Objective To longitudinally analyze the unit costs and technical efficiency of the model of male circumcision in the different kinds of persons .Methods Unit costs were calculated by the person and period using longitudinal data from 3 kinds of persons ,and then technical efficiency and Malmquist indices were measured with an approach to data envelopment analysis . Results Theunit costs for changing the willingness to accept surgery changed dramatically ,decreasing from 7 166 .67 yuan(mean) to 737 .31 yuan ,while the costs for changing the ratio of the surgery increased from 666 .64 yuan (mean) to 744 .58 yuan ,and its technical efficiency was averaging between 0 .95-0 .96 .Conclusion The time series of unit costs for changing the willingness to ac-cept surgery dramatically dropped ,while changing the ratio of the surgery formed a U-shape curve with an inflection point before which unit costs dramatically dropped and another inflection point beyond which unit costs went up .These findings can inform pro-gram managers of the changing unit costs when extending or expanding the program .

Objective To investigate the relationship between the genetic polymorphisms of glutathione S-Transferase M1,T1 and the susceptibility to sporadic colorectal adenocarcinoma(SCRAC) and smoking and alcohol consumption in Chinese Hans.Methods Multiplex polymerase chain reaction (M-PCR) was used in the study of genetic polymorphisms of GSTM 1,T1 gene.Logistic analysis was performed to elucidate the roles of GSTM1,GST1,smoking and alcohol.Results The null GSTM1,T1 genotypes could increase the susceptibility to SCRAC(OR=1.711,95% CI:1.043～2.805;OR=1.734,95% CI:1.057～2.843),but smoking and alcohol consumption made no significant effect on SCRAC(OR=0.584,95% CI:0.356～0.958;OR=0.378.95% CI:0.217～0.657).Further stratification of the SCRAC patients by chnical features showed that there were no relationship between the GST M1,T1 genotype and the age of the SCRAC patients.But the frequency of null GSTM1 genotype was significantly associated with distal colon adenocarcinoma (P=0.021),colorectal adenocarcinoma of Dukes C classification (P=0.003) and poor difierentiation (P=0.020),respectively.The frequency of null GSTF1 genotype was only higher in colorectal adenocarcinoma of Dukes C classification(P=0.041).No relationship was found between the location,the degree of differentiation and the frequency of null GSTF1 genotype(P＞0.05).Furthermore,the frequencies of homozygous deletion in GSTM1,T1 genes were found to be significantly increased in SCRAC patients than those in healthy controls(38.9%VS25.7%.P=0.023).Conclusion The GST genotype is strongly correlated with SCRAC incidence in Chinese Hans.The null GSTM1,T1 genotypes can enhance the genetic susceptibility to SCRAC.while smoking and alcohol consumption have no significant effect on the susceptibility to SCRAC.

BACKGROUND: How to obtain human-derived hepatocyte of high quality is the key problem for both bioartificial liver and hepatocyte transplantation. Bone marrow stem cells (BMSCs) can differentiate hepatocyte under proper condition, which provides a new think for obtaining hepatocyte.OBJECTIVE: To investigate the methods of the trans-differentiation of human BMSCs into hepatocyte in rats so as to provide a new think for clinical transplantation of liver and source of bioartificial liver.DESIGN: Randomized controlled study.SETTING: General Surgery of Zhujiang Hospital of Southern Medical University.MATERIALS: The experiment was conducted at Central Laboratory of Zhujia ng Hospital of Southern Medical University from May 2004 to February 2005. Totally 40 male SD rats of clean grade were divided randomly into five groups: model group, modeling + 14-day transplantation group of human BMSCs, modeling + 28-day transplantation group of human BMSCs, modeling + 14-day transplantation group of CL-1 cell (human hepatocyte family), and modeling + 28-day transplantation group of CL-1 cell (human hepatocyte family) with 8 in each group.acetaminofIuorene + carbon tetrachloride + cyclophosphamide were esand differentiated into hepatocyte with remedial liver regeneration. Human BMSCs were observed for 14 days in modeling + 14-day transplantation group of human BMSCs, for 28 days in modeling + 28-day transplantation group of human BMSCs, for 14 days in modeling + 14-day transplantation group of CL-1 cell and for 28 days in modeling + 28-day transplantation group of CL-1 cell. However, cells in model group function of rats was measured at normal state, before and after transplantation. The expressions of human albumin mRNA in liver were detected by immunohistochemistry staining, polymerase chain reaction (PCR) and real time reverse transcription polymerase chain reaction (RT-PCR) respectively.of human albumin mRNA in liver.transplantation of human BMSCs on hepatic function and content of total bilirubin: Hepatic function and content of total bilirubin in each transplantation group were similar to those in model group at normal state and before transplantation (P ＞ 0.05); values in each group were obviously increased before transplantation as compared with those at normal state (P ＜ 0.01) and were obviously decreased after transplantation as compared with those before transplantation (P ＜ 0.01) but were higher ical section of hepatic cells: At normal state, pathological section of hepatic cells showed that hepatic cells lined in strip-chorda shape and radian shape around central vein; and inflammatory cells were not infiltrated in crossed-channel area. Necrosis was observed in model group. Proliferated changes were observed in transplantation groups of human BMSCs after a few of necrosis, and ovale-round cells and small bile duct proliferation main histocompatibility antigen-I in liver: Positive rate was 0 in model group; (13.03±0.18)% in modeling + 14-day transplantation group of human BMSCs; (9.47±0.46)% modeling + 28-day transplantation group of human BMSCs; (10.27±0.50)% in modeling + 14-day transplantation group of CL-1 cell; and (9.84±0.23)% in modeling + 28-day transplanwas detected in model group, but Sox11 and Alu-sx were detected in both transplantation groups of human BMSCs and CL-1 cells at various RT-PCR: Expression of human albumin mRNA was not observed in model group, but expression of that was observed in transplantation groups of human BMSCs and CL-1 cell as well as positive controls at various time points respectively.CONCLUSION: Human BMSCs can promote recovery of hepatic function.Replaceable rate of human-derived cells is 10% in liver of rats, which suggests that human BMSCs can converse into hepatocyte in xenoma and replace partly.

Objective To investigate the possibility that bone marrow mesenchymal stem cells (BMSCs) differentiated into neuron-like cells induced by ganglioside in vitro.Methods BMSCs were separated, cultured and differentiate into neuron-like cells induced by ganglioside. Neuro-specific enolase (NSE) and neurofilament (NF) on the surface of differentiated and induced BMSCs were detected by immunocytochemistry.Results BMSCs were induced to differentiate into the cells with a typical neuronal morphology. The induced neuron-like cells expressed NSE and NF.Conclusion BMSCs can be differentiated into neuron-like cells by induction of ganglioside in vitro.

Objective To evaluate the efficacy of radiosynovectomy with 32P colloid in haemophilic synovitis of adolescents. MethodsRadiosynovectomy with 32P colloid was primary performed on 26 male haemophilic patients(26 joints),whose average age was 16 years(11 to 21 years).The average dose of 32P colloid was 2.1 mCi(1.0 to 3.0 mCi). Results After 6-month interval,haemarthrosis was reduced by no less than 30% in 23 patients,with a total efficacy of 88.5%.The mean frequency of haemarthrosis was reduced from 1.9 per month of presynovectomy to 0.3 per month of postsynovectomy(P

Objective To investigate the association of ulcerative colitis (UC) with fork head/ winged helix transcription factor-3 (Foxp3) polymorphisms in Han population in Zhejiang province,China.Methods A total of 381 UC patients and 490 healthy controls were enrolled in this study.The four single nucleotide polymorphisms (SNPs) of Foxp3 (rs3761547,rs2232365,rs2294021,rs3761548) were examined by SNaPshot.The analyses of linkage disequilibrium (LD) and haplotype were also performed in all study subjects.Results When male and female UC patients were compared with their corresponding controls respectively,the alleles and genotypes of the four SNPs were not statistically different (all P ＞0.05).According to severity and location of the disease,the UC patients were divided into different subgroups.The alleles (C,G,A) of (rs2232365,rs2294021,rs3761548) were more frequent in male patients with severe UC than in the male controls (69.6％ vs 34.3％,P =0.001;69.6％ vs 34.3％,P =0.001;39.1％ vs 14.4％,P =0.002,respectively).As compared with the female controls,the alleles (C,G,A) and genotypes (TC + CC,AG + GG,CA + AA) of (rs2232365,rs2294021,rs3761548) were significantly increased in the female patients with severe UC (51.9％ vs 38.0％,63.5％ vs 39.2％,53.8％ vs21.4％,80.8％ vs57.7％,84.6％ vs58.4％,76.9％ vs34.7％,all P＜0.05).The four SNPs above were shown to be in a strong LD both in male and in female subjects.When male and female UC patients were compared with their corresponding controls respectively,nevertheless,each haplotype frequency was not statistically different (all P ＞ 0.05).Conclusions Foxp3 (rs2232365,rs2294021,rs3761548) variations might engender the increased risk of severe UC in Chinese Han patients.

Objective To investigate the clinical features of patients with recurrent epithelial ovarian cancer (EOC),and explore the factors that can prolong the disease-free interval(DFI) after primary treatment.Methods We retrospectively reviewed the medical records of 54 patients with recurrent EOC and analyzed the clinical stage,histological subtypes,primary treatments,DFI,recurrent site,secondary treatment,and the response after secondary treatment.By Mann-Whitney test and T test,factors influent the DFI were analyzed,the relationship between DFI and the response after secondary treatment were analyzed also.Results The mean DFI for all 54 patients was 19.07 months.The DFI of patients received optimal cytoreductive surgery was longer than those received non-optimal cytoreductive surgery [(32 ± 19.10) months vs (18.77 ± 7.80) months,P ＜ 0.01];The DFI of patients with serous,mucous and clear cell tumor was [(20.16 ± 14.63) months,(14.00 ± 4.73) months and (16.67 ± 13.03) months,respectively],suggesting patients with mucous tumor might have shorter DFI.The DFI of patients with low tumor grade was longer than those with high tumor grade [(28.18 ± 16.97) months vs (16.52 ±9.46) months,respectively];The DFI of patients with stage Ⅰ and Ⅱ disease was [(19.60 ± 12.89)months],was compared to the DFI of patients with stage Ⅲ,stage Ⅳ disease,which was [(19.22 ± 12.38) months] and [(11.67 ±5.39) months],respectively.When disease recurred,the most frequent recurrent site was pelvic (50％,n =27),with upper abdominal (29.6％) and lymph node(29.6％) followed.When recurrence was found in lymph node,the most frequent site was pelvic and para-arotic lymph node.In our study,when disease recurred,response of the tumor after the secondary treatment has no relationship with the DFI.Conclusions Patients received optimal cytoreductive surgery,patients with low tumor grade and early stage have longer DFI.Retroperitoneal lymphadenectomy might be chosen during the primary cytoreductive surgery in some selected patients.

Objective To evaluate the efficacy and adverse reactions of CT-guided 125I radioactive seed implantation in treatment of locally recurrent rectal cancer (LRRC).Methods Thirty patients with LRRC who refused operation or were unable to endure pelvic radiotherapy received 125I seed implantation under CT guidance.Three-dimensional treatment planning system was used to calculate the number,activity,and dose of the seeds needed.The activity of seeds ranged from 14.8 to 29.6 MBq with a median of 25.9 MBq,the seed numbers ranged from 33 to 137 with a median of 74.5,the prescription doses ranged from120-160 Gy,and the actual verification dose D90 ranged from 75.91 to 159.32 Gy with a median of 119.77 Gy.Dosimetric verification by CT scanning was conducted immediately after the treatment.Follow-up was conducted for 15.2 months(4.2-35.0 months).Results The follow-up rate was 93.3％.The pain relief rate was 95.2％.The overall response rate was 50.0％,including a complete response rate of 13.3％ and a partial response rate of 36.7％.The 1-and 2-year local control rates were 30.0％ and 8.0％ respectively.The median local control survival time was 7.8 month.The 1-and 2-year survival rates were 66.5％ and 32.9％ respectively.The median overall survival time was 21.5 months.Complications,mainly adverse effects of skin and urinary system (frequent urination,urgent urination,and dysuria) occurred in 6 patients with a rate of 20.0％.Conclusions Minimally invasive and with satisfying efficacy and tolerable complications,CT-guided 125I radioactive seed implantation is a favorable option for treatment of LRRC,especially for the patients who have undergone previous pelvic radiation.

Objective:To evaluate the performance of RapidArc technique on cervical cancer patients with various filling status of the bladder. Methods: Conventional fixed field intensity modulation radiated therapy (IMRT) is used as the benchmark. In 10 fe-males suffering from cervical cancer, two CT scans were performed for treatment planning:one with an empty bladder and the other with filled bladder. The prescribed dose was 50 Gy. The images of that with an evacuated bladder and that with filled bladder were planned in the dual-arc RapidArc and the 7-field IMRT, respectively. The implementor of the plan was the Varian TrueBeam linear ac-celerator. Dose-volume histogram was used to evaluate the data from each plan. Results:When the bladder was filled, IMRT and Rapi-dArc homogeneity were 1.05 and 1.04 (P>0.05), respectively. When the bladder was emptied, the homogeneity was 1.04 for both plans (P>0.05). With or without bladder filling, the conformity index was 0.71 and 0.73 for IMRT and RapidArc (P>0.05), respectively. The effect of V30 and V40 (volume for receiving doses of 30 and 40 Gy) on the intestine and the bladder was more favorable in a full than in an empty bladder. No significant difference between the two plans was observed. IMRT exhibited improved V30 on the rectum and on the bladder. RapidArc was much better in terms of monitor unit (MU) and deliver time. Conclusion:No significant differences in the homogeneity and conformity index between dual-arc RapidArc and 7-field IMRT were observed. Filled bladder is better than empty bladder in intestine and bladder protection in both RapidArc and IMRT. IMRT is better on V30 of the rectum and the bladder, whereas RapidArc improved MU and deliver time.

Objective To analyze the clinical, radiological, pathological and microbiological features of invasive pulmonary aspergillosis (IPA) to improve clinical management.Methods Retrospective analysis of 20 pathologically and/or microbiologically confirmed IPA cases in our hospital from January 2005 to August 2008. Results Group A (with underlying diseases) included 13 patients (underlying malignancy in 9 patients, including 5 cases of hematological malignancy, COPD in 2 patients, pulmonary tuberculosis and bronchiectasis in 1 each). Group B (without underlying disease) included 7 patients (2 patients with a long time of fluffy toy contact, another 1 had exposure to moldy rice, and 3 had exposure to polluted water). All these 20 patients had pulmonary invasion revealed by CT imaging. Multiple changes were identified in 16 patients. Bilateral pulmonary infiltrates and/or consolidation were revealed in 7 patients. Multiple nodules were seen in 9 patients. Four patients had solitary lesions, including isolated nodules in 2 patients and segment consolidation in the other 2 patients. Pulmonary cavity without fluid level was found in 8 patients (40.0%). Eighteen cases received antifungal therapy. The overall efficacy rate was 55.6%. The efficacy rate in group A and B was 45.5% and 5/7 respectively. The average time to symptomatic relief was (12.0±2.8) days. The time to lung lesion improvement on CT was (17.4±2.9) days. The time to significant CT improvement was (34.3±9.9) days. The time to the resolution of active lesion was (56.4±6.2) days.Conclusions IPA may occur in immunocompetent patients without underlying disease. Most IPA patients have bilateral multiple pulmonary nodules and cavities on CT. The time to the resolution of active pulmonary lesions is about 6 weeks.