Objective To evaluate the association of prognostic factors and the interval between surgery and radiotherapy in postoperative radiotherapy for non small cell lung cancer (NSCLC). Methods Between December 1982 and December 1992, 132 patients with NSCLC were retrospectively analyzed. The time interval between surgery and radiotherapy ranged from 12 to 90 days, with a median of 36 days. All patients received D T 40～72 Gy. Results Cox proportional analysis showed that stage, Karnofsky performance status, and the interval between treatments were important prognostic factors. Patients with a long interval of 37～90 days had a better survival than those with a short interval of 12～36 days (P

0.05). Anastomotic leak was found in a intraoperative radiotherapy patient on the 9th day after surgery as slipping of the residual stomach into the field had been observed after completon of the intraoperative radiation.The patients recovered unevertfully after surgical repair. No radiation induced mediastinnitis,myelopathy or pneumonitis developed in patients who survived over 2 years.Conclusion IORT,as one of the methods of combination treatment for esophageal carcinoma, is benefitial in local control. Its efficacy,being closely related to the sige of the dose and radiation field, warrants further investigation.

0.05). In the xenogeneic fresh nerve graft group, the xenogeneic nerve segment was rejected and absorbed by the recipient. CONCLUSION Xenogeneic acellular nerve could sustain facial nerve regeneration, and may be a substitute to autograft for repairing facial nerve defects.

Objective To evaluate the role of spinal sigma-1 receptors in the maintenance of bone cancer pain (BCP) in rats and the relationship with extracellular signal-regulated kinase (ERK).Methods Part Ⅰ Twenty-four female Sprague-Dawley rats,weighing 180-220 g,were randomized into 2 groups using a random number table:sham operation group (S group,n =4) and BCP group (n =20).BCP was induced by inoculating Walker 256 mammary gland carcinoma cells into the medullary cavity of the right tibia.Four rats were sacrificed on day 10 after inoculation in S group or on day 3,5,7,10 and 14 after inoculation in BCP group,and the L4-6 segments of the spinal cord were removed to measure the expression of sigma-1 receptors by Western blot.Part Ⅱ Forty female Sprague-Dawley rats,weighing 180-220 g,were randomized into 4 groups (n =10 each) using a random number table:sham operation group (S group),sigma-1 receptor inhibitor BD1047 group (BD group),BCP group,and BCP + BD1047 group (BCP + BD group).On day 10 to 14 after inoculation,normal saline 20 μl was injected intrathecally once a day in S and BCP groups,or BD1047 120 nmol/20μl was injected intrathecally once a day in BD and BCP + BD groups.Mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured one day before inoculation,on day 3,5 and 7 after inoculation,and on day 10,12 and 14 after administration.After measurement of MWT on day 14 after inoculation,the rats were sacrificed and the L4-6 segments of the spinal cord were removed to determine the expression of phosphorylated ERK (p-ERK) by Western blot.Results Part Ⅰ Compared with group S,the expression of sigma-1 was significantly up-regulated and peaked on day 10 after operation in group BCP.Part Ⅱ Compared with S group,no significant changes were found in MWT and p-ERK expression at each time point in BD group,and MWT was decreased and p-ERK expression was up-regulated in BCP and BCP + BD groups.Compared with group BCP,after intrathecal injection of BD1047,MWT was significantly increased and the expression of p-ERK was down-regulated in BCP + BD group.Conclusion Spinal sigma-1 receptors are involved in the maintenance of BCP in rats possibly through promoting phosphorylation of ERK.

Objective To evaluate the value of Multi-slice spiral CT angiography for spinal cord vessels.Methods 11 adult subjects with suspected of myelopathy were performed with Multi-slice spiral CT angiography,An iodine contrast agent was injected at 3.5 ml/s,for total 100 ml.The parameters were axial 16 slice mode,0.625 mm slice thickness,0.8 s rotation,delay time depending on smartprep (15—25 s), multi-phase scan.The coronal and sagittal MPR and SSD were generated on a workstation compared with spinal digital subtraction angiography (DSA) to analyze normal or abnormal spinal cord vessels.Results Normal findings at spinal CTA and digital subtraction angiography in six adult normal subjects and spinal cord vascular malformations( 1 intradural extramedullary AVF,4 dural AVFs) in five cases,Recognizable intradural vessels corresponding to anterior median (midline) veins and/or anterior spinal arteries were show in six adult normal subjects.Abnormal intradural vessels were detected in all five spinal cord vascular malformation with CT angiography ,in comparison with digital subtraction angiography these vessels were primarily enlarged veins of the coronal venous plexus on the cord surface,radiculomedullary-dural arteries could not be clearly shown in four dural AVF,only one anterior spinal artery was detected in one patient with intradural medullary AVF,which direct shunt between anterior spinal artery and perimedullary vein with tortuous draining vessel.Conclusion Multi-slice CT angiography is able to visualize the normal or abnormal spinal cord vessels.It could be used as a noninvasive method to screen the spinal cord vascular disease.

Objective To explore the effectiveness and safety of deep brain magnetic stimulation technique (dTMS) for treatment of Alzheimer's disease (AD).Methods Totally 116 patients with AD were randomly divided into 4 groups:(1) dTMS:given dTMS really stimulation therapy,(2)medication group:treatment with donepezil 5 mg/d,(3) combination treatment group:given dTMS and donepezil therapy,(4) blank control group:given pseudorandom stimulation treatment.33 healthy control cases were given dTMS's stimulation treatment.The treatment course was 6 months.Application of mini mental state examination scale (MMSE),the Montreal cognitive assessment scale (MoCA),Hamilton Depression Scale (HAMD),ischemic scale (HIS),Boston naming test,activity of daily living(ADL) and neuropsychological questionnaire (NPI) were used to evaluate the cognitive function.All the participants received blood tests and ECG in order to evaluate the safety of dTMS.Results After 6 months treatment,compair with the blank control group,all scale scoresof dTMS group,medication group and combined treatment group were improved significantly in MMSE (t=2.49,2.46,2.20),MoCA(t=2.59,2.39,2.87),ADL(t=2.35,2.17,2.83),NPI(t=3.05,2.40,2.65) and sub-cognitive scale score (all P＜0.05).All scale scores of combination treatment group were better than dTMS group and medication group (P＜0.05).There's no significant difference between drug treatment groups and dTMS group (P＞0.05).After 6 months treatment,compared with healthy control group,the scale scores were aggravated in 4 groups of AD (P＜0.05)Conclusions dTMS can be effective and safe in the treatment of AD patients with cognitive and noncognitive symptoms.

OBJECTIVETo assess the feasibility and safety of robot-assisted laparoscopic radical prostatectomy (RLRP) in the treatment of prostate cancer.

METHODSUsing the da Vinci robot surgical system, we performed RLRP for 34 patients with localized prostate cancer and analyzed the intraoperative and follow-up data.

RESULTSThe procedures were performed successfully in all the patients, with the mean operation time of 198 min (range 135-340 min), average blood loss of 257 ml (range 50-700 ml), and 1 case of blood transfusion, but no postoperative complications. Three cases had positive surgical margins. Postoperative examination at 4 weeks showed PSA > 0.2 microg/L in 2 cases, suggestive of residual tumor, for which maximal androgen block therapy was administered. The other 32 patients were followed up for 3-10 (mean 7.5) months, during which the average level of serum tPSA remained < 0.2 microg/L. Urinary continence was found in 94% (32/34) and 97% (33/34) of the patients at 3 and 6 months, respectively, of whom 77% (26/34) and 88% (30/34) had no urinary leakage (0 pad per day).

CONCLUSIONRLRP, with its advantages of less perioperative blood loss, low rate of positive margin, and good urinary continence, is a safe and effective surgical option for the treatment of prostate cancer.

Aged ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery ; Retrospective Studies ; Robotics

Objective To study the clinicopathologic characteristics and differential diagnosis of T-cell immunophenotype in intestinal non-Hodgkin's lymphoma(NHL).Methods The clinicopathologic characteristics of 13 cases with intestinal T-cell lymphoma were analyzed by light microscopy and immunohistochemistry(Envision detection method).Results The lesions of 8 cases with T-cell lymphoma were found on the small intestine and 5 on the colon.Grossly,8 cases showed ulcer pattern,3 polypoid pattern and 2 presented as a regional thickening of intestinal wall.The tumor cells were medium to large size with pleomorphic nuclei and inflammatory background.The neoplastic lesions expressed the immunophenotype of peripheral T cells.The neoplastic cells of 13 cases(100%)expressed leukocyte common antigen(LCA);10(76.9%)cases expressed CD3;9(69.2%)CD45RO;5(38.5%)EB virus(EBV);3(23.1%)CD56 and 2(15.4%)vimentin(VIM).All the cases were negative for CD20,CD79a,CK,CDX2,NSE,CgA and CD117.ConclusionIntestinal T-cell lymphoma is a rare,aggressive neoplasm with poor prognosis and should be distinguished from other malignant tumors of intestine.

Objective To investigate the diagnostic significance of the difference values between Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)in elderly patients with dementia.Methods 331 elderly patients with dementia were collected from outpatients in our hospital.There were 148 people with Alzheimer's disease (AD),87 cases with vascular dementia (VaD),44 cases with mixed dementia (MD),41 cases with frontotemporal dementia (FTD) and 11 cases with dementia with Lewy bodies (DLB).MMSE and MoCA were applied to test the cognitive impairment separately.Results The difference values between MMSE and MoCA was (3.3±1.7) points,(6.6±2.1) points,(6.6±2.1) points,(5.4±2.3) points,(6.1 ± 1.9) points in AD,VaD,MD,FTD and DLB group respectively,and there were statistical differences among the five groups (F=46.420,P=0.000).Statistical differences were found in the difference values between MMSE and MoCA between dementia patients with AD and non-AD (t=-13.429,P=0.000).According to receiver operating characteristic curve (ROC curve),the optimal cut off point of the difference values between MMSE and MoCA for differential diagnosis between AD and non-AD dementia was 5 points,with 79.8％ sensitivity and 78.4％ specificity,and area under the curve was 0.848 (95％CI:0.807-0.890).Conclusions The difference values between MMSE and MoCA may be one of parameters for differential diagnosis between AD and non-AD dementia.

Objective To observe the effects of in vitro isolated Schwann cells co-cultured with chemically acellular nerve allografts on improving repair of large facial nerve defects. Methods A total of 30 Wistar rats were equally randomized into three groups, ie, experimental group, allograft group and autograft group. Nerve defect of 12 mm in length was made in the left inferior buccal branch of facial nerve and repaired with acellular nerve allograft implanted with Schwann cells, acellular nerve allograft and fresh tibial nerve autograft respectively. At the 5th month postoperatively, the function and morpholo-gy of the regenerated nerves were observed by electrophysiological method, methylene blue staining and transmission electron microscope. Results In experimental group, the recovery rate (operation side/normal side) of amplitude of nerve-muscle action potential was (35.8±2.5)%, the lantency recovery rate (normal side/operation side) (65.8±2.9)%, the number of the regenerated axon 1 570±188 and the myelin thickness (0.383±0.031) μm. The results in the experimental group were significantly supe-rior to those in the acellular nerve allograft group (P < 0.05), with similar results to fresh nerve autograft group (P > 0.05). Conclusion Transplantation of Schwarm cells in acellular nerve allograft can im-prove repair of large facial nerve defects.