in the control group was 19%(P＞0.05),when the whole radiotherapy was finished,the CRR was 57%and 31%(P＜0.05)respectively,and one month after radiotherapy.the CRR was 71%and 33%respectively(P＜0.01).Six months after radiotherapy,the CRR WaLa 74%and 36%respectively(P＜0.01).Thelocal controlrate of sixmonthswas 91% and 72% respectively in the two groups(P＜0.05).Conclusions Inspiring carbogen and low concentration oxygen combined with late course accelerated hyperfraction radiotherapy may sigllificantly improve short-term efficacy and local control rate in esophageal carcinoma patients in Ⅰ～Ⅲstage.Furthermore,its side effects can be tolerated,and its elongating life time of patients may be prognostic.

Objective To evaluate the efficacy and adverse effects of low doses gemcitabine chemotherapy combined with synchronous high-low oxygen radiotherapy in patients with locally advanced pancreatic cancer.Methods Fifty-six patients with locally advanced pancreatic cancer were randomly divided into two groups by envelop method:radio-chemotherapy group or chemotherapy group.Patients in radio-chmotherapy group were treated with low doses of gemcitabine chemotherapy ( 600 mg/m2 ) combined with high-low oxygen radiotherapy synchronously,paients in chmotherapy group were treated with full doses of gemcitabine chemotherapy ( 1000 mg/m2).The short-term effect,distant metastasis rate,clinical benefit rate,survival rate and adverse events of two groups were observed.Results There was one patient achievedcomplete relief and 15 patients achieved partial relief in radio-chemotherapy group with an overall effective rate of 66.7％ (16/24) ; there were 9 patients achieved partial relief in chemotherapy group with an overall effective rate of 36.0％ (9/25),the difference between the two groups was statistically significant (X2 =4.6082,P =0.0318 ).The clinical benefit rates were 83.3 ％ ( 20/24 ) and 60％ ( 15/25 ),respectively,the difference between the two groups was not statistically significant ( P =0.070).The distant metastasis rates were 66.7％(16/24) and 72％ (18/25),respectively,the difference between the two groups was not statistically significant (P =0.6855).The 12,24 months survival rates were 62.5％ vs 32％,37.5％ vs 12％,the difference between the two groups was statistically significant ( P =0.0325,0.0380).The incidence of serious adverse events was 45.8％ and 4 0 ％ without statistical difference.Conclusions Low doses of gemcitabine chemotherapy combined with high-low oxygen radiotherapy synchronously is better than full doses of gemcitabine chemotherapy with regard to total effective rates and 12,24 months survival rates,with no obvious increase in the incidence of serious adverse events.

objective To examine nuclear transIocation of peroxisome proliferator-activated receptor γ(PPARγ)in rats following focal cerebral ischemia/reperfusion(I/R),and to explore the significance of altered PPARγ,nuclear translocation in ischemic brain injury.Methods Healthy adult male SD rats underwent 60-min cerebral artery occlusion followed by reperfusion of 4,8,or 24 h,respectively.The cytoplasmic-to-nuclear shuttling of PPARγ was characterized by Western blot,immunohistochemical and immunofluoreseence staining.The effects of PPARγ agonist rosiglitazone (Ros) and antagonist GW9662 on I/R-induced PPARγ nuclear translocation were also examined in the present study. Furthermore,TTC staining war adopted to determine the change in cerebral infarction volume. Results (1)Western blot analysis revealed an increase of PPARγ in the nucleus and a simultaneous reduction in the cytosol following ischemia and reperfusion for 4 h(tcytosol=9.03,tmuclear=27.19,P=0.00).Prolonged the reperfusion further enhanced this I/R induced PPARγ translocation in a time-dependent manner.Using immunohistochemistry and immunofluorescence,nuclear PPAR γ positive staining increased from 48.3%in the sham control to 80.3% following ischemia and reperfusion for 24 h.(2)Western blot analysis revealed that PPARγ agonist Ros further increased I/R-induced nuclear enrichment of PPARγ,whereas PPARγ antagonist GW9662inhibited I/R-stimulated change in PPARγ.(3)When compared to the L/R group using TTC staining,Ros treatment significantly decreased the infarction volume by 48.40%(15.46±4.94 versus 29.96±3.39,t=5.93.P=0.00),whereas GW9662 increased by 58.95%(47.62±4.93 versus 29.96±3.39,t=7.23,P=0.00).Conclusions Cerebral I/R injury induces PPARγ translocation from the cytosol to the nucleus.This change may represent an intrinsic neuroprotective response against brain I/R injury.

Objective To evaluate the prevention and treatment effect of double-tube-drainage (DTD) method on anastomotic fistula(AF) after surgery of rectal carcinoma. Method One hundred and eight cases of rectal carcinoma with Dixon′s operation (from January 1998 to March 2005) were divided randomly into 2 groups: treatment group 52 cases underwent DTD, control group was 56 cases received a tube drainage. Results The incidence of anastomotic fistula were 1.9% and 14.3% in treatment group and control group, respectively. There was a significant difference between treatment group and control group (P

Objective To evaluate the efficacy of low dose 5-fluorouracil (5-Fu) combined with triamcinolone in the treatment of keloids, comparing with results with use of triamcinolone treatment alone.Methods Patient records from 2012 to 2013 were reviewed.45 patients (56 keloids) were completely randomized into 2 groups.Low dose of 5-Fu combined with triamcinolone were used to treat keloids in group A, while triamcinolone alone was used in group B.The therapeutic effects were evaluated by the certification of excellent remission, remission, inefficacy and total efficacy.The results were analyzed with statistics.Results In group A (27 keloids), the excellent remission cases were 16 (59.3%), the remission cases were 9 (33.3%), and the inefficacy cases were 2 (7.4%).The total percentage of efficacy in group A was 92.6%.In group B (29 keloids), the excellent remission cases were 9 (31.0%), the remission cases were 12 (41.4%), and the inefficacy cases were 8 (27.6%).The total therapy efficacy percentage of group B was 72.4%.Both the total percentage of efficacy and the excellent remission percentage in group A were apparently higher than those of group B, and the differences between the two groups were of statistical significance (P<0.05).The recurrence rates of group A were 3.7% (one case) while that of group B were 24.1% (7 cases).The differences between the two groups were also of statistical significance (P<0.05).Conclusions Low dose 5-Fu combined with triamcinolone is superior to intralesional triamcinolone therapy alone in the treatment of keloids.

Objective To investigate jugular vein morphological changes with three dimension phase contrast magnetic resonance venography(3D PC MRV),and to explore hemodynamic features using MR phase contrast cine (MR PC cine).Methods Sixty-five healthy volunteers performed 3D PC MRV and MR PC-cine sannings.MRV ranged from torcular herophili to brachiocephalic veins, and the raw data of PC-cine was acquired at cervical 2-3(C2-C3)level perpendicular to the Jugular veins(JVs)with the maximum encoding velocity of 50 cm/sec.Jugular vein showing absent or tip shape(cross-sectional area less than 12.5 mm2 )was considered abnormal,and flat,crescent,oval,round shapes were considered normal.Data of PC-cine was processed by computer to evaluate the hemodynamic features.Results Nine (13.85%)of 65 cases were abnormal that unilateral jugular vein showing needle-pointed narrow or absent,and 8 cases on the left,and one case on the right;Weak correlation was found between jugular veins pattern and the age.The right sided values in volunteers were higher than that of the left side.Conclusion The morphology and hemodynamics of jugular veins in volunteers showed significant difference between sides,and weak correlation is found between the morphology and aging.

Objective Examine and evaluate the influences and effects of Short-term Overseas Exchange Program (SOEP) on the medical students' global health capacity development.Methods This study collected data through interview and questionnaire of students participated in SOEP,and review of their exchange reports.The quantitative data was analyzed by using the SPSS 17.0 software.Results SOEP is a useful practice of global health capacity development of medicals students,the effects of which are shown in the following aspects:1.Learn and compare different medical education models; 2.Learn and compare different health care systems and models; 3.Cultivate students' global perspective; 4.Understand the different medical culture and medical humanistic philosophy; 5.Promote personal and career development.Conclusions SOEP has fundamental positive effects on the global health conception and capacities development of medical students.Therefore,SOEP should be promoted,and developed in a healthy,orderly and sustainable manner.

Peroxisome proliferators-activated receptor γ (PPARγ) belongs to a nuclear receptor superfamily. Many studies have shown that PPARγ can help to improve the outcome of cerebrovascular disease. PPARγ can reduce inflammatory response, oxidative stress as wel as enhance the hematoma removal abilities of microglia and macrophages, and it plays an important protective role in intracerebral hemorrhage.

Objective To evaluate the deep brain venous blood oxygen content changes in patients with multiple sclerosis(MS) using susceptibility weighted imaging (SWI), and to explore the ability of SWI in reflecting the clinical condition. Methods Forty-four MS patients were prospectively enrolled in the study. All the clinical-proved patients meeting the McDonald standards (2005 revised) underwent conventional MRI, SWI, and 12 cases of them underwent MRI review from 12 to 16 months interval. all the patients' clinical condition were quantified according to the expanded disability status scale(EDSS). The score was 0.5—6.5. Sixty-five age- and gender- matched healthy volunteers underwent conventional MRI and SWI. The blood oxygen content of the deep brain venous were estimated by the veins phase value, and differential phase values of blood vessels and surrounding tissues (Δφ) were processed with SPIN software. The blood vessels consist of bilateral BV, SMCV, ICV, STV and FMV, PMV, OMV. The difference of Δφvalue in different veins between MS patients and the controls was compared using independent sample t-test, and the Δφ value comparison of MS patients in different time were performed by using paired t test; The correlation ofΔφvalue between MS and EDSS was analyzed using Spearman correlation. Results TheΔφvalue of BV, SMCV, ICV, STV were 856.6 ± 246.4, 600.6 ± 155.2, 965.9 ± 205.4, 844.2 ± 149.7 in MS, and 767.6±145.1, 536.2±123.5, 892.8±156.3, 783.1±148.5 in controls, respectively. TheΔφvalue was higher in MS patients than the controls (t=2.157, 2.303, 2.005, 2.103,P<0.05). The twelve patients'Δφvalues of BV, ICV,STV were 729.4±275.1, 906.1±219.2, 737.2±159.1 in the first time, and 923.2±211.6, 1017.3±211.1, 919.3 ± 165.9 in the second time, and all the values increased in the review of the interval of 12 to 16 months (t=-3.092,-6.420,-3.972,P<0.05). The phase value of PMV and OMV had significant positive correlation with EDSS scores(r=0.638, 0.642,P<0.01). Conclusions The state of hypoxia of the brain parenchyma appears in MS patients, and hypoxia may become worse with the extension of course. The extent of hypoxia can reflect the disability of the patients.

Objective The aim of this study was to describe the clinical outcomes and improvement of clivo-axial angle (CAA) during the posterior approach surgery of upper cervical anomaly instability patients.Methods All of 32 patients with symptomatic upper cervical anomaly instability were followed up from 2004 Apr.to 2014 Aug.in which 1 patient was excluded because of reoperation.There were 10 patients with OS odontiodeum,5 with odontoid deformity,4 with Klipple-Feil syndrome,4 with atlantoaxial dislocation,4 with atlantoaxial instability,1 with rheumatoid arthritis,1 with old odontoid fracture,1 with OS odontoideum and foramen magnum stenosis,1 with basilarinvagination and Klipple-Feil syndrome.They were all performed posterior reduction internal fixation and fusion,and then released spinal cord compression with the promotion of CAA.The patients were divided into two groups on the basis of decompression or not:non-decompression group 17 cases (male 8 cases,female 9 cases;age 13-65 years old,average 50.1 years old) and decompression group 14 cases (male 7 cases,female 7 cases;age 19-68 years old,average 49.6 years old).The CAA numbers were measured and compared.The clinic date was compared between preoperatively and postoperatively,which included Neck Disability Index and Nurick Classification System for Myelopathy.Results All patients were followed up,the follow-up time of non-decompression group was 0.7-10.7 years,average 2.9 years;the follow-up time of compression group was 0.3-5.5 years,average 2.9 years.Analysis of CAA,NDI and Nurick score were performed with t-test.The postoperative CAA,NDI and Nurick score improved significantly compared to preoperative ones.There was no difference between non-decompression group and decompression group.One patient felt nausea and vomited,one got soleal vein thrombosis,one had a swelling face and blurring vision and one had decompression syndrome after operation,all of these were improved using respectively therapy.No such serious complications as injury to vertebral artery,infection or internal fixation loosening occurred.Conclusion Neck ability and spinal cord function was significantly improved through increasing CAA for the upper cervical anomaly instability patients underwent posterior reduction internal fixation and fusion.