Objective To learn about electrolytes imbalance and water intoxication in children treated with high-dose cyclophosphamide(HD-CTX)as well as the renal function and the relative clinical symptoms,and study the mechanisms of hyponatremia.Methods Patients' clinical manifestations during and after HD-CTX therapy were summarized.Serum electrolytes and creatinine(Cr)were detected before and 6 or 8 hours after therapy with HD-CTX,antidiuretic hormone(ADH) in some patients were measured.Results Of 108 therapeutic cases 24 accompanied with vomits and 22 with a decreased urine output,in which 4 developed eyelid or ankle edema.Seven cases had neural-sarcous symptoms and 5 cases had abdominal pain or diarrhea.Serum sodium decreased significantly after HD-CTX[(139.12?3.30) mmol/L vs(134.06?8.23) mmol/L] in whom rechecked after 6 h,(141.77?3.59) mmol/L vs(133.26?6.41) mmol/L in those rechecked after 8 h(Pa0.05].Serum Cr increased 8 h after therapy[(29.95?13.61) ?mol/L vs(43.33 ? 17.25) ?mol/L P

Diagnostic Errors ; Female ; Humans ; Middle Aged ; Thyroid Nodule ; diagnostic imaging ; Ultrasonography ; Zenker Diverticulum ; diagnostic imaging

Objective To explore the biological characteristics and karyotype of bone marrow-derived mesenchymal stem cells(MSCs)in patients with systemic lupus erythematosus(SLE)and hematopoietic sup- port of MSCs.Methods MSCs were isolated from bone marrow of 11 SLE patients and 6 healthy controls by density centrifugation and adhesive culture in vitro.The surface markers were detected by flow cytometry (FCM).The morphological changes of MSCs were observed in primary and passage cultures.The growth curves were assayed.The karyotype of MSCs was detected by blocking cellular mitosis with colchicines.The MSCs from SLE patients and healthy controls were infused to ICR mice after high-dose chemotherapy.The changes of peripheral blood counts of the mice were recorded.Results Approximately(6～9)?10~9 MSCs from SLE were obtained after 5 passages and their growth was slower than normal controls(P＜0.01).Both groups were positive for CD29,CD44 and CD105,and negative for CD14,CD34,CD45 and HLA-DR.MSCs from SLE had a normal karyotype.MSCs infusions of the two groups were accompanied by no adverse event and the recovery of white blood cell,hemoglobin and platelet count was quicker when compared with the controls(P＜0.05).Conclusion MSCs from SLE have demonstrated abnormalities in expansion in vitro.MSCs from SLE have a normal karyotype.Ex vivo MSCs infusion from SLE patients can support hematopoiesis as normal MSCs.

Objective To investigate the correlation between dose volume histogram(DVH)of tumor targets and organs at risk(OAR)at CT-image based 192Ir brachytherapy and effects and complications for patients with locally advanced cervical cancer. Methods Ten patients with FIGO stage ⅢB cervical cancer received CT image-based 192Ir intracavitary brachytherapy after 54 Gy of three-dimentional four-field pelvic external beam radiotherapy and concurrent weekly cisplatin chemotherapy. Before each brachytherapy,CT images were acquired with applicators in place. Gross tumor volume(GTV), clinical target volume (CTV)and OAR were contoured and inverse treatment planning was designed and optimized by using PLATO treatment planning system. Conventional two-dimensional plans were also designed for comparison.The total intracavitary brachytherapy dose was 30 -42 Gy in 5 -7 fractions. The patients were followed, and the local control and complications were analyzed. The biologically equivalent dose(BED)and biologically equivalent dose in 2 Gy fractions(BED2)for GTV, CTV and OAR were calculated. The minimum dose in the most irradiated tissue volume 2 cm3(D2 cm3)adjacent to the applicator of the sigmoid colon, rectum,bladder and small bowel was determined from the DVH. Results The 1-year local pelvic control rate was 90% and grade 1-2 late complication of sigmoid colon and rectum was 50%. No grade 3 or more complications developed. On CT-image based planning, the BED and BED2 to 90% of the CTV(D90)were 95.50 Gy ± 7. 81 Gy and 79. 73 Gy ± 6. 57 Gy. The BED and BED2 to 90% of the GTV(D90)were 101.86 Gy ± 7.27 Gy and 84. 95 Gy ± 6. 1 Gy. The volume enclosed by 90% of prescribed dose(V90)for GTV and CTV were 92% ±4% and 87% ±7% respectively. The D2cm3 for rectum and sigmoid colon were 74. 97 Gy ±1.64 Gy and 67. 93 Gy ± 4. 30 Gy(EQD2, α/β = 3). Comparing with 2D brachytherapy plans , CT - image based planning has improved D90 and V90 for GTV and CTV with similar dose at point A and rectum reference point. Conclusions Computer tomography-image based 192Ir brachytherapy has resulted in the better dose distribution to the tumor targets with excellent tumor control and acceptable toxicity.

Aged, 80 and over ; Antibodies, Monoclonal ; metabolism ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Diagnosis, Differential ; Granuloma ; metabolism ; pathology ; Humans ; Keratins ; immunology ; Male ; Mucin-1 ; metabolism ; Skin Neoplasms ; metabolism ; pathology

Objective To investigate and analyze the clinical and imageological features of skull base erosion in nasopharyngeal carcinoma( NPC). Methods 67 NPC patients proved by pathology were retrospectively reviewed. All patients underwent both CT and MRI plain plus enhancement scan. Scan slices were performed from oral pharynx (lower border of second cervical vertebra) to suprasellar cistern by axial CT scans and axial, sagittal and coronal MRI scans. Results (1) 52 patients with skull base erosion were found with MRI, and only 35 patients with CT. The following structures and figures were difined with CT and MRI respectively: pterygoid plates 8,14; clivus 22,25 ; petrous apex 25 ,28 ; sphenoid body or sinus 19,25; sphenoid wing 9, 12; cavernous sinus 14,17. The display difference between CT and MRI had statistical significance ( x2= 9. 47 , P = 0. 02). (2) CT- defined skull base erosion was most bone destruction , however, not only bone destruction but also tumor crossing skull base structure could be defined by MRI. (3) The incidence of headache was 82.7% (43/52) , cranial nerve palsy was 67. 3% (35/52) , both headache and cranial nerve palsy was 57. 7% (30/52). Conclusion Headache and cranial nerve palsy are primary characteristics of the skull base erosion in NPC. MRI is superior to CT in defining both bone erosion and brain tissue abnormality.

Objective To study the correlation of ~(18)F-fluorodeoxyglucose (FDG) PET/CT with pathological changes of the VX2 rabbit tumors after treatment of Ar-He knife,and to explore the evolution of the Ar-He knife curative effect for VX2 rabbit tumors.Methods Thirty-six Japanese white rabbits had successfully been implanted with VX2 tumors in thighs.Four weeks later,the rabbits with VX2 tumors were imaged with FDG PET/CT before they were treated with Ar-He cryoablation.The rabbits were evenly and randomly divided into 6 groups (6 rabbits in each group) and imaged with FDG PET/CT respectively on the first day,third day,seventh day,fourteenth day,thirtieth day and sixtieth day after cryoablation.The rabbits in each group were sacriftced after post-treatment FDG PET/CT imaging for pathology and immunohistochemistry studies.The standardized uptake value (SUV) of tumor regions were calculated and compared with pathology and immunohistochemistry findings in the cryoablative area in each group.Paired-samples t-test and bivariate correlation analysis were evaluated by statistical software SPSS 16.0.Results After ArHe cryoablation,pathological changes of "necrosis-inflammatory response→organization" were found.On CT imaging,the tumors enlarged during 3-14 d after treatment and then shrank gradually.On FDG PET imaging,the maximum SUV (SUV_(max)) dropped dramatically on the first day after the operation(from 2.54±1.12 to 0.67±0.12),and increased slightly on the third day (1.71±0.82),and then continually dropped to 0.51±0.32 (60 d afterthe operation).The differences of SUV_(max) between pre-and after cryoablationin each stage were significant,respectively (t=5.471,8.716,11.388,5.713,7.144 and 7.213,all P＜0.05).The size and SUV_(max) of the targeting area did not correlate with each other(r=0.259,P=0.675).The change of the MVD closely correlated with SUV_(max)(r=0.865,P=0.032).Conclusion FDG PET/CT can reveal the pathological change of tumor tissue after Ar-He cryoablation therapy and therefore may be a potential tool for evaluating the curative effect of this treatment modality.

Objective To summarize the experience of the prevention and treatment of iatrogenic hypo-parathyroidism in total thyroidectomy .Methods 377 patients received total thyroidectomy performed by the Thy-roid Professional Group of Hepatobiliary Surgery Department of the Third Affiliated Hospital of Soochow University from Jan.2010 to Dec.2012.Their clinical date were retrospectively analyzed .Results There was no perma-nent postoperative hypoparathyroidism .The incidence of temporary hypoparathyroidism was 13.79%( 52/377 ) . The occurrence of transient hypocalcemia was 10.61%( 40/377 ) .Conclusions Iatrogenic hypoparathyroidism can be prevented by intraoperative in situ protection of parathyroid glands and their blood supply using fine cap -sule anatomy method .Postoperative improvement of microcirculation and calcium supplement also help prevent postoperative hypoparathyroidism .

BACKGROUND:Santoni put forward the cortical bone trajectory technology by changing the traditional pedicle screw placement for lumbar internal fixation in order to obtain better control of the screw and bone in 2009. OBJECTIVE:To analyze biomechanical stability of cortical bone trajectory system in the lumbar fusion. METHODS:Twenty fresh newborn calf L3/4, L5/6 motion segment specimens were obtained, and their ranges of motion were detected under different states, as normal controls. Subsequently, twenty samples were divided into cortical bone trajectory screw group and traditional pedicle screw group, which underwent cortical bone trajectory screw fixation combined with posterior lumbar fusion and traditional pedicle screw fixation combined with posterior lumbar fusion, respectively. Without destruction, ranges of motion were detected under different states in both groups. In the revision group, after the test in the traditional pedicle screw group, screw was withdrawn, and cortical bone trajectory screw was used to detect its range of motion under different states. RESULTS AND CONCLUSION:Ranges of motion at bending to the left and right, anteflexion, posterior extension and axial rotation were significantly lower in the cortical bone trajectory screw group and traditional pedicle screw group than in the normal control group (P<0.05). No significant difference in bending to the left and right, anteflexion, posterior extension and axial rotation was detected between the cortical bone trajectory screw and revision groups and traditional pedicle screw group (P>0.05). These results confirmed that cortical bone trajectory technology combined with posterior lumbar fusion can obtain identical stability as the traditional pedicle screw fixation combined with posterior lumbar fusion. Simultaneously, it is a new choice for revision after traditional pedicle screw fixation.